The role of remote ischaemic preconditioning (RIPC) in colorectal surgery: a meta-analysis of randomized-controlled studies.

Introduction: Remote ischaemic preconditioning (RIPC) which consists of repeated brief episodes of non-lethal limb ischaemia is associated with organ protection and improved clinical outcomes through complex pathophysiological pathways. The aim of this meta-analysis was to evaluate the postoperative effects of RIPC in bowel recovery and surgical morbidity after colorectal surgery.

Methods: In strict adherence to the PRISMA guidelines, a systematic literature search was performed for studies comparing the postoperative effect RIPC in colorectal surgery. Data from eligible studies were extracted, qualitatively assessed, and included. Odds ratios (OR) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated.

Results: Four studies with a total of 311 patients were included. RIPC resulted in reduced rates of postoperative ileus (POI) (OR 0.42, 95% CI 0.21-0.85, p = 0.02) and lower postoperative TNF-α levels (SMD - 1.01, 95% CI -1.59,-0.43, p = 0.0007). There were no significant differences between the two groups in other clinical outcomes such as anastomotic leak, surgical morbidity and length of hospital stay.

Conclusions: RIPC demonstrated significantly reduced POI rates and TNF-α levels in colorectal surgery and could be a potential supportive strategy to promote less tissue trauma and thus enhance bowel recovery. Larger randomized controlled trials with standardized study protocols are needed to validate the results presented here.