Avaliação da função pulmonar após colecistectomias laparoscópicas e convencionais

Abstract

TCBC-GO 3 ; Enio Chaves de Oliveira, TCBC-GO 4 RESUMO: Objetivo: Avaliar a função pulmonar pós-colecistectomias laparoscópicas e subcostais abertas. Métodos: Tratou-se de um ensaio randomizado, onde se avaliaram espirometrias pós-operatórias de dois grupos, cada qual com 15 pacientes. O grupo GL foi submetido a colecistectomia laparoscópica. O grupo GA foi submetido a colecistectomia por via subcostal, por meio de mini-laparotomia e abreviado tempo anestésico-cirúrgico. As variáveis dos dois grupos foram comparadas entre si por meio da ANOVA. Entre um mesmo grupo, antes e depois das operações, utlizou-se do teste t-Student emparelhado. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: Todas as pacientes, dos dois grupos, apresentaram distúrbios ventilatórios restritivos pós-operatórios, com normalização espirométrica mais rápida nas pacientes operadas por laparoscopia. Grupos GL X GA, no pós-operatório imediato: Capacidade vital forçada (p < 0,001) e Volume Expiratório forçado em 1 segundo (p < 0,001). Conclusões: O prejuízo pós-operatório da função pulmonar foi significativamente menor nas colecistectomias laparoscópicas do que nas abertas, mesmo por meio de minilaparotomia e abreviado tempo anestésico-cirúrgico (Rev. Col. Bras. Cir. 2007; 34(5): 326-330). ABSTRACT Background:To evaluate pulmonary function after laparoscopic and subcostal cholecystectomies . Methods: This was a randomized study, in which postoperative spirometries in two groups of fifteen patients each were evaluated. Group GL underwent laparoscopic chlecystectomies. Group GA underwent open subcostal cholecystectomies by means of mini-laparatomy, in abbreviated anesthetic-surgical time. The two groups´ variables were compared using ANOVA. Within the same group, before and after the operations, the paired Student-t test was used. A value of p < 0.05 was considered statistically significant. Results: All patients from both groups presented restrictive postoperative ventilatory disturbances, with a faster spirometric normalization for those patients operated through laparoscopy. Groups GL vs. GA, in immediate post-operative: Forced Vital Capacity (p < 0.001) and Forced Expiratory Volume in one second (p < 0.001). Conclusion: Postoperative harm to pulmonary function was significantly less in laparoscopic than in open cholecystectomies, even with mini-laparotomies and abbreviated anesthetic-surgical time.

Benefits of maltodextrin intake 2 hours before cholecystectomy by laparotomy in respiratory function and functional capacity: a prospective randomized clinical trial

“…The decreased respiratory function found in this study was similar to what reported by some authors in this same type of surgery. ( 5 , 16 – 19 ) Gastaldi et al ( 20 ) showed lower values on the second postoperative day (FVC and FEV 1 ). Muehling et al ( 21 ) observed that a shortened fasting time in lung operations led to lower pulmonary complication rates.…”

“…However, when compared with data from literature, their return to preoperative values was quicker in laparoscopic surgery than in open abdominal surgery. ( 16 , 18 , 19 )…”

Inspiratory loading exercises on respiratory muscle function in post-operative gastroplasty patients: a randomized clinical trial

“…These findings were relevant since the pulmonary mechanics were directly changed due to intubation, the general anesthetic procedure, immobility, the use of neuromuscular blocks and invasive mechanical ventilation. Moreover, the surgical incision and the presence of pain are factors present in upper abdominal surgery [2,[37][38][39], having diaphragmatic dysfunction being considered the main cause of pulmonary compromise [40,41], and these factors Inspiratory loading exercises on respiratory muscle function in post-operative gastroplasty patients could explain the findings in the control group, in which the values of all studied variables dropped.…”

Laparotomia exploratória e colecistectomia: análise da frequência respiratória e saturação de oxigênio de pacientes no pós-operatório imediato

“…Estudios resaltan en relación a la respiración que es común algún nivel de limitación en la ventilación pulmonar en cirugías de Laparotomías y colecistectomías considerándose factores inherentes al acto quirúrgico como cuadro doloroso, disfunción diafragmática, extensión de la incisión y la proximidad con el aparato respiratorio, tiempo de cirugía y tipo de anestesia, que pueden resultar en problemas respiratorios restrictivos (9,10) .…”