Laparoscopic cholecystectomy has replaced conventional cholecystectomy as there are limited surgical incisions, decreased post-operative stay, less post-operative pain and decreased need for post-operative analgesia^4-6.

Traditionally, one of the first steps in laparoscopic cholecystectomy is the creation of pneumoperitoneum⁷ using carbon dioxide (CO₂) through Veress needle⁸ or through a port (hole) in the abdominal wall. Traditionally, the pressure used is around 15mm Hg (12-16 mm Hg)⁹.

The commonly seen complications due to pneumoperitoneum are shoulder tip pain and cardiopulmonary changes. These changes seen are directly due to pressure effects on peritoneum and diaphragm and indirectly due to absorbed carbon dioxide and hypercarbia, leading to local peritoneal acidosis, increased intrathoracic pressure, decreased venous return, and decreased cardiac output. These complications may be well tolerated by healthy and young individuals but lead to significant complications in old and those who have underlying cardiopulmonary diseases.

The increase in intrathoracic pressure depends to some extent on the pressure maintained in pneumoperitoneum due to upward compressive effects of diaphragm. This led researchers to think in term of low-pressure pneumoperitoneum cholecystectomies.

International guidelines recommend that the use of “the lowest intra-abdominal pressure allowing adequate exposure of operative field rather than a routine pressure” should be used to minimize the impact of pneumoperitoneum on normal physiology and the positive impact on postoperative pain¹⁰. Low pressure pneumoperitoneum is defined as a pressure of 6-10mm Hg¹¹. The main concern about low pressure pneumoperitoneum is its safety in terms of inadequate exposure resulting in longer than usual operating time, increased rate of intra-operative complications and also possibly increased frequency of conversion to open cholecystectomy¹². Therefore, attempts are made to use low pressure pneumoperitoneum in range of 6-10mm Hg in an attempt to minimize alteration of normal physiology and simultaneously to provide an adequate working space.

In present study outcome of the use of low-pressure pneumoperitoneum (LPP defined as 8-10mm Hg in our study) in comparison to the use of standard pressure pneumoperitoneum (SPP defined as 13-15mm Hg in this study) in patients undergoing laparoscopic cholecystectomy are studied.

The aim of the current study is to evaluate and compare the effects and outcomes of LPP versus SPP in laparoscopic cholecystectomy.