A randomized controlled trial of laparoscopic cholecystectomy using abdominal wall lifting technique or tension pneumoperitoneum in the treatment of gallstones

Abstract

Objective: To compare the results of laparoscopic cholecystectomy using either abdominal wall lifting technique or tension pneumoperitoneum. Design: A randomized controlled clinical trial. Setting: A university hospital Patients: Eighty-four patients with gallstone, who passed the eligibility criteria, were randomly allocated to either abdominal wall lifting or tension pneumoperitoneum group. Outcome Measurements: Success rate, complication rate including cardiac arrhythmia, postoperative pain and costs in patient’s and provider’s perspectives were evaluated. Main Results: Baseline characteristics of the 2 groups were comparable in age sex, associated diseases and history of previous cholecystitis. The clinical results were: 1. The success rate in tension pneumoperitoneum with CO2 group (TPC) was 95.2 per cent and abdominal wall lifting group (AWL) was 66.7 percent (p=0.001). 2. Operative time in TPC and AWL group was 64.6±24.1 and 104.0±32.2 minute, respectively, (p < 0.001) 3. Complication rate was equal in both groups (4.8 percent) 4. Cardiac arrhythmia occurred equally in both groups (9.6 percent) 5. There was no statistically significant difference in the pain score between the two groups. 6. Costs per successful case in TPC group were less than AWL group in both patient’s and provider’s perspective. Conclusion: Tension pneumoperitoneum technique gave better clinical benefits (success rate and operative time) than abdominal wall lifting technique in laparoscopic cholecystectomy. The adverse effects of tension pneumoperitoneum were not higher than the abdominal wall-lifting group.