Meta‐analysis of intermittent P ringle manoeuvre versus no P ringle manoeuvre in elective liver surgery

Background and objectives Intermittent P ringle manoeuvre ( IPM ) is frequently used during liver surgery. This meta‐analysis aimed to review the impact on blood loss, operating time and morbidity and mortality with and without use of IPM . Methods An electronic search was performed of the MEDLINE , EMBASE , PubMed databases using both subject headings ( MeSH ) and truncated word searches to identify all articles published that related to this topic. Pooled risk ratios were calculated for categorical outcomes, and mean differences ( MD s) for secondary continuous outcomes, using the fixed‐effects and random‐effects models for meta‐analysis. Results Four randomized controlled trials encompassing 392 patients were analysed to achieve a summated outcome. Pooled data analysis showed the use of IPM resulted in reduced transection time/cm 2 ( MD −0.53 (−0.88, −0.18) min/cm 2 ( P = 0.003)) but with comparable blood loss ( mL /cm 2 ) ( MD −1.67 (−4.41, 1.08) mL /cm 2 , P = 0.23), overall blood loss ( MD −20.42 (−89.42, 48.58) mL ), blood transfusion requirements (risk ratio 0.78 (0.40, 1.52, P = 0.47)) and morbidity and mortality compared to no P ringle manoeuvre. In addition, there was no significant difference in the post‐operative hospital stay ( MD 0.37 (−0.60, 1.34) days). Conclusions There is no evidence that the routine use of IPM improves perioperative and post‐operative outcomes compared to no P ringle manoeuvre and its routine may not be recommended.