Low-pressure versus standard-pressure pneumoperitoneum for laparoscopic cholecystectomy: a systematic review and meta-analysis

Abstract

Background: The feasibility and safety of low-pressure pneumoperitoneum in laparoscopic cholecystectomy remain unclear.

Methods: A meta-analysis of randomized controlled trials comparing low-pressure with standard-pressure pneumoperitoneum was performed.

Results: A total of 1,263 patients were included. Low-pressure pneumoperitoneum was associated with significantly decreased postoperative pain. The requirement for increased pressure was significantly greater in the low-pressure group (risk ratio = 6.16; P < .001). Operative time was similar, with only a slight statistical significance (weighted mean difference = 2.07; P < .001). Length of hospital stay was shorter in the low-pressure group (weighted mean difference = -.27; P = .01). No significant differences were found in surgical complications or conversion to open surgery.

Conclusions: Low-pressure pneumoperitoneum is feasible and safe and results in reduced postoperative pain and near-equal operative time compared with standard-pressure pneumoperitoneum. More studies are required to investigate the potential benefits of the reduced length of hospital stay.

Keywords: Laparoscopic cholecystectomy; Low-pressure pneumoperitoneum; Meta-analysis; Postoperative shoulder pain; Standard-pressure pneumoperitoneum.