Comparison of pulmonary function and postoperative pain after laparoscopicversus open gastric bypass: A randomized trial

BACKGROUND: Impairment of pulmonary function is common after upper abdomina l operations. The purpose of this study was to compare postoperative pulmon ary FUNCTION and analgesic requirements in patients undergoing either lapar oscopic or open Roux-en-Y gastric bypass (GBP). STUDY DESIGN:Seventy patients with a body mass index of 40 to 60 kg/m(2) we re randomly assigned to undergo laparoscopic (n = 36) or open (n = 34) GBP. The two groups were similar in age, gender, body mass index, pulmonary his tory, and baseline pulmonary function. Pulmonary function studies were perf ormed preoperatively and on postoperative days 1, 2, 3, and 7, Oxygen satur ation and chest radiographs were performed on both groups preoperatively an d on postoperative day 1. Postoperative pain was evaluated using a visual a nalog scale and the amount of narcotic consumed was recorded. Data are pres ented as mean +/- standard deviation. RESULTS: Laparoscopic GBP patients had significantly less impairment of pul monary function than open GBP patients on the first three postoperative day s (p < 0.05). By the 7th postoperative day all pulmonary function parameter s in the laparoscopic GBP group had returned to within preoperative levels, but only one parameter (peak expiratory flow) had returned to preoperative levels in the open GRP group. On the first postoperative day, laparoscopic GBP patients used less morphine than open GBP patients (46 <plus/minus> 31 mg versus 76 +/- 39 mg. respectively, p < 0.001), and visual analog scale pain scores at rest and during mobilization were lower after laparoscopic G BP than after open GBP (p < 0.05). Fewer patients after laparoscopic GBP th an after open GBP developed hypoxemia (31% versus 76%, p < 0.001) and segme ntal atelectasis (6% versus 55%, p = 0.003), CONCLUSIONS: Laparoscopic gastric bypass resulted ill less postoperative su ppression of pulmonary function, decreased pain, improved oxygenation, and less atelectasis than open gastric bypass. (J Am Coll Surg 2001;192:463-477 . (C) 2001 by the American College of Surgeons).