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Association between duration of carbon dioxide pneumoperitoneum during laparoscopic abdominal surgery and hepatic injury: a meta-analysis.

Lai H, Mo X, Yang Y, Xiao J, He K, Chen J, Lin Y - PLoS ONE (2014)

Bottom Line: The outcome of interest was postoperative liver function (ALT, AST, TB).Eleven 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China.

ABSTRACT

Background: The 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.

Methods: We 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).

Results: Eleven 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.

Conclusions: The 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.

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Related in: MedlinePlus

Forest plots of postoperative AST results in subgroup analysis.(a: day 1; b: day 3; c: day 7).
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pone-0104067-g004: Forest plots of postoperative AST results in subgroup analysis.(a: day 1; b: day 3; c: day 7).

Mentions: (Fig. 4, Table 2B) Ten studies evaluated AST results on postoperative day 1 [6], [7], [8], [9], [10], [11], [14], [15], [16], [27]. Subgroup analyses showed significant differences in all subgroup comparisons, except for LGBP versus OGBP (SMD = −0.21, 95% CI = −0.87–0.61, P = 0.44) and LCR versus OCR (SMD = 0.05, 95% CI = −0.16–0.26, P = 0.64; I2 = 0% and PQ = 0.43 for heterogeneity). The overall pooled estimates showed significant differences between the study and control groups (SMD = 0.53, 95% CI = 0.43–0.63, P<0.01; I2 = 91.6% and PQ<0.01 for heterogeneity).


Association between duration of carbon dioxide pneumoperitoneum during laparoscopic abdominal surgery and hepatic injury: a meta-analysis.

Lai H, Mo X, Yang Y, Xiao J, He K, Chen J, Lin Y - PLoS ONE (2014)

Forest plots of postoperative AST results in subgroup analysis.(a: day 1; b: day 3; c: day 7).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4128655&req=5

pone-0104067-g004: Forest plots of postoperative AST results in subgroup analysis.(a: day 1; b: day 3; c: day 7).
Mentions: (Fig. 4, Table 2B) Ten studies evaluated AST results on postoperative day 1 [6], [7], [8], [9], [10], [11], [14], [15], [16], [27]. Subgroup analyses showed significant differences in all subgroup comparisons, except for LGBP versus OGBP (SMD = −0.21, 95% CI = −0.87–0.61, P = 0.44) and LCR versus OCR (SMD = 0.05, 95% CI = −0.16–0.26, P = 0.64; I2 = 0% and PQ = 0.43 for heterogeneity). The overall pooled estimates showed significant differences between the study and control groups (SMD = 0.53, 95% CI = 0.43–0.63, P<0.01; I2 = 91.6% and PQ<0.01 for heterogeneity).

Bottom Line: The outcome of interest was postoperative liver function (ALT, AST, TB).Eleven 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastrointestinal Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China.

ABSTRACT

Background: The 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.

Methods: We 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).

Results: Eleven 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.

Conclusions: The 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.

Show MeSH
Related in: MedlinePlus