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Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review

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Abstract

Background

Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic cholecystolithiasis. Despite the many advantages over open surgery, many patients complain about referred pain to the shoulder during the postoperative course. The purpose of this review was to evaluate different intraoperative surgical methods to minimize shoulder pain (SP).

Methods

A search of the literature was conducted using PubMed, Excerpta Medica Database (EMBASE), and Cochrane database of systematic reviews. Eligibility criteria were: randomized clinical trials or meta-analysis evaluating intraoperative surgical methods applied to minimize incidence or severity of SP after LC. Only papers published in English were included. Data extracted were year of publication, number of participants and allocation, nonsignificant or significant effect on incidence or severity of SP.

Results

A total of 31 papers where included in the review. Seven, 8, and 12 papers investigated the effect of drains, abdominal wall lift (AWL), and low-pressure pneumoperitoneum respectively. Four papers investigated drain suction, active gas aspiration, low insufflation flow or N2O insufflation respectively. The interventions that overall showed a significant reduction on either the incidence or severity of SP were low-pressure pneumoperitoneum, low insufflation rate, and active gas aspiration.

Conclusions

Drainage and AWL are not recommended to reduce SP after LC. Low-pressure pneumoperitoneum with carbon dioxide is the best documented intraoperative surgical method to minimize both the incidence and severity of SP after LC.

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Disclosures

Anders Meller Donatsky, Flemming Bjerrum, and Ismail Gögenur have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Center for Perioperative Optimization, Herlev Hospital, University Hospital of Copenhagen, Herlev Ringgvej 75, 2730, Herlev, Denmark

    Anders Meller Donatsky & Ismail Gögenur

  2. Department of Obstetrics and Gynaecology, Juliane Marie Centre, Centre for Women, Children and Reproduction, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark

    Flemming Bjerrum

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  1. Anders Meller Donatsky
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Correspondence to Anders Meller Donatsky.

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Donatsky, A.M., Bjerrum, F. & Gögenur, I. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surg Endosc 27, 2275–2282 (2013). https://doi.org/10.1007/s00464-012-2759-5

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