Abstract
Background
Postoperative pain is a common issue following laparoscopic cholecystectomy. This meta-analysis aimed to determine if active gas aspiration is more effective than passive gas aspiration in reducing postoperative pain and analgesic requirements.
Methodology
The study conducted a systematic search of various databases, including Embase, Medline, and Cochrane Central Register of Controlled Trials (CENTRAL) via Ovid. It also searched trial registries and reference lists of included studies, with no date restrictions but limited to English language, up to December 21, 2022. The study included all randomized clinical trials that had documented elective laparoscopic cholecystectomy procedure and reported at least one relevant outcome. Articles that included subdiaphragmatic drain, intraperitoneal normal saline infusion, or pulmonary recruitment maneuver were excluded from the analysis. Two reviewers independently and in duplicate assessed the eligibility of studies and extracted data. The study reported findings according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The risk of bias of the included trials was assessed using the Revised Cochrane Risk of Bias Assessment Tool. The study used a random-effects model to pool data.
Results
This meta-analysis included 5 randomized clinical trials with 367 participants and found that active gas aspiration resulted in significantly lower residual gas volume and total analgesia requirements compared to passive gas aspiration. Active gas aspiration also led to significantly lower shoulder pain scores at 24 h postoperatively. However, no significant differences were observed in hospital stay duration or abdominal pain scores.
Conclusion
The study found that active gas aspiration can be effective in reducing postoperative shoulder pain and analgesic requirements after laparoscopic cholecystectomy, which has important implications for patient care and healthcare costs. Importantly, this intervention does not impose any additional time or financial burden. However, further research is needed to evaluate its impact on other laparoscopic procedures.
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AKH created the idea, downloaded articles for screening, extracted the data, and wrote the methodology and the results. EAA created the idea, did screening, extracted the data, and wrote the discussion. RSA created the tables of data extraction, wrote the abstract and the key points, supervised the work, and reviewed the manuscript. HMA wrote the introduction, did screening, and did risk of bias assessment. GAA did screening, wrote the methodology and the results, and did risk of bias assessment. Mohammed M. Bukhari did screening and wrote the discussion. ASA did the PROSPERO registration and did the meta-analysis. BSA downloaded articles for screening, created the tables of data extraction, and wrote the conclusion. AHA is the principal investigator and reviewed the manuscript. All authors gave final approval for the version to be published and agreed to be accountable for all aspects of the work.
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Ahmed K. Haneef, Elaf A. Aljohani, Raghad S. Alzahrani, Hanin M. Alowaydhi, Ghadah A. Alarif, Mohammed M. Bukhari, Ahmed S. Abdulhamid, Bassam AlRajhi, and Amro H. Ageel have no conflicts of interest or financial ties to disclose.
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Haneef, A.K., Aljohani, E.A., Alzahrani, R.S. et al. Active gas aspiration in reducing pain after laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. Surg Endosc 38, 597–606 (2024). https://doi.org/10.1007/s00464-023-10651-4
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DOI: https://doi.org/10.1007/s00464-023-10651-4