PURPOSE: Abdominal surgeries interfere with pulmonary mechanics and may induce restrictive ventilatory changes. Such restriction in peritoneal manipulation is possibly due to the manipulation of the viscera, causing reflex inhibition of the phrenic nerve and subsequent temporary paresis of the diaphragm muscle. The procedures that affect pulmonary function include videolaparoscopic surgeries, such as those performed for cholecystectomy (CC) and anti-reflux valve (ARV) placement that, despite allowing fast recovery, low pain and minimal visceral manipulation, require a pneumoperitoneum which increases intra-abdominal pressure and lead to atelectasis of pulmonary bases overlapping ventilatory mechanical deficit. Then, the purpose of this study is to analyze and compare changes in respiratory function and exercise capacity after videolaparoscopic surgeries with diaphragm manipulation (ARV) and without (CC).
METHODS: Seventy-five patients were included. Fifty of them underwent CC and 25 underwent ARV. Manuvacuometry, ventilometry, spirometry and 6-minute walk test were performed according to the guidelines of the American Thoracic Society, preoperatively and at 1 (PO1), 5 (PO5) and 30 (PO30) days after surgery. Stair-climbing test was undertaken at all time points but on PO1. During exercise testing, heart rate and respiratory rate monitoring and oxymetry were performed.
RESULTS: Respiratory pressures of manuvacuometry dropped on PO1, but were normalized on PO5 in both groups. Minute volume of ventilometry did not change in both groups, and spirometry (FEV1, VFC, MVV) dropped on PO1 in both groups, recovering on PO5. The 6-minute walk test distance was reduced on PO1, but showed evident recovery on PO5 in both groups. The time taken to ascend all the steps of the staircase of stair-climbing test was not measured on PO1 and was also normal on PO5.
CONCLUSION: Videolaparoscopic surgeries for ARV and CC decrease respiratory function and exercise capacity at PO1 returning to preoperative levels on PO5 in both groups: with and without diaphragm manipulation.
CLINICAL IMPLICATIONS: There is no significant clinical differences in postoperative pulmonary changes of laparoscopic surgeries with or without diaphragmatic manipulation and should therefore be considered similar in preoperative pulmonary evaluation.
DISCLOSURE: Daniele Cataneo, No Financial Disclosure Information; No Product/Research Disclosure Information