Dr. Pallavi Ajankar


Background and Aims- Respiratory complications account to majority of post-operative outcomes after abdominal surgeries. Data on exact
prevalence and probability after different surgeries is scanty. Aim of our study is to evaluate pre and post operative differences objectively by using
spirometry in patients undergoing upper abdominal laparoscopic and laparotomy surgeries.
Methods- Seventy-one patients consecutively undergoing surgeries were enrolled, of which 36 underwent laparoscopic and rest open laparotomy.
Patients were subjected to spirometry pre and post operatively, and FVC, FEV1, FEV1/FVC, VC were calculated. This cross sectional data was
analysed using paired “t” test, Students “t” test and Chi square.
Results- Preoperative FEV1,ERV, TLC, PEFR were significantly better in laparotomy than laparoscopic group (p value <0.05). Age, sex and BMI
were not significant determinants. Post operatively the laparoscopic group had better outcomes than laparotomy group. The exact mechanisms
were not known but minimal scar length, lesser damage to diaphragm and muscles, younger age of patients in laparoscopic group and early
postoperative rehabilitation could be possible explanations
Conclusions- Present study demonstrates that laparoscopic surgeries has less adverse effects on postoperative pulmonary function than
laparotomy surgeries. This may correlate with lower post op respiratory complications in laparoscopy group.

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Bablekos GD, Michaelides SA, Analitis A, Charalabopoulos KA: Effcts of laparoscopic cholecystectomy on lung function: A systematic review. World J Gastroenterol, 2014; 20(46): 17603–17.

Hall JC, Tarala RA, Hall JL, Mander J: A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest, 1991; 99: 923–27.

Yıldırım O, Ayser F, Arıkan S et al: The comparison of pulmonary functions in open versus laparoscopic cholecystectomy. J Pak Med Assoc, 2009; 51(4):201–4.

Koc A, Inan G, Bozkirli F et al: The evaluation of pulmonary function and blood gas analysis in patients submitted to laparoscopic versus open nephrectomy. Int Braz J Urol, 2015; 41(6): 1202–8

Berggren U, Gordh T, Grama D et al: Laparoscopic versus open cholecystectomy: Hospitalization, sick leave, analgesia and trauma responses. Br J Surg, 1994; 81: 1362–65.

Yılmaz EM, Cartı EB, Kandemir A: Our experience of laparoscopic colorectal surgery: Short term outcomes. Turk J Colorectal Dis, 2016; 26: 108–12.

Celik S, Yilmaz EM. Effcts of Laparoscopic and Conventional Methods on Lung Functions in Colorectal Surgery. Med Sci Monit, 2018;24:3244-3248.

Ranu H, Wilde M, Madden B. Pulmonary function tests. Ulster Med J 2011;80(2):84-90.

Lakshminarasimhachar A, Smetana GW: Preoperative evaluation: Estimation of pulmonary risk. Anesthesiol Clin, 2016; 34(1): 71–88.

Boni L, Benevento A, Rovera F et al: Infective complications in laparoscopic surgery. Surg Infect (Larchmt), 2006; 7(Suppl. 2): S109–11.

Antoniou SA, Antoniou GA, Koch OO et al: Laparoscopic versus open obesity surgery: A meta-analysis of pulmonary complications. Dig Surg, 2015;32(2): 98–107.

Coelho JCU, de Araujo RPM, Marchesini JB, Izabel Coelho CMM, de Araujo LRR. Pulmonary function after cholecystectomy performed through Kochers incision, a miniincision, and laparotomy. World J Surg, 1993;17: 544–546.

Joris J, Kaba A, Lamy M. Postoperative spirometry after laparoscopy for lower abdominal or upper abdominal surgical procedures. Br J Anaesth, 1997;79:422.

Ali J, Gana TJ. Lung volumes 24 h after laparoscopic cholecystectomy—justification for early discharge. Can Respir J, 1998; 5: 109–113.

Frazze RC, Roberts JW, Okeson GC, Symmonds RE, Snyder SK, Hendricks JC, Smith RW. Open versus laparoscopic cholecystectomy. A comparison of postoperative pulmonary function. Ann Surg, 1991;213: 651–653.

Karayiannakis AJ, Makri GG, Mantzioka A, Karousos D, Karatsaz G. Postoperative pulmonary function after laparoscopic and open cholecystectomy. Br J Anaesth, 1996; 77: 448–452.

Putensen HG, Putensen C, Lammer H, Lingnau W, Aigner F, Benzer H. Comparison of postoperative respiratory function after laparoscopy or open laparotomy for cholecystectomy. Anesthesiology, 1992; 77:675–680.

Schauer PR, Luna J, Ghiatas AA, Glen ME, Warren JM, Sirinek KM. Pulmonary function after laparoscopic cholecystectomy. Surgery, 1993; 114: 398–397.

