Laparoscopic cholecystectomy (LC) is an advantageous procedure that
widely replaced the traditional open cholecystectomy. However, highpressure
pneumoperitorteum was accused for precipitating some intraoperative
hemodynamic effects and postoperative shoulder-tip pain (S1P).
The objectives of this study were to determine the influence of lowpressure
pneurnoperitoneum on the frequency and intensity of shouldertip
pain and body hemodyncunics in patients undergoing laparoscopic
cholecystectomy. The study comprised 70 chronic calcular cholecystitis
patients (25 men 8/, 45 women). Thirty-three patients (Group I) were assigned
to undergo LC under high-pressure (13-15 mmHg) and 37 patients
under low-pressure (7-9 mmHg) (Group ID. Intraoperative monitoring inch
riled measurement of heart rate (I-ER), systolic, diastolic blood pressure,
and mean arterial blood pressure (MAP) was calculated. The frequency
of postoperative SIP was determined and its intensity was
determined using visual analogue scale charts (VAS). There was a signtflcant
(P<0.05) increase in MAP in both groups at 5 min, after insufflation
and after tilting the patient to reversed 7'rendelenberg position (RTP), but
there was a significant decrease of MAP in Group II as compared to
Group 1(2(2=7.716, P<0.05). There was a significant reduction of both frequency
(13.5% vs. 33.3%) and intensity of STP in low-pressure group compared
to high-pressure group. This difference was especially significant
6,12,24 hours postoperatively. Moreover there was a positive significant
correlation between the insufflated pressure and the frequency (r=0.691 P<0.05) and intensity (r=0.612. P<0.05) of ,511-1. There was a significant
reduction of the amount consumed analgesic (declphenac potassium
75 mg/ cc, amp.) in low-pressure group compared to high-pressure group.
We can conclude that reduction of the pressure of the pneumoperitoneum
to 7-9 mmHg results in a significant reduction of both the frequency and
intensity of shoulder-tip pain and allows more stable hemodynamics of
the patients through the duration of laparoscopic cholecystectomy. On the
basis of these results, the widespread use of low-pressure pn.eumoperitoneum
throughout most of a laparoscopic cholecystectomy procedure is
recommended |
