Low pressure pneumoperitonium laparoscopic cholecystectomy: A comparison of intra-operative hemodynamic stability and physiological changes with standard pressure pneumoperitonium laparoscopic cholecystectomy

Objective: To compare the intra-operative changes in heart rate, mean arterial blood pressure, oxygen saturation and end-tidal carbon dioxide volume between patients undergoing low pressure and standard pressure pneumoperitonium laparoscopic cholecystectomy. Methods: A randomized control trial was conducted at department of Surgery, Pakistan Airforce Hospital, Islamabad, from August 2011 to July 2013. A total of 214 patients, who met inclusion criteria, were randomized into two groups. Pulse rate, mean arterial blood pressure, oxygen saturation and end-tidal carbon dioxide were measured after anesthesia induction and at 20, 40 and 60 minutes post-anesthesia induction and at the end of laparoscopic procedure of the two groups. Results: The operating time in both groups was comparable. The intra-operative hemodynamic stability and physiological changes were closer to the pre-operative state in the low pressure pneumoperitonium group compared to the standard pressure pneumoperitonium group. The technical difficulties were greater in low pressure pneumoperitonium due to the limited exposure. Post-operative recovery was similar. Conclusion: Low-pressure pneumoperitonium laparoscopic cholecystectomy is valuable to reduce the untoward physiologic changes associated with standard pressure pneumoperitonium group as it minimally alters the physiological parameters per-operatively. Performing laparoscopic cholecystectomy with low pressure pneumoperitoneum has potential limitations and its safety has to be further established. So we propose that it is best reserved for patients with compromised cardiovascular and respiratory functions and the elderly. (author)