Laparoscopic and laparotomic cholecystectomy: a randomized trial comparing postoperative respiratory function.
BACKGROUND
The fact that pulmonary complications occur in 20-60% of the patients subjected to abdominal operations clearly indicates that the lungs are the most endangered organ during the postoperative period.


OBJECTIVE
The aim of this study was to demonstrate the impact of cholecystectomy on postoperative respiratory disturbances by comparing the laparotomic cholecystectomy with laparoscopic gallbladder removal.


METHODS
A hundred cholecystectomized patients were included in the prospective randomized clinical trial. Half of the patients were operated on by the laparotomic procedure, whereas the other half underwent laparoscopic cholecystectomy. Spirometric parameters, arterial blood gases, and acid-base balance were determined before the operation, and at 6, 24, 72 and 144 h postoperatively. Abdominal distension was assessed by auscultating intestinal peristaltics, abdominal circumference measurement, and time interval to restitution of defecation.


RESULTS
Six hours postoperatively, the values of ventilation parameters decreased on average by 40-50% from the baseline preoperative values in both groups of patients. The group of patients submitted to laparotomic cholecystectomy had significantly lower spirometric values and slower recovery of the ventilation parameters than the laparoscopic cholecystectomy group. Abdominal circumference was significantly greater and the time needed for restitution of peristaltics and defecation was significantly longer in the laparotomic cholecystectomy group compared to the group of laparoscopic cholecystectomy.


CONCLUSIONS
Statistically significant impairments including hypoxia, hypocapnia and hyperventilation were observed in the patients submitted to laparotomic cholecystectomy, indicating the presence of objective respiratory risk, especially in elderly patients and patients with obstructive pulmonary diseases or cardiac insufficiency.
Mimica
Z
Z
Department of Surgery, Split University Hospital, Split, Croatia. zmimica@st.tel.hr
Biocić
M
M
Bacić
A
A
Banović
I
I
Tocilj
J
J
Radonić
V
V
Ilić
N
N
Petricević
A
A
D000005:Abdomen / Q000502:physiology; D002763:Cholecystectomy / Q000009:adverse effects*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D003672:Defecation / Q000502:physiology; D005069:Evaluation Studies as Topic; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D008176:Lung Volume Measurements; D010528:Peristalsis / Q000502:physiology; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D013147:Spirometry; D016896:Treatment Outcome