title: A prospective double-blinded randomized controlled trial comparing systemic stress response in Laparoascopic cholecystectomy between low-pressure and standard-pressure pneumoperitoneum.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) has become the gold-standard treatment for gallstone diseases. However, despite huge reduction in operative injury, systemic stress response remains high. This randomized controlled trial (RCT) aimed to compare systemic stress response between 2 different techniques of CO2 pneumoperitoneum.
  
  
  METHODS
  Trough a prospective, double-blinded RCT, serum levels of cortisol, adrenaline, glucose, and C-reactive protein (CRP) were compared between the two groups consisted of 50 patients undergoing LC under low-pressure and standard-pressure CO2 pneimoperitoneum.
  
  
  RESULTS
  A total of fifty patients undergoing LC were equally assigned to 2 groups of twenty five patients. Average age was 48 ± 13.8 years (range, 19-74 years). Operative time was similar between standard-pressure group (47.8 ± 16.8 min) and low-pressure group (53.6 ± 25.1). Moreover, intra-operative IV volume administration and urine output did not differ significantly between the 2 groups (p > 0.05). Although the average heart rate and mean arterial pressure were slightly higher in a standard-pressure group compared with a low-pressure group, serial measurements of these parameters were statistically similar between the 2 groups. Serial changes of serum levels of cortisol, glucose, adrenaline, and CRP were compared between surgery day, postoperative 6-h and 1st postoperative day, which did not differ significantly between the standard-pressure and the low-pressure groups (p > 0.05).
  
  
  CONCLUSIONS
  Our study did not reveal any alteration in systemic stress response with reduction in intra-abdominal pressure of pneumoperitoneum in LC. RCT REGISTRATION: irct.ir ID: IRCT201110072982N5.
authors.affiliation: Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Saeed
authors.initials: S
authors.lastname: Shoar
authors.affiliation: Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: moh@naderan.com.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Naderan
authors.affiliation: Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Ebrahimpour
authors.affiliation: Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ahmadreza
authors.initials: A
authors.lastname: Soroush
authors.affiliation: Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Shirzad
authors.initials: S
authors.lastname: Nasiri
authors.affiliation: Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Movafegh
authors.affiliation: Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zhamak
authors.initials: Z
authors.lastname: Khorgami
mesh_terms: D000005:Abdomen / Q000503:physiopathology; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000379:methods*; D011312:Pressure; D011446:Prospective Studies; D013312:Stress, Physiological / Q000502:physiology*; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D002097:C-Reactive Protein; D006854:Hydrocortisone; D004837:Epinephrine
keywords: Laparoscopic cholecystectomy; Low pressure laparoscopy; Systemic stress response