• W Schwenk, B Böhm, C Witt, T Junghans, K Gründel, and J M Müller.
• Department of General, Visceral, Vascular, and Thoracic Surgery, Medical Faculty of the Humboldt-University of Berlin, Charité, Germany. schwenk@charite.de
• Arch Surg Chicago. 1999 Jan 1; 134 (1): 6-12; discussion 13.

BackgroundLaparotomy causes a significant reduction of pulmonary function, and atelectasis and pneumonia occur after elective conventional colorectal resections.ObjectiveTo evaluate the hypothesis that pulmonary function is less restricted after laparoscopic than after conventional colorectal resection.DesignA randomized clinical trial.SettingThe surgical department of an academic medical center.PatientsSixty patients underwent laparoscopic (n = 30) or conventional (n = 30) resection of colorectal tumors. The 2 groups did not differ significantly in age, sex, localization or stage of tumor, or preoperative pulmonary function.Main Outcome MeasuresForced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, mid-expiratory phase of forced expiratory flow, and oxygen saturation of arterial blood.ResultsThe forced vital capacity (mean +/- SD values: conventional resection group, 1.73+/-0.60 L; laparoscopic surgery group, 2.59+/-1.11 L; P<.01) and the forced expiratory volume in 1 second (conventional resection group, 1.19+/-0.51 L/s; laparoscopic surgery group, 1.80+/-0.80 L/s; P<.01) were more profoundly suppressed in the patients having conventional resection than in those having laparoscopic surgery. Similar results were found for the peak expiratory flow (conventional resection group, 2.51+/-1.37 L/s; laparoscopic resection group, 3.60+/-2.22 L/s; P<.05) and the midexpiratory phase of forced expiratory flow (conventional resection group, 1.87+/-1.12 L/s; laparoscopic surgery group, 2.67+/-1.76 L/s; P<.05). The oxygen saturation of arterial blood, measured while the patients were breathing room air, was lower after conventional than after laparoscopic resections (P<.01). The recovery of the forced vital capacity and forced expiratory volume in 1 second to 80% of the preoperative value took longer in patients having conventional resection than in those having laparoscopic resection (P<.01). Pneumonia developed in 2 patients having conventional resection, but no pulmonary infection occurred in the laparoscopic resection group (P>.05).ConclusionsPulmonary function is better preserved after laparoscopic than after conventional colorectal resection. Pulmonary complications may be reduced after laparoscopic resections because of the better postoperative pulmonary function.

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