NORMAL INSPIRATORY MUSCLE STRENGTH IS RESTORED MORE RAPIDLY AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Respiratory complications after laparotomy cholecystectomy may result from generalised muscle weakness and fatigue, or from reduced respirat ory muscle function secondary to an upper abdominal incision. In a pro spective study we compared maximal inspiratory effort (Pi(max)/mmHg) a nd dominant hand grip strength (kPa) (expressed as a percentage of zer o hour value) in patients undergoing open cholecystectomy (OC) (n=12), laparoscopic cholecystectomy (LC) (n=25) and a control group of patie nts undergoing lower limb surgery (n=12). Of the 12 OC patients, three suffered respiratory complications: two had atelectasis and one a che st infection, compared with no such complications in the other two gro ups (P < 0.05). Pi(max) decreased postoperatively in all groups (P < 0 .05) and had returned to normal by 48 h in the LC and control groups. In contrast, in the OC group Pi(max), fell from 112.5 +/- 17.8 mmHg to as low as 81.3 +/- 16.5 mmHg at 72 h and only returned to preoperativ e levels at 120 h. The hand grip strength fell significantly in all gr oups at 24 h (P < 0.05) but normal levels were achieved again by 48 h in all groups, and there was no significant difference in the hand gri p strength between the groups over the 5 days. These results suggest t hat generalised muscle fatigue after surgery is similar after open and laparoscopic cholecystectomy. Open cholecystectomy does, however, cau se a more prolonged reduction in respiratory muscle function and this is likely to contribute to the higher incidence of respiratory complic ations in this group of patients.