title: Normal inspiratory muscle strength is restored more rapidly after laparoscopic cholecystectomy.
abstract: Respiratory complications after laparotomy cholecystectomy may result from generalised muscle weakness and fatigue, or from reduced respiratory muscle function secondary to an upper abdominal incision. In a prospective study we compared maximal inspiratory effort (Pimax/mmHg) and dominant hand grip strength (kPa) (expressed as a percentage of zero hour value) in patients undergoing open cholecystectomy (OC) (n = 12), laparoscopic cholecystectomy (LC) (n = 25) and a control group of patients undergoing lower limb surgery (n = 12). Of the 12 OC patients, three suffered respiratory complications: two had atelectasis and one a chest infection, compared with no such complications in the other two groups (P < 0.05). Pimax decreased postoperatively in all groups (P < 0.05) and had returned to normal by 48 h in the LC and control groups. In contrast, in the OC group Pimax fell from 112.5 +/- 17.8 mmHg to as low as 81.3 +/- 16.5 mmHg at 72 h and only returned to preoperative levels at 120 h. The hand grip strength fell significantly in all groups at 24 h (P < 0.05) but normal levels were achieved again by 48 h in all groups, and there was no significant difference in the hand grip strength between the groups over the 5 days. These results suggest that generalised muscle fatigue after surgery is similar after open and laparoscopic cholecystectomy. Open cholecystectomy does, however, cause a more prolonged reduction in respiratory muscle function and this is likely to contribute to the higher incidence of respiratory complications in this group of patients.
authors.affiliation: Department of Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin.
authors.forename: M L
authors.initials: ML
authors.lastname: Da Costa
authors.forename: M A
authors.initials: MA
authors.lastname: Qureshi
authors.forename: N M
authors.initials: NM
authors.lastname: Brindley
authors.forename: P E
authors.initials: PE
authors.lastname: Burke
authors.forename: P A
authors.initials: PA
authors.lastname: Grace
authors.forename: D
authors.initials: D
authors.lastname: Bouchier-Hayes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D018737:Hand Strength; D006801:Humans; D001239:Inhalation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D012120:Respiration Disorders / Q000209:etiology; D012132:Respiratory Muscles / Q000502:physiology*