Open Versus Laparoscopie Cholecystectomy A Comparison of Postoperative Pulmonary Function

Postoperative Pulmonary Changes after Laparoscopic Cholecystectomy

A clinical study. To measure the changes in pulmonary function and thoracic volume associated with surgical correction of kyphotic deformities. No prior study has focused on the pulmonary function and thoracic cavity volume before and after corrective surgery for kyphosis. Thirty-four patients with kyphosis underwent posterior deformity correction with instrumented fusion. Preoperative and postoperative pulmonary function was measured, and pulmonary function grade was evaluated as mild, significant, or severe. The change in preoperative to postoperative pulmonary function was analyzed, using 6 comparative subgroupings of patients on the basis of age, severity of kyphosis, location of kyphosis apex, length of follow-up time after surgery, degree of kyphosis correction, and number of segments fused. A second group of 19 patients also underwent posterior surgical correction of kyphosis, which had thoracic volume measured preoperatively and postoperatively with computed tomographic scanning. All of the pulmonary impairments were found to be restrictive. After surgery, most of the patients had improvement of the pulmonary function. Before surgery, the pulmonary function differences were found to be significant based on both severity of preoperative kyphosis (<60° vs. >60°) and location of the kyphosis apex (above T10 vs. below T10). Younger patients (younger than 35 yr) were more likely to exhibit statistically significant improvements in pulmonary function after surgery. However, thoracic volume was not significantly related to pulmonary function parameters. After surgery, average thoracic volume had no significant change. The major pulmonary impairment caused by kyphosis was found to be restrictive. Patients with kyphosis angle of 60° or greater or with kyphosis apex above T10 had more severe pulmonary dysfunction. Patients' age was significantly related to change in pulmonary function after surgery. However, the average thoracic volume had no significant change after surgery. 3.

Postoperative Pulmonary Complications (PPCs) is one of the major cause of perioperative mortality and morbidity in thoracic and upper abdominal surgery. Preoperative risk assessment enables clinicians to reduce perioperative risk in high risk patients.. In upper abdominal surgery, there is a larger alteration in pulmonary functions. This study was performed in 30 patients scheduled for laparoscopic cholecystectomy and for upper abdominal open cholecystectomy. The study revealed that after both laparoscopic &amp; open upper abdominal cholecystectomy there was significant alteration of pulmonary function. There was significant alteration at six hours and after operation which then gradually improved, but it took about 24 hours for its complete recovery. The alteration was more evident in open cholycystectomy. Nevertheless these alterations did not cause any clinical derangement as expressed by SpO2, HR, &amp; BP. The study also showed a significant dose reduction of opioid in case of laparoscopic cholecystomy. The lung function at postoperative ward correlated well with the level of analgesia. But persistent alteration of pulmonary function indicated presence of other mechanical factors. Key Words: Surgery-Lap.Cholecystectomy, Surgery- Upper abdominal, Complication-post- Operative, complication-pulmonary, Patient control analgesia Journal of BSA, Vol. 17, No. 1 &amp; 2, 2004 p.12-16DOI: http://dx.doi.org/10.3329/jbsa.v17i1.4045

The primary goals of this study were to evaluate early changes in pulmonary function and retrobulbar hemodynamics and to examine the correlation between these parameters in patients with type 2 diabetes during the preclinical stages of diabetic retinopathy. For the single-time point measurements, 63 subjects with type 2 diabetes without diabetic retinopathy (diabetes group) and 32 healthy subjects (control group) were selected to evaluate any early changes in pulmonary function and retrobulbar hemodynamics and to examine the correlation between these parameters. In the longitudinal follow-up study, 32 subjects who were newly diagnosed with type 2 diabetes were divided into 2 groups according to their resistivity index (≤0.7 and >0.7). Early changes in pulmonary function and retrobulbar hemodynamics were studied in these groups and compared with the previous values. For the single-time point measurements, the fasting plasma glucose, 2-h postprandial blood glucose, glycosylated hemoglobin A1c, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels as well as the pulmonary function parameters were significantly higher in the diabetes group than in the control group. The pulmonary function parameters were negatively and significantly correlated with glycosylated hemoglobin A1c and the duration of diabetes. The retrobulbar hemodynamics were positively correlated with glycosylated hemoglobin A1c and diabetes duration; in contrast, the correlation between retrobulbar hemodynamics and glycosylated hemoglobin A1c. In the longitudinal follow-up study, the pulmonary function of the 2 groups categorized by their resistivity index levels indicated that subjects with resistivity index levels ≤0.7 showed significantly better pulmonary function, and the pulmonary function of this group showed improvement and a significantly smaller decrease. The incidence of diabetic retinopathy in the group with resistivity index levels ≤0.7 (9 of 22, 40.9%) was significantly lower than that in the group with resistivity index levels >0.7. Pulmonary function and retrobulbar hemodynamics changed during the preclinical stages of diabetic retinopathy. Regulating glycemia may improve retrobulbar hemodynamics in the retrobulbar arteries (ie, central retinal artery, posterior ciliary artery, and arteria ophthalmica). By detecting the retrobulbar resistivity index and the levels of glycosylated hemoglobin A1c, we could predict future changes in pulmonary function during the preclinical stages of diabetic retinopathy as well as the degree of retinopathy. (ClinicalTrials.gov registration NCT02774733.).

