| Background and Objective:The choices of pneumoperitoneum in Laparoscopic cholecystectomy might affect the surgical results and prognosis of the patients, so this study aimed to use meta-analysis methods and network meta-analysis methods to evaluate the effectiveness and complications of different Pneumoperitoneum in laparoscopic cholecystectomy surgery, thereby screening the best gas abdominal pressure.Methods:This study systematically and comprehensively searched databases including Pubmed, Cochrane Library, Embase, Web of Science, China Academic Journals Full-text Database, Chinese Journal Full-text Database, Wanfang database. Two independent reviewers screened studies, abstracted data and assessed quality of included studies. Data analysis was conducted by Revman and Addis software. Dichotomous variable was expressed using odds ratio (Odds ratio, OR) and 95% confidence intervals (95% Confidence interval,95% CI) or 95% confidence interval (95% Credibility Interval,95% CrI), continuous variables were expressed by mean difference (Mean Difference, MD) and 95% CI or 95% CrI. Statistical heterogeneity was assessed by I2 test, we considered I2 greater than 50% as significant heterogeneity. Inconsistencies were detected by node splitting method, while all sorts of interventions were ranked, and their possibility to be the best was also calaulated.Results:Twenty-nine randomized controlled trials were finally included.Direct comparison meta-analysis showed that 12 mmHg pneumoperitoneum could reduce operative time as compared to 7 mmHg pneumoperitoneum (MD -3.76,95% CI -6.44-1.08),10 mmHg pneumoperitoneum could reduce operative time as compared to 8 mmHg pneumoperitoneum (MD -9.00,95% CI -15.82 -2.18),14 mmHg pneumoperitoneum could increase operative time as compared to 8 mmHg pneumoperitoneum (MD 4.68,95% CI 0.16 9.20),14 mmHg pneumoperitoneum could increase operative time as compared to 12 mmHg pneumoperitoneum (MD 7.14,95% CI 3.16 11.12); network meta-analysis showed that there were statistical differences between 12 mmHg and 14 mmHg (MD -5.49,95% CrI -10.48,-0.65) in operative time. The rank plot showed that 13 mmHg might have the shortest operation time with its probability (50%) and the second shortest operative time (24%) for 12 mmHg.Direct comparison meta-analysis showed that 12 mmHg pneumoperitoneum could increase the length of hospital stay as compared to 8 mmHg (MD 19.69,95% CI 10.76 28.63),15 mmHg pneumoperitoneum could increase the length of hospital stay as compared to 8 mmHg (MD 32.07,95% CI 21.16 42.98). Network meta-analysis did not show significant differences between any two groups. The rank plot showed that 8 mmHg has the shortest length of hospital stay with its probability 62%, and the second is as 14 mmHgwith its probability 23%.Direct comparison meta-analysis showed that 12 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 7 mmHg (OR 2.65,95% CI 1.07 6.56),12 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 8 mmHg (OR 5.11,95% CI 2.05 12.75),14 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 8 mmHg (OR 6.06,95% CI 2.85 12.87),13 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 9 mmHg (OR 3.83,95% CI 1.24 11.78),12 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 10 mmHg (OR 3.06,95% CI 1.62 5.78),14 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 10 mmHg (OR 4.20,95% CI 2.70 6.53),15 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 10 mmHg (OR 6.96,95% CI 3.58 13.57),14 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 12 mmHg (OR 1.76,95% CI 1.04 2.99).Network meta-analysis showed that,12 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 10 mmHg (OR 0.31,95% CrI 0.17 0.56),14 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 10 mmHg (OR 0.21,95% CrI 0.13 0.34),15 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 10 mmHg (OR 0.17,95% CrI 0.08, 0.36),15 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 7 mmHg (OR 3.25,95% CrI 1.07 10.11),15 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 8 mmHg (OR 6.77,95% CrI 2.81 15.29),14 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 7 mmHg (OR 2.68,95% CrI 1.14 6.53),14 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 8 mmHg (OR 5.42,95% CrI 2.56 10.80),12 mmHg pneumoperitoneum could increase the incidence of should-neck pain as compared to 8 mmHg (OR 3.74,95% CrI 1.70 8.10). The rank plot showed that 8 mmHg has the lowest postoperative shoulder-neck pain with its probability 63% and the second best is10 mmHg with its probability 32%.Direct comparison meta-analysis showed that 14 mmHg pneumoperitoneum could increase postoperative nausea and vomiting as compared to 10 mmHg (OR 5.29,95% CI 1.36 20.53),15 mmHg pneumoperitoneum could increase postoperative nausea and vomiting as compared to 12 mmHg (OR 3.76,95% CI 1.24 11.38). Network meta-analysis showed no statistically significant difference in postoperative nausea and vomiting among each group. The rank plot showed that 10 mmHg has the smalleset postoperative nausea and vomiting with its probability of 65%, followed by 12 mmHg with its possibility of 19%.Conclusion:This study showed that the 8 mmHg pneumoperitoneum has the shortest hospital stay and smallest postoperative shoulder-neck pain,10 mmHg has the least postoperative nausea and vomiting,13 mmHg has shortest operation time. This means that the best pneumoperitoneum is 8 mmHg which could reduce postoperative neck pain and postoperative hospital stay.But due to small number of included studies, low sample size of the original study, and high risk of bias in included studies, therefore the conclusions of this study has some limitations. |
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