Skip to main content

Advertisement

SpringerLink
Log in

Active aspiration versus simple compression to remove residual gas from the abdominal cavity after laparoscopic cholecystectomy: a randomized clinical trial

  • Controlled Clinical Trials
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

After laparoscopic surgical procedures, residual gas in the abdominal cavity can cause post-operative pain, which is commonly located in the shoulder region. Previous studies suggested that post-laparoscopy pain can be prevented by active suctioning of intraabdominal gas at the end of surgery.

Methods

This randomized controlled trial (registered at DRKS 00,023,286) compared active suctioning versus manual compression in their ability to reduce pain after laparoscopic cholecystectomy. Patients scheduled for laparoscopic cholecystectomy were eligible for trial participation. The primary outcome measure was post-operative pain intensity after 12 h. All the patients were examined by MRI scanning to quantify the intraabdominal gas volume after the intervention.

Results

As planned, 60 patients were recruited. The two groups (n = 30 each) were very similar at the end of surgery. Active suctioning reduced the amount of residual pneumoperitoneum more than simple compression (median volume 1.5 versus 3.0 ml, p = 0.002). The primary outcome measure, abdominal pain after 12 h, was slightly lower in the intervention group (− 0.5 points, 95% confidence interval + 0.5 to − 1.7), but without reaching statistical significance (p = 0.37). After 12 h, shoulder pain was present in 10 patients in each group (p = 1.0). Independent of group assignment, however, residual gas volume was significantly associated with higher pain intensity.

Conclusions

Active suctioning appears to have only a minor preventive effect on post-laparoscopy pain, probably because evacuation of the pneumoperitoneum remains incomplete in some patients. Other more effective maneuvers for gas removal should be preferred.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Fredman B, Jedeikin R, Olsfanger D, Flor P, Gruzman A (1994) Residual pneumoperitoneum: a cause of postoperative pain after laparoscopic cholecystectomy. Anesth Analg 79(1):152–154

    CAS  PubMed  Google Scholar 

  2. Jackson SA, Laurence AS, Hill JC (1996) Does post-laparoscopy pain relate to residual carbon dioxide? Anaesthesia 51(5):485–487

    Article  CAS  Google Scholar 

  3. Lee DH, Song T, Kim KH, Lee KW (2018) Incidence, natural course, and characteristics of postlaparoscopic shoulder pain. Surg Endosc 32(1):160–165

    Article  Google Scholar 

  4. Ure BM, Troidl H, Spangenberger W, Dietrich A, Lefering R, Neugebauer E (1994) Pain after laparoscopic cholecystectomy Intensity and localization of pain and analysis of predictors in preoperative symptoms and intraoperative events. Surg Endosc 8(2):90–96

    Article  CAS  Google Scholar 

  5. Li X, Li K (2021) Time characteristics of shoulder pain after laparoscopic surgery. JSLS 25:2

    Article  Google Scholar 

  6. Song T, Kim KH, Lee KW (2017) The intensity of postlaparoscopic shoulder pain is positively correlated with the amount of residual pneumoperitoneum. J Minim Invasive Gynecol 24(6):984-989.e981

    Article  Google Scholar 

  7. Sabzi Sarvestani A, Zamiri M (2014) Residual pneumoperitoneum volume and postlaparoscopic cholecystectomy pain. Anesth Pain Med 4(4):e17366

    Article  Google Scholar 

  8. McGrath B, Elgendy H, Chung F, Kamming D, Curti B, King S (2004) Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: a survey of 5,703 patients. Can J Anaesth 51(9):886–891

    Article  Google Scholar 

  9. Rettenmaier MA, Micha JP, Lopez KL, Wilcox AM, Goldstein BH (2017) A prospective, observational trial assessing the efficacy of abdominal compression in reducing laparoscopic-induced shoulder pain. Surg Innov 24(6):552–556

    Article  Google Scholar 

  10. Nursal TZ, Yildirim S, Tarim A, Noyan T, Poyraz P, Tuna N, Haberal M (2003) Effect of drainage on postoperative nausea, vomiting, and pain after laparoscopic cholecystectomy. Langenbecks Arch Surg 388(2):95–100

