Prospective randomized comparison of low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy

Abstract EN

Background: Postoperative shoulder tip pain occurs frequently following laparoscopic cholecystectomy.

The origin of shoulder pain is partly understood, but it is commonly assumed that the cause is overstretching of the diaphragmatic muscle fibers due to high rate of insufflations.

The aim of this study is to compare the frequency and intensity of shoulder tip pain between low pressure (7 mmHg) and standard-pressure (14 mmHg) pneumoperitoneum after laparoscopic cholecystectomy.

Setting: Aljumhori Teaching Hospital during the period from January 2011 to June 2012.

Design: A prospective randomized study.

Patients and methods: One hundred and forty consecutive patients undergoing elective laparoscopic cholecystectomy were randomized prospectively into two groups, either low pressure (group A) or standard pressure (group B) pneumoperitoneum, they were blinded to the research doctors who assessed the patients during the postoperative period by the visual analogue scale (VAS) of pain.

Comparative analysis between the two groups included gender, mean age, operative time, complication rate and postoperative shoulder tip pain.

Results: The demographic data were nearly similar in the two groups.

There were no significant intraoperative complications in both groups, likewise the mean operative time was nearly similar in either group.

The mean frequency and intensity of postoperative shoulder tip pain assessed by visual analogue scale was less in group A than in group B.

Conclusion: No difference was found between low pressure and standard pressure pneumoperitoneum in the duration of operation and complication, but low pressure pneumoperitoneum tended to produce lower incidence and intensity of shoulder tip pain.