Physiological effects of standard versus gradual pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.

Abstract

Objective: To compare the physiological effects of standard versus gradual open pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. Study Design: Prospective Comparative study. Setting: Operation Room, Tertiary Care Hospital Jizan, Saudi Arabia. Period: Sep 2024 to Aug 2025. Methods: Hundred patients recruited for study were randomly divided in two Groups. In Group A, a pressure of 14mmHg was achieved by creating open pneumoperitoneum by CO2 in a standard fashion, while in the intervention Group B, pressure of 5, 10, and 14 mmHg was achieved gradually. At different time intervals, BP, heart rate, SpO2 and EtCO2 were measured. Results: Mean heart rate in group A and B was 77.66±8.21and 76.41±7.47 respectively (P-value=0.051). Mean systolic BP in group A and B was 117.7±12.13 and 119.14±7.75 respectively (P-value=0.082). Mean diastolic BP in Group A and B was 77.96±6.45 and 77.38 ± 5.01 respectively (P-value=0.023). Mean SpO2 in group A and B was 99.59 ± 0.53 and 99.6±0.76 (P-value=0.8). Mean EtCO2 in group A and B was 36.86±2.38 and 36.6±2.35 respectively (P-value=0.17). Mean VAS score in group A and B was 2.34±0.72 and 2.06±0.24 respectively (P-value=0.01). In Group A, 13 (26%) patients received injection pethidine due to pain while in Group B only 4 (8%) patients received pethidine (P-value=0.017). Conclusion: Gradual open pneumoperitoneum results in more stable physiological and hemodynamic parameters compared to standard rapid open insufflation, without compromising surgical conditions. This is particularly beneficial in patients with cardiovascular compromise.