Pulmonary Dysfunction

Upper abdominal surgery results in postoperative changes in pulmonary function. Respiratory dysfunction is less severe and recovery is quicker after laparoscopy. ^{[3] [72] [163] [175] [177] [178] [211] [212] [213] [214]} Nevertheless, diaphragmatic function remains significantly impaired after laparoscopy.^{[215] [216] [217]} Thoracic epidural analgesia does not improve lung function after laparoscopic cholecystectomy.^[175] Greater reductions in expiratory volumes and slower recovery of pulmonary function after laparoscopy are reported in older patients,^[218] obese patients,^{[181] [219]} smokers, and patients with COPD^[219] than in healthy patients. Postoperative pulmonary function of these patients, however, is improved after laparoscopy as compared with laparotomy.^{[181] [182] [219]} Postoperative pulmonary function is less impaired after gynecologic laparoscopy than after upper abdominal laparoscopic surgery.^[220]