Abstract: Poster Presentations |

Comparative Evaluation of Late Postoperative Effects on Respiratory Mechanics Parameters Between Laparoscopic and Open Cholecystectomy FREE TO VIEW

George D. Bablekos, MD; Trianthi Roussou, MD; Stylianos A. Michaelides, MD, FCCP; Torben R. Rasmussen, MD, PhD; Markos Tsakopoulos, MD, PhD; Konstantinos Charalabopoulos, MD, PhD
Author and Funding Information

Dept. of Experimental Physiology, School of Medicine, University of Athens, Athens, Greece


Chest. 2003;124(4_MeetingAbstracts):162S-b-163S. doi:10.1378/chest.124.4_MeetingAbstracts.162S-b
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PURPOSE:  To evaluate and compare late postoperative alterations in respiratory mechanics associated with the laparascopic and open surgical technique for gall bladder removal.

METHODS:  We studied 28 patients without active cardiac or pulmonary disease of which 18, aged 52.6 ± 12.2 yrs (mean ±SD) were scheduled to undergo laparoscopic cholecystectomy(LC) while the rest 10, aged 54.8 ± 9.2 yrs (mean ± SD) were scheduled to undergo open cholecystectomy (OC). In both groups the same anesthetic protocol was used and analgesia was not prescribed on the days when lung function measurements were made. We used the Medgraphics body plethesmography system 1085D to record total lung capacity (TLC), residual volume (RV) and its ratio to TLC (RV/TLC), functional residual capacity (FRC), forced expiratory volume in 1 second (FEV1) and airways resistance (Raw). These parameters were recorded preoperatively, on the 2nd and 8th postoperative day. For the purpose of this study evaluations and comparisons were made between preoperative values and values of the 8th postoperative day. Statistical analysis used the t-test for paired observations.

RESULTS:  Lung function parameters measured preopperatively and on the 8th postoperative day are shown in Table 1

LC Group, Mean Values (± SD)

VariablesPreoperatively8th postop. daySignificanceTLC (L)5.03 ± 0.75.1 ± 0.9NS (p=0.769)RV (L)1.9 ± 0.42.2 ± 0.8NS (p=0.210)RV/TLC(%)36.6 ± 10.642.3 ± 13.2mean increase by 23.3 ± 10.5%9(p<0.05)FRC (L)2.9 ± 0.33.2 ± 0.7mean increase by 10.9 ± 6.1% (p<0.10)FEV1 (L)2.4 ± 0.62.3 ± 0.6NS (p=0.1)Raw (% pred.)85.3 ± 20.1101.4 ± 34.2mean increase by 16.64 ± 7.4% (p<0.05)for the laparoscopic cholecystectomy (LC) group and in Table 2

OC Group, mean values (± SD)

VariablesPreoperatively8th postop. daySignificanceTLC (L)5.9 ± 1.35.5 ± 1.1NS ± (p=0.162)RV (L)2.3 ± 0.72.1 ± 0.9NS ± (p=0.465)RV/TLC%39.0 ± 6.638.4 ± 13.7NS ± (p=0.882)FRC (L)3.4 ± 0.93.5 ± 0.6NS ± (p=0.874)FEV1 (L)2.6 ± 0.62.3 ± 0.5mean decrease by 9.7 ± 3.7% (p<0.05)Raw (%predicted)119.8 ± 65.3123.3 ± 45.9NS ± (p=0.930)for the open cholecystectomy (OC) group.

CONCLUSIONS:  By the 8th postoperative day there seemed to be a sustained increase in residual volume and airway resistance only in the laparoscopic colecystectomy group possibly attributable to a sustained thoracoabdominal movement derangement caused by CO2 insufflation used in this technique.

CLINICAL IMPLICATIONS:  Laparoscopic surgery may incur greater postoperative compromise in respiratory function in patients with obstructive lung disease prolonging recovery and contributing to postoperative respiratory complications.

DISCLOSURE:  G.D. Bablekos, None.

Wednesday, October 29, 2003

12:30 PM - 2:00 PM




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