Publication: Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery
Issued Date
2020-01-01
Resource Type
ISSN
13652168
00071323
00071323
Other identifier(s)
2-s2.0-85086022157
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Mahidol University
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SCOPUS
Bibliographic Citation
British Journal of Surgery. (2020)
Suggested Citation
O. Díaz-Cambronero, G. Mazzinari, B. Flor Lorente, N. García Gregorio, D. Robles-Hernandez, L. E. Olmedilla Arnal, A. Martin de Pablos, M. J. Schultz, C. L. Errando, M. P. Argente Navarro Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery. British Journal of Surgery. (2020). doi:10.1002/bjs.11736 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/58333
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Title
Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery
Other Contributor(s)
Hospital General Universitario Gregorio Marañon
Hospital Universitari i Politècnic La Fe
Hospital General Universitario de Valencia
Mahidol University
Hospital General de Castellon
Nuffield Department of Medicine
Hospital Universitario Virgen Macarena
Amsterdam UMC - University of Amsterdam
Research Group in Perioperative Medicine
Hospital Universitari i Politècnic La Fe
Hospital General Universitario de Valencia
Mahidol University
Hospital General de Castellon
Nuffield Department of Medicine
Hospital Universitario Virgen Macarena
Amsterdam UMC - University of Amsterdam
Research Group in Perioperative Medicine
Abstract
© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd Background: It remains uncertain whether individualization of pneumoperitoneum pressures during laparoscopic surgery improves postoperative recovery. This study compared an individualized pneumoperitoneum pressure (IPP) strategy with a standard pneumoperitoneum pressure (SPP) strategy with respect to postoperative recovery after laparoscopic colorectal surgery. Methods: This was a multicentre RCT. The IPP strategy comprised modified patient positioning, deep neuromuscular blockade, and abdominal wall prestretching targeting the lowest intra-abdominal pressure (IAP) that maintained acceptable workspace. The SPP strategy comprised patient positioning according to the surgeon's preference, moderate neuromuscular blockade and a fixed IAP of 12 mmHg. The primary endpoint was physiological postoperative recovery, assessed by means of the Postoperative Quality of Recovery Scale. Secondary endpoints included recovery in other domains and overall recovery, the occurrence of intraoperative and postoperative complications, duration of hospital stay, and plasma markers of inflammation up to postoperative day 3. Results: Of 166 patients, 85 received an IPP strategy and 81 an SPP strategy. The IPP strategy was associated with a higher probability of physiological recovery (odds ratio (OR) 2·77, 95 per cent c.i. 1·19 to 6·40, P = 0·017; risk ratio (RR) 1·82, 1·79 to 1·87, P = 0·049). The IPP strategy was also associated with a higher probability of emotional (P = 0·013) and overall (P = 0·011) recovery. Intraoperative adverse events were less frequent with the IPP strategy (P < 0·001) and the plasma neutrophil–lymphocyte ratio was lower (P = 0·029). Other endpoints were not affected. Conclusion: In this cohort of patients undergoing laparoscopic colorectal surgery, an IPP strategy was associated with faster recovery, fewer intraoperative complications and less inflammation than an SPP strategy. Registration number: NCT02773173 (http://www.clinicaltrials.gov).