Impact of Pneumoperitoneum Pressure on Post-Cholecystectomy Pain.

Background and Aims: Laparoscopic cholecystectomy (LC) often causes significant postoperative pain. While low-pressure pneumoperitoneum (8 mmHg) may reduce pain, optimal patient selection remains unclear. This trial compared pain outcomes between low-pressure (LPLC) and standard-pressure (SPLC) LC and identified predictors for pressure conversion. Methods: This prospective randomized controlled trial (June 2023 to September 2024) randomized 200 elective LC patients 1:1 to 8 or 12 mmHg groups. Postoperative pain was assessed using a facial visual analog scale at 1-72 hours and analyzed by both intention-to-treat (ITT) and per-protocol (PP) approaches. Intraoperative parameters, recovery outcomes, and biochemical markers were also compared. Risk factors for pressure conversion were analyzed using univariate/multivariate methods. Results: LPLC significantly reduced: visceral pain at 12 hours (ITT: P = .046, PP: P = .005), incisional pain at 48 hours (ITT: P = .017, PP: P = .003), postoperative aspartate aminotransferase (AST)/alanine aminotransferase (ALT) elevation (P < .05). Preoperative C-reactive protein (CRP) ≥12.70 mg/L predicted intraoperative conversion from 8 to 12 mmHg (odds ratio [OR] 1.053, area under the curve [AUC] = 0.704). Conclusion: The use of low-pressure pneumoperitoneum (8 mmHg) for LC significantly reduces postoperative pain and decreases the impact on liver function. LPLC demonstrates comparable safety and feasibility to SPLC. To achieve maximum benefit in patients with LC, we recommend that patients with preoperative CRP ≥12.70 mg/L carefully choose LPLC as the initial procedure.