Postoperative outcome and hemodynamic changes in high versus low pressure to pneumoperitoneum in patients undergoing laparoscopic cholecystectomy


  • Valarmathi Marimuthu Department of General Surgery, Sree Balaji Medical College and Hospital, Tamil Nadu, India
  • Bhuvaneswari Murugan Madras Medical College, Tamil Nadu, India



Gallstone, High-pressure pneumoperitoneum, Laparoscopic cholecystectomy, Low-pressure pneumo-peritoneum


Background: A pneumoperitoneum is created by insufflating a gas (usually carbon dioxide) into the peritoneal cavity during laparoscopic surgery. Intra-abdominal pressure (IAP) rises as a result of this. At a rate of 4–6 liter min-1, carbon dioxide is insufflated into the peritoneal cavity at a pressure of 10–20 mm Hg. Aim of the research was to compare the hemodynamic effects and the level of post-operative symptoms due to high pressure and low-pressure pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.

Methods: 60 patients fulfilling inclusion criteria who were posted for elective cholecystectomy under general anaesthesia were divided into two groups, 30 patients in each group. Group L included pneumoperitoneum created with intra-abdominal pressure of 7-10 mmHg, and group H included pneumoperitoneum created with intra-abdominal pressure of 12-14 mmHg. Variables such as the systolic blood pressure, diastolic blood pressure, heart rate, end-tidal CO2, the level of post-operative abdominal pain, shoulder-tip pain, nausea and vomiting, and the liver function test were compared between the two groups.

Results: Between groups, no statistical difference has been noted in the demographic characters of the patient. There was a statistical difference of intraoperative and post-operative systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) between groups. End-tidal CO2 was compared between the two groups during the surgery and a significant difference regarding EtCO2. Liver function tests showed a significant difference in all measured factors after surgery between the two groups.

Conclusions: Low-pressure pneumoperitoneum decreases hemodynamic complications. Post-operative abdominal pain, shoulder tip pain, nausea and vomiting are reduced.


Njeze GE. Gallstones. Niger J Surg. 2013;19(2):49-55.

Trondsen E, Reiertsen O, Andersen OK, Kjaersgaard P. Laparoscopic and open cholecystectomy. A prospective, randomized study. Eur J Surg. 1993;159:217-21.

Berggren U, Gordh T, Grama D, Haglund U, Rastad J, Arvidsson D. Laparoscopic versus open cholecystectomy: hospitalization, sick leave, analgesia and trauma responses. Br J Surg. 1994;81:1362-5.

Yu T, Cheng Y, Wang X, Tu B, Cheng N, Gong J, Bai L. Gases for establishing pneumoperitoneum during laparoscopic abdominal surgery. Cochrane Database Syst Rev. 2017;6(6):CD009569.

Mahajan S, Shankar M, Garg VK, Gupta V, Sorout J. Intraoperative safety of low pressure pneumoperitoneum cholecystectomy: a comparative study. Int Surg J. 2017;4(11):3679-84.

Mohammadzade AR, Esmaili F. Comparing Hemodynamic Symptoms and the Level of Abdominal Pain in High- Versus Low-Pressure Carbon Dioxide in Patients Undergoing Laparoscopic Cholecystectomy. Indian J Surg. 2018;80(1):30-5.

Özdemir-van Brunschot DM, van Laarhoven KC, Scheffer GJ, Pouwels S, Wever KE, Warlé MC. What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review. Surg Endosc. 2016;30(5):2049-65.

Kanwer DB, Kaman L, Nedounsejiane M. Comparative study of low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy—a randomised controlled trial. Trop Gastroenterol. 2009;30(3):171-4.

Dexter SPL, Vucevic M, Gibson J, McMahon MJ. Hemodynamic consequences of high-and low pressure capnoperitoneum during laparoscopic cholecystectomy. Surg Endosc. 1999;13(4):376-81.

Vezakis A, Davides D, Gibson JS, Moore MR, Shah H, Larvin M, McMahon MJ. Randomized comparison between low-pressure laparoscopic cholecystectomy and gasless laparoscopic cholecystectomy. Surg endosc. 1999;13(9):890-3.

Al-Dabbagh AA, Ismaeel NH. Randomized, prospective comparison of post-operative pain in low-versus high-pressure pneumoperitoneum in laparoscopic cholecystectomy. Zanco J Med Sci. 2010;14(2):35-40.

Hasukić Š. Post-operative changes in liver function tests: randomized comparison of low-and high-pressure laparoscopic cholecystectomy. Surg Endosc Interv Tech. 2005;19(11):1451-5.






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