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

Valarmathi Marimuthu, Bhuvaneswari Murugan


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.


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

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