COMPARISON OF POSTOPERATIVE RESPIRATORY-FUNCTION AFTER LAPAROSCOPY OR OPEN LAPAROTOMY FOR CHOLECYSTECTOMY

Cholecystectomy performed via laparotomy is associated with reduction of lung volumes including functional residual capacity that may lead to postoperative hypoxia and atelectasis. Laparoscopic cholecystectomy is associated with faster recovery compared to open laparotomy and cholecystectomy. To determine whether laparoscopic cholecystectomy was associated with less pulmonary dysfunction, 20 patients (ASA Physical Status I) undergoing elective cholecystectomy were randomly assigned to surgical teams performing either laparoscopy or open laparotomy for cholecystectomy. Patients in whom one or the other surgical technique had to be performed for medical or psychologic indications were excluded from the study. A standardized anesthetic technique and postoperative analgesic regimen were used. Forced vital capacity and forced expiratory volume in 1 s; functional residual capacity determined by a closed-circuit, constant volume helium dilution technique; and arterial O2 and CO2 tensions were measured preoperatively and at 6, 24, and 72 h postcholecystectomy. Forced vital capacity and forced expiratory volume in 1 s were significantly greater (P < 0.05) in the laparoscopy compared to the laparotomy group at 6, 24, and 72 h postoperatively. Forced vital capacity relative to preoperative values was significantly (P < 0.05) greater in patients with laparoscopy (24 h, 70 +/- 14%; 72 h, 91 +/- 6%) compared to open laparotomy (24 h, 57 +/- 23%; 72 h, 77 +/- 14%). Similarly, forced expiratory volumes in 1 s relative to preoperative values were significantly (P < 0.05) greater in patients with laparoscopy (24 h, 85 +/- 13%; 72 h, 92 +/- 9%) compared to open laparotomy (24 h, 54 +/- 22%; 72 h, 77 +/- 11%). Functional residual capacity was decreased in the laparoscopy group at 6 h (P < 0.05) postoperatively and in the open laparotomy group at 6 h (P < 0.01), 24 h (P < 0.05), and 72 h (P < 0.05) postoperatively. The difference in functional residual capacity between the groups was evident at 72 h postoperatively. Significantly higher arterial O2 tension (P < 0.05) was observed in the laparoscopic cholecystectomy group. The authors conclude that respiratory function is less impaired and its recovery improved after laparoscopic cholecystectomy compared to open cholecystectomy.