The evaluation of pulmonary function and blood gas analysis in patients submitted to laparoscopic versus open nephrectomy

Abstract

Background:The aim of this study was to assess the early postoperative pulmonary function and arterial blood gases in patients who have undergone open versus laparoscopic nephrectomy.Materials and Methods:Forty patients were randomly assigned to undergo laparoscopic (LN, n=20) or open nephrectomy (ON, n=20). Pulmonary function tests including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), forced expiratory volume at 25% (FEF25), forced expiratory volume at 50% (FEF50), forced expiratory volume at 25% to 75% (FEF25–75), forced expiratory volume in 1 second (FIV1) and peak expiratory flow (PEF) were performed one day before the operation and on the postoperative day 1. The arterial blood gas analysis (pH, pCO2, pO2, SaO2) was made at breathing room preoperatively, in the recovery phase and on postoperative day 1.Results:All spirometric variables decreased after both open and laparoscopic nephrectomy on postoperative day 1. FEV1, FVC, FEF25 and FEF25–75 values decreased on postoperative day 1 (39.7%, 37.4%, 27.7%, 51.8% respectively) in the open surgery group and they were significantly lower in laparoscopic group (29.9%, 32.5%, 23.2%, 44.5% respectively). There were no significant differences in FEF50, PEF and FIV1 between the groups. The SaO2 and pO2 values also decreased in both groups. During early recovery, pH decreased while pCO2 increased significantly but they returned to preoperative values on postoperative day 1 in both groups.Conclusion:Laparoscopic nephrectomy is better than open nephrectomy considering pulmonary functions.

Changes of diaphragmatic excursion and lung compliance during major laparoscopic pelvic surgery: A prospective observational study

“…Laparoscopic surgery has resulted in shorter hospital stay, less pulmonary complication, less postoperative pain than open surgery [1, 2]. However, this study revealed that lung compliance was also decreased following transiently decreased diaphragmatic excursion during major laparoscopic pelvic surgery with steep Trendelenburg position and pneumoperitoneum.…”

“…In recent years, laparoscopic surgery has been preferred to open techniques because it results in less incisional pain, fewer pulmonary complications, and shorter hospital stays [1, 2]. However, pneumoperitoneum decreases pulmonary compliance due to cephalad displacement of the diaphragm [3].…”

Respiratory function following major emergency abdominal surgery

“…The specific reason to this dysfunction is unknown; however, a combination of postoperative inflammation and diaphragm irritation are the most likely reasons. Reduced postoperative respiratory function has been documented to be associated with non-modifiable variables such as age, reduced preoperative O 2 saturation, emergency surgery, smoking, pre-existing cardiopulmonary disease and upper gastrointestinal surgery, as well as modifiable variables such as surgical procedure (open surgery versus laparoscopic surgery) and preoperative anaemia (Bablekos et al 2014, Canet et al 2010, Koc et al 2015, Siddiqui et al 2015). Clinical causes for respiratory dysfunction after surgery include pulmonary atelectasis, pneumonia, pleural effusion, pulmonary embolism, pulmonary oedema due to inflammatory mediated capillary leak, perioperative fluid therapy and the risk of respiratory dysfunction caused by the substantial perioperative surgical stress that patients undergo during major emergency abdominal surgery (Kohl and Deutschman 2006, Ruiz et al 2016).…”

A Comparative Study of Pulmonary Function Test in Laparotomy And Laparoscopic Surgeries

“…Laparoscopic abdominal surgery is considered to cause less pulmonary dysfunction than open abdominal surgery since it causes less incisional pain in the postoperative period and 1,3 consequently has less effect on postoperative lung oxygenation . While there are many studies that compared open and laparoscopic surgery regarding their pulmonary effects in procedures such as cholecystectomy, obesity surgery, esophagogastric surgery, and 4 nephrectomy, there are very few such studies on colorectal surgeries.…”