ALTERATIONS IN RESPIRATORY MECHANICS AFTER LAPAROSCOPIC AND OPEN SURGICAL-PROCEDURES

OBTECTIVE: To compare the effects of laparoscopic and open surgical pr ocedures on postoperative strength and respiratory mechanics. DESIGN: Prospective cohort study. SETTING: Adult university hospital. PARTICIP ANTS: Fifty-one women aged 21 to 62 years scheduled to undergo electiv e cholecystectomy or hysterectomy (or related procedures), othwrwise i n good health. INTERVENTION: Open or laparoscopic cholecystectomy or h ysterectomy (or related procedures). MAIN OUTCOME MEASURES: Maximum vo luntary handgrip strength (HGS), forced vital capacity (VC), forced es piratory volume in 1 second (FEV(1)), and maximal inspiratory pressure (MIP) were each measured preoperatively and on the first postoperativ e morning. A visual analogue pain scale score was evaluated in relatio n to performance of the postoperative strength and respiratory measure ments. RESULTS: VC, FEV, and MIP, but not HGS, were decreased after su rgery. Postoperative VC, FEV, and MIP were lower after open procedures than after laparoscopic procedures and after cholecystectomy than aft er hysterectomy (all p < 0.001). Pain scores were lower after laparosc opic than after open procedures (p < 0.005) and could account in part for differences in postoperative respiratory mechanics. CONCLUSIONS: C holecystectomy and hysterectomy do not result in generalized muscle we akness, unlike more major abdominal procedures. Postoperative alterati ons in respiratory mechanics are related to the site of the surgery, t he use of an open versus a laparoscopic approach and postoperative pai n.