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

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.