We hypothesize that the addition of modified incentive spirometry to standard postoperative chest physiotherapy will be associated with faster return to baseline/predicted pulmonary function and fewer postoperative pulmonary complications in patients following laparotomy.

The primary objective of this study is to determine how quickly patients' peak expiratory flow measurement returns to baseline or predicted values following laparotomy with or without the assistance of modified incentive spirometry. The secondary objective is to assess the effectiveness of modified incentive spirometry in preventing postoperative pulmonary complications in patients following laparotomy. Specifically, this study will track length of stay, mortality, and evidence of pulmonary infection in both treatment and non-treatment arms.

Inclusion Criteria:

• Adult patients who undergo laparotomy at Kamuzu Central Hospital, Malawi

Exclusion Criteria:

• Patients with known pre-existing pulmonary disease
• Pregnant women
• Patients who cannot perform maximal expiration for measurement of peak expiratory flow meter because of inability to understand or follow directions and demonstrations
• Patients with terminal cancer or illness with life-expectancy less than 1 month
• Patients with burn injuries
• Patients with illness requiring intubation and mechanical ventilation or postoperative ICU admission
• Patients who require additional operations during the course of their hospital stay