Comparative Study of Post-operative Pulmonary Mechanics between Subcostal and Midline Laparotomy

Background

Commonly two incisions are used in Upper Abdominal Surgeries (UAS): Midline and Subcostal. Following either of the surgeries patients develop significant alteration in breathing pattern due to the restrictive type of pulmonary dysfunction.

Aims & Objectives

To compare the effects of both the incisions on pulmonary mechanics, assess which of the two incisions affect the pulmonary mechanics more than the other and to accordingly modify the post-operative Chest Physiotherapy treatment plan.

Materials and methods 10 subjects in each group (subcostal and midline incision) were selected. Parameters like diaphragm excursion on U.S.G., Peak Expiratory Flow Rate (PEFR) and chest expansion at three levels were measured pre-operatively, post-operatively on the 3rd and 7th day.

Results

There was a decrease in the diaphragm excursion, PEFR and chest expansion at umbilical level on post-operative day 3 but the decrease was much more in the midline group than the subcostal group. The above parameters improved on post-operative day 7 as compared to post-operative day 3 in both the groups but the improvement was much more in the subcostal group than the midline group. Both the results were statistically significant.

Conclusion

The study shows that the pulmonary mechanics are affected post-operatively in both the groups, the affection being more in the midline group than in the subcostal group. Also the return of function to the pre-operative values was earlier in the subcostal group as compared to the midline group. Hence administration of Chest Physiotherapy postoperatively should be modified accordingly to improve the function especially in the midline group.