Postoperative Pulmonary Function in Open versus Laparoscopic Cholecystectomy: A Meta-Analysis of the Tiffenau Index

Abstract

Background: Available scientific literature about open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) does not show univocal results in terms of postoperative pulmonary function. A meta-analysis was carried out to evaluate the postoperative pulmonary function after OC and LC focusing on the Tiffenau index. Methods: Electronic databases were consulted (Cochrane Library, Embase and Pubmed). Standardized mean difference (SMD) with 95% CI was calculated for the Tiffenau Index. The kappa test was performed to evaluate agreement between the reviewers regarding the quality of the selected studies. A sensitivity analysis was carried out to assess the robustness of our study. Heterogeneity among studies was tested by using a χ² test at 0.05 significance level. A random effects model meta-analysis was performed. Results: Meta-analysis of the 13 articles included, resulted in a SMD of 53% (95% CI 0.04, 1.02) for the Tiffenau Index in favor of laparoscopic cholecystectomy. The χ² test analysis showed the presence of heterogeneity among studies (Tiffenau index χ² = 99.97, p = 0.03). The sensitivity analysis confirms the validity of our results. Conclusions: Postoperative pulmonary function is better preserved after laparoscopic cholecystectomy than open cholecystectomy.

Anästhesie bei laparoskopischen Eingriffen

“…Die postoperative Lungenfunktion ist nach laparoskopischen Verfahren deutlich weniger und kürzer eingeschränkt als nach vergleichbaren offenen Eingriffen. Da die Manipulation in der Nähe des Zwerchfells die Lungenfunktion zusätzlich beeinträchtigt, stellt sich dieser Vorteil der Laparoskopie bei Operationen im Oberbauch im Vergleich zu Eingriffen am Unterbauch deutlicher dar [2]. Die einzige absolute Kontra indikation der Laparoskopie ist der erhöhte Hirndruck ("intracranial pressure", ICP).…”

“…Je langsamer das Blut in einem verletzten Gefäß fließt, desto mehr CO 2 kann resorbiert werden. Somit steigt mit zunehmenden IAP bei laparoskopischen Eingriffen an der Leber die Gefahr einer CO2 -Embolie. Eine kritische Grenze scheint ein IAP von 8 mmHg zu sein, unter der die Emboliegefahr gering ist.…”

Comparison of respiratory function recovery in the early phase after laparoscopy-assisted gastrectomy and open gastrectomy

“…However, pneumoperitoneum may have an adverse effect on respiratory function [10][11][12]. There have been two randomized studies of gastric bypass and colonic resection, and a meta-analysis of cholecystectomy and respiratory function recovery, comparing laparoscopic and open surgery [13][14][15]. In these studies, early recovery of respiratory function was seen in studies of cholecystectomy and gastric bypass, which are upper abdominal operations [14,15].…”

“…These findings suggest that laparoscopic upper abdominal surgery confers an advantage in the early recovery of respiratory function. In general, respiratory function is examined with a respiratory function test or blood gas analysis [2,8,[13][14][15]; however, respiratory function tests cause severe pain during the early postoperative period, and the long-term placing of an arterial catheter or frequent puncture of the artery should be avoided. On the other hand, SaO 2 is regarded as a simple and noninvasive indicator of pulmonary gas exchange and is routinely performed after major operations in all hospitals [16].…”

Laparoscopic versus open gastrectomy for gastric cancer patients with COPD

“…Some studies have reported that pulmonary function is more favorably preserved in laparoscopic cholecystectomy and colectomy compared to the open methods for healthy individuals. The values of FVC and FEV1 are reduced by almost 50% after open cholecystectomy as compared to only 19-27% after laparoscopic cholecystectomy [6,7]. Use of epidural anesthesia in order to reduce postoperative abdominal pain resulted in only partial restoration of vital capacity and a minimal increase in functional residual capacity [8].…”