Euroasian Journal of Hepato-Gastroenterology

Register      Login

VOLUME 9 , ISSUE 1 ( January-June, 2019 ) > List of Articles

Original Article

Comparative Analysis of Hemodynamic Changes and Shoulder Tip Pain Under Standard Pressure Versus Low-pressure Pneumoperitoneum in Laparoscopic Cholecystectomy

Apoorv Goel, Shalabh Gupta, Tripta S Bhagat, Prakhar Garg

Keywords : Cholelithiasis, Laparoscopic cholecystectomy, Low pressure, Pneumoperitoneum, Standard pressure

Citation Information : Goel A, Gupta S, Bhagat TS, Garg P. Comparative Analysis of Hemodynamic Changes and Shoulder Tip Pain Under Standard Pressure Versus Low-pressure Pneumoperitoneum in Laparoscopic Cholecystectomy. Euroasian J Hepatogastroenterol 2019; 9 (1):5-8.

DOI: 10.5005/jp-journals-10018-1287

License: CC BY-NC 4.0

Published Online: 01-06-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Laparoscopic cholecystectomy is the gold standard procedure for cholelithiasis. Pneumoperitoneum is created using carbon dioxide (CO2), which is usually maintained at a range of 12–14 mm Hg. An emerging trend has been the use of low-pressure pneumoperitoneum in the range of 7–10 mm Hg in an attempt to lower the impact of pneumoperitoneum on the human physiology while providing adequate working space. Our study proposes to compare the effects of low-pressure pneumoperitoneum with the use of standard pressure of pneumoperitoneum. Aims and objective: To compare and analyze various factors like blood pressure, heart rate, end-tidal CO2 and postoperative shoulder tip pain in cases undergoing laparoscopic cholecystectomy using standard pressure versus low pressure. Materials and methods: This is a prospective randomized study carried out at Santosh Medical College and Hospitals, Ghaziabad from September 2017 to December 2018. This study included 60 patients of cholelithiasis which were divided into two groups of 30 patients each. Group I was offered laparoscopic cholecystectomy under standard pressure pneumoperitoneum and group II underwent laparoscopic cholecystectomy using low-pressure pneumoperitoneum. Patients in each group were evaluated for various intraoperative physiological changes and post-operative shoulder tip pain. Observations and results: Cholelithiasis is commonly seen in middle-aged females. There is no significant difference in duration of surgery between the two groups. However, various factors like systolic blood pressure, heart rate, end-tidal CO2 were significantly better in the low-pressure group. Postoperative shoulder tip pain (measured by VAS scoring system) was significantly less in the low-pressure group during the first 24 hours. Conclusion: Laparoscopic cholecystectomy under low-pressure pneumoperitoneum causes minimal physiological changes and less post-operative shoulder tip pain.


PDF Share
  1. Dubois F, Berthelot G, et al. Laparoscopic cholecystectomy: historic perspective and personal experience. Surg Laparosc Endosc 1991;1(1):52-57.
  2. Mulvihill SJ. Laparoscopic management of gallstone disease. Semin Gastrointest Dis 1994;5(3):120-127.
  3. Farello G, Cerofolini A, et al. Laparoscopic cholecystectomy for gallbladder stones. Chir Ital 1995;47(1):24-43.
  4. Berg K, Wilhelm W, et al. Laparoscopic cholecystectomy-effect of position changes and CO2 pneumoperitoneum on hemodynamic, respiratoryand endocrinologicparameters. Zentralbl Chir 1997;122(5):395-404.
  5. Gurusamy KS, Samraj K, et al. Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev 2009;(2):CD006930.
  6. Sandhu T, Yamada S, et al. Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy, a prospective randomized clinical trial. Surg Endosc 2009;23(5):1044-1047.
  7. 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 2016;80(1):30-35.
  8. Sarli L, Costi R, et al. Prospective randomized trial of lowpressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy. Br J Surg 2000;87(9):1161-1165.
  9. Yasir M, Mehta KS, et al. Evaluation of postoperative shoulder tip pain in low pressure versus standard pressure pneumoperitoneum during laparoscopic cholecystectomy. Surgeon 2012;10(2):71-74.
  10. Bhattacharjee HK, Jalaludeen A, et al. Impact of standardpressure and low-pressure pneumoperitoneum on shoulder pain following laparoscopic cholecystectomy: a randomised controlled trial. Surg Endosc 2017;31(3):1287-1295.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.