Impact of Standard Versus Low Pneumoperitoneum Pressure on Peritoneal Environment in Laparoscopic Cholecystectomy. Randomized Clinical Trial.

IF 1.1 4区 医学 Q3 SURGERY
Ana Belén Serrano, Óscar Díaz-Cambronero, María Montiel, José Molina, Mónica Núñez, Elena Mendía, María Nuria Mané, Eduardo Lisa, Javier Martínez-Botas, Diego Gómez-Coronado, Andrea Gaetano, María José Casarejos, Ana Gómez, Alfonso Sanjuanbenito
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引用次数: 0

Abstract

Background: High CO 2 pneumoperitoneum pressure during laparoscopy adversely affects the peritoneal environment. This study hypothesized that low pneumoperitoneum pressure may be linked to less peritoneal damage and possibly to better clinical outcomes.

Materials and methods: One hundred patients undergoing scheduled laparoscopic cholecystectomy were randomized 1:1 to low or to standard pneumoperitoneum pressure. Peritoneal biopsies were performed at baseline time and 1 hour after peritoneum insufflation in all patients. The primary outcome was peritoneal remodeling biomarkers and apoptotic index. Secondary outcomes included biomarker differences at the studied times and some clinical variables such as length of hospital stay, and quality and safety issues related to the procedure.

Results: Peritoneal IL6 after 1 hour of surgery was significantly higher in the standard than in the low-pressure group (4.26±1.34 vs. 3.24±1.21; P =0.001). On the contrary, levels of connective tissue growth factor and plasminogen activator inhibitor-I were higher in the low-pressure group (0.89±0.61 vs. 0.61±0.84; P =0.025, and 0.74±0.89 vs. 0.24±1.15; P =0.028, respectively). Regarding apoptotic index, similar levels were found in both groups and were 44.0±10.9 and 42.5±17.8 in low and standard pressure groups, respectively. None of the secondary outcomes showed differences between the 2 groups.

Conclusions: Peritoneal inflammation after laparoscopic cholecystectomy is higher when surgery is performed under standard pressure. Adhesion formation seems to be less in this group. The majority of patients undergoing surgery under low pressure were operated under optimal workspace conditions, regardless of the surgeon's expertise.

腹腔镜胆囊切除术中标准气压与低气压对腹膜环境的影响。随机临床试验。
背景:腹腔镜检查时CO2气腹压力过高会对腹膜环境产生不利影响。本研究假设低气腹压力可能与较少的腹膜损伤有关,并可能有更好的临床结果。材料和方法:100例腹腔镜胆囊切除术患者按1:1随机分为低气压组和标准气压组。所有患者在基线时间和腹膜充气后1小时进行腹膜活检。主要终点是腹膜重塑生物标志物和凋亡指数。次要结果包括研究时间的生物标志物差异和一些临床变量,如住院时间长短,以及与手术相关的质量和安全问题。结果:标准组术后1 h腹膜il - 6明显高于低压组(4.26±1.34∶3.24±1.21;P = 0.001)。相反,低压组结缔组织生长因子和纤溶酶原激活物抑制剂- i水平较高(0.89±0.61 vs. 0.61±0.84;P=0.025, 0.74±0.89比0.24±1.15;分别为P = 0.028)。两组细胞凋亡指数相近,低压组为44.0±10.9,标准压组为42.5±17.8。两组间的次要结果均无差异。结论:标准压力下腹腔镜胆囊切除术后腹膜炎症发生率较高。粘连形成在这组中似乎较少。大多数在低压下接受手术的患者在最佳工作空间条件下进行手术,而不考虑外科医生的专业知识。
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来源期刊
CiteScore
2.00
自引率
10.00%
发文量
103
审稿时长
3-8 weeks
期刊介绍: Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.
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