A Prospective Randomized Study of Systemic Inflammation and Immune Response After Laparoscopic Nissen Fundoplication Performed With Standard and Low-pressure Pneumoperitoneum

Schietroma, Mario; Carlei, Francesco; Cecilia, Emanuela Marina; Piccione, Federica; Sista, Federico; Vita, Fabiola De; Amicucci, Gianfranco

doi:10.1097/sle.0b013e3182827e51

Cited by 26 publications

(22 citation statements)

References 73 publications

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“…The disturbance, traction and the compression of the thoracic cavity by pneumoperitoneum during surgery are the important elements of trauma 28 . Studies have demonstrated that trauma is closely associated with the stability of the internal environment 29 , 30 .…”

Section: Discussionmentioning

confidence: 99%

Three-Step Hand-Assisted Laparoscopic D2 Radical Gastrectomy for Chinese Obese Patients: A Highly Efficient and Feasible Surgical Approach

Gong¹,

Cao²,

Wang³

et al. 2015

J. Cancer

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Three-step hand-assisted laparoscopic D2 radical gastrectomy (HALG) is a modified surgical procedure that has achieved satisfactory results for obese patients in our surgical center. To fully elucidate the advantages of this procedure, in this study, comprehensive and in-depth comparative analyses were performed to assess clinical data from obese gastric cancer patients who underwent HALG, laparoscopic-assisted D2 radical gastrectomy (LAG), and open D2 radical gastrectomy (OG) in our surgical center during a specific time period. For the 3 groups, incision length was 1.25 cm longer for the HALG group than for the LAG group but was significantly shorter for the HALG group than for the OG group (P =0.00). The rate of conversion to laparotomy , the pneumoperitoneum time and the number of recovered lymph nodes were significantly better for the HALG group than for the LAG group (P <0.05). The pain score at day 2 after surgery, intestinal function recovery time, and duration of postoperative hospital stay were not significantly different for the HALG and LAG groups ( P >0.05) but were significantly better for the HALG group than for the OG group (P <0.05). There were significantly fewer postoperative complications for the HALG group than for the LAG and OG groups (P =0.049). According to the results, the “three-step HALG method” incorporates both the thoroughness of the radical OG approach and the minimal invasiveness of the LAG approach for obese patients. Thus, the HALG approach is a relatively safe and extremely feasible surgical procedure for the treatment of these patients.

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Section: Discussionmentioning

confidence: 99%

Three-Step Hand-Assisted Laparoscopic D2 Radical Gastrectomy for Chinese Obese Patients: A Highly Efficient and Feasible Surgical Approach

Gong¹,

Cao²,

Wang³

et al. 2015

J. Cancer

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“…A possible cause of higher levels of cortisol, ACTH and aldosterone may be the pneumoperitoneum, which is previously known to initiate an inflammatory reaction [28,29] and hormonal stress response [30][31][32]. The increase in these hormones is measurable after only a few minutes after the introduction of pneumoperitoneum, and stays high during the pneumoperitoneum time.…”

Section: Outcomes and Estimationmentioning

confidence: 99%

Perioperative humoral stress response to laparoscopic versus open aortobifemoral bypass surgery

Krog

Thorsby

Sahba

et al. 2017

Scandinavian Journal of Clinical and Laboratory Investigation

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“…A recent pilot study performed by our group has shown that low pressure pneumoperitoneum (7 mmHg) was feasible and significantly reduced postoperative pain scores during the first 72 hours after surgery [ 7 ]. Others have shown that low pressure pneumoperitoneum in other laparoscopic procedures is associated with a reduction of post-operative pain and analgesic consumption [ 8 – 10 ]. However, low pressure pneumoperitoneum was also associated with longer operation time, probably due to less optimal perioperative visibility.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness of low pressure pneumoperitoneum with profound muscle relaxation during laparoscopic donor nephrectomy to optimize the quality of recovery during the early post-operative phase: study protocol for a randomized controlled clinical trial

Brunschot

Scheffer

Dahan

et al. 2015

Trials

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BackgroundSince technique modifications of laparoscopic donor nephrectomy, e.g. retroperitoneoscopic donor nephrectomy or hand-assistance, have not shown significant benefit regarding safety or improvement of recovery, further research should focus on improving postoperative recovery. The use of low pressure pneumoperitoneum has shown to significantly reduce postoperative pain after laparoscopy. To facilitate the use of low pressure pneumoperitoneum, deep neuromuscular block will be used.Methods/DesignThis trial is a phase IV, single center, double-blind, randomized controlled clinical trial in which 64 patients will be randomized to: low pressure pneumoperitoneum (6 mmHg) and deep neuromuscular block or normal pressure pneumoperitoneum (12 mmHg) and deep neuromuscular block. Deep neuromuscular block is defined as post tetanic count < 5. Primary outcome measurement will be Quality of Recovery-40 questionnaire (overall score) on day 1.DiscussionThis study is the first randomized study to assess the combination of low pressure pneumoperitoneum in combination with deep neuromuscular block from a patients’ perspective. The study findings may also be applicable for other laparoscopic procedures.Trial registrationThe trial was registered at trials.gov (NCT02146417) in July 2014.

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A Prospective Randomized Study of Systemic Inflammation and Immune Response After Laparoscopic Nissen Fundoplication Performed With Standard and Low-pressure Pneumoperitoneum

Abstract: This study demonstrated that reducing the pressure of the pneumoperitoneum to 6 to 8 mm Hg during LNF is reduced p.o. inflammatory response and avoided p.o. immunosuppression.

Cited by 26 publications

References 73 publications

Three-Step Hand-Assisted Laparoscopic D2 Radical Gastrectomy for Chinese Obese Patients: A Highly Efficient and Feasible Surgical Approach

Three-Step Hand-Assisted Laparoscopic D2 Radical Gastrectomy for Chinese Obese Patients: A Highly Efficient and Feasible Surgical Approach

Perioperative humoral stress response to laparoscopic versus open aortobifemoral bypass surgery

Comparison of the effectiveness of low pressure pneumoperitoneum with profound muscle relaxation during laparoscopic donor nephrectomy to optimize the quality of recovery during the early post-operative phase: study protocol for a randomized controlled clinical trial

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