Laparoscopic cholecystectomy for patients with chronic obstructive pulmonary disease

Laparoscopic cholecystectomy (LC) is accepted as a "gold standard" for treating most gallbladder diseases because it is superior to the open method, causes less postoperative pulmonary dysfunction, and promotes earlier postoperative recovery. The laparoscopically associated adverse effects of a carbon dioxide (CO(2)) pneumoperitoneum, however, such as hypercarbia and arterial acidosis, are more pronounced in patients with chronic obstructive pulmonary disease (COPD). The clinical results of LC for patients with COPD are analyzed in this study.

Twenty-two patients with COPD (group 1) and undergoing LC were compared with 25 control patients without COPD and also undergoing LC (group 2). Patient demographics, intraoperative end-tidal CO(2) (both before and after CO(2) insufflation), and clinical outcome, including surgical duration, length of postoperative hospital stay, and any associated complications, were analyzed.

The procedure of one group 1 patient was converted to the open method, and this patient was excluded from the study. Comprising the COPD group were 20 patients with mild COPD and one patient with moderate COPD. With similar settings of tidal volume and ventilation rate for the two groups, the measured end-tidal CO(2) value was significantly greater for group 1 than for group 2 patients after the creation of a CO(2) pneumoperitoneum (34.2 +/- 2.7 vs. 30.7 +/- 3.6 mm Hg; P =.012). The duration of surgery was similar for groups 1 and 2 (88.9 +/- 36.0 vs. 83.2 +/- 38.3 minutes), as was the duration of the postoperative hospital stay (3.3 +/- 1.6 vs. 3.4 +/- 2.2 days). No pulmonary complications were noted for any of the patients.

LC can be safely performed in COPD patients with mild or even a moderate degree of airway obstruction. Intraoperative CO(2) retention did not complicate the postoperative recovery in terms of the complication rate or the duration of the postoperative hospital stay.