A Comparative Study of Standard Versus Low-Pressure Pneumoperitoneum on Patients Outcome Following Laparoscopic Cholecystectomy at Khyber Teaching Hospital Peshawar a Randomized Controlled Trial

Abstract

Laparoscopic cholecystectomy (LC) is the gold-standard treatment for gallstone disease, typically performed under standard-pressure pneumoperitoneum (SPP, 12–14 mmHg). High intra-abdominal pressure, however, has been associated with increased postoperative pain and shoulder-tip discomfort, leading to the proposal of low-pressure pneumoperitoneum (LPP, 8–10 mmHg) as a safer alternative. This randomized controlled trial, conducted at Khyber Teaching Hospital, Peshawar, enrolled 60 patients undergoing elective LC to compare postoperative outcomes between LPP and SPP. Patients were randomized into two equal groups (n=30 each). Postoperative outcomes included requirement for additional analgesia, incidence of shoulder-tip pain, and 24-hour postoperative abdominal pain measured on the Visual Analog Scale (VAS). Baseline demographics were comparable across groups (mean age 37.0 ± 9.9 years; mean BMI 25.6 ± 1.7 kg/m²; 61.7% female; most ASA I–II). The analysis demonstrated no significant differences between groups in 24-hour VAS scores (p = 0.32), requirement for additional analgesia (93.3% vs. 96.7%), or incidence of shoulder-tip pain (66.7% vs. 73.3%, p = 0.58). Subgroup analyses also failed to demonstrate statistically significant differences, though trends suggested a possible benefit of LPP among patients with normal BMI, lower socio-economic background, and rural residence. The findings indicate that LPP does not provide a significant advantage over SPP in reducing postoperative pain, shoulder-tip discomfort, or analgesic requirement within 24 hours. Larger, multicenter trials with extended follow-up and standardized analgesic regimens are warranted to further evaluate potential subgroup benefits.