Correlation of postoperative inflammatory markers and clinical outcomes with intraoperative carbon dioxide pneumoperitoneum pressure levels in laparoscopic appendectomy

doi:10.4240/wjgs.122076

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Publication Name

World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Sep 27, 2026; 18(9): 122076
Published online Sep 27, 2026. doi: 10.4240/wjgs.122076

Correlation of postoperative inflammatory markers and clinical outcomes with intraoperative carbon dioxide pneumoperitoneum pressure levels in laparoscopic appendectomy

Jing Deng, Mei-Ling Luo, Qin-Hua Li

Jing Deng, Mei-Ling Luo, Qin-Hua Li, Department of General Surgery, The Fifth People’s Hospital of Shunde District, Foshan City (Longjiang Hospital of Shunde District, Foshan City), Foshan 528300, Guangdong Province, China

Author contributions: Deng J designed the research study; Luo ML and Li QH collected and analyzed the data; Deng J and Luo ML has been involved in drafting the manuscript; Deng J, Luo ML, and Li QH performed the research, involved in revising it critically for important intellectual content, give final approval of the version to be published, participated sufficiently in the work to take public responsibility for appropriate portions of the content and agreed to be accountable for all aspects of the work in ensuring that questions related to its accuracy or integrity.

AI contribution statement: No AI tools were used in the preparation of this manuscript.

Supported by the Self-funded Science and Technology Innovation Project, Foshan City, Guangdong Province, No. 2220001004804.

Institutional review board statement: The study was reviewed and approved by Medical Ethics Committee of The Third Affiliated Hospital of Guangdong Medical University (approval No.[2022]85).

Clinical trial registration statement: This study was a retrospective observational analysis of routine clinical data. All patients underwent laparoscopic appendectomy as part of standard clinical care, and the carbon dioxide pneumoperitoneum pressure applied was determined by the attending surgeon’s routine practice or institutional protocol, not by prospective allocation for research purposes. No experimental intervention, drug, or device was administered, and patient assignment to pressure groups (12, 13, 14, or 15 mmHg) was performed retrospectively based on documented clinical records. Consequently, this study did not meet the definition of a “clinical trial” as outlined by the International Committee of Medical Journal Editors or the World Health Organization, which require prospective registration for interventional studies involving prospective assignment of participants to health-related interventions. Therefore, the study was exempt from prospective clinical trial registration.

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at zmc0403@126.com. Participants gave informed consent for data sharing.

Corresponding author: Jing Deng, Department of General Surgery, The Fifth People’s Hospital of Shunde District, Foshan City (Longjiang Hospital of Shunde District, Foshan City), No. 39 Donghua Road, Longjiang Town, Shunde District, Foshan 528300, Guangdong Province, China. zmc0403@126.com

Received: May 12, 2026
Revised: June 16, 2026
Accepted: July 9, 2026
Published online: September 27, 2026
Processing time: 125 Days and 18.9 Hours

Abstract

BACKGROUND

Laparoscopic appendectomy (LA) is the preferred surgical approach for acute appendicitis. Carbon dioxide (CO₂) is used to establish a pneumoperitoneum to provide clear surgical visualization and adequate operative space. However, the specific prognostic impacts of various pressure levels remain unclear.

AIM

To investigate the effects of various CO₂ pneumoperitoneum pressures during LA on postoperative inflammatory marker levels and clinical outcomes.

METHODS

Patients were assigned to one of four groups according to the pneumoperitoneum pressure during LA: A [12 mmHg (n = 55)], B [13 mmHg (n = 54), C [14 mmHg (n = 53)], and D [15 mmHg (n = 55)]. Preoperative and postoperative inflammatory markers, including white blood cell (WBC) count and procalcitonin (PCT) level, were compared. Clinical efficacy indicators, including operative duration, pain score (s), basic activities of daily living scores, time to first ambulation and flatus, length of postoperative hospital stay, and complication rates were analyzed.

RESULTS

There were no differences in the preoperative WBC count or PCT levels among the four groups (P > 0.05). On postoperative days 1 and 3, group A exhibited lower WBC counts and PCT levels than groups B, C, and D (P < 0.01). Clinical efficacy analysis revealed no differences in operative duration or intraoperative blood loss (P > 0.05). Patients in group A exhibited significantly lower numerical pain rating scale scores on postoperative days 1 and 3 (P < 0.05) and significantly higher basic activities of daily living scores (P < 0.01) than those in the other groups. Furthermore, patients in group A experienced significantly shorter times to first ambulation and flatus (P < 0.05) and shorter hospital stays (P < 0.05). There were no statistically significant differences in the postoperative complication rates among the four groups (P > 0.05).

CONCLUSION

Maintaining a CO₂ pneumoperitoneum pressure of 12 mmHg during LA reduces postoperative inflammation and alleviates pain more effectively, accelerates recovery, and shortens hospital stay without increasing the risk of complications.

Keywords: Acute appendicitis; Laparoscopic appendectomy; Carbon dioxide pneumoperitoneum pressure; Inflammatory markers; Clinical efficacy; Randomized controlled trial

Core Tip: This prospective randomized controlled trial included 217 patients. We compared the effects of four different intraoperative carbon dioxide pneumoperitoneum pressures (12-15 mmHg) during laparoscopic appendectomy. The results showed that a 12-mmHg pneumoperitoneum pressure significantly reduced postoperative white blood cell and procalcitonin levels, lowered the score on the numeric pain scale, shortened the time to first ambulation and anal gas expulsion, and reduced the length of hospital stay, without increasing the risk of complications (Clavien-Dindo classification ≤ grade II). The above results confirm that 12 mmHg is the ideal pneumoperitoneum pressure that balances surgical field visibility and accelerates recovery.