Evaluation of thiol-disulfide homeostasis under low and standard pneumoperitoneum in elderly patients undergoing laparoscopic cholecystectomy: a prospective comparative study.

backgroundThis study aimed to evaluate the impact of different intra-abdominal pressure (IAP) levels on oxidative stress, as measured by thiol-disulfide homeostasis parameters, in geriatric patients undergoing laparoscopic cholecystectomy.

methodsA total of 62 patients aged 65 years and older diagnosed with cholelithiasis were included. Patients were randomly assigned to either the low-pressure group (10 mmHg) or the high-pressure group (15 mmHg). Standard laparoscopic cholecystectomy was performed under general anesthesia by the same surgical team. Preoperative and postoperative blood samples were collected to evaluate oxidative stress parameters (native thiol, total thiol, disulfide), as well as basic biochemical markers (AST, ALT, urea, creatinine) and hematological indices (WBC, hemoglobin, hematocrit, platelet count).

resultsPostoperative AST levels were significantly higher in the high-pressure group compared to the low-pressure group (p = 0.031), while ALT differences were not statistically significant. Although disulfide and oxidized thiol ratios were higher in the high-pressure group preoperatively, no significant differences were observed between the groups postoperatively.

conclusionWhile higher intra-abdominal pressure may be associated with mild hepatic stress, it does not appear to cause significant oxidative imbalance in geriatric patients. Both low and high-pressure pneumoperitoneum levels can be used safely during laparoscopic cholecystectomy in elderly individuals, provided that appropriate perioperative management is ensured.