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Effects of Different Levels of Intra-Abdominal Pressure on the Postoperative Hepatic Function of Patients Undergoing Laparoscopic Cholecystectomy

A Systematic Review and Meta-Analysis

Cheng, Zheng-Jun, MD*; Wang, Yun-Bing, PhD; Chen, Long, MD; Gong, Jian-Ping, PhD; Zhang, Wei, PhD

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: October 2018 - Volume 28 - Issue 5 - p 275–281
doi: 10.1097/SLE.0000000000000525
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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.

*Department of General Surgery, The Second People’s Hospital of Jiulongpo District

Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing

Department of Hepatobiliary Surgery, The People’s Hospital of Jianyang City, Jianyang, Sichuan Province, China

The authors declare no conflicts of interest.

Reprints: Wei Zhang, PhD, Department of Hepatobiliary Surgery, The People’s Hospital of Jianyang City, No. 180, Yixueyuan Road, Jianyang, Sichuan 641400, China (e-mail: zhangwei1824@126.com).

Received February 4, 2018

Accepted March 5, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.