Laparoscopic Cholecystectomy and Pulmonary Function?
Laparoscopic Cholecystectomy and Pulmonary Function?
How do you decide whether to perform a laparoscopic vs an open surgical procedure for cholethiasis in a 45-year-old male who is an active smoker (40 cigarettes/day for last 20 years) with no cardiac problems and FEV1 of 40%?
Babak Tabandeh, MD
Most patients with impaired pulmonary function do well with laparoscopic procedures. However, several studies have demonstrated that laparoscopic cholecystectomy (LC) is associated with decreased pulmonary function in the initial postoperative period. These changes are typically smaller than those accompanying open cholecystectomy (OC), but 3 of these studies used historical controls. In the single study that directly compared LC (n = 30) with OC (n = 9), forced vital capacity (23% vs 35%), forced expiratory volume (24% vs 36%), and forced expiratory flow (24% vs 40%) were all decreased less in the LC group compared with the OC group. Although the patient demographic characteristics were similar between groups, the study has a small patient population and the data do not directly assess postoperative pulmonary function in patients with impaired preoperative lung function. Patients with preserved cardiac function in the face of pulmonary insufficiency will likely have fewer complications with LC than will patients with decreased cardiac and pulmonary function. Patients with poor cardiopulmonary function tend to become acidotic with carbon dioxide pneumoperitoneum, which further impairs cardiac function.
Most patients with poor lung function can tolerate a LC with careful perioperative monitoring. Intraoperative monitoring may require not only an arterial line to monitor blood pressure and obtain blood gases, but a pulmonary arterial catheter may also be necessary in some patients with severe cardiopulmonary insufficiency. With careful intraoperative monitoring, almost all patients can have attempted LC with conversion to open cholecystectomy if intraoperative cardiac or pulmonary function deteriorate to the degree that oxygen delivery to the tissues is impaired.
How do you decide whether to perform a laparoscopic vs an open surgical procedure for cholethiasis in a 45-year-old male who is an active smoker (40 cigarettes/day for last 20 years) with no cardiac problems and FEV1 of 40%?
Babak Tabandeh, MD
Most patients with impaired pulmonary function do well with laparoscopic procedures. However, several studies have demonstrated that laparoscopic cholecystectomy (LC) is associated with decreased pulmonary function in the initial postoperative period. These changes are typically smaller than those accompanying open cholecystectomy (OC), but 3 of these studies used historical controls. In the single study that directly compared LC (n = 30) with OC (n = 9), forced vital capacity (23% vs 35%), forced expiratory volume (24% vs 36%), and forced expiratory flow (24% vs 40%) were all decreased less in the LC group compared with the OC group. Although the patient demographic characteristics were similar between groups, the study has a small patient population and the data do not directly assess postoperative pulmonary function in patients with impaired preoperative lung function. Patients with preserved cardiac function in the face of pulmonary insufficiency will likely have fewer complications with LC than will patients with decreased cardiac and pulmonary function. Patients with poor cardiopulmonary function tend to become acidotic with carbon dioxide pneumoperitoneum, which further impairs cardiac function.
Most patients with poor lung function can tolerate a LC with careful perioperative monitoring. Intraoperative monitoring may require not only an arterial line to monitor blood pressure and obtain blood gases, but a pulmonary arterial catheter may also be necessary in some patients with severe cardiopulmonary insufficiency. With careful intraoperative monitoring, almost all patients can have attempted LC with conversion to open cholecystectomy if intraoperative cardiac or pulmonary function deteriorate to the degree that oxygen delivery to the tissues is impaired.
Source...