Both preclinical and clinical studies indicate that raised intra-abdominal pressure (IAP) associated with
pneumoperitoneum during laparoscopic surgical procedures can cause renal damage, the severity of which may be influenced by variables such as pressure level and duration. Several of these variables have been investigated in animal studies, but synthesis of all preclinical data has not been performed. This systematic review summarizes all available pre-clinical evidence on this topic, including an assessment of its quality and risk of bias. We performed meta-analysis to assess which aspects of the
pneumoperitoneum determine the severity of its adverse effects. A systematic search in two databases identified 55 studies on the effect of
pneumoperitoneum on renal function which met our inclusion criteria. There was high heterogeneity between the studies regarding study design, species, sex, pressure and duration of
pneumoperitoneum, and type of gas used. Measures to reduce bias were poorly reported, leading to an unclear risk of bias in the majority of studies. Details on randomisation, blinding and a sample size calculation were not reported in ≥80% of the studies. Meta-analysis showed an overall increase in serum
creatinine during
pneumoperitoneum, and a decrease in urine output and renal blood flow. Subgroup analysis indicated that for serum
creatinine, this effect differed between species. Subgroup analysis of pressure level indicated that urine output decreased as IAP level increased. No differences between types of gas were observed. Data were insufficient to reliably assess whether sex or IAP duration modulate the effect of
pneumoperitoneum. Four studies assessing long-term effects indicated that serum
creatinine normalized ≥24 hours after desufflation of
pneumoperitoneum at 15mmHg. We conclude that harmful effects on renal function and perfusion during
pneumoperitoneum appear to be robust, but evidence on long-term effects is very limited. The reliability and clinical relevance of these findings for healthy patients and patients at high risk of renal impairment remain uncertain. We emphasize the need for rigorous reporting of preclinical research methodology, which is of vital importance for clinical translation of preclinical data.