Torrington KG, Bilello JF, Hopkins TK, Hall EA Jr. Postoperative pulmonary changes after laparoscopic cholecystectomy. Southern Med J, 1996; 89: 675–678.

Martel J. Pulmonary function test. Healthline. 2017. [Available from: https://www.healthline.com/health/pulmonary-function-tests] [Accessed on 5th April, 2019]

Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R. General considerations for lung function testing. Eur Respir J. 2005; 26(1):153-61.

Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R. Interpretative strategies for lung function tests. Eur Respir J. 2005;26(5):948-68.

Macintyre N, Crapo RO, Viegi G, Johnson DC, van der Grinten CP, Brusasco V. Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J. 2005; 26(4):720-35.

Wanger J, Clausen JL, Coates A, Pedersen OF, Brusasco V, Burgos F. Standardisation of the measurement of lung volumes. Eur Respir J. 2005; 26(3):511-22.

Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A. Standardisation of spirometry. Eur Respir J. 2005; 26(2):319-38.

Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society. Am Rev Respir Dis. 1991;144(5):1202-18.

Wilde M, Nair S, Madden B. Pulmonary function tests-a review. Care of the Crit Ill. 2007; Dec 23(6):173-7.

Fabbri L, Pauwels RA, Hurd SS. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: GOLD Executive Summary updated 2003. COPD. 2004;1(1):105-41;discussion 103-4.

Ranu H, Madden B. A is for airway. BMJ. 2010;340:c2367.

Evans JA, Whitelaw WA. The assessment of maximal respiratory mouth pressures in adults. Respir Care. 2009; 54(10):1348-59.

ATS/ERS Statement on respiratory muscle testing. American Thoracic Society/ European Respiratory Society. Am J Respir Crit Care Med. 2002; 166(4):518-624.

ERS Taskforce, Palange P, Ward SA, Carlsen KH, Casaburi R, Gallagher CG. Recommendations on the use of exercise testing in clinical practice. Eur Respir J. 2007;29(1):185-209.

A Chetta, P Tzani, E Marangio, P Carbognani, A Bobbio, D Olivieri. Respiratory effects of surgery and pulmonary function testing in the preoperative evaluation. ACTA BIOMED 2006; 77; 69-74.

Hasukic S, Mesic D, Dizdarevic E, Keser D, Hadžiselimovic S. Pulmonary function after laparoscopic and open cholecystectomy. SurgEndosc 2002;16: 163–165.

Schwenk W, Bohm B, Will C, Junghans T, Grundel K, Muller JM. Pulmonary Function Following Laparoscopic or Conventional Colorectal Resection. Arch Surg. 1999;134:6-12.

Freeman JA, Armstrong IR. Pulmonary function tests before and after laparoscopic cholecystectomy. Anaesthesia 1994;49:579-582.

Cooper BG. An update on contraindicatio ns for lung function testing. Thorax 2011; 66:714 e723.

Lao L, Weng X, Qiu G, Shen J. The role of preoperative pulmonary function tests in the surgical treatment of extremely severe scoliosis. Journal of Orthopaedic Surgery and Research 2013 8:32.

Yin S, Tao H, Du H, Feng C, Yang Y, Yang W. Postoperative pulmonary complications following posterior spinal instrumentation and fusion for congenital scoliosis. PLoS ONE, 2018; 13(11): e0207657.

Zhao Y, Leng S, Li D, Feng S, Wang Z, Tao C. Pulmonary function impairment predicted poor prognosis ofpatients with hepatocellular carcinoma after hepatectomy. Oncotarget, 2017;8(43):75326-75335.

Christensen EF, Schultz P, Jensen OV, Egebo K, Engberg M, Grøn I, Juhl B.Postoperative pulmonary complications and lung function in high-risk patients: a comparison of three physiotherapy regimens after upper abdominal surgery in general anesthesia.Acta Anaesthesiol Scand. 1991 Feb;35(2):97-104.

Akhan SE, Baysal B.Laparotomy or laparoscopic surgery? Factors affecting the surgeons choice for the treatment of ectopic pregnancy.Arch Gynecol Obstet. 2002 Apr;266(2):79-82.

Janssens JP. Aging of the respiratory system: Impact on pulmonary function tests and adaptation to exertion. Clin.Chest. Med., 2005;26(3): 469-84.

Knudson RJ, Lebowitz MD, Holberg CJ, Burrows B. Changes in the normal maximal expiratory flow-volume curve with growth and aging. Am. Rev. Respir.Dis.,1983;127: 725-34.

Pruthi N, Multani NK. Influence of Age on Lung Function Tests. Journal of Exercise Science and Physiotherapy, 2012;8(1): 1–6.

Harms CA. Does gender affect pulmonary function and exercise capacity?.Respir PhysiolNeurobiol. 2006 Apr 28;151(2-3):124-31.

Ford ES. The epidemiology of obesity and asthma. J Allergy Clin Immunol. 2005;11:897-909.

