Repercussões imediatas nas provas de função pulmonar no pós-operatório de indivíduos com obesidade grau II e mórbida submetidos à cirurgia de redução gástrica por celiotomia ou videolaparoscopia

Abstract

Obesity is the most common chronic disease in developed countries and is associated to the most severe and morbid clinical situations, including respiratory disturbances that can be aggravated by surgical techniques, increasing the hospitalar permanence. The gastric reduction has been considered, after 45 years of study, the only efficient and lasting method in body weight reduction. To identify and quantify the impact of surgical method in pulmonary function considering the laparotomy and videolaparoscopy approaches, 37 patients were submitted to the gastroplasty by technique; 17 of them (8 woman and 9 man) by laparotomy (age and BMI means of 32±9,8 years and 47±7,2Kg/m2, respectively) and 20 (13 woman and 7 man) by videolaparoscopy (age and BMI means of 35±9,6 years and 44±5,9 Kg/m2, respectively). All of them were submitted to espirometry, blood gas transcutaneous (oximetry) and respiratory frequency monitoring before and after surgery (until the 30th hour) and were also evaluated by a modified pain visual analogic scale at the espirometry. In pre-operatory, all patients presented normal pulmonary function tests. We observed a significant mean reduction of 38.53% in Forced Vital Capacity (FVC), 39.11% in Forced Expiratory Volume in 1 second (FEV1) and 37% in Expiratory Peak Flow (PFE) in laparotomy group (LG). In the videolaparoscopy group (VG) there was a mean reduction of 38.37% in FVC, 35.53% in FEV1 and 41.57% in PFE. The respiratory frequency had a mean increase of 16.98 and 14.79% in LG and VG respectively, both with statistic significance. The mean reduction in oximetry was not statistically significant in both groups. The mean operating time was 179 minutes in LG and 163 minutes in VG. Pain scores were 3.58 in LG and 3.40 in VG. Based on these results, we concluded that the patients with degree 2 and morbid obesity presented normal espirometry values in pre-operatory and, after being submitted to gastroplasty by the surgical technique (laparotomy or videolaparoscopy), they developed an espirometric compatible with pulmonary restriction in early post-operatory.