Open Versus Laparoscopie Cholecystectomy A Comparison of Postoperative Pulmonary Function

Abstract

Upper abdominal surgery is associated with characteristic changes in pulmonary function which increase the risk of lower lobe atelectasis. Sixteen patients undergoing open cholecystectomy and 20 patients undergoing laparoscopic cholecystectomy were prospectively evaluated by pulmonary function tests (forced vital capacity [FVC], forced expiratory volume [FEV-1], and forced expiratory flow [FEF] 25% to 75%) before operation and on the morning after surgery to determine if the laparoscopic technique lessens the pulmonary risk. Fraction of the baseline pulmonary function was calculated by dividing the postoperative pulmonary function by the preoperative pulmonary function and multiplying by 100%. Postoperative FVC measured 52% of preoperative function for open cholecystectomy and 73% for laparoscopic cholecystectomy (p = 0.002). Postoperative FEV-1 measured 53% of baseline function for open cholecystectomy and 72% for laparoscopic cholecystectomy (p = 0.006). Postoperative FEF 25% to 75% measured 53% for open cholecystectomy and 81% for laparoscopic cholecystectomy (p = 0.07). It is concluded that laparoscopic cholecystectomy offers improved pulmonary function compared to the open technique.

Postoperative Pulmonary Changes after Laparoscopic Cholecystectomy

“…al. 3 showed a significant decrease in FEV 1 and FVC after laparoscopic cholecystectomy, reflecting a restrictive pulmonary dysfunction. The etiology of such postoperative dysfunction can involve multiple factors including activity of the phrenic nerve.…”

“…After laparoscopic cholecystectomy, the FVC decreases to 21%-46%, the FEV 1 to 20%-46%, and the FEF 25-75% to 12%-32% of the preoperative values. 3,4,6,8 The total lung capacity is suppressed to 8%. 6 Abdominal wall trauma and postoperative pain are reduced after laparoscopy.…”

“…Operations in the upper abdomen produce significant changes in the pulmonary function, including a reduction in vital capacity, forced expiratory volume in 1 second, peak expiratory flow and functional residual capacity. 3,4 Postoperative pulmonary dysfunction has primarily been considered a restrictive process. These changes may lead to the development of atelectasis, hypoxemia and pneumonia.…”

“…1,2 The suspension of pulmonary function is a well-known sequelae of upper abdominal surgery and has been characterized as a restrictive pattern dysfunction, faster recovery of preoperative pulmonary function, and less atelectasis. [1][2][3][4][5][6] Many authors have demonstrated that postoperative pulomonary function is better after laparoscopic cholecystectomy than after open cholecystectomy. [3][4][5][6] The purpose of our study was to measure the alteration in lung volumes, arterial blood gas values, and chest radiographs that follow laparoscopic cholecystectomy.…”

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.…”