Association between Duration of Carbon Dioxide Pneumoperitoneum during Laparoscopic Abdominal Surgery and Hepatic Injury: A Meta-Analysis

Abstract

BackgroundThe aim of this study is to accurately assess whether the duration of intraoperative carbon dioxide pneumoperitoneum (CDP) is associated with the induction of hepatic injury.MethodsWe conducted a systematic review of PubMed, Embase, and Cochrane Library databases (through February 2014) to identify case-match studies that compared high-pressure CDP with low-pressure CDP or varied the duration of CDP in patients who underwent abdominal surgery. The outcome of interest was postoperative liver function (ALT, AST, TB).ResultsEleven comparative studies involving 2,235 participants were included. Overall, levels of ALT, AST, and TB (on postoperative days 1, 3, and 7) were significantly elevated in the study groups. However, the results of the subanalyses of those who underwent laparoscopic colorectal cancer resection (LCR) versus open colorectal cancer resection (OCR) and those who underwent laparoscopic gastric bypass (LGBP) versus open gastric bypass (OGBP) were inconsistent.ConclusionsThe current evidence suggests that the duration of CDP during laparoscopic abdominal surgery may be associated with hepatic injury. Additional large-scale, randomized, controlled trials are urgently needed to further confirm this.

Cohort Multicenter Study on the Role of Medications in Parenteral Nutrition–Related Alteration of Liver Function Tests in Adults

“…Surgical procedures have also been associated with LFT alterations, which can last at least 7 days, especially in abdominal laparoscopic procedures. 29 Other factors present during surgery, such as hepatosplanchnic microcirculation, tissue hypoxemia, blood nutrient delivery, and the local effects of intraoperative medications such as vasopressors or catecholamines, 30 as well as anesthetics, particularly volatile medications, 31 and propofol. 32 Antibiotic prophylaxis in presurgical procedures may also have a role in LFT alterations when cefazolin is used.…”

Comparison Postoperative Shoulder Pain, Nausea, and Vomiting Between Low and Normal Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy

“…The incidence of postoperative nausea and vomiting was assessed following low and normal pneumoperitoneum and the results were different. In some surveys there were no differences between the incidence of postop nausea and vomiting in low-and standardpressure pneumoperitoneum (9,10), but some studies showed that the level of liver enzymes was controlled better during low-pressure pneumoperitoneum (11,12). This finding may indirectly have a role in the prevention of postoperative nausea and vomiting.…”

Small-Incision Laparoscopy-Assisted Surgery Under Abdominal Cavity Irrigation in a Porcine Model

“… 19 Although laparoscopic surgery performed with intraabdominal pressure near 10 mm Hg does not provoke serious circulatory effects to the abdominal organs, injury to the liver is not negligible. 5 , 20 Insufflation of CO 2 exerts uniform pressure on the abdominal organs together with a wide field of view. In contrast, the pressure exerted with irrigation depends on the depth of the water in the cistern, and it is not uniform.…”

“… 3 , 4 Furthermore, recent reports indicated that CO 2 pneumoperitoneum is associated with hepatic injury. 5 Replacing the CO 2 gas with an isotonic liquid would avoid desiccation, hypothermia, and excessive abdominal pressure, adding various advantages related to the aquatic properties of irrigants. We previously reported the feasibility of surgical maneuvers under irrigation with an isotonic liquid during cholecystectomy in a porcine model: water-filled laparoendoscopic surgery (WaFLES).…”