Are Elevated Liver Enzymes and Bilirubin Levels Significant After Laparoscopic Cholecystectomy in the Absence of Bile Duct Injury?

Abstract

ObjectiveIncreased aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin levels were noted incidentally after a laparoscopic cholecystectomy. The percentage in which such elevation occurs and its clinical significance in the absence of bile duct injury were investigated. Summary Background DataBile duct injury is the most feared complication of laparoscopic cholecystectomy. Some laboratory tests may be indicative of this complication, such as increases in liver enzyme (AST, ALT, and alkaline phosphatase [ALP]) and bilirubin. These parameters have not been investigated in patients who had laparoscopic cholecystectomy and in whom no damage to the bile duct was noted. MethodsSixty-seven patients with normal results of preoperative liver function test were entered into the study. Blood was collected 24 hours after laparoscopic cholecystectomy, and AST, ALT, ALP, and bilirubin levels were measured. ResultsA mean 1.8-fold increase in AST occurred in 73% of patients; 82% showed a 2.2-fold increase in ALT. A statistically nonsignificant increase was noted in 53% of patients (ALP remained within normal limits), and in 14% of patients bilirubin levels were increased (they were primarily of the unconjugated type). ConclusionsIn many patients a significant increase in AST and ALT levels occurred after laparoscopic cholecystectomy, but they returned to normal values within 72 hours. The cause of this is unclear, and these elevations appear to have no clinical significance. 362

Study in Change in Liver Enzymes After Laproscopic Cholecystectomy : A Retrospective Study

“…11,12 Halevy et al in 1994 first studied that laproscopic cholecystectomy may lead to alteration of liver enzymes. 13 Besides pneumoperitoneum increased intra-abdominal pressure other causes which lead to deranged liver functions are-squeeze pressure effect on the liver, excessive use of diathermy, pull on the gall bladder or passage of micro calculi in the bile duct during manipulation of gall bladder which are usually limited in open cholecystectomy. 13 Intraperitoneal pressure used for laproscopic cholecystectomy is higher than the pressure in the portal venous system which impedes portal circulation which in turn reduces portal flow up to 50%, hence causes depression of the hepatic reticular endothelial system.…”

Estudo da função hepática de ratos espontaneamente hipertensos submetidos a diferentes pressões de pneumoperitônio com CO2

“…Halevy et al (9) relataram, em estudo clínico, que aumentos significantes das aminotransferases ocorreram em pacientes submetidos à colecistectomia laparoscópica, entretanto, retornando aos níveis basais até 72 horas após o procedimento. Morino et al (7) , em pesquisa clínica, referiram que as alterações de função hepática durante procedimentos laparoscópicos, eram decorrentes da duração e do nível de pressão intra-abdominal.…”

“…Pouco se encontra na literatura sobre os efeitos do pneumoperitônio sobre a função hepática (7,9,10) , sendo que somente um estudo e foi realizado em animais (10) . Entretanto, existem vários trabalhos que avaliam o fluxo sangüíneo portal, da artéria hepática e da microcirculação hepática na vigência de pneumoperitônio (5,23,27,28) .…”

“…A repercussão da queda do fluxo sangüíneo hepáti-co na atividade das aminotransferases tem sido estudada, tanto em seres humanos como em animais de experimentação, porém não em associação a uma doença preexistente (3,7,9) .…”

A Prospective Study of Alteration in Liver Function Test after Laparoscopic Surgeries

“…The growing interest in laparoscopy is mostly attributable to cumulative evidence suggesting a reduction in patient morbidity, shortening in hospital stay, and early return to normal activity. During the last decade many studies have disclosed 'unexplained' changes in postoperative liver function tests in patients undergoing laparoscopic procedures 1,2 . These studies demonstrate that transient elevation of hepatic enzymes could occur after laparoscopic procedures.…”