Laparoscopic versus Open Obesity Surgery: A Meta-Analysis of Pulmonary Complications

The clinical effects of laparoscopy in the pulmonary function of obese patients have been poorly investigated in the past. A systematic review was undertaken, with the objective to identify published evidence on pulmonary complications in laparoscopic surgery in the obese. Outcome measures included pulmonary morbidity, pulmonary infection and mortality. The random effects model was used to calculate combined overall effect sizes of pooled data. Data are presented as the odds ratio (OR) with 95% confidence interval (CI). A total of 6 randomized and 14 observational studies were included, which reported data on 185,328 patients. Pulmonary complications occurred in 1.6% of laparoscopic and in 3.6% of open procedures (OR 0.45, 95% CI 0.34-0.60). Pneumonia was reported in 0.5% and in 1.1%, respectively (OR 0.45, 95% CI 0.40-0.51). Available evidence suggests lower pulmonary morbidity for laparoscopic surgery in obese patients; further quality studies are however necessary to consolidate these findings.

[1]  A. Santos,et al.  Obese patients: Respiratory complications in the post-anesthesia care unit , 2014 .

[2]  P. Tugwell,et al.  The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses , 2014 .

[3]  J. Sweeney,et al.  Impact of operative duration on postoperative pulmonary complications in laparoscopic versus open colectomy , 2013, Surgical Endoscopy.

[4]  M. Castro Cabezas,et al.  Pulmonary Function Testing and Complications of Laparoscopic Bariatric Surgery , 2013, Obesity Surgery.

[5]  M. Canciani,et al.  Impact of obesity on respiratory function , 2013 .

[6]  R. Schumann.  Pulmonary Physiology of the Morbidly Obese and the Effects of Anesthesia , 2013, International anesthesiology clinics.

[7]  L. Yao,et al.  Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer: an update meta-analysis based on randomized controlled trials , 2013, Surgical Endoscopy.

[8]  T. Hernandez-Boussard,et al.  Laparoscopic vs open gastric bypass surgery: differences in patient demographics, safety, and outcomes. , 2012, Archives of surgery.

[9]  S. Morales-Conde,et al.  Perioperative Morbi-mortality Associated with Bariatric Surgery: from Systematic Biliopancreatic Diversion to A Tailored Laparoscopic Gastric Bypass or Sleeve Gastrectomy Approach , 2012, Obesity Surgery.

[10]  S. Littleton.  Impact of obesity on respiratory function , 2012, Respirology.

[11]  C. Lien.  Residual Neuromuscular Block: Lessons Unlearned. Part I: Definitions, Incidence, and Adverse Physiologic Effects of Residual Neuromuscular Block , 2012 .

[12]  D. Costa,et al.  Silicone-Ring Roux-en-Y Gastric Bypass in the Treatment of Obesity: Effects of Laparoscopic Versus Laparotomic Surgery on Respiration , 2011, Obesity surgery.

[13]  P. Pelosi,et al.  Intraoperative Recruitment Maneuver Reverses Detrimental Pneumoperitoneum-induced Respiratory Effects in Healthy Weight and Obese Patients Undergoing Laparoscopy , 2010, Anesthesiology.

[14]  G. Hedenstierna,et al.  Ventilation-perfusion distributions and gas exchange during carbon dioxide-pneumoperitoneum in a porcine model. , 2010, British journal of anaesthesia.

[15]  M. Reed,et al.  Pulmonary system and obesity. , 2010, Critical care clinics.

[16]  Michele Tarsilla.  Cochrane Handbook for Systematic Reviews of Interventions , 2010, Journal of MultiDisciplinary Evaluation.

[17]  E. Greenblatt,et al.  Noninvasive ventilation immediately after extubation improves lung function in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery. , 2010, Anesthesia and analgesia.

[18]  G. Sakellaropoulos,et al.  Comparison of Early and Late Complications after Various Bariatric Procedures: Incidence and Treatment During 15 Years at a Single Institution , 2010, World Journal of Surgery.

[19]  W. Strodel,et al.  Preoperative weight loss before bariatric surgery. , 2009, Archives of surgery.

[20]  H. Talab,et al.  Intraoperative Ventilatory Strategies for Prevention of Pulmonary Atelectasis in Obese Patients Undergoing Laparoscopic Bariatric Surgery , 2009, Anesthesia and analgesia.

[21]  J. Ioannidis,et al.  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration , 2009, BMJ : British Medical Journal.

[22]  J. Ioannidis,et al.  The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration , 2009, Annals of Internal Medicine [serial online].

[23]  J. Alhashemi,et al.  Effects of four intraoperative ventilatory strategies on respiratory compliance and gas exchange during laparoscopic gastric banding in obese patients. , 2009, British journal of anaesthesia.

[24]  B. Schirmer,et al.  Safety and efficacy of simultaneous cholecystectomy at Roux-en-Y gastric bypass. , 2009, Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery.

