POSTOPERATIVE RESPIRATORY-FUNCTION FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY

Open cholecystectomy is associated with characteristic changes in pulm onary function showing a restrictive pattern. Laparoscopic cholecystec tomy without opening of the peritoneal cavity could be an alternative in reducing postoperative respiratory dysfunction. Having given their informed consent, 13 healthy ASA1 patients (age : 41 +/- 18 yrs) under going laparoscopic cholecystectomy were enrolled in this study, in ord er to assess their postoperative pulmonary function tests (forced vita l capacity [FRC], forced expiratory volume [FEV1], functional residual capacity [FRC]) before operation (TO) and 4 h (T4), 24 h (T24), 48 h (T48) after surgery. Anaesthesia technique was the same associating pr opofol-atracurium-fentanyl, 50 % N2O/O2. Ventilation was adapted to ma intain end-tidal carbon dioxide pressure up to 30-35 mmHg. Postoperati ve analgesic regimen consisted of paracetamol-ketoprofen. Mean length of surgery was 84 +/- 15 min ; mean duration of anaesthesia was 110 +/ - 24 min. An immediate and harmonious restrictive breathing pattern de veloped postoperatively. Postoperative FVC measured 65 % (T4). 63 % (T 24), 72 % (T48) of preoperative function (p < 0.025) ; postoperative F EV1 measured respectively 60, 66 and 75 % of preoperative function (p > 0.001), without change in FEV1/CV and FRC; a significant hypoxia occ urred (T0: 86 mmHg, T4: 80 mmHG, T24: 75 mmHg, T48: 81 mmHg [p < 0.05] ). Laparoscopic cholecystectomy resulted in less postoperative respira tory dysfunction than conventional cholecystectomy, as previously repo rted ; this restrictive pattern observed without changes in FRC was si milar to that following lower abdominal surgery.