Low pressure pneumoperitoneum appears effective in decreasing pain in laparoscopic cholecystectomy, but the safety has to be established

For key-hole removal of the gallbladder, carbon-dioxide is injected into the abdomen. A pressure of 12 to 16 mmHg of pressure is used for the surgery. Several physiological parameters related to heart and lung (cardiopulmonary changes) occur during insufflation of abdomen. While these changes can be tolerated by normal individuals, patients with poor heart or lung function may not tolerate the changes. Lowering the pressure of the insufflated gas might decrease the ability of the surgeon to view the surgical field. In this systematic review, 15 trials randomised 690 patients to low pressure (n = 336) and standard pressure (n = 354). All the trials were of high risk of bias. There was no difference in the mortality, post-operative complications, or conversion to open cholecystectomy between the groups. The intensity of overall pain was lower in the low pressure group at various time points. The incidence of shoulder pain was lower in the low pressure group. The analgesic consumption was also lower. The operating time did not differ between the groups. Because the data on all the patients were not available in seven trials, it was not possible to conclude about the safety of low pressure pneumoperitoneum. In conclusion, low pressure pneumoperitoneum appears effective in decreasing pain after laparoscopic cholecystectomy, but its safety has to be established.