[25]  D. Altman,et al.  Assessing Risk of Bias in Included Studies , 2008 .

[26]  L. Gellman,et al.  Laparoscopic vs Open Gastric Bypass in the Management of Morbid Obesity: A 7-year Retrospective Study of 1,364 Patients from a Single Center , 2008, Obesity surgery.

[27]  E. Vittinghoff,et al.  Spectrum and risk factors of complications after gastric bypass. , 2007, Archives of surgery.

[28]  N. Nguyen,et al.  Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers. , 2007, Journal of the American College of Surgeons.

[29]  W. Henderson,et al.  Laparoscopic Versus Open Gastric Bypass for Morbid Obesity: A Multicenter, Prospective, Risk-Adjusted Analysis From the National Surgical Quality Improvement Program , 2006, Annals of surgery.

[30]  Randomized clinical trial of hand‐assisted laparoscopic versus open Roux‐en‐Y gastric bypass for the treatment of morbid obesity , 2004, The British journal of surgery.

[31]  P. Parrilla,et al.  Laparoscopic Versus Open Gastric Bypass in the Treatment of Morbid Obesity: A Randomized Prospective Study , 2004, Annals of surgery.

[32]  Sherman C. Smith,et al.  Open vs Laparoscopic Roux-en-Y Gastric Bypass: Comparison of Operative Morbidity and Mortality , 2004, Obesity surgery.

[33]  L. Brunt,et al.  Perioperative outcomes of laparoscopic versus open splenectomy: a meta-analysis with an emphasis on complications. , 2003, Surgery.

[34]  J. Luketich,et al.  Comparing the Outcomes after Laparoscopic versus Open Gastric Bypass: a Matched Paired Analysis , 2003, Obesity Surgery.

[35]  M. Gagner,et al.  Laparoscopic vs. open biliopancreatic diversion with duodenal switch: A comparative study , 2003, Journal of Gastrointestinal Surgery.

[36]  S. Wicky,et al.  Morbid Obesity and Postoperative Pulmonary Atelectasis: An Underestimated Problem , 2002, Anesthesia and analgesia.

[37]  F. Benseñor,et al.  The Effects of Abdominal Opening on Respiratory Mechanics During General Anesthesia in Normal and Morbidly Obese Patients: A Comparative Study , 2002, Anesthesia and analgesia.

[38]  C. J. Rosenquist,et al.  Laparoscopic Versus Open Gastric Bypass: A Randomized Study of Outcomes, Quality of Life, and Costs , 2001, Annals of surgery.

[39]  T. Hemmerling,et al.  Influence of pneumoperitoneum and patient positioning on respiratory system compliance. , 2001, Journal of clinical anesthesia.

[40]  B. Wolfe,et al.  Comparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: a randomized trial. , 2001, Journal of the American College of Surgeons.

[41]  R. Tacchino,et al.  The Effects of the Reverse Trendelenburg Position on Respiratory Mechanics and Blood Gases in Morbidly Obese Patients During Bariatric Surgery , 2000, Anesthesia and analgesia.

[42]  B. Wolfe,et al.  A comparison study of laparoscopic versus open gastric bypass for morbid obesity. , 2000, Journal of the American College of Surgeons.

[43]  E. Bignami,et al.  Effects of pneumoperitoneum and reverse Trendelenburg position on cardiopulmonary function in morbidly obese patients receiving laparoscopic gastric banding. , 2000, European journal of anaesthesiology.

[44]  I. Olkin,et al.  Meta-analysis of observational studies in epidemiology - A proposal for reporting , 2000 .

[45]  E. Rosato,et al.  Hand-assisted laparoscopic vertical banded gastroplasty: early results. , 2000, Surgical endoscopy.

[46]  D. Gouma,et al.  Open versus laparoscopic adjustable silicone gastric banding: a prospective randomized trial for treatment of morbid obesity. , 1999, Annals of surgery.

[47]  P. Pelosi,et al.  Positive end-expiratory pressure improves respiratory function in obese but not in normal subjects during anesthesia and paralysis. , 1999, Anesthesiology.

[48]  P. De Simone,et al.  Laparoscopic gastric reduction surgery. Preliminary results of a randomized, prospective trial of laparoscopic vs open vertical banded gastroplasty. , 1999, Surgical endoscopy.

[49]  A J Cunningham,et al.  Laparoscopic cholecystectomy: haemodynamic and neuroendocrine responses after pneumoperitoneum and changes in position. , 1997, British journal of anaesthesia.

[50]  L. Nuutinen,et al.  Hemodynamic changes due to Trendelenburg positioning and pneumoperitoneum during laparoscopic hysterectomy , 1995, Acta anaesthesiologica Scandinavica.

[51]  The Effects of Increased Abdominal Pressure on Lung and Chest Wall Mechanics During Laparoscopic Surgery , 1995, Anesthesia and analgesia.

[52]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.