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 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.