Background: Globally, gallstone disease (GS) is a significant health issue, especially for adults although cholecystitis is common, there is an evidence of variance in its diagnosis and course of therapy, including surgery. In place of open cholecystectomy, laparoscopic cholecystectomy is now the preferred course of treatment for symptomatic cholelithiasis. In situations where laparoscopic cholecystectomy is dangerous; a surgeon may be forced to change from laparoscopy to an open procedure. The aim of the study was to clarify the benefits and role of minimally invasive surgery in comparison to the open conventional method of cholecystectomy, with a focus on the postoperative phase and to compare the ratio of Laparoscopic and open cholecystectomy between male and female genders. Methods: 185 Patients of cholecystitis aged between 10 years to 80 years (86.5% males and 13.5% females) were presented to Zawia Medical Center during the period from March 2005 till April 2006 that randomly get an open or laparoscopic cholecystectomy. They were divided into open and laparoscopic Cholecystectomy group. Results: In this study, a total of 185 patients were included: 160 females (86.5% of the total) and 25 males (13.5% of the total). Whereas, 86 females (53.7%) were operated on by laparoscopic cholecystectomy, and 74 females (46%) were operated on by open cholecystectomy. In comparison, of a total of 25 males, 12 (48%) underwent laparoscopic cholecystectomy and 13 (52%) underwent open cholecystectomy. The conversion rate was eight cases (8.2%) due to technical, bleeding, or massive adhesion. Conclusion: From this study, we concluded that the laparoscopic cholecystectomy versus open cholecystectomy ratio (female: male ratio) was 86.5% to 13.5% of the total 185 patients, and laparoscopic cholecystectomy appears to be a safe procedure with quick recovery, early discharge from the hospital, and less postoperative pain as compared to open cholecystectomy.

Radiation therapy (RT) for lung cancer is commonly limited to subtherapeutic doses due to unintended toxicity to normal lung tissue. Reducing the frequency of occurrence and magnitude of normal lung function loss may benefit from treatment plans that incorporate the regional lung and radiation dose information. In this article, the authors propose a method that quantitatively measures the regional changes in lung tissue function following a course of radiation therapy by using 4DCT and image registration techniques. 4DCT data sets before and after RT from two subjects are used in this study. Nonlinear 3D image registration is applied to register an image acquired near end inspiration to an image acquired near end expiration to estimate the pulmonary function. The Jacobian of the image registration transformation, indicating local lung expansion or contraction, serves as an index of regional pulmonary function. Approximately 120 annotated vascular bifurcation points are used as landmarks to evaluate registration accuracy. The authors compare regional pulmonary function before and after RT to the planned radiation dose at different locations of the lung. In all registration pairs, the average landmark distances after registration are on the order of 1 mm. The pulmonary function change as indicated by the Jacobian change ranges from -0.15 to 0.1 in the contralateral lung and -0.22 to 0.23 in the ipsilateral lung for subject A, and ranges from -0.4 to 0.39 in the contralateral lung and -0.25 to 0.5 in the ipsilateral lung for subject B. Both of the subjects show larger range of the increase in the pulmonary function in the ipsilateral lung than the contralateral lung. For lung tissue regions receiving a radiation dose larger than 24 Gy, a decrease in pulmonary function was observed. For regions receiving a radiation dose smaller than 24 Gy, either an increase or a decrease in pulmonary function was observed. The relationship between the pulmonary function change and the radiation dose varies at different locations. With the use of 4DCT and image registration techniques, the pulmonary function prior to and following a course of radiation therapy can be measured. In the preliminary application of this approach for two subjects, changes in pulmonary function were observed with a weak correlation between the dose and pulmonary function change. In certain sections of the lung, detected locally compromised pulmonary function may have resulted from radiation injury.

