Table 2.
Summary of findings table
| Patients | Individuals undergoing laparoscopic surgery | ||||||
|---|---|---|---|---|---|---|---|
| Intervention | Low intra-abdominal pressure (<10 mmHg) | ||||||
| Comparison | Standard intra-abdominal pressure (≥10 mmHg) | ||||||
| Outcome | Number of participants (studies) | Relative effects (95% CI) | P | I 2 (%) | Certainty of the evidence (GRADE) | Comments | |
| 2A: Main outcomes20 | |||||||
| Mortality/survival | |||||||
| Overall mortality | No data | NA | NA | NA | NA | ||
| Long-term survival | No data | NA | NA | NA | NA | ||
| Perioperative complications | |||||||
| (Major) Postoperative complications | |||||||
| CD grade 1–2 | 1597 (13) | RR=0.60 (0.46–0.78) | 0.0001 | 0 | ⊕⊕⊕⊕ High |
||
| CD grade 3–4 | 1507 (12) | RR=1.25 (0.71–2.20) | 0.44 | 0 | |||
| No classification | 290 (6) | RR=0.40 (0.05–3.34) | 0.40 | 10 | |||
| Total | 3394 (21) | RR=0.68 (0.53–0.86) | 0.001 | 0 | |||
| Complications with permanent disability | No data | NA | NA | NA | NA | ||
| Resource use | |||||||
| Hospital stay | 2562 (22) | MD=−0.29 (−0.46 to −0.11) | 0.001 | 89 | ⊕⊕⊕⊝ Moderate Due to inconsistency |
Substantial heterogeneity | |
| Hospital readmission | No data | NA | NA | NA | NA | ||
| Short-term recovery after surgery | |||||||
| Postoperative Pain (NRS) | |||||||
| 0–12 h | 2355 (24) | MD=−0.72 (−0.96 to −0.47) | <0.00001 | 55 | ⊕⊕⊕⊝ Moderate Due to inconsistency |
Substantial heterogeneity | |
| 12–24 h | 1977 (23) | MD=−0.72 (−0.98 to −0.47) | <0.00001 | 73 | |||
| 24–72 h | 1389 (16) | MD=−0.60 (−0.86 to −0.35) | <0.00001 | 66 | |||
| Total | 5721 (27) | MD=−0.68 (−0.82 to −0.54) | <0.00001 | 67 | |||
| PONV (yes/no) | |||||||
| 0–12 h | 434 (5) | RR=0.80 (0.55–1.17) | 0.25 | 44 | ⊕⊕⊕⊝ Moderate Due to inconsistency |
Moderate heterogeneity | |
| 12–24 h | 238 (2) | RR=0.61 (0.18–2.13) | 0.44 | 69 | |||
| 24–72 h | 238 (2) | RR=0.46 (0.19–1.14) | 0.09 | 0 | |||
| No timestamp | 429 (5) | RR=0.59 (0.39–0.90) | 0.01 | 29 | |||
| Total | 1339 (10) | RR=0.67 (0.51–0.88) | 0.004 | 42 | |||
| Psychological wellbeing | No data | NA | NA | NA | NA | ||
| Discharge destination | No data | NA | NA | NA | NA | ||
| Longer term recovery after surgery | |||||||
| Overall health-related quality of life | No data | NA | NA | NA | NA | ||
| Overall success/failure of surgery | |||||||
| Patient satisfaction | No data | NA | NA | NA | NA | ||
| 2B: Safety outcomes surgical procedural feasibility and success | |||||||
| Intraoperative complications | 1661 (16) | RR=1.15 (0.77–1.73) | 0.50 | 0 | ⊕⊕⊕⊕ High |
||
| Quality of the surgical fielda | 896 (10) | MD=−0.63 (−1.14 to −0.13) | 0.01 | 97 | ⊕⊕⊕⊝ Moderate Due to inconsistency |
Considerable heterogeneity | |
| Conversion | |||||||
| To laparotomy | 1718 (20) | RR=1.36 (0.55–3.33) | 0.50 | 0 | ⊕⊕⊕⊕ High |
||
| To higher pressure | 1411 (16) | RR=4.71 (2.88–7.69) | <0.00001 | 0 | |||
| Duration of surgery (min) | 5047 (55) | MD=1.75 (0.15–3.64) | 0.07 | 89 | ⊕⊕⊕⊝ Moderate Due to inconsistency |
Substantial heterogeneity | |
| Blood loss (ml) | 861 (8) | MD=16.30 (−9.40 to 41.99) | 0.21 | 92 | ⊕⊕⊕⊝ Moderate Due to inconsistency |
Considerable heterogeneity | |
CD, Clavien–Dindo; MD, mean difference; NA, not available; NRS, Numerical Rating Scale; PONV, postoperative nausea and vomiting; RR, risk ratio.
a
Scored on the Leiden Surgical Rating Scale: 5=excellent, 4=good, 3=improvement is welcome, 2=bad, 1=very.