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Introduction
Laparoscopic cholecystectomy is one of the most commonly performed abdominal surgical procedures, and is considered the ‘gold standard’ for the surgical treatment of gallstone disease.1,2 The advantages of the procedure are milder postoperative pain, reduced analgesia and shorter recovery period and hospital stay, compared with a traditional open procedure.3-5
The pain that occurs after laparoscopic cholecystectomy can be divided into three types: visceral, parietal and shoulder pain. Visceral pain usually occurs due to the surgical dissection and tissue stretch by handling at the gallbladder bed. This type of pain is felt by the innervation of the visceral peritoneum covering the majority of the abdominal viscera via the same nerve supply as the neighbouring viscera. Parietal or somatic pain is caused by the trauma to the abdominal wall by the insertion of the trocars. Shoulder pain is frequent in the postoperative period, and is thought to be related to residual carbon dioxide.6,7
Studies of pain mechanisms are usually based on somatic rather than visceral nociception. However, more complications are associated with accessing visceral structures, with adequate visceral stimuli studied in research models. Nociceptive mechanisms in both pain stimuli have common features and but differ in neurology and psychology. Treatment of both forms of pain is largely independent of the accompanying disease. The pain itself is thus regarded as a syndrome rather than a symptom or by-product of illness.8
During dissection of the gallbladder, the liver capsule (the visceral peritoneum of the liver, Glisson’s capsule) may be cauterised unintentionally if a cautery instrument slips or necessarily during manipulation due to a difficult dissection. The possible relation between visceral peritoneal injury and postoperative pain has not been studied rigorously. The aim of this study was to evaluate the association between visceral peritoneal (Glisson’s capsule) injury due to cauterisation during laparoscopic cholecystectomy and postoperative pain.
Materials and Methods
We designed a prospective case-control study. The institutional review board approved the study and the universal principles of the 1964 Declaration of Helsinki and its later amendments were applied. Written informed consent was obtained from all patients.
Participants
Patients scheduled for laparoscopic cholecystectomy with presumptive diagnosis of benign gallbladder disease (i.e., gallstone, gallbladder polyp and American Society of Anesthesiologists physical status I-II) were assessed. A total...