Evaluation of Coagulation Profile Alterations in Patients Undergoing Laparoscopic Cholecystectomy With Carbon Dioxide (CO₂) Pneumoperitoneum

TL;DR

This study found that CO₂ pneumoperitoneum during laparoscopic cholecystectomy slightly increases blood clotting, but rarely causes serious issues in low-risk patients.

Contribution

The study provides new empirical evidence on coagulation changes caused by CO₂ pneumoperitoneum in laparoscopic cholecystectomy patients.

Findings

Post-operative PT and aPTT times were shortened, indicating a procoagulant state.

INR and D-dimer levels increased significantly after surgery.

The observed changes suggest a mild hypercoagulable state without major thrombosis risks in low-risk patients.

Abstract

Background and aim: Laparoscopic cholecystectomy is commonly performed for the removal of the gallbladder. This widely performed minimally invasive surgical procedure requires the creation of a pneumoperitoneum by insufflation of carbon dioxide (CO₂), which may affect coagulation dynamics. The objective was to assess the impact of CO₂ pneumoperitoneum on coagulation parameters in patients undergoing elective laparoscopic cholecystectomy.

Methods: All patients undergoing elective laparoscopic cholecystectomy, aged between 18 and 60 years, were included in this prospective observational study. Post-operative samples were collected 6 h after the creation of pneumoperitoneum. The patients’ blood samples were collected pre- and post-surgery and analyzed for D-dimer, blood coagulation profile, and international normalized ratio (INR).

Results: A total of 81 patients were enrolled in this research. A male dominance (59 {72.8%}) was noted with a male-to-female ratio of 2.7:1, with a mean age of 38.9±11.9 years. A decreased trend was observed in post-operative values of prothrombin time (PT) (pre-operative: 12.0±0.448 and post-operative: 11.8±0.458 s) and activated partial thromboplastin time (aPTT) (pre-operative: 30.0±2.13 and post-operative: 28.0±2.22 s), with ~1 s and 2 s, respectively. These changes were indicative of a procoagulant state. The INR (0.998±0.0379) and D-dimer (0.868±0.314) values were noted to increase significantly post-operatively.

Conclusion: Laparoscopic cholecystectomy with CO₂ pneumoperitoneum creates a mild, subclinical hypercoagulable state marked by shortened clotting times and elevated fibrin degradation products. This state rarely causes symptomatic thrombosis in low-risk patients but warrants vigilance and prophylaxis in those with additional risk factors.