Background: Cholecystectomy, surgical removal of the gallbladder, is one of the most common elective procedures performed by general surgeons.Upper abdominal operations may induce postoperative restrictive ventilatory defects. They are more pronounced in open procedures, yet also seen in laparoscopic ones cholecystectomy.Methods: This observational study entitled “pulmonary function changes in patients undergoing laparoscopic cholecystectomy” was conducted after clearance from board of studies and ethical committee in the department of general surgery, Sharda hospital, school of medical sciences and research (Greater Noida) during the period 2019-2021. The study population has been calculated by using G-power software with 80% of the power and 5% of the significance level. The total sample size was determined to be 100 patients.Results: The study population consisted of 34 (34.0%) belonged to 19-30 years. There were 23 (23.0%) males and 77 (77.0%) females among study population. The mean forced vital capacity (FVC) (L), FEV1 (L), FEV1/FVC (%), FEF 25-75 (L) and SpO2 was compared between Pre-operative and post-operative using the paired t test. Mean FVC (L), FEV1 (L), FEV1/FVC (%), FEF 25-75 (L) and SpO2 decreased significantly from pre-operatively to post-operatively.Conclusions: To conclude my study, it has been observed that pulmonary function variables (FVC, FEV1, FEV1/FVC, FEF-25-75%) were significantly impaired after laparoscopic cholecystectomy.

Is There a Dose Response Relationship for Pulmonary Function Changes After Stereotactic Body Radiation Therapy for Early-stage Non-small Cell Lung Cancer?

Do volume metrics predict pulmonary function changes in lung irradiation

Pulmonary function in 42 patients with chronic myelogenous leukemia (CML) was tested before and after HLA-matched (39 related, 3 unrelated) allogeneic bone marrow transplantation (BMT) between 1985 and 1999. Pulmonary function tests (PFTs) including ventilatory capacity, lung volumes, and diffusion capacity for carbon monoxide (DLCO) were performed before and 3, 6, 12, and 24 months after BMT, and every 12 months thereafter. Possible pre- and post-BMT risk factors were evaluated for their influence on pulmonary function. Patients were divided into two groups according to their survival duration for more than 12 months or not.Pretransplant PFTs were essentially normal except for mild reduction in DLCO values in the short-term survival group. Overall pulmonary function changes revealed persistent and significant decrease of forced vital capacity (FVC) and DLCO values after BMT. The DLCO values reached abnormal levels (<80%) and showed a trend of incomplete recovery. Decrease of forced expiratory volume in the first second (FEV1) and vital capacity were also noted but the FEV1/FVC ratio remained within normal limits after BMT. Transient fall of total lung capacity after BMT was noted. However, its values did not reach abnormal levels such as to cause restrictive ventilatory impairment. Possible risk factors including gender, smoking, bronchiolitis obliterans, acute and chronic graft-versus-host disease (GVHD) were found to have significant influences on posttransplant pulmonary function changes by multiple regression analysis. Most patients except those who developed bronchiolitis obliterans were clinically asymptomatic. Development of bronchiolitis obliterans was the most important factor to cause both clinical symptoms and impaired pulmonary function.In summary, pulmonary function changes before and after HLA-matched allogeneic BMT in long-term survivors of CML only showed modest dysfunction. The primary negative presentation with the development of oxygenation defect had no clinical significance in most patients. The influences on the impairment of pulmonary function were multifactorial.

Human aging is associated with decline in cognitive and physical functioning. Although pulmonary function predicts long-term performance (up to 10 years) on measures of cognitive function, recent data suggest the opposite relationship: Cognitive decline predicts self-reported physical limitations. In the study reported here, we utilized dual-change-score models to determine the directional relationship between pulmonary and cognitive function. Our sample consisted of 832 participants (ages 50–85 years at baseline), who were assessed in up to seven waves of testing across 19 years as part of the longitudinal Swedish Adoption/Twin Study of Aging. Changes in pulmonary function led to subsequent changes in fluid cognitive function, specifically, in tasks reflecting psychomotor speed and spatial abilities. There was no evidence that declines in cognitive function led to subsequent declines in pulmonary function. Thus, these data indicate a directional relationship from decreased pulmonary function to decreased cognitive function, a finding that underscores the importance of maintaining pulmonary function to ensure cognitive performance.

Objective To retrospectively analyze pulmonary function changes after growing rod surgery for progressive early-onset scoliosis.Methods Ten cases of progressive early-onset scoliosis treated with growing rod technique from September 2002 to July 2011 were enrolled in the study.There were 3males and 7 females,aged from 6 to 9 years (average,7.0±1.1 years).Four patients had finished the final fusion surgery (Group fusion),and 6 patients (Group non-fusion) were in the process of periodic lengthening.Forced vital capacity (FVC),FVC/predicted FVC ratio,forced expiratory volume in one second (FEV1),FEV1/predicted FEV1 ratio,Cobb’s angle,and C7-S1 distance before each surgery were recorded.Lung function changes and correlations between lung function changes and radiographic changes (Cobb’s angle and C7-S1 distance) were analyzed.Results In Group fusion,both FVC and FEV1 increased,and FVC showed a significant difference.In Group non-fusion,FVC and FEV1 also increased and both showed a significant difference.FVC/predicted FVC ratio and FEV1/predicted FEV1 ratio both changed similarly and did not show statistical differences in the two groups.There were no significant correlations between lung function changes and radiographic changes (Cobb’s angle and C7-S1 distance).Conclusion Pulmonary function improves after growing rod surgery for progressive early-onset scoliosis.The pulmonary function changes do not correlate with changes of Cobb’s angle and C7-S1 distance. Key words: Scoliosis; Internal fixators; Respiratory function tests

