Correlation of Postoperative Shoulder Tip Pain in Low- Versus Standard-Pressure Pneumoperitoneum During Laparoscopic Cholecystectomy

Abstract

Introduction During laparoscopic cholecystectomy, pneumoperitoneum is created to facilitate exposure of the operative site. It provides the surgeon with adequate visualization; however, it has been associated with postoperative shoulder tip pain. As an alternative, low-pressure pneumoperitoneum (8-10 mmHg) has been proposed. This study compared the postoperative shoulder tip pain between standard- and low-pressure pneumoperitoneum created during laparoscopic cholecystectomy. Methods This was a prospective comparative study conducted in the Department of General Surgery over 18 months, following approval from the institutional ethics committee. After sample size calculation, 80 patients were enrolled who underwent elective laparoscopic cholecystectomy for uncomplicated cholelithiasis. They were randomly allocated into two equal groups: Group A (standard-pressure pneumoperitoneum) and Group B (low-pressure pneumoperitoneum). Postoperative shoulder tip pain and abdominal pain were assessed using the Visual Analog Scale. Additionally, demographic variables, operative time, intraoperative complications, and hospital stay duration were recorded. Results The mean intra-abdominal pressure (IAP) was significantly higher in Group A (11.51 ± 0.28 mmHg) than in Group B (9.50 ± 0.27 mmHg, p = 0.001). There were no reported instances of postoperative shoulder tip pain. Postoperative abdominal pain was recorded at 6, 12, and 24 hours, but it was comparable between both groups with no statistically significant differences. No statistically significant difference was observed for operative time, intraoperative complications, hospital stay, and postoperative complications between both groups. Conclusions No significant difference was noted between postoperative shoulder tip or abdominal pain in low- and standard-pressure pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. Our findings suggest that pressure selection in laparoscopic cholecystectomy may be guided by surgeon preference rather than by differences in postoperative pain.