Postoperative changes on pulmonary function after laparoscopic and open cholecystectomy

We examined 28 patients who underwent cholecystectomy for acute or chronic cholecystitis and/or cholelithiasis in order to evaluate the effect of surgical technique on respiratory functional parameters.

We compared lung volume, flow parameters and blood gas indices in two groups of patients, eighteen of which underwent laparoscopic and ten of which open cholecystectomy, specifically on the 2nd and 8th postoperative day lung function indices were compared to preoperative values. The same anesthetic protocol was administered for all patients. No underlying illness other than the cholecystitis and/or cholelithiasis was present.

From the results of lung volume parameters, ERV (%pred) data indicate a better expiratory ability for the Open Cholecystectomy [preop.: 93.10 (38.80), 8th day: 116.90 (63.69) compared to the Laparoscopic Cholecystectomy group (preop.: 105.39 (31.51), 8th day: 98.72 (35.80). For IC (%pred.) parameter, in the Open Cholecystectomy group a marked but not statistically significant decrease remained into the 8th day (preop.: 86.70 (16.40). 8th day: 68.40 (16.98)] whereas for the Laparoscopic Cholecystectomy group, IC %pred value reflected a better respiratory performance [preop.: 92.83 (17.87), 8th day: 82.50 (18.82)]. For RV and RV/TLC parameter measurements a marked increase in the %pred value was observed for the Laparoscopic Cholecystectomy group on the 8th postoperative day as compared to preoperative data [RV: 122.94 (42.80), 109.22 (33.23) respectively, RV/TLC: 122.68 (31.10), 109.14 (21.56) respectively]. From the analysis of the flow parameters, a distinct difference was evident for PEF between the preoperative and 8th postoperative day data with the Laparoscopic Cholecystectomy group showing statistically significant better flow rates [preop.: 93.72 (15.91), 8th day: 84.33 (20.67)] as compared to the Open Cholecystectomy group [preop.: 82.30 (22.98), 8th day: 59.10 (15.23)].

Having compared the 8th postoperative day with preoperative data for the two surgical methods, open cholecystectomy presented a better expiratory performance as compared to the laparoscopic method. However, laparoscopic cholecystectomy resulted in an overall better postoperative respiratory function.