Randomized controlled trial comparing the effects of usual gas release, active aspiration, and passive‐valve release on abdominal distension in patients who have undergone laparoscopic cholecystectomy

Residual, intra‐abdominal CO 2 contributes to abdominal distension and pain after laparoscopic surgery. The study was designed to assess recovery after gas release in patients who have undergone laparoscopic cholecystectomy (LC). Methods A total of 142 patients undergoing laparoscopic cholecystectomy were randomly divided into three groups: (i) group 1 (control group), gas release from the surgical wound without port release ( n  = 47); (ii) group 2, active gas aspiration via a subdiaphragmatic port ( n  = 48); and (iii) group 3, passive‐valve release via a subdiaphragmatic port valve opening ( n = 47). Abdominal distension and shoulder pain levels were assessed postoperatively. Results The active aspiration group had significantly reduced postoperative abdominal distensions at 30 min, 4, and 24 h compared with the control group (50.0% vs 80.9%, 43.8% vs 76.6%, 33.3% vs 57.4%, respectively; P  < 0.05). Similarly, the passive‐valve release group had significantly reduced postoperative abdominal distensions at 4 and 24 h compared with the control group (51.1% vs 76.6%, 57.4% vs 36.2%; P  < 0.05). Both intervention groups had significantly reduced postoperative shoulder pain at 4 and 24 h compared with the control group ( P  < 0.001). In addition, the postoperative ambulation times for the active aspiration group were significantly shorter than those for the control and passive‐valve release groups ( P  < 0.001). Conclusion Releasing residual CO 2 from the intra‐abdominal cavity at the end of laparoscopic cholecystectomy by either the active aspiration or passive‐valve release technique is an effective way to reduce postoperative abdominal distension and shoulder pain.