PDF(Pubmed)
Abstract：
BACKGROUND: To evaluate outcomes of low with high intraabdominal pressure during laparoscopic colorectal resection surgery.
METHODS: A systematic search of multiple electronic data sources was conducted, and all studies comparing low with high (standard) intraabdominal pressures were included. Our primary outcomes were post-operative ileus occurrence and return of bowel movement/flatus. The evaluated secondary outcomes included: total operative time, post-operative haemorrhage, anastomotic leak, pneumonia, surgical site infection, overall post-operative complications (categorised by Clavien-Dindo grading), and length of hospital stay. Revman 5.4 was used for data analysis.
RESULTS: Six randomised controlled trials (RCTs) and one observational study with a total of 771 patients (370 surgery at low intraabdominal pressure and 401 at high pressures) were included. There was no statistically significant difference in all the measured outcomes; post-operative ileus [OR 0.80; CI (0.42, 1.52), P = 0.50], time-to-pass flatus [OR -4.31; CI (-12.12, 3.50), P = 0.28], total operative time [OR 0.40; CI (-10.19, 11.00), P = 0.94], post-operative haemorrhage [OR 1.51; CI (0.41, 5.58, P = 0.53], anastomotic leak [OR 1.14; CI (0.26, 4.91), P = 0.86], pneumonia [OR 1.15; CI (0.22, 6.09), P = 0.87], SSI [OR 0.69; CI (0.19, 2.47), P = 0.57], overall post-operative complications [OR 0.82; CI (0.52, 1.30), P = 0.40], Clavien-Dindo grade ≥ 3 [OR 1.27; CI (0.59, 2.77), P = 0.54], and length of hospital stay [OR -0.68; CI (-1.61, 0.24), P = 0.15].
CONCLUSIONS: Low intraabdominal pressure is safe and feasible approach to laparoscopic colorectal resection surgery with non-inferior outcomes to standard or high pressures. More robust and well-powered RCTs are needed to consolidate the potential benefits of low over high pressure intra-abdominal surgery.
METHODS: A systematic search of multiple electronic data sources was conducted, and all studies comparing low with high (standard) intraabdominal pressures were included. Our primary outcomes were post-operative ileus occurrence and return of bowel movement/flatus. The evaluated secondary outcomes included: total operative time, post-operative haemorrhage, anastomotic leak, pneumonia, surgical site infection, overall post-operative complications (categorised by Clavien-Dindo grading), and length of hospital stay. Revman 5.4 was used for data analysis.
RESULTS: Six randomised controlled trials (RCTs) and one observational study with a total of 771 patients (370 surgery at low intraabdominal pressure and 401 at high pressures) were included. There was no statistically significant difference in all the measured outcomes; post-operative ileus [OR 0.80; CI (0.42, 1.52), P = 0.50], time-to-pass flatus [OR -4.31; CI (-12.12, 3.50), P = 0.28], total operative time [OR 0.40; CI (-10.19, 11.00), P = 0.94], post-operative haemorrhage [OR 1.51; CI (0.41, 5.58, P = 0.53], anastomotic leak [OR 1.14; CI (0.26, 4.91), P = 0.86], pneumonia [OR 1.15; CI (0.22, 6.09), P = 0.87], SSI [OR 0.69; CI (0.19, 2.47), P = 0.57], overall post-operative complications [OR 0.82; CI (0.52, 1.30), P = 0.40], Clavien-Dindo grade ≥ 3 [OR 1.27; CI (0.59, 2.77), P = 0.54], and length of hospital stay [OR -0.68; CI (-1.61, 0.24), P = 0.15].
CONCLUSIONS: Low intraabdominal pressure is safe and feasible approach to laparoscopic colorectal resection surgery with non-inferior outcomes to standard or high pressures. More robust and well-powered RCTs are needed to consolidate the potential benefits of low over high pressure intra-abdominal surgery.
摘要：
背景：评估腹腔镜结直肠切除术中低腹内压和高腹内压的结果。
方法：对多个电子数据源进行了系统搜索，纳入了所有比较低和高(标准)腹内压的研究.我们的主要结果是术后肠梗阻的发生和肠蠕动/排气的恢复。评估的次要结果包括：总手术时间，术后出血,吻合口漏,肺炎,手术部位感染,术后总体并发症（按Clavien-Dindo分级分类），和住院时间。使用Revman5.4进行数据分析。
结果：共纳入6项随机对照试验（RCT）和1项观察性研究，共771例患者（370例低腹压手术，401例高腹压手术）。所有测量结果无统计学差异;术后肠梗阻[OR0.80;CI(0.42,1.52),P=0.50],排气时间[OR-4.31；CI（-12.12，3.50），P=0.28],总手术时间[OR0.40；CI（-10.19,11.00），P=0.94],术后出血[OR1.51；CI（0.41，5.58，P=0.53]，吻合口漏[OR1.14；CI（0.26，4.91），P=0.86],肺炎[OR1.15；CI（0.22，6.09），P=0.87],SSI[OR0.69；CI（0.19，2.47），P=0.57],术后总并发症[OR0.82；CI（0.52，1.30），P=0.40],Clavien-Dindo等级≥3[OR1.27；CI（0.59，2.77），P=0.54],和住院时间[OR-0.68；CI（-1.61，0.24），P=0.15]。
结论：低腹内压是腹腔镜结直肠切除术安全可行的方法，其结局不低于标准或高压。需要更强大且功能良好的RCT来巩固低压高于高压的腹腔内手术的潜在益处。
方法：对多个电子数据源进行了系统搜索，纳入了所有比较低和高(标准)腹内压的研究.我们的主要结果是术后肠梗阻的发生和肠蠕动/排气的恢复。评估的次要结果包括：总手术时间，术后出血,吻合口漏,肺炎,手术部位感染,术后总体并发症（按Clavien-Dindo分级分类），和住院时间。使用Revman5.4进行数据分析。
结果：共纳入6项随机对照试验（RCT）和1项观察性研究，共771例患者（370例低腹压手术，401例高腹压手术）。所有测量结果无统计学差异;术后肠梗阻[OR0.80;CI(0.42,1.52),P=0.50],排气时间[OR-4.31；CI（-12.12，3.50），P=0.28],总手术时间[OR0.40；CI（-10.19,11.00），P=0.94],术后出血[OR1.51；CI（0.41，5.58，P=0.53]，吻合口漏[OR1.14；CI（0.26，4.91），P=0.86],肺炎[OR1.15；CI（0.22，6.09），P=0.87],SSI[OR0.69；CI（0.19，2.47），P=0.57],术后总并发症[OR0.82；CI（0.52，1.30），P=0.40],Clavien-Dindo等级≥3[OR1.27；CI（0.59，2.77），P=0.54],和住院时间[OR-0.68；CI（-1.61，0.24），P=0.15]。
结论：低腹内压是腹腔镜结直肠切除术安全可行的方法，其结局不低于标准或高压。需要更强大且功能良好的RCT来巩固低压高于高压的腹腔内手术的潜在益处。
