Year: 2026 | Month: October | Volume: 16 | Issue: 10 | Pages: 76-83
DOI: https://doi.org/10.52403/ijhsr.20261009
Comparing the Open Versus Closed Methods of Creating Pneumoperitoneum in Patients Undergoing Laparoscopic Cholecystectomy in Terms of Safety, Operating Time and Port-Site Infection
Diptanu Deb1, Ambhrin Saha2, Dipti Debbarma3
1Assistant Professor, Department of Surgery TMC & Dr. BRAM Teaching Hospital, Agartala, Tripura, India.
2Assistant Professor, Department of Anaesthesiology, TMC & Dr. BRAM Teaching Hospital, Agartala, Tripura, India.
3Assistant Professor, Department of Pathology, TMC & Dr. BRAM Teaching Hospital, Agartala, Tripura, India.
Corresponding Author: Dr. Diptanu Deb
ABSTRACT
Background: Laparoscopic cholecystectomy is the gold standard for symptomatic gallstone disease, yet the optimal method of pneumoperitoneum creation remains debated. The closed (Veress needle) technique is faster but carries risks of blind entry, while the open (Hasson) method is considered safer but slower.
Objective: To compare the open versus closed methods of pneumoperitoneum creation in terms of safety, operating time, and port‑site infection (PSI) in patients undergoing elective laparoscopic cholecystectomy.
Methods: A prospective interventional study was conducted at Tripura Medical College and Dr. BRAM Teaching Hospital between March and May 2026. A total of 120 patients were randomly assigned to either the closed (n=60) or open (n=60) technique. Primary outcomes included entry‑related complications, access time, total operative time, and PSI incidence. Statistical analysis was performed using independent samples t‑tests and Pearson’s correlation.
Results: The closed group demonstrated significantly shorter access times (3.69 ± 0.90 min vs. 6.87 ± 0.87 min, p<0.01). Total operative time was comparable between groups (71.15 ± 16.92 min vs. 71.78 ± 11.76 min, p=0.81). PSI rates were low and not statistically different (1.69% vs. 3.44%, p=1.00). BMI showed no significant correlation with access time (r = 0.04, p = 0.83) or total operative time (r = 0.14, p = 0.13). Importantly, three entry‑related complications (one major vascular, one minor vascular, and one visceral injury) occurred in the closed group, while none were observed in the open group.
Conclusion: The closed method offers faster access but carries a higher risk of entry‑related complications. The open method, though slower, demonstrated superior safety. Both techniques showed similar operative times and low PSI rates. Safety should remain the primary consideration, with the open method preferred in patients at higher risk of entry‑related injury.
Key words: Laparoscopic cholecystectomy, Pneumoperitoneum, Veress needle, Hasson technique, Port site infection, Entry complications, Operating time