Chen Y, Dales R, Tang M, Krewski D. Obesity may increase the incidence of asthma in women but not in men: longitudinal observations from the Canadian national population health surveys. Am J Epidemiol2002;155:191-97.

Chen,Y, Rennie D, Cormier Y, Dosman, J. Sex specifiity of asthma associated with objectively measured body mass index and waist circumference: The Humbolt study. Chest. 2005;128:3048-54.

Guerra S, Sherrill D, Bobadilla A, Martinez F, Barbee RA. The relation of body mass index to asthma, chronic bronchitis, and emphysema. Chest. 2001;122(4):1256-63.

McLachlan CR, Poulton R, Car G. Adiposity, asthma, and airway inflmmation. J Allergy Clin Immunol. 2007;119: 624-39.

Chen Y, Dales R, Krewski D, Briethaupt K. Increased effects of smoking and obesity on asthma among female Canadians: the national population health survey, 1994-1995. Am J Epidemiol. 1999;150:255-62.

Jenkin SC, Moxha J. The effects of mild obesity on lung function. Respir Med. 1991;85:309–311.

Sutherland TJT, Cowan JO, Goulding A, Young S. The association between obesity and asthma: interactions between systemic and airway inflmmation. Am J Respir Crit Care Med. 2008;178:469–75.

Collins, LC, Hoberty, PD, Walker, JF, et al The effect of body fat distribution on pulmonary function tests. Chest. 1995;107:1298-1302.

Al Ghobain M. The effect of obesity on spirometry tests among healthy nonsmoking adults. BMC Pulmonary Medicine. 2012;12:10.

Watson RA, Pride NB. Postural changes in lung volumes and respiratory resistance in subjects with obesity. J ApplPhysiol 2005; 98: 512–517.

Richard L, Mary-Magdalene U. Nzekwu. The Effects of Body Mass Index on lung volumes. Chest. 2006;130;827-33.

Cheryl M. Salome, Gregory G. King and Norbert Berend: Physiology of obesity and effects on lung function. J Appl Physiol. 2010;108:206-11.

Biring M, Lewis M, Liu JT, Mohsenifar Z. Pulmonary physiologic changes of morbid obesity. Am J Med Sci. 1999;318:293–97.

Sin DD, Jones RL, Man SFP. Obesity is a risk factor for dyspnea but not for airflw obstruction. Arch Intern Med. 2002;162:1477-81.

Andrew J, Debbie B, Ali B. The Association of Body Mass Index with Airway Obstruction in Non-Asthmatics: Implications for the Inaccurate Differential Diagnosis of Asthma in Obesity. Canadian Journal of Respiratory Therapy 2011;47:2.

Fahy BG, Barnas GM, Nagke SE, Flowers JL, Njoku MJ, Agarwal M. Changes in lung and chest wall properties with abdominal insufflation of carbon dioxide are immediately reversible. AnesthAnalg, 1996;82: 501–505.

Ford GT, Witelaw WA, Rosenal TW. Diaphragm function after upper abdominal surgery in humans. Am Rev Respir Dis, 1983;127: 431–436.

Khetarpal R, Bali K, Chatrath V, Bansal D. Anesthetic considerations in the patients of chronic obstructive pulmonary disease undergoing laparoscopic surgeries. Anesth Essays Res. 2016; 10(1):7–12.

Miller TE, Raghunathan K, Gan TJ. State-of-the-art fluid management in the operating room. Best Pract Res Clin Anaesthesiol. 2014; 28(3):261–73.

Oh TK, Park IS, Ji E, Na H-S (2018) Value of preoperative spirometry test in predicting postoperative pulmonary complications in high risk patients after laparoscopic abdominal surgery. PLoS ONE 13(12): e0209347.

Tajima Y, Tsuruta M, Yahagi M, Hasegawa H, Okabayashi K, Shigeta K, et al. Is preoperative spirometry a predictive marker for postoperative complications after colorectal cancer surgery? Jpn J Clin Oncol. 2017; 47(9):815–9.

Clavellina-Gaytan D, Velazquez-Fernandez D, Del-Villar E, Dominguez-Cherit G, Sanchez H, Mosti M, et al. Evaluation of spirometric testing as a routine preoperative assessment in patients undergoing bariatric surgery. Obes Surg. 2015; 25(3):530–6.

Huh J, Sohn TS, Kim JK, Yoo YK, Kim DK. Is routine preoperative spirometry necessary in elderly patients undergoing laparoscopy-assisted gastrectomy? J Int Med Res. 2013; 41(4):1301–9.

Rock P, Rich PB. Postoperative pulmonary complications. Current Opinion in Anesthesiology. 2003; 16(2):123–31.

Lai Y, Wang X, Li P, Li J, Zhou K, Che G. Preoperative peak expiratory flow (PEF) for predicting postoperative pulmonary complications after lung cancer lobectomy: a prospective study with 725 cases. J Thorac Dis 2018;10(7):4293-4301.


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