    Article  Google Scholar 

  11. Haghgoo A, Chaichian S, Ghahremani M, Nooriardebili S, Akbaian A, Moazzami B (2016) The use of peritoneal suction drainage to reduce shoulder pain caused by gynecological laparoscopy. Arch Iran Med 19(3):173–178

    PubMed  Google Scholar 

  12. Tuvayanon W, Silchai P, Sirivatanauksorn Y, Visavajarn P, Pungdok J, Tonklai S, Akaraviputh T (2018) Randomized controlled trial comparing the effects of usual gas release, active aspiration, and passive-valve release on abdominal distension in patients who have undergone laparoscopic cholecystectomy. Asian J Endosc Surg 11(3):212–219

    Article  Google Scholar 

  13. Vafaei F, Kamely A, Nouri G, Teshnizi SH, Shokri A (2021) Effect of utilizing a drain on shoulder pain in laparoscopic cholecystectomy. A randomized clinical trial. Indian J Surg 83:859–864

    Article  Google Scholar 

  14. Yang SC, Chang KY, Wei LF, Shyr YM, Ho CM (2021) To drain or not to drain: the association between residual intraperitoneal gas and post-laparoscopic shoulder pain for laparoscopic cholecystectomy. Sci Rep 11(1):7447

    Article  CAS  Google Scholar 

  15. Jorgensen JO, Gillies RB, Hunt DR, Caplehorn JR, Lumley T (1995) A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy. Aust N Z J Surg 65(7):466–469

    Article  CAS  Google Scholar 

  16. Das K, Karateke F, Menekse E, Ozdogan M, Aziret M, Erdem H, Cetinkunar S, Ozdogan H, Sozen S (2013) Minimizing shoulder pain following laparoscopic cholecystectomy: a prospective, randomized, controlled trial. J Laparoendosc Adv Surg Tech A 23(3):179–182

    Article  Google Scholar 

  17. Atak I, Ozbagriacik M, Akinci OF, Bildik N, Subasi IE, Ozdemir M, Ayta NI (2011) Active gas aspiration to reduce pain after laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 21(2):98–100

    Article  Google Scholar 

  18. Salman JM, Merdan I, Asfar SN (2013) The effect of active gas suctioning to decrease the residual CO2 for preventing post-laparoscopic cholecystectomy shoulder pain. J Arab Board Health Specializations 14(2):2–8

    Google Scholar 

  19. Leelasuwattanakul N, Bunyavehchevin S, Sriprachittichai P (2016) Active gas aspiration versus simple gas evacuation to reduce shoulder pain after diagnostic laparoscopy: a randomized controlled trial. J Obstet Gynaecol Res 42(2):190–194

    Article  Google Scholar 

  20. Suginami R, Taniguchi F, Suginami H (2009) Prevention of postlaparoscopic shoulder pain by forced evacuation of residual CO(2). JSLS 13(1):56–59

    PubMed  PubMed Central  Google Scholar 

  21. Tsai HW, Chen YJ, Ho CM, Hseu SS, Chao KC, Tsai SK, Wang PH (2011) Maneuvers to decrease laparoscopy-induced shoulder and upper abdominal pain: a randomized controlled study. Arch Surg 146(12):1360–1366

    Article  Google Scholar 

  22. Ryu KH, Lee SH, Cho EA, Kim JA, Lim GE, Song T (2019) Comparison of impacts of intraperitoneal saline instillation with and without pulmonary recruitment maneuver on post-laparoscopic shoulder pain prevention: a randomized controlled trial. Surg Endosc 33(3):870–878

    Article  Google Scholar 

  23. Barthelsson C, Sandblom G, Ljesevic-Nikoletic S, Hammarqvist F (2015) Effects of intra-abdominally instilled isotonic saline on pain, recovery, and health-related quality-of-life following laparoscopic cholecystectomy: a randomized prospective double-blind controlled study. World J Surg 39(6):1413–1420

    Article  CAS  Google Scholar 

  24. Kihlstedt Pasquier E, Andersson E (2021) Pulmonary recruitment maneuver reduces shoulder pain and nausea after laparoscopic cholecystectomy: a randomized controlled trial. World J Surg 45(12):3575–3583

