Low-pressure versus standard-pressure pneumoperitoneum in laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials

Ortenzi, Monica; Montori, Giulia; Sartori, Alberto; Balla, Andrea; Botteri, Emanuele; Piatto, Giacomo; Gallo, Gaetano; Vigna, Silvia; Guerrieri, Mario; Williams, Sophie; Podda, Mauro; Agresta, Ferdinando

doi:10.1007/s00464-022-09201-1

Cited by 29 publications

(20 citation statements)

References 59 publications

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“…Our findings are in accordance with the recently reported systematic review and meta-analysis of 44 randomized trials which focused on the clinical consequences of low vs standard pneumoperitoneum pressures during laparoscopic cholecystectomy [ 5 ]. With the exception of a debatable decrease in pain scores, most previous studies on laparoscopic cholecystectomy failed to show a measurable change in any clinical outcome parameter.…”

Section: Discussionsupporting

confidence: 92%

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Low-Pressure Pneumoperitoneum During Laparoscopic Sleeve Gastrectomy: a Safety and Feasibility Analysis

2023

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Purpose Laparoscopy is advised under the lowest possible intra-peritoneal pressure. The aim of this study is to analyze the safety/feasibility of low pneumoperitoneum pressure (LPP) during laparoscopic sleeve gastrectomy (LSG). Materials and Methods All primary LSGs who completed a 3-month follow-up were included. Re-do operations and LSGs performed with concomitant procedures were excluded. All LSGs were performed by the senior author. Upon trocar insertions, pressure was set to 10 mmHg, and the procedure was started. The pressure was increased step-wise, according to the senior author’s assessment of the quality of exposure. Doing so, three pressure groups were formed: groups 1 (10 mmHg), 2 (11–13 mmHg), and 3 (14 mmHg). All data was retrieved from our database. Statistical analysis was performed using one-way ANOVA/Tukey’s HSD test/Chi-square test. P values < 0.05 were regarded as significant. Results Between February 2018 and October 2022, 708 consecutive/primary LSGs were studied. No mortality/conversion/thromboembolic event was observed. Groups 1, 2, and 3 comprised 376 (53.1%), 243 (34.3%), and 89 (12.6%) patients, respectively. Demographics, initial weight, duration of surgery, history for abdominoplasty, drain output, length of stay, and %total weight loss were evenly distributed among groups. Among 16 bleeding episodes, 14 occurred in the LPP group ( p = 0.019). Including the only leak and stenosis, 8/9 of Clavien-Dindo 3b + 4 complications were observed in the LPP group ( p = 0.092). Conclusions LSG with LPP is feasible in about half of the patients. However, almost all potentially life-threatening complications occurred in the LPP group where a significantly higher rate of bleeding was observed. Our findings suggest caution for routinely using LPP during LSG. Graphical Abstract

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Section: Discussionsupporting

confidence: 92%

“…Laparoscopic sleeve gastrectomy (LSG) mandates pneumoperitoneum. Pneumoperitoneum has adverse effects on cardiovascular/pulmonary/hepatic/renal function [ 1 – 3 ], portal/femoral venous flow [ 3 , 4 ], and postoperative pain [ 5 ]. These can be more consequential in morbidly obese patients.…”

Section: Introductionmentioning

confidence: 99%

Low-Pressure Pneumoperitoneum During Laparoscopic Sleeve Gastrectomy: a Safety and Feasibility Analysis

2023

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“…Previous studies have shown that a higher PP could reduce blood loss during LLR 16,33 . In this study, the total volumes of estimated blood loss and blood transfusion rate were similar in the two groups, which was consistent with a recent systematic review 34 . In addition, reducing CVP under low airway pressure is considered safer than increasing PP to control bleeding; 35 however, the effects of low CVP on the incidence of gas embolism remains controversial.…”

Section: Discussionsupporting

confidence: 90%

Low Pneumoperitoneum Pressure Reduces Gas Embolism During Laparoscopic Liver Resection

