Effects of Different Levels of Intra-Abdominal Pressure on the Postoperative Hepatic Function of Patients Undergoing Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis.

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.