BACKGROUND: The advantage of a laparoscopic cholecystectomy has led to a trend toward performing it in the elderly. It is well recognised that this can cause changes in respiratory mechanics. However, few studies have measured the effects of abdominal insufflation with CO2 in the elderly. This study was done to evaluate changes in respiratory compliance and peak airway pressure during a laparoscopic cholecystectomy. METHODS: Thirty patients undergoing a laparoscopic cholecystectomy were divided into two groups; aged 65 years or more (elderly group) and under 60 years (control group). A pneumoperitoneum up to an intraabdominal pressure of 12 mmHg was created with CO2 insufflation. Respiratory and peak airway pressure were measured with a continuous spirometry. Measurements were obtained pre-insufflation, just after CO2 insufflation, at 15, 30, 45 and 60 minutes and after abdominal deflation. RESULTS: In both groups, respiratory compliance decreased significantly (P < 0.05) and equally by about 40% after CO2 insufflation. The decrement continued during the pneumoperitoneum, the changes were not significant between the groups. Each group showed an equal improvement immediately after abdominal deflation. No differences between the peak airway pressure during a laparoscopic cholecystectomy was seen in either group. CONCLUSIONS: We have demonstrated that during a laparoscopic cholecystectomy in the elderly the respiratory compliance decreased and peak airway pressure significantly increased as in the control group.