We report two cases of prolonged hypercapnia following laparoscopic cholecystectomy. Case 1: A 44-year-old man suffered from recurrent right subcostalgia and icterus and gallstones were pointed out. He underwent a laparoscopic cholecystectomy. During the operation P_ETCO₂ was not markedly elevated, but upon a awaking P_ETCO₂ increased and hypercapnia was prolonged until the 3rd postoperative day. One year and 7 months later he was admitted for pneumonia and aphea. During this hospitalization we examined his disease in detail and made a diagnosis of central alveolar hypoventilation due to mitochon drial disease. About two years later, he returned to the hospital because of lower limb weakness. Then, his respiratory state progressively deteriorated and he was intubated. Finally, he died of perforative peritonitis due to a duodenal ulcer. Case 2: The 65-year-old mother of case 1 complained of back pain, right subcostalgia and general fatigue. She had a laparoscopic cholecystectomy and took almost the same postoperative course as her son. Nasal BIPAP was performed to treat sleep apnea. Her sleep apnea and fatigue improved.
Many factors causes hypercapnia following laparoscopic surgery. Needless to say, these two cases had rare disorders, but we must treat the various etiologies of this problem.