| dc.description.abstract | Chest physiotherapy has undergone considerable changes during the last couple of decades. The main purpose of this thesis was to evaluate the effects of the present prophylactic chest physiotherapy in open and laparocopic surgery, to follow respiratory function after laparoscopic surgery close to the diaphragm and to describe breathing patterns during breathing exercises common in the treatment of patients undergoing abdominal surgery The effects of prophylactic chest physiotherapy and respiratory function were investigated in a prospective, randomised, controlled trial in which 368 patients undergoing major abdominal surgery participated. The use of risk-classification and two different regimens for high- versus low risk patients decreased the risk of postoperative pulmonary complications and increased oxygen saturation and the postoperative mobilisation rate compared to an untreated control group. Abdominal surgery has also undergone changes with the introduction of the laparoscopic technique. Two consecutive series of patients undergoing laparoscopic fundoplication (N=25) or vertical banded gastroplasty (N=29) were compared with patients operated upon openly (N= 32 versus 17). The results indicate that laparoscopic surgery impairs respiratory function postoperatively, but not as much as an open procedure. The effects of chest physiotherapy in combination with laparoscopic surgery close to the diaphragm, represented by fundoplication and vertical banded gastroplasty, were evaluated in two series of 40 patients each. In each series, 20 patients were randomised to a treatment group receiving chest physiotherapy and 20 to a control group without treatment. In spite of a decreased respiratory function postoperatively, chest physiotherapy did not affect the outcome. To investigate the mechanisms behind the effects of the treatments used in connection with abdominal surgery, a laboratory study was performed including 21 persons of normal weight and 21 obese persons (BMI>40). The investigated breathing techniques were deep breaths without any resistance (DB), positive expiratory pressure (PEP) and inspiratory resistance positive expiratory pressure (IR-PEP). Breathing patterns, studied as volume against time, were monitored in a body plethysmograph. Tidal volume and alveolar ventilation were highest during DB without resistance. Peak inspiratory volume (Functional residual capacity (FRC) + tidal volume) was, however, significantly higher than during PEP and IR-PEP only in the group of obese subjects, due to significantly lower FRC during DB compared to PEP and IR- PEP. The breathing cycles were prolonged in all techniques but most in PEP and IR-PEP. Functional residual capacity determined within two minutes after finishing each breathing technique was identical to before the breathing manoeuvres. The overall conclusion of the thesis is that prophylactic chest physiotherapy is effective in preventing postoperative pulmonary complications in patients undergoing major abdominal surgery. Laparoscopic fundoplication and VBG impair lung function but less compared to an open procedure and chest physiotherapy cannot improve the outcome. In addition, the breathing patterns during the three different breathing techniques are described and the mechanics behind their effects in connection with abdominal surgery are discussed | en |
