EFFECT OF LOW-PRESSURE PNEUMOPERITONEUM VERSUS STANDARD PRESSURE ON POST-OPERATIVE DISCOMFORT AND CHANGES IN VARIOUS INFLAMMATORY MARKERS IN LAPAROSCOPIC CHOLECYSTECTOMY: A RANDOMIZED CONTROL TRIAL dr.dharmendrapipal2007@gmail.com

 

EFFECT OF LOW-PRESSURE PNEUMOPERITONEUM VERSUS STANDARD PRESSURE ON POST-OPERATIVE DISCOMFORT AND CHANGES IN VARIOUS INFLAMMATORY MARKERS IN LAPAROSCOPIC CHOLECYSTECTOMY: A RANDOMIZED CONTROL TRIAL

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India

Oral only

This randomized controlled trial compares low-pressure (8-10mmHg) versus standard-pressure (12-14mmHg) CO₂ pneumoperitoneum in elective laparoscopic cholecystectomy to evaluate stress and inflammatory responses. Adult patients were randomly assigned to either pressure group, with standardized anesthesia and postoperative care. The primary outcome is C-reactive protein (CRP) at 24 hours; secondary outcomes include cortisol levels, liver function tests, pain scores, analgesic use, shoulder pain, operative visibility, and complications. Blood tests are taken preoperatively and at 6, 12 and 24 hours and 7 days, and pain is assessed at similar intervals. If visualization is inadequate, pressure may be increased, and changes are documented. Data were analyzed on an intention-to-treat basis to determine whether low-pressure pneumoperitoneum reduces inflammatory and stress markers and improves postoperative comfort without compromising surgical safety.

This prospective randomised controlled trial was conducted in the Department of General Surgery at the All India Institute of Medical Sciences, Gorakhpur, India after getting the approval from the institutional ethics committee and getting the CTRI number. A total of 100 patients fulfilling the inclusion and exclusion criteria were enrolled and randomised into two equal groups: 50 patients in the low-pressure pneumoperitoneum group and 50 in the standard-pressure group. All participants were ASA grade I or II and underwent laparoscopic cholecystectomy for symptomatic gallstone disease. Postoperative clinical and biochemical parameters were assessed at 6, 12, and 24 hours, and on the 7th postoperative day to compare recovery outcomes between the two groups.

The serum cortisol levels were significantly lower (p value < 0.05) in the low-pressure group following surgery. In this group, four patients (8%) required an increase in pressure, compared to six patients (12%) in the standard pressure group. Additionally, postoperative pain, including shoulder tip pain, was significantly reduced in the low-pressure group (p value < 0.05).

The use of low-pressure pneumoperitoneum is associated with significantly lower postoperative serum cortisol levels, reduced pain (including shoulder-tip pain), and a comparable need for pressure up-titration versus standard pressure. These findings suggest that low-pressure pneumoperitoneum is a safe and effective alternative that may enhance postoperative recovery and patient comfort.