COMPARING HEMODYNAMIC PARAMETERS AND THE LEVEL OF ABDOMINAL PAIN IN STANDARD AND LOW - PRESSURE CARBON DIOXIDE IN PATIENTS UNDERGOING LAPROSCOPIC CHOLECYSTECTOMY
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Keywords
Laparoscopic cholecystectomy, Low pressure pneumoperitoneum, standard pressure pneumoperitoneum, Gallstones
Abstract
Aim: Aim of this study is to compare the symptoms associated with the low pressure and standard pressure carbondioxide used for creating pneumoperitoneum in laproscopic cholecystectomy.
Introduction: Laproscopic cholecystectomy is the gold standard to treat the gallstones nowadays. The advantages of this surgical procedure such as less postoperative morbidity and short hospital stay have encouraged the patients and surgeons towards it. Pneumoperitoneum created using carbon dioxide enters peritoneal cavity and the standard pressure of 12 to 14 mm hg is kept constant throughout the surgery. It is associated with complications that usually happen following the prolonged surgery. Using low pressure of 7 to 10mm Hg shows the better advantages in elderly respiratory and cardiovascular patients.
Materials And Methods: A Total number of 60 patients of cholelithiasis admitted in surgery ward for the period of 6 months for laparoscopic cholecystectomy were included in the study. Patients were randomly categorized into two groups of 30. Pneumoperitoneum with carbondioxide (CO2) of 7 to 10 mm Hg and 12 to 14 mm Hg were used in the first and second groups. Preoperative hemodynamic parameters were recorded. Postoperatively hemodynamic parameters, LFT were evaluated. Abdominal pain and shoulder tip pain were evaluated using Visual Analog Scale.
Statistical analysis was carried out using SPSS 24 for windows. P value less than 0.01 was considered statistically significant.
Results: The low-pressure group exhibited better hemodynamic stability, reduced pain frequencies, and distinctive liver enzyme changes. Systolic blood pressure and heart rate were significantly lower in the low-pressure group. Abdominal and shoulder-tip pain were markedly lower postoperatively in the low-pressure cohort. Alkaline phosphatase showed a significant difference between the groups.
Conclusion: Although using standard pressure for peritoneal CO2 insufflation provides better surgical site and short duration of surgery, low pressure CO2 insufflations showed decreased hemodynamic symptoms, abdominal and shoulder tip pains.
References
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Ahila.M
Surgery resident, Department of General Surgery, SVMCH&RC, Pondicherry
Indrajit Anandakannan
Assistant professor, Department of General Surgery, SVMCH&RC, Pondicherry
Selvakumar K
Professor and Head of the Department, Department of General Surgery, SVMCH&RC, Pondicherry
Gowthaman.M.D
Assistant professor, Department of General Surgery, SVMCH&RC, Pondicherry
Lochan Thanigachalam
Surgery resident, Department of General Surgery, SVMCH&RC, Pondicherry