Department of General Surgery/ Minimally invasive surgery, School of Medicine, Jordan University Hospital, The University of Jordan, Amman, Jordan.
Department of General Surgery/Hepatobiliary Division Jordan University Hospital, School of Medicine, The University of Jordan, Amman, Jordan.
BMC Res Notes. 2023 Sep 28;16(1):235. doi: 10.1186/s13104-023-06492-y.
We aim to assess the effect of low-pressure pneumoperitoneum on post operative pain and ten of the known inflammatory markers.
The standard of care pneumoperitoneum set pressure in laparoscopic cholecystectomy is set to 12-14 mmHg, but many societies advocate to operate at the lowest pressure allowing adequate exposure of the operative field. Many trials have described the benefits of operating at a low-pressure pneumoperitoneum in terms of lower post operative pain, and better hemodynamic stability. But only few describe the effects on inflammatory markers and cytokines.
A prospective, double-blinded, randomised, controlled clinical trial, including patients who underwent elective laparoscopic cholecystectomy. Patients randomised into low-pressure (8-10 mmHg) vs. standard-pressure (12-14 mmHg) with an allocation ratio of 1:1. Perioperative variables were collected and analysed.
one hundred patients were allocated, 50 patients in each study arm. Low-pressure patients reported lower median pain score 6-hour post operatively (5 vs. 6, p-value = 0.021) in comparison with standard-pressure group. Eight out of 10 inflammatory markers demonstrated better results in low-pressure group in comparison with standard-pressure, but the effect was not statistically significant. Total operative time and surgery difficulty was not significantly different between the two groups even in the hands of inexperienced surgeons.
low-pressure laparoscopic cholecystectomy is associated with less post operative pain and lower rise of inflammatory markers. It is feasible with comparable complications to the standard of care. Registered on ClinicalTrials.gov (NCT05530564/ September 7th, 2022).
评估低压气腹对术后疼痛和十种已知炎症标志物的影响。
腹腔镜胆囊切除术的标准气腹压力设定为 12-14mmHg，但许多学会主张在能充分暴露手术视野的最低压力下操作。许多试验已经描述了在低压气腹下操作的好处，包括术后疼痛减轻和更好的血液动力学稳定性。但只有少数描述了对炎症标志物和细胞因子的影响。
这是一项前瞻性、双盲、随机、对照的临床试验，纳入了接受择期腹腔镜胆囊切除术的患者。患者随机分为低压（8-10mmHg）组和标准压（12-14mmHg）组，比例为 1:1。收集并分析围手术期变量。
共分配了 100 例患者，每组 50 例。与标准压组相比，低压组患者术后 6 小时的中位疼痛评分（5 分比 6 分，p 值=0.021）较低。10 种炎症标志物中有 8 种在低压组的结果更好，但差异无统计学意义。即使在经验不足的外科医生手中，两组的总手术时间和手术难度也没有显著差异。
低压腹腔镜胆囊切除术与术后疼痛减轻和炎症标志物升高减少相关。与标准治疗相比，它具有类似的并发症，是可行的。该研究已在 ClinicalTrials.gov 注册（NCT05530564/2022 年 9 月 7 日）。
