Effect of an individualized <i>versus</i> standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery

Díaz‐Cambronero, Óscar; Mazzinari, Guido; Lorente, Blas Flor; Gregorio, N. García; Robles-Hernández, Daniel; Arnal, L. E. Olmedilla; Pablos, Ángel Martín de; Schultz, Marcus J.; Errando, C.L.; Navarro, María

doi:10.1002/bjs.11736

Cited by 29 publications

(26 citation statements)

References 42 publications

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“…Paralleling with local acute response, gas pressure was described as a factor influencing systemic inflammation. In fact, lower pneumoperitoneum pressure has been associated with less intense inflammatory cellular response after laparoscopy in subjects undergoing colorectal surgery [30]. Moreover, higher plasma TNF-α levels were found in 10 mm Hg pneumoperitoneum rats compared to those in 6 mm Hg and control groups.…”

Section: Inflammationmentioning

confidence: 93%

The “Dark Side” of Pneumoperitoneum and Laparoscopy

Umano

Delehaye

Noviello

et al. 2021

Minimally Invasive Surgery

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Laparoscopic surgery has been one of the most common procedures for abdominal surgery at pediatric age during the last few decades as it has several advantages compared to laparotomy, such as shorter hospital stays, less pain, and better cosmetic results. However, it is associated with both local and systemic modifications. Recent evidence demonstrated that carbon dioxide pneumoperitoneum might be modulated in terms of pressure, duration, temperature, and humidity to mitigate and modulate these changes. The aim of this study is to review the current knowledge about animal and human models investigating pneumoperitoneum-related biological and histological impairment. In particular, pneumoperitoneum is associated with local and systemic inflammation, acidosis, oxidative stress, mesothelium lining abnormalities, and adhesion development. Animal studies reported that an increase in pressure and time and a decrease in humidity and temperature might enhance the rate of comorbidities. However, to date, few studies were conducted on humans; therefore, this research field should be further investigated to confirm in experimental models and humans how to improve laparoscopic procedures in the spirit of minimally invasive surgeries.

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Section: Inflammationmentioning

confidence: 93%

The “Dark Side” of Pneumoperitoneum and Laparoscopy

Umano

Delehaye

Noviello

et al. 2021

Minimally Invasive Surgery

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“…In the previous study, approximately 30% of patients undergoing laparoscopic colorectal surgery showed recovery in the PQRS nociceptive domain at POD 1. 17 We expect that 50% of patients receiving deep NMB and low IAP would have their nociceptive recovery, with an absolute increase rate of 20%. To detect such a difference with an α level of 0.05 and a power of 80%, we estimate that 94 participants are needed per group.…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…26 Later, many studies have validated the use of PQRS to assess postoperative recovery. 17,[27][28][29] The PQRS consists of six domains: physiologic, nociceptive, emotive, activities of daily living, cognitive, and overall patient perspective. 26 For each patient, the baseline PQRS values will be obtained before surgery.…”

Section: Postoperative Quality Recovery Scalementioning

confidence: 99%

“…[14][15][16] In a recent study of patients undergoing laparoscopic colorectal surgery, an individualized pneumoperitoneum pressure strategy (ie, deep NMB, abdominal wall stretching, and targeting the lowest IAP) improved patients' physiological recovery on the Postoperative Quality Recovery Scale (PQRS), reduced intraoperative cough and movement, and attenuated inflammation during postoperative 3 days. 17 While these findings are promising, this study is underpowered to test postoperative pain and PONV. In addition, patients' recovery data were assessed in the early postoperative days only.…”

Section: Introductionmentioning

confidence: 99%

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Deep Neuromuscular Blockade Combined with Low Pneumoperitoneum Pressure for Nociceptive Recovery After Major Laparoscopic Gastrointestinal Surgery: Study Protocol for a Randomized Controlled Trial

Long¹,

Shan²,

Feng³

et al. 2021

JPR

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“…However, these new procedures, while reducing the incidence of postoperative complications, are still criticized for high postoperative recurrence rates. [14,15] In this study, a retrospective case-control study was conducted to investigate the safety and efficacy of PPH in the treatment of high-grade hemorrhoids and to compare the clinical efficacy of stapler superior hemorrhoidectomy with that of traditional hemorrhoidectomy in a single-center experience for the clinical application of the 2 treatments.…”

Section: Department Of General Surgery Wuxi Clinical Medical School O...mentioning

confidence: 99%

Comparison of the outcomes of hemorrhoidectomy and PPH in the treatment of grades III and IV hemorrhoids

Zhang

2022

Medicine

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To investigate the clinical effect and outcome of traditional hemorrhoidectomy and procedures for prolapse and hemorrhoid (PPH) for the treatment of grades III and IV hemorrhoids.We retrospectively reviewed 1003 grades III and IV hemorrhoid patients who presented to our hospital. A total of 585 patients underwent PPH, and 418 patients underwent hemorrhoidectomy. The outcomes were 1-year recurrence, postoperative complications, surgery-related complications, and indicators.No significant difference between the 2 treatment groups regarding patient demographics. All patients underwent more than 12 months of postoperative follow-up. No significant difference between the 2 treatment groups in 1-year recurrence. PPH can markedly improve anal pain, postoperative bleeding, difficult urination, and postoperative resting anal pressure. The operative blood loss, operative time, wound healing time, and wound infection rates were decreased significantly in the PPH group compared with the traditional hemorrhoidectomy group.Our data suggest that PPH is useful and safe for grades III and IV hemorrhoids. It can reduce postoperative and surgery-related complications. However, this was a single-hospital retrospective study. Therefore, well-designed, multicenter, randomized controlled trials are needed to evaluate the value of PPH for grades III and IV hemorrhoids.Abbreviations: PPH = procedures for prolapse and hemorrhoid, RAP = resting anal pressure.

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Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery

Abstract: on behalf of the IPPColLapSe II study investigators*

Cited by 29 publications

References 42 publications

The “Dark Side” of Pneumoperitoneum and Laparoscopy

The “Dark Side” of Pneumoperitoneum and Laparoscopy

Deep Neuromuscular Blockade Combined with Low Pneumoperitoneum Pressure for Nociceptive Recovery After Major Laparoscopic Gastrointestinal Surgery: Study Protocol for a Randomized Controlled Trial

Comparison of the outcomes of hemorrhoidectomy and PPH in the treatment of grades III and IV hemorrhoids

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