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GENERAL ARTICLES

Diaphragm Movement Before and After Cholecystectomy: A Sonographic Study

Jean Ayoub, MD, PhD^*§, Robert Cohendy, MD, PhD, Jacques Prioux, PhD^§, Saïd Ahmaidi, PhD^||, Jean Marie Bourgeois, MD, Michel Dauzat, MD, PhD^*, Michèle Ramonatxo, PhD^§, and Christian Préfaut, MD^§

Departments of *Medical Imaging, Anesthesia and Intensive Care, and Ultrasound, University Hospital, Nîmes; §Laboratory of Physiological Interactions, University Hospital, Montpellier; and ||Sciences and Sport University, Amiens, France

Address correspondence and reprint requests to Jean Ayoub, MD, PhD, Laboratoire de Physiologie, Université Rennes 2-Haute Bretagne, UFR-STAPS Campus la Harpe, Av Charles Tillon, 35044 Rennes Cedex 02, France. Address e-mail to ayoub.jean{at}wanadoo.fr

Respiratory disorders after abdominal surgery are commonly explained by changes in diaphragmatic movement that are difficult to demonstrate and quantify. Our aim was thus to quantify these changes using a noninvasive method. We used M-mode sonography for the prospective study to measure diaphragmatic amplitude in 14 patients before and after cholecystectomy. During quiet breathing, the diaphragm inspiratory amplitude (DIA) was significantly decreased after surgery from 1.4 ± 0.2 cm to 1 ± 0.1 cm and from 1.6 ± 0.3 cm to 1.2 ± 0.3 cm in the Laparoscopic and Open Cholecystectomy groups, respectively. The total time cycle of diaphragmatic motion decreased significantly in the two groups. The DIA also decreased significantly during deep breathing after cholecystectomy from 6.0 ± 0.8 cm to 3.0 ± 1.8 cm and from 6.1 ± 1.3 cm to 3.1 ± 1.6 cm in the Laparoscopic and Open Cholecystectomy groups, respectively. The six patients who underwent spirometric examination showed, during quiet breathing, a significant decrease in DIA without change in tidal volume, i.e., 0.51 ± 0.08 L to 0.45 ± 0.08 L. We found a significant decrease in DIA after cholecystectomy and a significant interindividual correlation between DIA during deep inspiration and inspiratory capacity. Using M-mode sonography techniques, we were able to demonstrate changes in diaphragmatic mobility after laparoscopic or open cholecystectomy.

Implications: Cholecystectomy at times results in impaired respiratory and diaphragmatic functions. The techniques currently used to study these repercussions are both laborious and invasive. Our sonographic technique is completely noninvasive and can be used to study diaphragm morphology and movement in real time.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999