Effect of Lowering Intra-Abdominal Pressure on Systemic Inflammatory Reaction And Pain After Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy (LC) is a commonly adopted therapy for symptomatic gallbladder pathologies. Although regarded as minimally invasive, the insufflation of carbon dioxide to establish pneumoperitoneum elevates intra-abdominal pressure (IAP), which may foster a systemic inflammatory state and exacerbate postoperative discomfort. Decreasing the IAP offers a potential avenue to lessen these adverse effects, but comprehensive evidence on its efficacy remains scarce.

Methods: In this prospective study, 50 individuals scheduled for elective LC were enrolled. Demographic data and baseline clinical measures were recorded. Participants were then randomly assigned to either a “standard” IAP group (12–15 mmHg) or a “reduced” IAP group (8–10 mmHg). Systemic inflammatory indicators—namely C-reactive protein (CRP), total leukocyte count (TLC), platelet counts, and arterial blood pH—were tracked before and approximately 24 hours after surgery. Postoperative pain assessments were carried out using the Visual Analogue Scale (VAS) at 6, 12, and 24 hours, and the need for rescue analgesics was noted. Data interpretation employed both descriptive and comparative statistical methods.

Results: Among the 50 patients analyzed (mean age: 38.6 ± 10.9 years; 31 women and 19 men), those in the reduced IAP arm registered lower VAS scores at each postoperative interval, most notably at 6 and 12 hours. Inflammatory markers rose in both groups after surgery, reflecting the typical postsurgical stress response. Yet participants in the reduced IAP cohort displayed smaller increments in CRP levels and less pronounced fluctuations in arterial pH. While TLC values exhibited mild elevations post-surgery in all participants, platelet counts remained relatively unchanged. Individuals in the reduced IAP branch generally required fewer doses of analgesics during the initial 24 hours.

Conclusion: Adopting a reduced IAP during LC appears to moderate the body’s inflammatory response and alleviate post-surgical pain. Such a strategy could bolster patient comfort and potentially diminish reliance on pain medications. Although these observations are encouraging, extensive randomized trials involving larger samples are necessary to corroborate these outcomes and refine pneumoperitoneum guidelines.