Laparoscopic and Laparotomic Cholecystectomy: A Randomized Trial Comparing Postoperative Respiratory Function

Abstract

Background: The fact that pulmonary complications occur in 20–60% of the patients subjected to abdominal operations clearly indicates that the lungs are the most endangered organ during the postoperative period. Objective: The aim of this study was to demonstrate the impact of cholecystectomy on postoperative respiratory disturbances by comparing the laparotomic cholecystectomy with laparoscopic gallbladder removal. Patients and Methods: A hundred cholecystectomized patients were included in the prospective randomized clinical trial. Half of the patients were operated on by the laparotomic procedure, whereas the other half underwent laparoscopic cholecystectomy. Spirometric parameters, arterial blood gases, and acid-base balance were determined before the operation, and at 6, 24, 72 and 144 h postoperatively. Abdominal distension was assessed by auscultating intestinal peristaltics, abdominal circumference measurement, and time interval to restitution of defecation. Results: Six hours postoperatively, the values of ventilation parameters decreased on average by 40–50% from the baseline preoperative values in both groups of patients. The group of patients submitted to laparotomic cholecystectomy had significantly lower spirometric values and slower recovery of the ventilation parameters than the laparoscopic cholecystectomy group. Abdominal circumference was significantly greater and the time needed for restitution of peristaltics and defecation was significantly longer in the laparotomic cholecystectomy group compared to the group of laparoscopic cholecystectomy. Conclusions: Statistically significant impairments including hypoxia, hypocapnia and hyperventilation were observed in the patients submitted to laparotomic cholecystectomy, indicating the presence of objective respiratory risk, especially in elderly patients and patients with obstructive pulmonary diseases or cardiac insufficiency.

Comparação entre inspirometria de incentivo e pressão positiva expiratória na função pulmonar após cirurgia bariátrica

“…Essas alterações são descritas tanto em cirurgias por laparotomia quanto por videolaparoscopia, sendo menos acentuadas neste último tipo [8][9][10] . No entanto, ainda não está bem definido se a cirurgia videolaparoscópica reduz a incidência de CPP 1,2 .…”

Effects of laparotomy or laparoscopicprocedures for cholecystectomy on diaphragmatic and thoracoabdominal mobility

“…[6][7][8][9][10][23][24][25][26][27][28][29][30] Contudo, ainda não está totalmente esclarecido se um destes procedimentos cirúrgicos interfere mais do que o outro na mobilidade diafragmática e toracoabdominal do indivíduo.…”

“…6 Entretanto, alguns estudos mostraram que a manipulação da cavidade abdominal tanto na colecistectomia por laparotomia quanto na videolaparoscopia leva à diminuição significativa dos volumes e capacidades pulmonares nas primeiras horas de pós-operatório. [7][8][9][10] Isso ocorre possivelmente devido as duas formas cirúrgicas promoverem inibição reflexa do nervo frênico, com consequente disfunção diafragmática, afetando assim a ventilação e a expansão pulmonar. [11][12][13][14][15] Em 2008, Keus et al 9 compararam pacientes submetidos às duas formas de cirurgia e concluíram não existirem diferenças na função pulmonar dos pacientes em relação à técnica utilizada.…”

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

“…(High quality evidence). LC seems a relatively safe procedure for special groups of patients such as the elderly, pregnant women or patients with cirrhosis and portal hypertension Child A y B (Low quality evidence) (ANDEM, 1994;Downs, 1996;Korolija, 2004;Mimica, 2000;Ros, Clinical High quality: it is very unlikely that future studies change our confidence in the estimate of effect and therefore our confidence is high. Moderate quality: it is likely that future studies change our confidence in the estimate of effect.…”

“…Four SRs (ANDEM, 1994;Downs, 1996;Korolija, 2004;Keus, 2006a;Keus, 2006b), two RCTs (Mimica, 2000;Ros, 2001), three cohort studies (Devereaux, 2005;Elder, 1996;Finan, 2006), one CPG (Zacks, 2002), one cross-sectional study (Collet, 1997) and one case series (Ibrahim, 2006) were included. One SR concluded that laparoscopic techniques take longer than conventional techniques.…”