Vol. 8, Issue 3, Part A (2024)

Objective: To determine the study of days required resolving of pneumoperitoneum after laparoscopic cholecystectomy.

Methods: A prospective study was carried out at Department of Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from July to December 2022. Sixty (60) patients who underwent laparoscopic cholecystectomy were studied prospectively. A total of 44 women and 16 men, 23 to 72 years old (mean, 48 years old), completed the study. Patients were excluded only if they were minors, were pregnant, lived elsewhere, or were unable to give consent. Before surgery, each patient signed an informed-consent form that included an explanation of the radiation risk. Upright posteroanterior chest radiographs were obtained 6 hr after surgery (day 1); additional radiographs were obtained on days 2, 4, 7, and 14, if required, until the pneumoperitoneum resolved.

Results: Total 60 patients in this study. 31 (51.6%) of the 60 patients had no evidence of pneumoperitoneum on the initial chest radiograph obtained 6 hr after surgery (day-1). For the remaining 29 patients (48.4%), pneumoperitoneum was detected postoperatively for various lengths of time. For all but one of these 29 patients, the pneumoperitoneum resolved in the first week after surgery. Chest radiographs showed trace pneumoperitoneum for 21 patients (72.4%) and mild pneumoperitoneum for 8 patients (27.6%). No cases of pneumoperitoneum were graded as moderate. For four patients, more extensive pneumoperitoneum was seen on the chest radiograph obtained on day 2 than on the first chest radiograph obtained after surgery. For all remaining patients, the maximum amount of free air was seen on the initial radiograph. Our study showed an inverse correlation between body weight and the duration of pneumoperitoneum (Spearman correlation coefficient =-48; p<.001). Thin patients showed more extensive pneumoperitoneum that lasted longer. Obese patients, on the other hand, had less extensive pneumoperitoneum (if they had any at all) that disappeared sooner. Only 9 (31.03%) of 29 obese patients had postoperative pneumoperitoneum. In comparison, 20 (68.7%) of 32 thin or average- weight patients had postoperative pneumoperitoneum. No evidence of pneumoperitoneum was seen on chest radiographs taken 6hr after surgery (day 1) in 31 (51.6%) of the 60 patients who completed the study. 

Conclusion: Despite the use of carbon dioxide gas during laparoscopic cholecystectomy, a significant number of patients have post-surgery pneumoperitoneum that is visible on upright chest radiographs. The pneumoperitoneum resolves in most patients within the first week after surgery.