ABSTRACT
Background: With the establishment of laparoscopic cholecystectomy as gold standard management of cholelithiasis, the current stress is being given on increasing patient safety and reducing the post-operative morbidity associated with this procedure. An emerging trend is to use of low-pressure pneumoperitoneum in an attempt to lower the impact of pneumoperitoneum while providing adequate working space.Methods: In this prospective randomized study 66 participants were allocated into two arms i.e. low-pressure pneumoperitoneum (LPP) and standard pressure pneumoperitoneum (SPP). The necessary data were collected using laboratory investigations, clinical examination and perioperative findings. Data were analyzed using suitable statistical software.Results: Mean duration of surgery, surgical difficulty and field visualization difficulty were insignificantly greaterin LPP group than SPP group. CO2 consumption was significantly less in LPP. Incidence of bile spillage, usage of drain was insignificantly increased in LPP. Post-operative pain was significantly greater in SPP group. Time for per oral tolerance of food and incidence of nausea were significantly greater in SPP group. Standard pressure group needed significantly more tramadol injection than LPP. There were no significant haemodynamic changes in SPP group compared to LPP group. Length of hospital stay was significantly greater in SPP.Conclusions: Laparoscopic cholecystectomy in low pressure pneumoperitoneum is safe and feasible. Intra-operative complications like operative field visualization, operative difficulties, conversion rates, duration of surgery are not affected moreover, low-pressure pneumoperitoneum, decreases consumption of intra-operative CO2, post-operative pain, shoulder tip pain, need of analgesia, nausea and promotes early per oral feeding, thus reduces hospital stay.
ABSTRACT
Introduction: This study proposes to compare the use of thelow pressure pneumoperitoneum/LPLC (< 9 mm Hg) with theuse of standard pressure pneumoperitoneum/SPLC (14 mmHg) in patients undergoing laparoscopic cholecystectomy ina prospective randomized manner in an attempt to lower theimpact of pneumoperitoneum on human physiology.Method and Materials: The study was carried out with asample size of 50 patients randomised into two groups, onewith 25 patients - SPLC while the other group with 25 patientsLPLC. To compare post-operative pain incidence of shouldertip pain, average operation duration, need of additionalanalgesia post-operatively, duration of hospital stay, change inPulse rate, SBP & DBP in both groups.Result: Incidence and intensity of post-operative pain, postoperative pain referred to the tip of the right shoulder weresignificantly lower in LPLC group compare with SPLC group.The average change in SBP in patients who underwent LPLCwas an increase of 0.83 ± 8.66 mm Hg and in SPLC groupwas an increase of 0.91 ± 14.67 mm Hg. Average change inDBP in patients who underwent LPLC was increase of 1.75± 8.33 mm Hg and in SPLC group was an increase of 2.64 ±8.34 mm Hg and in LPLC group was a decrease of 0.8 ± 12.01beats per minute and in SPLC group was an increase of 1.8± 5.33 beats per minute. The average change in SBP, DBP &heart rate in patients who underwent LPLC & SPLC was notstatistically significant. Average hospital stay for LPLC groupare 1.92 days and for SPLC group its 2.48 days.Conclusion: An uncomplicated gall stone disease can betreated by low pressure laparoscopic cholecystectomy withreasonable safety by an experienced surgeon. It is significantlyadvantageous in terms of post-operative pain, use ofanalgesics, less shoulder tip pain and hospital stay.
ABSTRACT
Pneumoperitoneum of 12-16mmHg is created by instillation of carbon dioxide during laparoscopic cholecystectomy .Nowadays low pressure pneumoperitoneum of 8-10 mmHg is used to decrease the side effects. In our study we have compared the two methods. Methods: Eighty patients with gallstones admitted in Government Hospital Gandhinagar (district hospital Jammu) for laparoscopic cholecystectomy were divided into two groups of forty each. Forty patients were subjected to standard pressure pneumoperitoneum during the procedure and forty patients to low pressure pneumoperitoneum. Results: Very slight difference in operating time of two groups was seen. No significant change in postoperative blood pressure and heart rate seen. Only two patients had shoulder tip pain and required more analgesics. Conclusion: High pressure pneumoperitoneum has no effect on intra operative and post operative hemodynamics but can lead to increase in post operative pain.
ABSTRACT
PURPOSE: There were many studies for adverse effects of carbon dioxide insufflation for laparoscopic cholecystectectomy, mainly focused on cardiovascular and respiratory system. The use of low pressure pneumoperitoneum has been shown to reduce adverse hemodynamic effects. However, its effect on tissue trauma & postoperative pain remains controversial. The aim of this study was to compare postoperative pain intensity between different insufflation pressures in laparoscopic cholecystecetomy. METHODS: We randomly allocated fifty four patients to 7 mmHg (LC7), 9 mmHg (LC9) and 12 mmHg (LC12) pneumoperitoneum group and examined operation time, postoperative pain intensity using visual analogue scale, amount of administered analgesics and complications prospectively. RESULTS: The characteristics of the patients were similar among groups. The procedure was successfully completed in all patients in the LC12 gruop, but in five patients of LC7 group and one patient of LC9 group the insufflation pressure was increased to 12 mmHg to complete the operation. There were no significant difference in postoperative pain scores, analgesic comsumptions among groups. There were difficulties to get a safe hemostasis and to create a adequate working space at acute cholecystitis in LC7 group. CONCLUSION: In our study, there was no superior advantage for postoperative pain when low pressure pneumoperitoneum was applied.
Subject(s)
Humans , Analgesics , Carbon Dioxide , Cholecystectomy, Laparoscopic , Cholecystitis, Acute , Hemodynamics , Hemostasis , Insufflation , Pain, Postoperative , Pneumoperitoneum , Prospective Studies , Respiratory SystemABSTRACT
Objective To study the safety of laparoscopic cholecystectomy (LC) with low pressure pneumoperitoneum for high risk patients with gallstone. Methods 72 high risk patients with gallstones were undergone LC with low pressure pneumoperitoneum and their clinical data were analysed in our hospital during last three years. Results one of 72 patients was converted into open cholecystectomy due to bleeding, and two of them were converted due to severe adhesion. The others were performed successfully and no serious complications occurred. Conclusions LC is a safe method for high risk patients with gallstone. The key point is to use low pressure pneumoperitoneum during LC.