Surgical Endoscopy

, Volume 29, Issue 8, pp 2101–2108 | Cite as

Pulmonary recruitment maneuver to reduce pain after laparoscopy: a meta-analysis of randomized controlled trials

  • Vasilios Pergialiotis
  • Dimitrios-Efthymios G. Vlachos
  • Konstantinos Kontzoglou
  • Despina Perrea
  • Georgios D. Vlachos



We investigated the impact of pulmonary recruitment maneuver in reducing shoulder pain after laparoscopic procedure.


We conducted a systematic review of the literature using Medline (1966–2014), Scopus (2004–2014), Popline (1974–2014), (2008–2014), and Google Scholar (2004–2014) along with reference lists of electronically retrieved studies. Statistical meta-analysis was performed using the RevMan 5.1 software.


Six studies were included in the present systematic review, involving 571 patients. Among them, 291 (51 %) were offered a pulmonary recruitment maneuver, and 280 patients (49 %) were treated with conventional evacuation of pneumoperitoneum that included either passive evacuation or gentle pressing of the abdominal walls with the trocar ports open. The introduction of a pulmonary recruitment maneuver significantly decreased postoperative shoulder pain 12 h (435 patients, REM, MD −1.55, 95 % CI −2.01, −1.10), 24 h (435 patients, REM, MD −1.59, 95 % CI −2.00, −1.18), and 48 h post-operatively (335 patients, REM, MD −0.93, 95 % CI −1.37, −0.50). We also identified evidence of a potential beneficial effect in the reduction of postoperative upper abdominal pain. However, discrepancies in the interpretation of abdominal pain among the included studies precluded meta-analysis of this index.


According to the results of our meta-analysis, pulmonary recruitment maneuver seems to be an easily performed, potentially preventive measure of post-laparoscopic shoulder pain. Further research is mandated, however, in the field, because firm results are precluded by the small number of included studies.


Pulmonary recruitment Laparoscopy Pain Carbon dioxide Pneumoperitoneum 



American society of anesthesiologists


Randomized controlled trial


Mean difference


Confidence interval


Random-effects model



Vasilios Pergialiotis, Dimitrios-Efthymios G. Vlachos, Kostantinos Kontzoglou, Despina Perrea, and Georgios D. Vlachos have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Vasilios Pergialiotis
    • 1
  • Dimitrios-Efthymios G. Vlachos
    • 2
  • Konstantinos Kontzoglou
    • 3
  • Despina Perrea
    • 1
  • Georgios D. Vlachos
    • 2
  1. 1.Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical SchoolAthens UniversityAthensGreece
  2. 2.1st Department of Obstetrics and Gynecology, Alexandra Hospital, Medical SchoolAthens UniversityAthensGreece
  3. 3.2nd Department of Surgery, Laiko HospitalAthens UniversityAthensGreece

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