Low-pressure Pneumoperitoneum in Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Area of Science:

• Minimally invasive surgery
• Laparoscopic cholecystectomy
• Abdominal surgery

Background:

• Laparoscopic cholecystectomy is a common surgical procedure.
• Pneumoperitoneum is essential for laparoscopic surgery, but insufflation pressure can affect patient physiology and surgeon comfort.
• Investigating the impact of different pneumoperitoneum pressures is crucial for optimizing surgical outcomes.

Purpose of the Study:

• To compare hepatic enzyme changes and surgeon comfort between low-pressure (7 mmHg) and normal-pressure (14 mmHg) pneumoperitoneum during laparoscopic cholecystectomy.
• To evaluate the safety and efficacy of low-pressure pneumoperitoneum in this procedure.

Main Methods:

• Eighty-two patients were randomized into low-pressure pneumoperitoneum laparoscopic cholecystectomy (LPPLC) and normal-pressure pneumoperitoneum laparoscopic cholecystectomy (NPPLC) groups.
• Serum hepatic enzymes (bilirubin, SGOT, SGPT, ALP, LDH) were measured preoperatively, immediately post-op, 24 hours, and 7 days post-op.
• Surgeon's comfort, operative time, and conversion rates were recorded.

Main Results:

• While both groups showed significant bilirubin changes, only NPPLC exhibited a sustained increase after 24 hours.
• Hepatic enzymes (SGOT, SGPT, LDH) significantly increased post-op and at 24 hours in the NPPLC group only.
• Surgeon comfort was significantly higher in the NPPLC group, though LPPLC demonstrated safety with some conversions due to dissection difficulty.

Conclusions:

• Low-pressure pneumoperitoneum laparoscopic cholecystectomy is a safe procedure with clinically insignificant systemic effects, particularly for experienced surgeons.
• Normal pressure pneumoperitoneum offers superior surgeon comfort.
• For patients with compromised hepatic function, initiating surgery with low-pressure pneumoperitoneum is advisable, with potential for pressure escalation based on surgeon preference.