Dourado Justin, Rogers Peter, Horesh Nir, Emile Sameh Hany, Aeschbacher Pauline, Wexner Steven D
Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel.
Gastroenterol Rep (Oxf). 2024 Jul 19;12:goae052. doi: 10.1093/gastro/goae052. eCollection 2024.
We aimed to assess the efficacy and safety of low-pressure pneumoperitoneum (LPP) in minimally invasive colorectal surgery.
A PRISMA-compliant systematic review/meta-analysis was conducted, searching PubMed, Scopus, Google Scholar, and clinicaltrials.gov for randomized-controlled trials assessing outcomes of LPP vs standard-pressure pneumoperitoneum (SPP) in colorectal surgery. Efficacy outcomes [pain score in post-anesthesia care unit (PACU), pain score postoperative day 1 (POD1), operative time, and hospital stay] and safety outcomes (blood loss and postoperative complications) were analyzed. Risk of bias2 tool assessed bias risk. The certainty of evidence was graded using GRADE.
Four studies included 537 patients (male 59.8%). LPP was undertaken in 280 (52.1%) patients and associated with lower pain scores in PACU [weighted mean difference: -1.06, 95% confidence interval (CI): -1.65 to -0.47, =0.004, =0%] and POD1 (weighted mean difference: -0.49, 95% CI: -0.91 to -0.07, =0.024, =0%). Meta-regression showed that age [standard error (SE): 0.036, <0.001], male sex (SE: 0.006, <0.001), and operative time (SE: 0.002, =0.027) were significantly associated with increased complications with LPP. In addition, 5.9%-14.5% of surgeons using LLP requested pressure increases to equal the SPP group. The grade of evidence was high for pain score in PACU and on POD1 postoperative complications and major complications, and blood loss, moderate for operative time, low for intraoperative complications, and very low for length of stay.
LPP was associated with lower pain scores in PACU and on POD1 with similar operative times, length of stay, and safety profile compared with SPP in colorectal surgery. Although LPP was not associated with increased complications, older patients, males, patients undergoing laparoscopic surgery, and those with longer operative times may be at risk of increased complications.
我们旨在评估低压气腹（LPP）在微创结直肠手术中的疗效和安全性。
进行了一项符合PRISMA标准的系统评价/荟萃分析，在PubMed、Scopus、谷歌学术和clinicaltrials.gov上检索评估结直肠手术中LPP与标准压力气腹（SPP）结局的随机对照试验。分析疗效结局[麻醉后护理单元（PACU）疼痛评分、术后第1天（POD1）疼痛评分、手术时间和住院时间]和安全性结局（失血和术后并发症）。采用偏倚风险2工具评估偏倚风险。使用GRADE对证据的确定性进行分级。
四项研究纳入537例患者（男性占59.8%）。280例（52.1%）患者接受LPP，其与PACU中较低的疼痛评分相关[加权平均差：-1.06，95%置信区间（CI）：-1.65至-0.47，P = 0.004，I² = 0%]以及POD1（加权平均差：-0.49，95%CI：-0.91至-0.07，P = 0.024，I² = 0%）。Meta回归显示，年龄[标准误（SE）：0.036，P < 0.001]、男性（SE：0.006，P < 0.001）和手术时间（SE：0.002，P = 0.027）与LPP并发症增加显著相关。此外，使用LLP的外科医生中有5.9%-14.5%要求增加压力以使其与SPP组相等。PACU疼痛评分、术后并发症和主要并发症以及失血方面的证据等级为高，手术时间方面为中等，术中并发症方面为低，住院时间方面为极低。
与结直肠手术中的SPP相比，LPP与PACU和POD1中较低的疼痛评分相关，手术时间、住院时间和安全性相似。虽然LPP与并发症增加无关，但老年患者、男性、接受腹腔镜手术的患者以及手术时间较长的患者可能有并发症增加的风险。