    Article  CAS  Google Scholar 

  25. Kietpeerakool C, Rattanakanokchai S, Yantapant A, Roekyindee R, Puttasiri S, Yanaranop M, Srisomboon J (2020) Pulmonary recruitment maneuver for reducing shoulder pain after laparoscopic gynecologic surgery: a network meta-analysis of randomized controlled trials. Minim Invasive Surg 2020:7154612

    PubMed  PubMed Central  Google Scholar 

  26. Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, Fuchs KH, Jacobi C, Jansen FW, Koivusalo AM, Lacy A, McMahon MJ, Millat B, Schwenk W (2002) The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc 16(7):1121–1143

    Article  CAS  Google Scholar 

  27. Barazanchi AWH, MacFater WS, Rahiri JL, Tutone S, Hill AG, Joshi GP (2018) Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth 121(4):787–803

    Article  CAS  Google Scholar 

  28. Wood S, Lewis W, Egan R (2019) Optimising surgical technique in laparoscopic cholecystectomy: a review of intraoperative interventions. J Gastrointest Surg 23(9):1925–1932

    Article  Google Scholar 

  29. Kaloo P, Armstrong S, Kaloo C, Jordan V (2019) Interventions to reduce shoulder pain following gynaecological laparoscopic procedures. Cochrane Database Syst Rev 1(1):Cd011101

    PubMed  Google Scholar 

  30. Li XY, Tian M, Li AZ, Han CL, Li KZ (2021) The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients. Sci Rep 11(1):13421

    Article  CAS  Google Scholar 

  31. Bahreini M, Jalili M, Moradi-Lakeh M (2015) A comparison of three self-report pain scales in adults with acute pain. J Emerg Med 48(1):10–18

    Article  Google Scholar 

  32. Olsen MF, Bjerre E, Hansen MD, Hilden J, Landler NE, Tendal B, Hróbjartsson A (2017) Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain. BMC Med 15(1):35

    Article  Google Scholar 

  33. Probst P, Zaschke S, Heger P, Harnoss JC, Hüttner FJ, Mihaljevic AL, Knebel P, Diener MK (2019) Evidence-based recommendations for blinding in surgical trials. Langenbecks Arch Surg 404(3):273–284

    Article  Google Scholar 

  34. Amer MA, Herbison GP, Grainger SH, Khoo CH, Smith MD, McCall JL (2021) A meta-epidemiological study of bias in randomized clinical trials of open and laparoscopic surgery. Br J Surg 108(5):477–483

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General and Abdominal Surgery, Evangelical Hospital, Wiedenbrücker Str. 33, 59555, Lippstadt, Germany

    Ahmed Abdelsamad, Lutz Peter Lerch, Ehab Ibrahim & Mike Ralf Langenbach

  2. Department of Surgery II, University of Witten/Herdecke, Witten, Germany

    Ahmed Abdelsamad & Mike Ralf Langenbach

  3. Department of Radiology, Evangelical Hospital, Lippstadt, Germany

    Lars Ruehe

  4. Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany

    Lars Daenenfaust

Authors
  1. Ahmed Abdelsamad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lars Ruehe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lutz Peter Lerch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ehab Ibrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lars Daenenfaust
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mike Ralf Langenbach
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Abdelsamad, Ahmed: study conception and design, acquisition of data analysis and interpretation of the data, drafting of manuscript, and critical revision of the manuscript. Ruehe, Lars: study conception and design, acquisition of the data, analysis and interpretation of the data MRI analysis, and interpretation of the data. Lerch, Lutz Peter: study conception and design, acquisition of the data analysis, and interpretation of the data, and critical revision of manuscript. Ibrahim, Ehab: study conception and design, analysis and interpretation of the data, and critical revision of the manuscript. Daenenfaust, Lars: study conception and design, acquisition of the data analysis and interpretation of the data. Langenbach, Mike Ralf: study conception and design, acquisition of the data analysis and interpretation of the data, drafting of manuscript, and critical revision of the manuscript.

Corresponding author

Correspondence to Ahmed Abdelsamad.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdelsamad, A., Ruehe, L., Lerch, L.P. et al. Active aspiration versus simple compression to remove residual gas from the abdominal cavity after laparoscopic cholecystectomy: a randomized clinical trial. Langenbecks Arch Surg 407, 1797–1804 (2022). https://doi.org/10.1007/s00423-022-02522-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-022-02522-8

Keywords

Search

Navigation