Comparison of Low Pressure versus high Pressure Laparoscopic Cholecystectomy; A Randomized Controlled Trial

Abstract

Aim: To compare the frequency of doubling in liver enzymes with low pressure (LP) versus high pressure (HP) laparoscopic cholecystectomy (LC). Methodology: A total number of sixty (60) patients planned for elective cholecystectomy having age 20-70 years, of any gender, having normal ALT, AST levels before cholecystectomy were included in this randomized clinical trial within a duration of six months from Jan-2017 to June-2017. In group LP-LC, low pressure CO2 (7mmHg) was used to create pneumo-peritoneum. In group HP-LC, high pressure CO2 (14mmHg) was used to create pneumoperitoneum. Veress needle was used for creation of pneumo-peritoneum. Liver enzymes such as ALT and AST were measured after 48 hours of cholecystectomy. Results: Mean age of patients was 43.35±9.75 years in LP-LC group and 42.36 ± 10.58 years in HP-LC group (p-value 0.70). Female population was predominant, 23(76.7%) were male patients in LP-LC group and 24 (80%) in HP-LC group (p-value 0.75). Mean operation time was 89.47±17.14 minutes in HP-LC group and 93.41±19.79 minutes in LP-LC groups (p-value 0.41). In post-operative period, doubling of liver enzymes was found in 2 (6.67%) patients, and in 10(33.3%) patients in HP-LC group (p-value 0.009). Conclusion: Low pressure laparoscopic cholecystectomy (LP-LC) is more safe as compared to the high pressure laparoscopic cholecystectomy (HP-LC) and is associated with less increase in liver enzymes in postoperative period.