Abdominal lift for laparoscopic cholecystectomy

Evidence Summaries

Level of Evidence = C
Abdominal wall lift may not have a clear benefit over pneumoperitoneum in patients with low anaesthetic risk undergoing laparoscopic cholecystectomy. The quality of evidence is downgraded by study limitations (unclear allocation concealment and lack of blinding) and by imprecise results (limited study size for each comparison).

A Cochrane review 1 included a total of 5 trials with 130 participants (all with low anaesthetic risk) scheduled for elective laparoscopic cholecystectomy to abdominal wall lift with pneumoperitoneum versus pneumoperitoneum only. There was no mortality or conversion to open cholecystectomy in any of the participants in the trials that reported these outcomes. There was no significant difference in the rate of serious adverse events between the two groups (two trials; 2/29 events (0.069 events per person) versus 2/29 events (0.069 events per person); rate ratio 1.00; 95% CI 0.17 to 5.77). There was no significant difference in the operating time between the two groups (four trials; 53 participants versus 54 participants; 13.39 minutes longer (95% CI 2.73 less to 29.51 minutes longer) in the abdominal wall lift with pneumoperitoneum group and 100 minutes in the pneumoperitoneum group).

For abdominal wall lift versus pneumoperitoneum, 18 trials with a total of 774 participants (the majority with low anaesthetic risk) scheduled for elective laparoscopic cholecystectomy were randomised to abdominal wall lift without pneumoperitoneum versus pneumoperitoneum. There was no mortality in any of the trials that reported this outcome. There was no significant difference in the proportion of participants with serious adverse events (six trials; 5/172 (weighted proportion 2.4%) versus 2/171 (1.2%); RR 2.01; 95% CI 0.52 to 7.80). There was no significant difference in the rate of serious adverse events between the two groups (three trials; 5/99 events (weighted number of events per person = 0.346 events) versus 2/99 events (0.020 events per person); rate ratio 1.73; 95% CI 0.35 to 8.61). There was no significant difference in the proportion of people who underwent conversion to open cholecystectomy (11 trials; 5/225 (weighted proportion 2.3%) versus 7/235 (3.0%); RR 0.76; 95% CI 0.26 to 2.21). The operating time was significantly longer in the abdominal wall lift group than in the pneumoperitoneum group (16 trials; 6.87 minutes longer (95% CI 4.74 minutes to 9.00 minutes longer) in the abdominal wall lift group versus 75 minutes in the pneumoperitoneum group). There was no significant difference in the proportion of people discharged as laparoscopic cholecystectomy day-patients (two trials; 15/31 (weighted proportion 48.5%) versus 9/31 (29%); RR 1.67; 95% CI 0.85 to 3.26).

References

1. Gurusamy KS, Koti R, Davidson BR. Abdominal lift for laparoscopic cholecystectomy. Cochrane Database Syst Rev 2013;8():CD006574.  [PMID:23996298].


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