Impact of Standard Versus Low Pneumoperitoneum Pressure on Peritoneal Environment in Laparoscopic Cholecystectomy. Randomized Clinical Trial

Author:

Serrano Ana Belén1,Díaz-Cambronero Óscar23,Montiel María1,Molina José4,Núñez Mónica1,Mendía Elena4,Mané María Nuria1,Lisa Eduardo4,Martínez-Botas Javier5,Gómez-Coronado Diego5,Gaetano Andrea6,Casarejos María José7,Gómez Ana7,Sanjuanbenito Alfonso4

Affiliation:

1. Anesthesiology

2. Department of Anesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politécnic La Fe, Valencia, Spain

3. EuroPeriscope: The ESA-IC Onco-Anaesthesiology Research Group

4. Surgery

5. Biochemistry-Research

6. Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid

7. Neurobiology-Research

Abstract

Background: High CO2 pneumoperitoneum pressure during laparoscopy adversely affects the peritoneal environment. This study hypothesized that low pneumoperitoneum pressure may be linked to less peritoneal damage and possibly to better clinical outcomes. Materials and Methods: One hundred patients undergoing scheduled laparoscopic cholecystectomy were randomized 1:1 to low or to standard pneumoperitoneum pressure. Peritoneal biopsies were performed at baseline time and 1 hour after peritoneum insufflation in all patients. The primary outcome was peritoneal remodeling biomarkers and apoptotic index. Secondary outcomes included biomarker differences at the studied times and some clinical variables such as length of hospital stay, and quality and safety issues related to the procedure. Results: Peritoneal IL6 after 1 hour of surgery was significantly higher in the standard than in the low-pressure group (4.26±1.34 vs. 3.24±1.21; P=0.001). On the contrary, levels of connective tissue growth factor and plasminogen activator inhibitor-I were higher in the low-pressure group (0.89±0.61 vs. 0.61±0.84; P=0.025, and 0.74±0.89 vs. 0.24±1.15; P=0.028, respectively). Regarding apoptotic index, similar levels were found in both groups and were 44.0±10.9 and 42.5±17.8 in low and standard pressure groups, respectively. None of the secondary outcomes showed differences between the 2 groups. Conclusions: Peritoneal inflammation after laparoscopic cholecystectomy is higher when surgery is performed under standard pressure. Adhesion formation seems to be less in this group. The majority of patients undergoing surgery under low pressure were operated under optimal workspace conditions, regardless of the surgeon’s expertise.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

General Medicine

Reference46 articles.

1. Laparoscopic versus open cholecystectomy. An analytical clinical and financial aspects;Schietroma;Panminerva Med,2001

2. Evaluation of hemodynamic changes using different intra-abdominal pressures for laparoscopic cholecystectomy;Umar;Indian J Surg,2013

3. Effects of pneumoperitoneal pressure and position changes on respiratory mechanisms during laparoscopic colectomy;Park;Korean J Anesthesiol,2012

4. Prospective randomized trial of post-operative pain following different insufflation pressures during gynecologic laparoscopy;Topçu;Eur J Obstet Gynecol Reprod Biol,2014

5. Evaluation of post-operative shoulder tip pain in low pressure versus standard pressure pneumoperitoneum during laparoscopic cholecystectomy;Yasir;Surgeon,2012

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