Background: Acute cholecystitis is clinically characterized as an episode of acute biliary pain; fever and right hypochondrial tenderness with symptoms persistence exceeding 24 hours. Aims &amp; Objectives: We compared and analyzed open and laparoscopic cholecystectomy in the current study on the basis of the duration of the operation, intra and postoperative complications and the length of hospital stay &amp; return to work.Material and Methods: This was a prospective comparative, randomized hospital-based study performed in patients of 20 - 80 years of age with acute cholecystitis in the Department of General Surgery from July 2019 to January 2021 at SMH&amp;RC, Datta Meghe Medical College Nagpur. Patients were divided randomly into two classes as Open cholecystectomy (60 patients) and laparoscopic cholecystectomy (60 patients). The key assessed outcome was death, peri-operative &amp; post-operative complications; length of hospital stay and wound infection, return to work. The gathered data was statistically analyzed. Results: In both categories, the most common age group was 40-59 years old. The female population (78%) was greater than the male population (22 percent). 1: 3.6 was the male to female ratio. The mean time needed for open cholecystectomy was 53.18 ± 12.74 minutes, while 38.37 ± 6.21 minutes for laparoscopic cholecystectomy, and the difference was statistically important. 2 (3.3 percent) laparoscopic procedures involved conversion to open surgery due to difficult dissection, bleeding &amp; blurred vision. In terms of postoperative pain (VAS &gt; 4), hospital stay period and return to work, laparoscopic cholecystectomy had better outcomes than open cholecystectomy and the difference was statistically important. In Open Cholecystectomy patients, wound infection, post-operative paralytic ileus was substantially greater. There were 2 patients with wound dehiscence from open cholecystectomy. No significant morbidity or any mortality during the study period was reported.Conclusion: Laparoscopic cholecystectomy provides decisive advantages over open cholecystectomy in acute cholecystitis (e.g. shorter time of surgery, fewer post-operative complications, less paralytic ileus, less analgesic use, early discharge and mobilization).

Effects of Nitrogen Dioxide on Pulmonary Function in Normal Healthy Humans and Subjects with Asthma and Chronic Bronchitis

Adolescent Idiopathic Scoliosis negatively impacts chest wall development. Bracing and fusion surgery have shown varied effects on pulmonary outcomes. Vertebral Body Tethering presents a growth-sparing alternative that might mitigate these effects by reducing biomechanical disruptions. Aim was to evaluate changes in pulmonary functions during the course of the follow-up after VBT surgery. Retrospective cohort study including patients who underwent Thoracic, Thoracolumbar and Bilateral VBT surgery with a minimum 24months follow-up. Forced Vital Capacity (FVC%), Forced Expiratory Volume in the first second (FEV1%) and FEV1/FVC ratio were evaluated at multiple time points. Four groups were formed using main curve location and surgical technique. Analyses of variance were used to assess changes over time. 81 consecutive patients (76F, 5M; 12.5 ± 1.6years) with a mean follow-up 53.4 (24-105) months were included. Preoperatively, the median Sanders was 3 (1-7) and the median Risser was 0 (- 1-5). The mean MT curve of 50.8º ± 11.0º was corrected to 26.0º ± 7.3º at 6weeks, which was modulated to 22.4º ± 13.4º. FVC%, FEV1%, and FEV1/FVC showed significant improvements over time for the entire cohort up to 2-3years (p < 0.0005) where the curve type and surgical technique influenced improvement patterns. For patients with longer follow-up, values at 4-6years did not differ from those at 2-3years (p > 0.05, for all comparisons). Thoracoscopic VBT surgery led to consistent increases in FVC%, FEV1%, and FEV1/FVC values across the entire cohort, which were sustained at longer follow-up in a subset of patients. Surgeries on thoracic curves showed more pronounced improvements compared to thoracolumbar curves. Pulmonary function test results (FVC%, FEV1% and FEV1/FVC) improved following VBT surgery for AIS patients. Thoracic and thoracolumbar surgery for thoracic curves, and bilateral surgery resulted in more pronounced FVC% and FEV1% improvements. Improvement in FVC% and FEV1% values started earlier after Thoracic VBT. Thoracolumbar surgery for thoracolumbar curves displayed significant improvement only in FEV1/FVC results, as they had better preoperative pulmonary functions. Observed improvements in FVC%, FEV1% and FEV1/FVC were preserved at 4-6 and 7-8 years follow-up in a subset of patients, averaging a mean duration of 48.7 months for the whole cohort.