Laparoscopic vs. small incision cholecystectomy: Implications for pulmonary function and pain. A randomized clinical trial

Abstract

When evaluated with strict methodology and standardization of care, no clinically relevant differences were found between SIC and LC regarding pulmonary function. Our results suggest that the popularity of the laparoscopic technique cannot be attributed to pulmonary preservation.

Minimal impairment in pulmonary function following laparoscopic surgery

“…The primary outcome was assessed in all analysed patients, but some patients were unable to perform the pulmonary function testing after surgery, with approximately 87% being able to perform the assessment of shunt, O 2 loss, as well as spirometry 2 h postoperatively, which is comparable with previous studies. 14 The reduction in PaO 2 after laparoscopic cholecystectomy found in this study was smaller than the reductions reported earlier. 4,5,14 Important differences include higher consumption of morphine 5 and that the measurements were done 1 h after surgery instead of 2 h where residual anaesthetic effects may have an impact.…”

“…14 The reduction in PaO 2 after laparoscopic cholecystectomy found in this study was smaller than the reductions reported earlier. 4,5,14 Important differences include higher consumption of morphine 5 and that the measurements were done 1 h after surgery instead of 2 h where residual anaesthetic effects may have an impact. 5,14 A reduction of 1.1 kPa in PaO 2 1 h after laparoscopic cholecystectomy and an almost identical reduction 24 h postoperatively (1.0 kPa) was found in a previous study.…”

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.…”

“…[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. Contudo, outros estudos afirmam que a técnica videolaparoscópica gera menos complicações pulmonares.…”