Laparoscopic Cholecystectomy at low pressure VS standard pressure pneumoperitoneum: A comparative study

Abstract

Background: Laparoscopic cholecystectomy is established as gold standard for management
of cholelithiasis, the current trend is towards patient safety and satisfactory results. Hence this
study was undertaken to compare the low pressure pneumoperitoneum (LPP 8-10mm Hg)
versus standard pressure pneumoperitoneum (SPP 12-14mmHg) in patients undergoing
laparoscopic cholecystectomy with main areas of interest are operative duration, intraoperative gas consumption, bile spillage, postoperative ileus assessed by return of bowel
sounds, passage of flatus and tolerance of oral feed.
Methods: 50 patients in the age group of 30-60 years with uncomplicated gallstone diseases
were randomized into the LPP(8-10mmHg) and the SPP (12-14 mmHg) group (n=25)
prospectively. Difficulty in secondary port insertion, contact of trocar to visceral peritoneum,
major vascular injury, organ injury, visibility and difficulty of Calot’s triangle dissection,
time for dissection of Calot’s triangle, bile spillage, intra-operative gas consumption, mean
duration of procedure, postoperative pain and nausea, early return of bowel activity and early
tolerance to oral feed were assessed.
Results: There was significant difference in terms of difficulty in secondary port insertion,
visibility and difficulty of Calot’s triangle, time for dissection of Calot’s triangle, duration of
procedure, intra-operative gas consumption, post-operative pain and nausea, early return of
bowel activity and early tolerance to oral feed.
Conclusions: Laparoscopic Cholecystectomy is safe and feasible at 8-10 mmHg. Further
studies are required to establish the application of using low pressure pneumoperitoneum in
laparoscopic cholecyustectomy.