Comparative Analysis of Hemodynamic Changes During Laparoscopic and Open Cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy has largely replaced open cholecystectomy because of reduced postoperative morbidity; however, carbon dioxide (CO₂) pneumoperitoneum may induce respiratory and cardiovascular alterations, while open surgery may provoke greater sympathetic stimulation due to tissue trauma. The comparative intraoperative effects of these techniques on end-tidal carbon dioxide (EtCO₂) and hemodynamic stability remain clinically relevant. Objective: To compare intraoperative EtCO₂ dynamics and hemodynamic responses between laparoscopic and open cholecystectomy in ASA I–II adult patients undergoing elective surgery under general anesthesia. Methods: In this cross-sectional observational study, 54 patients (27 laparoscopic, 27 open) were consecutively enrolled. Standardized general anesthesia and mechanical ventilation protocols were applied. EtCO₂, heart rate (HR), systolic (SBP), diastolic (DBP), and mean arterial pressure (MAP) were recorded at baseline, post-induction, 5, 15, and 30 minutes intraoperatively, and at the end of surgery. Linear mixed-effects modeling assessed group–time interactions with adjustment for baseline covariates. Results: Baseline characteristics were comparable except for modestly higher baseline MAP and DBP in the open group. At 5 minutes, open cholecystectomy demonstrated significantly higher HR (+6.6 beats/min; p<0.001), SBP (+7.0 mmHg; p=0.034), DBP (+5.2 mmHg; p=0.023), and MAP (+6.9 mmHg; p=0.008). End-of-surgery DBP and MAP remained significantly elevated in the open group (+6.7 mmHg; p<0.001 and p=0.001, respectively). Group×time interaction was significant for DBP and MAP (p<0.05). Conclusion: Open cholecystectomy is associated with greater early and late intraoperative hemodynamic variability, whereas laparoscopic cholecystectomy demonstrates comparatively stable cardiovascular profiles under controlled ventilation.