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Functional impairment of the abdominal wall following laparoscopic and open cholecystectomy
B Balogh1, A Zauner-Dung, P Nicolakis
1Department of Plastic and Reconstructive Surgery, KH Lainz, Wolkersbergenstrasse 1, A-1130 Vienna, Austria. bab@pch.khl.magwien.gv.at
Background:
Subcostal incisions for open cholecystectomy (OC) denervate the right upper and middle abdomen.
Methods:
Sensory and abdominal muscle function (Janda's muscle function test, Cybex 6000) was evaluated. Healthy volunteers (10 women, 12 men) were compared with 13 women and 12 men after OC and 11 women and 11 men after laparoscopic cholecystectomy (LC). For computed tomography (CT) studies, a spiral scanner was used.
Results:
Of the OC patients, 21 (95.5%) complained of dys- and anesthesias below the incision. Of the LC patients, only nine (2.4%) reported anesthesias around the port sites. Normal subjects scored significantly higher in muscle strength (p <.01). LC patients scored higher than OC patients at 10 degrees and 20 degrees trunk flexion (p <.05). Depending on the flexion angles, the men in all groups developed 30-114% more muscle power than the women. Denervation of the abdominal muscles was confirmed by CT.
Conclusion:
OC reduced skin sensitivity and abdominal muscle function. Although the procedure is minimally invasive, LC also causes sensory and functional losses, albeit minor ones.