Impact of standard-pressure and low-pressure laparoscopic cholecystectomy on postoperative complications: a randomized controlled trial

Background: this study aimed to evaluate the effect of standard-pressure and low-pressure laparoscopic cholecystectomy on postoperative tip shoulder pain, nausea, and vomiting. Materials and Methods: This double-blind trial was conducted in the department of General Surgery in Imam Reza Hospital, affiliated with Kermanshah University of Medical Sciences (KUMS), Kermanshah Province, Iran from January ۲۰۲۰ to June ۲۰۲۱. A total of ۱۰۴ patients for laparoscopic cholecystectomy were recruited, ۵۲ patients in each group randomly (low pressure received ۷-۹ mmHg vs. standard pressure received ۱۴-۱۵ mmHg). Postoperative tip shoulder pain, nausea, and vomiting were studied. Result: The mean intensity of nausea at ۲ (۵.۷±۰.۹۱ vs. ۵.۳±۰.۸۰, p-value= ۰.۰۱۹) and ۱۲ hours (۱.۹±۰.۷۹ vs. ۱.۳±۰.۷۶, p-value= ۰.۰۰۱) after surgery in standard pressure group was significantly higher than low pressure group. The mean intensity of vomiting at recovery (۴.۳±۰.۸۱ vs. ۳.۹±۰.۷۰, p-value= ۰.۰۰۸), ۲ (۳.۵±۰.۶۸ vs. ۳.۲±۰.۷۱, p-value= ۰.۰۳۰), and ۶ hours (۲.۷±۱.۳ vs. ۲.۲±۰.۹۶, p-value= ۰.۰۲۸) after surgery in standard pressure group was significantly higher than low pressure group. The mean intensity of shoulder tip pain at recovery (۵.۱±۰.۹۷ vs. ۴.۷±۰.۹۶, p-value= ۰.۰۳۷) and ۴ hours (۳.۲±۰.۷۵ vs. ۲.۷±۰.۶۱, p-value= ۰.۰۰۱) after surgery in standard pressure group was significantly higher than low pressure group. Conclusion: Low pressure laparoscopic surgery is safe with least intensity of post-operative tip shoulder pain, nausea, and vomiting when performed by experienced surgeons.

Keywords:

Laparoscopic cholecystectomy , pneumoperitoneum , nausea , vomiting , shoulder tip pain.