Effects of Different Levels of Intra-Abdominal Pressure on the Postoperative Hepatic Function of Patients Undergoing Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis

Surg Laparosc Endosc Percutan Tech. 2018 Oct;28(5):275-281. doi: 10.1097/SLE.0000000000000525.

Abstract

Objective: The aim of this meta-analysis is to compare the differences in postoperative markers of the hepatic function under different intra-abdominal pressures in laparoscopic cholecystectomy (LC).

Methods: Several databases were searched for control studies, and then the weighted data were pooled with random-effect models.

Results: A total of 11 studies involving 865 patients were included. The meta-analysis reveals that the level of the aspartate aminotransferase and alanine transaminase of the low-pressure group has a lower postoperative increase than the moderate-pressure group (P<0.001). The level of the aspartate aminotransferase and alanine transaminase of the moderate-pressure group has a lower postoperative increase than the high-pressure group (P<0.001). Totally, the effect of lower pressure LC on postoperative hepatic functions is less significant than that of the higher one. Potential subgroup analysis does not modify these results.

Conclusions: The recommended pressure in LC is suggested to be lower so as to result in a better surgical safety, especially for special populations.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Alanine Transaminase / metabolism
  • Aspartate Aminotransferases / metabolism
  • Biomarkers / metabolism
  • Cholecystectomy, Laparoscopic / methods*
  • Humans
  • Liver / enzymology
  • Liver / physiology*
  • Liver Function Tests
  • Pneumoperitoneum, Artificial
  • Postoperative Care
  • Pressure
  • Randomized Controlled Trials as Topic

Substances

  • Biomarkers
  • Aspartate Aminotransferases
  • Alanine Transaminase