Between May, 1980, and October, 1981, 22 morbidly obese patients ranging in weight from 93.4 to 236.8 kg (average, 145.2 kg) underwent transthoracic gastric stapling. Fourteen of these operations were performed using endobronchial intubation and selective collapse of the left lung to facilitate surgical exposure. The patients were compared with 22 consecutive patients treated by trans-abdominal gastric stapling during the same period. None of the 44 patients had evidence of chronic alveolar
hypoventilation (
pickwickian syndrome). In terms of operating time, blood loss, duration of intubation, and
hospital stay, the two groups did not differ significantly. Despite marked shunting during
one-lung ventilation, satisfactory arterial
oxygen tension (PaO2) could be demonstrated on 100%
oxygen for all
thoracotomy patients (PaO2 range, 67 to 230 torr; mean, 132.3 torr). In fact, except for a lower PaO2 during one-lung
anesthesia, the
thoracotomy patients were indistinguishable from the
laparotomy patients in terms of perioperative respiratory function.
Pain, sedation, and positioning led to significant decreases in vital capacity and one-second forced expiratory volume in both groups on the first post-operative day, and in the
thoracotomy group on the second day. There were only two
wound infections in the
thoracotomy group, as opposed to six
infections with two dehiscences in the
laparotomy group. It is concluded that lateral
thoracotomy with or without one-lung
anesthesia can be performed safely in massively obese patients--at least in those without preexisting
alveolar hypoventilation syndrome.