Luo,

Jin,

Huang

et al. 2023

Annals of Surgery

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Objective: To compare the effect of low and standard pneumoperitoneal pressure (PP) on the occurrence of gas embolism during laparoscopic liver resection (LLR). Background: LLR has an increased risk of gas embolism. Although animal studies have shown that low PP reduces the occurrence of gas embolism, clinical evidence is lacking. Methods: This parallel, dual-arm, double-blind, randomized controlled trial included 141 patients undergoing elective LLR. Patients were randomized into standard (“S,” 15 mm Hg; n = 70) or low (“L,” 10 mm Hg; n = 71) PP groups. Severe gas embolism (≥ grade 3, based on the Schmandra microbubble method) was detected using transesophageal echocardiography and recorded as the primary outcome. Intraoperative vital signs and postoperative recovery profiles were also evaluated. Results: Fewer severe gas embolism cases (n = 29, 40.8% vs n = 47, 67.1%, P = 0.003), fewer abrupt decreases in end-tidal carbon dioxide partial pressure, shorter severe gas embolism duration, less peripheral oxygen saturation reduction, and fewer increases in heart rate and lactate during gas embolization episodes was found in group L than in group S. Moreover, a higher arterial partial pressure of oxygen and peripheral oxygen saturation were observed, and fewer fluids and vasoactive drugs were administered in group L than in group S. In both groups, the distensibility index of the inferior vena cava negatively correlated with central venous pressure throughout LLR, and a comparable quality of recovery was observed. Conclusions: Low PP reduced the incidence and duration of severe gas embolism and achieved steadier hemodynamics and vital signs during LLR. Therefore, a low PP strategy can be considered a valuable choice for the future LLR.

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“…One of the main steps in laparoscopic cholecystectomy is the induction of pneumoperitoneum, usually accompanied by hemodynamic and respiratory adverse effects. However, these negative changes can be managed and controlled [ 18 , 19 ]. Complications that the patient may encounter during or after laparoscopic surgery are still a problem faced by the surgeons [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Port Site Consequences After Laparoscopic Cholecystectomy Using an Open Versus Closed Approach of Pneumoperitoneum

Sultan¹,

Ali²,

Ghareeb³

2022

Cureus

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Introduction: Laparoscopic surgery is the standard method for cholecystectomy, and pneumoperitoneum is performed either in a closed or open technique. However, exposure to the consequences of the port site may increase the patient's morbidity. Therefore, this study was conducted to compare both approaches in terms of complications at the port site of each procedure and potential risk factors.Methods: A prospective study was conducted in the department of surgery, in hospitals affiliated with Kirkuk and Diyala governorates in Iraq, from January 2019 to March 2022. The participating patients (200) were electively divided into two groups, each group comprising 100 patients. The pneumoperitoneum was established in the first group by an open technique (Hasson) while in the second group it was by using a closed technique (Veress needle). A comparison was made between the two techniques for intraoperative and postoperative complications that may have occurred due to port insertion up to 18 weeks.Results: According to the results, the highest percentage was for the following: females (84.0%), ages between 50 and 59 years (43.5%), and body mass index (BMI) range 25-30 kg/m 2 (49.0%). No significant difference was observed between those variables for the two surgical techniques (p-value > 0.05). No death was recorded in the study. Consequences at the port site were observed in 10.5% of patients, the majority reported in the open approach (8.5%) as follows: bleeding (3.0%), hematoma (2.0%), wound infection (1.5%), hernia (1.5%), and vascular injury (0.5%).Conclusions: Thus, we concluded that port site complications are lowest in closed laparoscopic surgery which was not shown to be statistically significant but values showed less complications. Furthermore, samples could be used to gain a good statistical significance.

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Low-pressure versus standard-pressure pneumoperitoneum in laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials

Cited by 29 publications

References 59 publications

Low-Pressure Pneumoperitoneum During Laparoscopic Sleeve Gastrectomy: a Safety and Feasibility Analysis

Low-Pressure Pneumoperitoneum During Laparoscopic Sleeve Gastrectomy: a Safety and Feasibility Analysis

Low Pneumoperitoneum Pressure Reduces Gas Embolism During Laparoscopic Liver Resection

Port Site Consequences After Laparoscopic Cholecystectomy Using an Open Versus Closed Approach of Pneumoperitoneum

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