An observational study on the effect of high versus low carbon dioxide pressure in laparoscopic cholecystectomy

Authors

  • Jenishkumar V. Modi Department of Surgery, Surat Municipal Institute of Medical Education And Research, Surat, Gujarat, India
  • Mitesh Trivedi Department of Surgery, Surat Municipal Institute of Medical Education And Research, Surat, Gujarat, India

DOI:

https://doi.org/10.18203/2349-2902.isj20223161

Keywords:

Low CO2 pressure, High CO2 pressure, Laparoscopic cholecystectomy

Abstract

 

Background: Gall bladder stone is one of the common diseases of hepatobiliary system. If it is symptomatic then it needs to be treated and sometimes it may lead to multiple complications. Laparoscopic approach for cholecystectomy is widely acceptable and routinely done procedure for gall bladder stone. Laparoscopic cholecystectomy reduces postoperative pain and hospital stay as compared to open surgery. Laparoscopic surgeries require carbon dioxide (CO2) to inflate peritoneal cavity.

Methods: It is an observational study at tertiary care centre. In present study authors have included all patients undergoing elective laparoscopic cholecystectomy. Patients required conversion to open cholecystectomy from laparoscopic cholecystectomy and emergency laparoscopic cholecystectomy and laparoscopic cholecystectomy for malignancy were not included. In present study, patients were randomly allocated into two groups: group A (n=50) low CO2 pressure (8-10 mmHg) pneumoperitonium and group B (n=50) high CO2 pressure (12-14 mmHg) pneumoperitonium to perform laparoscopic cholecystectomy. In present study authors have compared post operative effects in term of pain (at 4, 8 and 12 hrs post operatively), hospital stay and requirements of injectable analgesics between group A and group B.

Results: 14 patients in group B complained of post operative shoulder tip pain as compared to only 5 patients in group A. Analgesic requirement and mean length of post operative hospital stay were also less in group A as compared to group B.

Conclusions: Low pressure laparoscopic cholecystectomy (LPLC) significantly decrease the frequency and intensity of post operative shoulder tip pain. So, LPLC decrease the demand for postoperative analgesics and decrease post operative hospital stay.

Metrics

Metrics Loading ...

Author Biographies

Jenishkumar V. Modi, Department of Surgery, Surat Municipal Institute of Medical Education And Research, Surat, Gujarat, India

General surgery

Mitesh Trivedi, Department of Surgery, Surat Municipal Institute of Medical Education And Research, Surat, Gujarat, India

General Surgery

References

Keus F, De jong JA, Gooszen HG, Van Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholelithiasis. Cochrane Database Syst Rev. 2006;CD006231.

Tandon RK. Prevalence and type of biliary stones in India. World J Gastroenterol. 2000;6(3):4-5.

Johnston DE, Kaplan MM. pathogenesis and treatment of gallstone. N. Engl J Med. 1993;328:412-21.

Peery AF, Crockett SD, Barritt AS, Dellon ES, Eluri S, Gangarosa LM, et al. Burden of gastrointestinal, liver and pancreatic diseases in the United States. Gastroenterology. 2015;149:1731.

Beal JM. Historical perspective of gall stone disease. Surg Gynecol Obstet. 1984;158:181-9.

Schoenfield I, Lachin J. The steering committee TNCGSG. Chenodiol(chenodeoxycholic acid) for dissolution of gallstones: the national cooperative gallstone study. Ann Intern Med. 1981;95:257-82.

Schoenfield I, Berci G, Carnovale R, Casarella W, Caslowitz P, Chumley D, et al. The effect of ursodiol on the efficacy and safety of extracorporeal shockwave lithotripsy of gallstones. N Engl J Med. 1990;323:1239-45.

Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparoscopic cholecystectomy: the new gold standard? Arch Surg. 1992;127S:917-21.

Soper NJ, Brunt LM, Kerbl K. Laparoscopic general surgery. N Engl J Med. 1994;330:409-19.

NIH Consensus conference. Gallstone and laparoscopic cholecystectomy. JAMA. 1992;269:1018-24.

Barkun JS, Barkun AN, Sampalis JS, Fried G, Taylor B, Wexler MJ, et al. Randomized controlled trial of laparoscopic versus mini cholecystectomy. Lancet. 1992;340:1116-9.

Bass EB, Pitt HA, Lillemoe KD. Cost effectiveness of laparoscopic cholecystectomy versus open cholecystectomy. Am J Surg. 1993;165:466-71.

Mcmahon A, Russell I, Baxter J, et al. Laparoscopic versus open cholecystectomy: a randomized trial. Lancet. 1994;343:135-138.

Soper NJ. Laparoscopic cholecystectomy. Curr Probl Surg. 1991;28:585-655.

Soper NJ, Barteau J, Clayman R. laparoscopic versus standard open cholecystectomy: comparisons of early results. Surg Gynecol Obstet. 1992;174:114-8.

Joshipura VP, Haribhakti SP, Patel NR, Naik RP, Soni HN, Patel B, et al. A prospective randomized, controlled study comparing low pressure pneumoperitoneum versus high pressure pneumoperitoneum during laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2009;19(3):234-40.

Sarli L, Costi R, Sansebastiano G, Trivelli M, Roncoroni L. Prospective randomized trial of low pressure pneumoperitoneum for reduction of shoulder tip pain following laparoscopy. Br J Surg. 2000;87(9):1161-5.

Barczynski M, Herman RM. A prospective randomized trial on comparison of low pressure and standard pressure pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc. 2003;17(4):533-8.

Hua J, Gong J, Yao L, Zhou B, Song Z. Low pressure versus standard pressure pneumoperitoneum for laparoscopic cholecystectomy: a systemic review and meta-analysis. Am J Surg. 2014;208(1):143-50.

Downloads

Published

2022-11-28

Issue

Section

Original Research Articles