Diaphragm movement before and after cholecystectomy: A sonographic study

Respiratory disorders after abdominal surgery are commonly explained by cha nges in diaphragmatic movement that are difficult to demonstrate and quanti fy. Our aim was thus to quantify these changes using a noninvasive method. We used M-mode sonography for the prospective study to measure diaphragmati c amplitude in 14 patients before and after cholecystectomy. During quiet b reathing, the diaphragm inspiratory amplitude (DIA) was significantly decre ased after surgery from 1.4 +/- 0.2 cm to 1 +/- 0.1 cm and from 1.6 +/- 0.3 cm to 1.2 +/- 0.3 cm in the Laparoscopic and Open Cholecystectomy groups, respectively. The total time cycle of diaphragmatic motion decreased signif icantly in the two groups. The DIA also decreased significantly during deep breathing after cholecystectomy from 6.0 +/- 0.8 cm to 3.0 +/- 1.8 cm and from 6.1 +/- 1.3 cm to 3.1 +/- 1.6 cm in the Laparoscopic and Open Cholecys tectomy groups, respectively. The six patients who underwent spirometric ex amination showed, during quiet breathing, a significant decrease in DIA wit hout change in tidal volume, i.e., 0.51 +/- 0.08 L to 0.45 +/- 0.08 L. We f ound a significant decrease in DIA after cholecystectomy and a significant interindividual correlation between DIA during deep inspiration and inspira tory capacity. Using M-mode sonography techniques, we were able to demonstr ate changes in diaphragmatic mobility after laparoscopic or open cholecyste ctomy.