Dataset Information

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

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.

SUBMITTER: Lai H

PROVIDER: S-EPMC4128655 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Lai Hao H Mo Xianwei X Yang Yang Y Xiao Jun J He Ke K Chen Jiansi J Lin Yuan Y

PloS one 20140811 8

<h4>Background</h4>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.<h4>Methods</h4>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 ...[more]

PMID: 25110982

Similar Datasets

Project description:BACKGROUND:The aim of this study was to monitor the effect of humidified-warm carbon dioxide (HWCO2 ) delivered into the open abdomen of mice, simulating laparotomy. METHODS:Mice were anaesthetized, ventilated and subjected to an abdominal incision followed by wound retraction. In the experimental group, a diffuser device was used to deliver HWCO2 ; the control group was exposed to passive air flow. In each group of mice, surgical damage was produced on one side of the peritoneal wall. Vital signs and core temperature were monitored throughout the 1-h procedure. The peritoneum was closed and mice were allowed to recover for 24 h or 10 days. Tumour cells were delivered into half of the mice in each cohort. Tissue was then examined using scanning electron microscopy and immunohistochemistry. RESULTS:Passive air flow generated ultrastructural damage including mesothelial cell bulging/retraction and loss of microvilli, as assessed at 24 h. Evidence of surgical damage was still measurable on day 10. HWCO2 maintained normothermia, whereas open surgery alone led to hypothermia. The degree of tissue damage was significantly reduced by HWCO2 compared with that in controls. Peritoneal expression of hypoxia inducible factor 1α and vascular endothelial growth factor A was lowered by HWCO2 . These effects were also evident at the surgical damage sites, where protection from tissue trauma extended to 10 days. HWCO2 did not reduce tumorigenesis in surgically damaged sites compared with passive air flow. CONCLUSION:HWCO2 diffusion into the abdomen in the context of open surgery afforded tissue protection and accelerated tissue repair in mice, while preserving normothermia. Surgical relevance Damage to the peritoneum always occurs during open abdominal surgery, by exposure to desiccating air and by mechanical trauma/damage owing to the surgical intervention. Previous experimental studies showed that humidified-warm carbon dioxide (HWCO2 ) reduced peritoneal damage during laparoscopic insufflation. Additionally, this intervention decreased experimental peritoneal carcinomatosis compared with the use of conventional dry-cold carbon dioxide. In the present experimental study, the simple delivery of HWCO2 into the open abdomen reduced the amount of cellular damage and inflammation, and accelerated tissue repair. Sites of surgical intervention serve as ideal locations for cancer cell adhesion and subsequent tumour formation, but this was not changed measurably by the delivery of HWCO2 .

Project description:BackgroundIn high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is challenging to adopt and implement in low resource settings. This systematic review and meta-analysis evaluate the clinical effectiveness of gasless laparoscopy compared to conventional laparoscopy with CO2 pneumoperitoneum and open surgery for general surgery and gynaecological procedures.MethodsA search of the MEDLINE, EMBASE, Global Health, AJOL databases and Cochrane Library was performed from inception to January 2021. All randomised (RCTs) and comparative cohort (non-RCTs) studies comparing gasless laparoscopy with open surgery or conventional laparoscopy were included. The primary outcomes were mortality, conversion rates and intraoperative complications.Secondary outcomesoperative times and length of stay. The inverse variance random-effects model was used to synthesise data.Results63 studies were included: 41 RCTs and 22 non-RCTs (3,620 patients). No procedure-related deaths were reported in the studies. For gasless vs conventional laparoscopy there was no difference in intraoperative complications for general RR 1.04 [CI 0.45-2.40] or gynaecological surgery RR 0.66 [0.14-3.13]. In the gasless laparoscopy group, the conversion rates for gynaecological surgery were high RR 11.72 [CI 2.26-60.87] when compared to conventional laparoscopy. For gasless vs open surgery, the operative times were longer for gasless surgery in general surgery RCT group MD (mean difference) 10 [CI 0.64, 19.36], but significantly shorter in the gynaecology RCT group MD - 18.74 [CI - 29.23, - 8.26]. For gasless laparoscopy vs open surgery non-RCT, the length of stay was shorter for gasless laparoscopy in general surgery MD - 3.94 [CI - 5.93, - 1.95] and gynaecology MD - 1.75 [CI - 2.64, - 0.86]. Overall GRADE assessment for RCTs and Non-RCTs was very low.ConclusionGasless laparoscopy has advantages for selective general and gynaecological procedures and may have a vital role to play in low resource settings.

Project description:BackgroundThe hemodynamic variations of cardiac and cerebral blood monitoring during pneumoperitoneum and head-down tilt position in general anesthetized elderly patients remain unresolved. We evaluated the time course of cerebral tissue oxygen saturation (SctO2) and cardiac output (CO) and investigated how the changes in hemodynamic values during the surgery would affect cerebral perfusion in elderly patients.MethodsIn this prospective observational study of 47 elderly patients (≥65 years old, American Society of Anesthesiologists Physical status I to III) undergoing laparoscopic colorectal radical resection with head-down position, SctO2 by near-infrared spectroscopy and arterial pressure-based cardiac output (APCO), Cardiac index (CI), stroke volume (SV), and SV index (SVI) according to FloTrac/Vigileo were measured at 9 time points. Heart rate (HR), mean arterial blood pressure (MAP), end-tidal carbon dioxide (ETCO2), bispectral index (BIS), central venous pressure (CVP), and ventilator settings were recorded. Results are reported as medians [95% confidence interval (CI)].ResultsHeart Rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), MAP, CO, CI, SV, SVI, and SctO2 before incision decreased significantly compared with the waking state (P<0.05). SBP, CO, CI, SV, and SVI before incision decreased significantly compared with induction and intubation (P<0.05). SBP, DBP, MAP, and CVP increased significantly after pneumoperitoneum and head-down tilt, and then decreased during the following hour. CO and SVI decreased, while CI and SV increased after pneumoperitoneum and head-down tilt. CO, CI, SV and SVI decreased at the following 20, 40, and 60 minutes respectively. SctO2 increased after pneumoperitoneum and head-down tilt and remained stable during the following hour. CVP decreased while CO, CI, SV, and SVI increased significantly at the end of pneumoperitoneum and head-down tilt (P<0.05). HR and MAP increased significantly at the end of surgery compared to at the end of pneumoperitoneum and head-down tilt (P<0.05). CI was associated with SctO2 as indicated by a Pearson r of 0.035 (P<0.05).ConclusionsAnesthesia, pneumoperitoneum, and head-down tilt affect cardiac function and cerebral perfusion in elderly patients. cardiac index independently affects elderly patients' cerebral blood flow.

Dataset Information

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

Background

Methods

Results

Conclusions

Publications

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

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets