Gokdere, Osman GokhanOndes, BahadirAydin, Ahmet2026-06-192026-06-1920261471-2482https://doi.org/10.1186/s12893-026-03567-yhttps://hdl.handle.net/20.500.12899/5485Background Residual carbon dioxide (CO2) after laparoscopic cholecystectomy (LC) may contribute to early postoperative pain. Active aspiration of CO2 has been proposed as a simple adjunct, but large cohort data remain limited. Methods This non-randomized prospective cohort study included 270 patients undergoing LC between May 2025 and October 2025. Patients were allocated to either the active aspiration group (n = 135) or the passive evacuation group (n = 135). Pain was evaluated using the Visual Analog Scale (VAS) at 4 and 24 h. Statistical analyses included chi-square tests, independent and paired t-tests, and Pearson correlation. A priori power analysis determined that 266 patients (133 per group) were required (effect size d = 0.40, alpha = 0.05, power = 0.90). Results The aspiration group had significantly lower pain scores at both 4 h (3.48 +/- 1.08 vs. 5.30 +/- 1.60; p < 0.001) and 24 h (1.69 +/- 0.94 vs. 3.59 +/- 1.38; p < 0.001). Active aspiration was associated with lower pain scores at both time points (p < 0.001). Conclusion Active evacuation of residual CO2 was associated with lower postoperative pain scores following LC. Given the non-randomized design, causal inference is limited, and the findings should be interpreted cautiously.eninfo:eu-repo/semantics/openAccessLaparoscopic CholecystectomyActive Gas AspirationCarbon Dioxide EvacuationPostoperative PainVisual Analog ScaleArticle10.1186/s12893-026-03567-y261416397872-s2.0-105032701155Q2WOS:001712654500001Q20000-0002-8080-9664