Systematic Reviews
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World J Gastroenterol. Dec 14, 2014; 20(46): 17603-17617
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17603
Effects of laparoscopic cholecystectomy on lung function: A systematic review
George D Bablekos, Stylianos A Michaelides, Antonis Analitis, Konstantinos A Charalabopoulos
George D Bablekos, Konstantinos A Charalabopoulos, Department of Experimental Physiology, Medical School, Democritous University of Thrace, 68100 Alexandroupolis, Greece
George D Bablekos, Technological Educational Institute of Athens, 12243 Egaleo, Greece
Stylianos A Michaelides, First Thoracic Medicine Department, “Sismanogleio” General Hospital, 15126 Athens, Greece
Antonis Analitis, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Goudi, Athens, Greece.
Author contributions: Bablekos GD contributed to the acquisition of data; research design; drafting of the paper; analysis and medical interpretation of the data; and writing, revision and contribution to the final manuscript after reviewers’ suggestions; Michaelides SA contributed to the research design; drafting of the paper, analysis and medical interpretation of the data; and revision, and contribution to the final manuscript after reviewers’ suggestions; Analitis A contributed to the research design; drafting of the paper; statistics; and revision, and contribution to the final manuscript after reviewers’ suggestions; Charalabopoulos KA contributed to research design; drafting of the paper; and revision and contribution to the final manuscript after reviewers’ suggestions.
Correspondence to: George D Bablekos, MD, PhD, Department of Experimental Physiology, Medical School, Democritous University of Thrace, Dragana, 68100 Alexandroupolis, Greece. gbableko@otenet.gr
Telephone: +30-694-6030153 Fax: +30-210-8044779
Received: December 5, 2013
Revised: March 17, 2014
Accepted: June 17, 2014
Published online: December 14, 2014
Processing time: 378 Days and 0.2 Hours
Abstract

AIM: To present and integrate findings of studies investigating the effects of laparoscopic cholecystectomy on various aspects of lung function.

METHODS: We extensively reviewed literature of the past 24 years concerning the effects of laparoscopic cholecystectomy in comparison to the open procedure on many aspects of lung function including spirometric values, arterial blood gases, respiratory muscle performance and aspects of breathing control, by critically analyzing physiopathologic interpretations and clinically important conclusions. A total of thirty-four articles were used to extract information for the meta-analysis concerning the impact of the laparoscopic procedure on lung function and respiratory physiopathology. The quality of the literature reviewed was evaluated by the number of their citations and the total impact factor of the corresponding journals. A fixed and random effect meta-analysis was used to estimate the pooled standardized mean difference of studied parameters for laparoscopic (LC) and open (OC) procedures. A crude comparison of the two methods using all available information was performed testing the postoperative values expressed as percentages of the preoperative ones using the Mann-Whitney two-sample test.

RESULTS: Most of the relevant studies have investigated and compared changes in spirometric parameters.The median percentage and interquartile range (IQR) of preoperative values in forced vital capacity (FVC), forced expiratory volume in 1 s and forced expiratory flow (FEF) at 25%-75% of FVC (FEF25%-75%) expressed as percentage of their preoperative values 24 h after LC and OC were respectively as follows: [77.6 (73.0, 80.0) L vs 55.4 (50.0, 64.0) L, P < 0.001; 76.0 (72.3, 81.0) L vs 52.5 (50.0, 56.7) L, P < 0.001; and 78.8 (68.8, 80.9) L/s vs 60.0 (36.1, 66.1) L/s, P = 0.005]. Concerning arterial blood gases, partial pressure of oxygen [PaO2 (kPa)] at 24 or 48 h after surgical treatment showed reductions that were significantly greater in OC compared with LC [LC median 1.0, IQR (0.6, 1.3); OC median 2.4, IQR (1.2, 2.6), P = 0.019]. Fewer studies have investigated the effect of LC on respiratory muscle performance showing less impact of this surgical method on maximal respiratory pressures (P < 0.01); and changes in the control of breathing after LC evidenced by increase in mean inspiratory impedance (P < 0.001) and minimal reduction of duty cycle (P = 0.01) compared with preoperative data.

CONCLUSION: Laparoscopic cholecystectomy seems to be associated with less postoperative derangement of lung function compared to the open procedure.

Keywords: Laparoscopic; Open procedure; Cholecystectomy; Respiratory function; Respiratory physiology

Core tip: Laparoscopic cholecystectomy does not damage the abdominal muscles and diaphragmatic function is significantly less affected compared to the open method. This procedure is accompanied by a lower impact on respiratory function and better oxygenation. Mobilization can occur within the first twenty-four h postoperatively, thus preventing the formation of atelectasis. Atelectasis is known to be the primary cause of infective sequelae, which are associated with increased morbidity and mortality especially for patients with deranged lung function.