الفهرس 
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Abstract
Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gallstones. Although the overall mortality of laparoscopic surgery is low, adopting laparoscopic cholecystectomy in a treatment of symptomatic cholelithiasis introduced a new spectrum of associated intraoperative and postoperative complications. Intra and postoperative pulmonary complications are one of the common complications of laparoscopic cholecystectomy and represented by hypoxemia, barotrauma, pulmonary edema, and atelectasis. Recently, a growing body of evidence has reported a significant protective role of positive end expiratory pressure (PEEP) during laparoscopic surgeries. Nevertheless, the optimal level of PEEP during laparoscopic cholecystectomy is still debatable; there is a scarcity in the published literature that investigate the role of different levels of PEEP on lung atelectasis. Therefore, we conducted the present prospective study to compare the effect of different PEEP levels (5 & 10 cm H2O) on laparoscopic-induced lung atelectasis using lung ultrasound in patients undergoing elective laparoscopic cholecystectomy.
In the present study, we included 60 patients who were scheduled to undergo elective laparoscopic cholecystectomy, patients were divided in equal manner to receive either PEEP 5 or 10 cm H2O, or no PEEP. The mean age of the included patients was almost 36 years; while the majority of patients were females (91.6%) with a mean BMI of almost 33.5 kg/cm2. In the present study, patients who received PEEP 10 cm H2O showed a trivial change in alveolar-.arterial gradient postoperatively, which was significantly lower than other studied groups. Moreover, patients who received PEEP 5 cm
H2O showed significantly lower gradients than no PEEP group. On the other hand, patients in PEEP 10 cm H2O had significantly lower systolic and diastolic blood pressures than other studied groups. Similarly, patients who received PEEP 5 cm H2O had significantly lower pressures than no PEEP group. However, there was no statistically significant difference regarding heart rate. With regard to our primary outcome, patients who received PEEP 10 cm H2O showed a statistically significant lower incidence of US-proven atelectasis 1 hour postoperative than other studied groups (20% vs. 50% vs. 70%, p =0.006). However, there was no statistically significant differences between study’s groups in term of the incidence of atelectasis after 24 hours.
We acknowledge that the present study has a number of limitations. The sample size of our study was relatively small which may affect the generalizability of our findings. Moreover, long-term patient centered outcomes were not utilized in our study.
In conclusion, the present study showed that PEEP is an effective option in preventing subtle atelectasis among patents undergo laparoscopic procedures. Patients who received PEEP 10 cm H2O showed a statistically significant lower incidence of US-proven atelectasis 1 hour postoperative than other studied groups. However, there was no statistically significant differences between study’s groups in term of the incidence of atelectasis after 24 hours. Nevertheless, further large-scale studies are still needed to confirm our findings.