Role of respiratory physiotherapy in the postoperative period of cholecystectomy

Abstract

Introduction: Cholecystectomy is a primary procedure used to treat cholelithiasis and other gallbladder diseases. Although frequently performed laparoscopically, the procedure can lead to postoperative respiratory changes, such as reduced lung volumes, decreased respiratory muscle strength, impaired chest wall expansion, and altered oxygenation. In this context, respiratory physiotherapy can contribute to functional recovery and the prevention of pulmonary complications. Objective: To synthesize the available scientific evidence on respiratory physiotherapy interventions following cholecystectomy and their effects on pulmonary function, respiratory muscle strength, functional recovery, and the prevention of respiratory complications. Methods: This is an integrative literature review of a qualitative and descriptive nature. Studies were searched in the PubMed/MEDLINE, SciELO, and Virtual Health Library (VHL) databases using descriptors related to cholecystectomy, respiratory physiotherapy, breathing exercises, postoperative care, lung function, and postoperative complications, combined using the Boolean operators AND and OR. Initially, 365 records were identified, 15 of which were duplicates. Following screening and eligibility assessment, 13 studies met the established criteria and comprised the final sample. Results: The included studies featured various designs, including randomized clinical trials, as well as prospective, observational, comparative, and epidemiological studies and a systematic review. The main interventions evaluated were respiratory kinesiotherapy, deep and diaphragmatic breathing exercises, lung expansion exercises, cough stimulation, incentive spirometry, intermittent positive pressure, perioperative guidance, and breathing control techniques. The primary outcomes analyzed included vital capacity, forced vital capacity, forced expiratory volume in the first second, respiratory muscle strength, chest wall expansion, oxygenation, pain, sleep quality, analgesic consumption, and the occurrence of pulmonary complications. Overall, the studies demonstrated that cholecystectomy can cause transient changes in respiratory function and that certain physical therapy interventions can facilitate pulmonary and functional recovery. However, results were not uniform across all techniques, particularly regarding incentive spirometry and prophylactic interventions routinely applied to low-risk patients. Conclusion: Respiratory physical therapy is potentially significant in the post-operative period following cholecystectomy, especially regarding the recovery of pulmonary function, respiratory muscle strength, and ventilatory mechanics. Nevertheless, the effectiveness of interventions varies according to the patient's clinical profile and the technique employed, underscoring the need for individualized assessment and the judicious selection of physical therapy modalities. Further clinical studies using standardized protocols and larger sample sizes are needed to strengthen the evidence regarding the best physical therapy strategies in this context.