Role of routine preoperative chest X-ray in patients candidate to laparoscopic surgery. Results of a prospective study

Background. The aim of the present study was to evaluate the clinical usefulness and the costs/benefits of routine preoperative X-ray of the chest, in patients candidate to elective laparoscopic surgery. Methods. 1157 patients with benign diseases were enrolled in the study, classified in 4 groups on the basis of cardiopulmonary risks and the undergone to laparoscopic surgery. Results. The preoperative studies (X-rays and questionnaire) results were: in 51 patients (4.4%) there was a pathologic finding on X-rays, in 22 of them the results were unexpected. Anesthesia was not changed in any case, while the surgical approach was modified from laparoscopy to laparotomy in one case. Conclusions. Chest X-ray is not able to detect pathologic conditions requiring a changing of the anesthetic and/or surgical procedures better than the history and the examination of the patients. Since preoperative X-rays are an emission source of radiations and an element of cost, a definition of a guideline for clinical use is needed. The conclusion is drawn that routine preoperative chest X-ray, is of little use in absence of risk factors.