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

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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.

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Randomized controlled trial


Mean difference


Confidence interval


Random-effects model


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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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Correspondence to Vasilios Pergialiotis.

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Pergialiotis, V., Vlachos, DE.G., Kontzoglou, K. et al. Pulmonary recruitment maneuver to reduce pain after laparoscopy: a meta-analysis of randomized controlled trials. Surg Endosc 29, 2101–2108 (2015).

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