title: Association between duration of carbon dioxide pneumoperitoneum during laparoscopic abdominal surgery and hepatic injury: a meta-analysis.
abstract: BACKGROUND
  The aim of this study is to accurately assess whether the duration of intraoperative carbon dioxide pneumoperitoneum (CDP) is associated with the induction of hepatic injury.
  
  
  METHODS
  We conducted a systematic review of PubMed, Embase, and Cochrane Library databases (through February 2014) to identify case-match studies that compared high-pressure CDP with low-pressure CDP or varied the duration of CDP in patients who underwent abdominal surgery. The outcome of interest was postoperative liver function (ALT, AST, TB).
  
  
  RESULTS
  Eleven comparative studies involving 2,235 participants were included. Overall, levels of ALT, AST, and TB (on postoperative days 1, 3, and 7) were significantly elevated in the study groups. However, the results of the subanalyses of those who underwent laparoscopic colorectal cancer resection (LCR) versus open colorectal cancer resection (OCR) and those who underwent laparoscopic gastric bypass (LGBP) versus open gastric bypass (OGBP) were inconsistent.
  
  
  CONCLUSIONS
  The current evidence suggests that the duration of CDP during laparoscopic abdominal surgery may be associated with hepatic injury. Additional large-scale, randomized, controlled trials are urgently needed to further confirm this.
authors.affiliation: Department of Gastrointestinal Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Lai
authors.affiliation: Department of Gastrointestinal Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China.
authors.forename: Xianwei
authors.initials: X
authors.lastname: Mo
authors.affiliation: Department of Gastrointestinal Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Gastrointestinal Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Department of Neck and Head Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China.
authors.forename: Ke
authors.initials: K
authors.lastname: He
authors.affiliation: Department of Gastrointestinal Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China.
authors.forename: Jiansi
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Gastrointestinal Surgery, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, Guangxi Autonomous Region, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Lin
mesh_terms: D000005:Abdomen / Q000601:surgery*; D002245:Carbon Dioxide / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008099:Liver / Q000293:injuries*; D011027:Pneumoperitoneum / Q000139:chemically induced* / Q000150:complications*; D013997:Time Factors
chemical_list: D002245:Carbon Dioxide
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