TY - JOUR
T1 - Normal inspiratory muscle strength is restored more rapidly after laparoscopic cholecystectomy
AU - Da Costa, M. L.
AU - Qureshi, M. A.
AU - Brindley, N. M.
AU - Burke, P. E.
AU - Grace, P. A.
AU - Bouchier-Hayes, D.
PY - 1995
Y1 - 1995
N2 - Respiratory complications after laparotomy cholecystectomy may result from generalised muscle weakness and fatigue, or from reduced respiratory muscle function secondary to an upper abdominal incision. In a prospective study we compared maximal inspiratory effort (Pi(max)/mmHg) and dominant hand grip strength (kPa) (expressed as a percentage of zero hour value) in patients undergoing open cholecystectomy (OC) (n=12), laparoscopic cholecystectomy (LC) (n=25) and a control group of patients undergoing lower limb surgery (n=12). Of the 12 OC patients, three suffered respiratory complications: two had atelectasis and one a chest infection, compared with no such complications in the other two groups (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 preoperative levels at 120 h. The hand grip strength fell significantly in all groups 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 grip strength between the groups over the 5 days. These results suggest that generalised muscle fatigue after surgery is similar after open and laparoscopic cholecystectomy. Open cholecystectomy does, however, cause a more prolonged reduction in respiratory muscle function and this is likely to contribute to the higher incidence of respiratory complications in this group of patients.
AB - Respiratory complications after laparotomy cholecystectomy may result from generalised muscle weakness and fatigue, or from reduced respiratory muscle function secondary to an upper abdominal incision. In a prospective study we compared maximal inspiratory effort (Pi(max)/mmHg) and dominant hand grip strength (kPa) (expressed as a percentage of zero hour value) in patients undergoing open cholecystectomy (OC) (n=12), laparoscopic cholecystectomy (LC) (n=25) and a control group of patients undergoing lower limb surgery (n=12). Of the 12 OC patients, three suffered respiratory complications: two had atelectasis and one a chest infection, compared with no such complications in the other two groups (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 preoperative levels at 120 h. The hand grip strength fell significantly in all groups 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 grip strength between the groups over the 5 days. These results suggest that generalised muscle fatigue after surgery is similar after open and laparoscopic cholecystectomy. Open cholecystectomy does, however, cause a more prolonged reduction in respiratory muscle function and this is likely to contribute to the higher incidence of respiratory complications in this group of patients.
KW - Laparoscopic cholecystectomy
KW - Respiratory muscles
UR - http://www.scopus.com/inward/record.url?scp=0029074410&partnerID=8YFLogxK
M3 - Article
C2 - 7574314
AN - SCOPUS:0029074410
SN - 0035-8843
VL - 77
SP - 252
EP - 255
JO - Annals of the Royal College of Surgeons of England
JF - Annals of the Royal College of Surgeons of England
IS - 4
ER -