Objective To systematically assess the effectiveness and safety of ProSeal laryngeal mask (PLMA) compared to endotracheal tube (TT) for airway management in the patients undergoing laparoscopic biliary tract surgery.Methods Using the Cochrane systematic review methods, we searched the Cochrane Controlled Trial Registers (CCTR) of The Cochrane Library, MEDLINE, VIP, and CNKI databases through May 2008. We also handsearched relevant journals and conference proceedings. Two reviewers independently selected studies and assessed the quality of the trials. Disagreements were resolved by discussion, in consultation with a third reviewer. RevMan 4.2 software provided by the Cochrane Collaboration was used for meta-analysis which was performed for combining the results of homogeneitystudies. Results Seven studies involving 493 patients undergoing laparoscopic biliary tract surgery were included. Meta analysis results showed that: ① Side effects: none of the patients experienced regurgitation or hypoventilation. ② PLMA was superior to TT in terms of less postoperative sore throat (OR=0.27, 95%CI 0.13 to 0.53, P=0.0002) and response during extubation (OR=0.01, 95%CI 0.00 to 0.03, Plt;0.00001). ③ PLMA was similar to TT in terms of effective ventilation during peritoneal insufflation (Ppeak: WMD=0.01, 95%CI -0.66 to 0.68, P=0.98; PetCO2: WMD=0.01, 95%CI -0.58 to 0.59, P=0.99) and ease of insertion (OR=0.58, 95%CI 0.23 to 1.47, P=0.25). ④ Hemodymatics changed during the procedure: PLMA was more stable than TT. Conclusion It is safe to use PLMA for ventilation in laparoscopic biliary tract surgery. However, up to now, we still cannot draw a definite conclusion due to the low quality of the included studies, and more high quality trials of PLMA airway management for laporoscopic surgery are needed.
