Randomized, Prospective Comparison of Post-Operative Pain In Low - Versus High -Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy

Background and Objectives: CO2 insuflation constitutes the commonest means of creating the pneumoperitoneum (PP), but it is attributed to many post-laparoscopic cholecystecomy adverse effects including pain triggering. The aim of this trial was to evaluate the efficacy of low-pressure CO2 PP during laparoscopic cholecystectomy (LC) in reducing the incidence of postoperative pain. Methods: A double-blind, randomized, clinical trial was conducted on 100 patients with symptomatic gall stones. Patients were randomized preoperatively into group A (n=50) who underwent LC with 8 mmHg CO2 PP throughout the procedure and those in group B (n=50) had LC with 12 mmHg CO2 PP. Abdominal and shoulder-tip pain were assessed with verbal rating scale (VRS) scoring at 4, 8, 12 and 24 hours postoperatively. Results: The low-pressure PP did not increase the duration of surgery. There were neither significant peri-operative complications nor conversion to open procedure in either group. A statistical comparison of mean cumulative VRS scores for abdominal and shoulder-tip pain in both groups shows statistical significance at 4, 8, 12 and 24 hours after operation. Conclusions: A CO2 PP at 8 mmHg reduces both the frequency and intensity of abdominal and shoulder-tip pain following LC without increasing the rate of intra-operative complications.