Comparison of Postoperative Hepatic Function between Laparoscopic and Open Cholecystectomy

Abstract

Objective: In this prospective study, we evaluated the effects of pneumoperitoneum on hepatic function during laparoscopic (LC) and open cholecystectomy (OC). Subjects and Methods: One hundred patients who underwent LC (n = 50) or OC (n = 50) were included in the study. The groups were similar in age, sex, weight and height. Following liver function tests (total bilirubin; γ-glutamyltransferase, GGT; alkaline phosphatase, ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) were obtained preoperatively and at 24 and 48 h postoperatively. Similar anesthesiologic protocol was used for both LC and OC. During LC, the intra-abdominal pressure was maintained within the conventional range of 12–14 mm Hg. Results: Total bilirubin, ALP, GGT and LDH levels remained unchanged from baseline in both groups without significant difference between them. A higher number of patients had increased values of ALT (26/50 vs. 5/50) and AST (23/50 vs. 6/50) in LC compared to OC group. Although the difference was statistically significant (p < 0.000 for ALT and p = 0.0004 for AST) the increased level decreased at 48 compared to 24 h. Conclusion: The results indicate that LC is associated with transient elevation of ALT and AST. The disturbances in the function of the liver after LC are self-limited and not associated with any morbidity in patients with a normal liver function.

What Is the Role of the Abdominal Perfusion Pressure for Subclinical Hepatic Dysfunction in Laparoscopic Cholecystectomy?

“…23 Similar agents are used for general anesthesia in both open and laparoscopic approaches, but the results of liver function tests exhibit a significant difference. 24 Among these probable causes, hepatic hypoperfusion seems to be the most prominent factor. However, the elevation rates of liver-function tests exhibit a wide range of difference among patients.…”

Effect of contrast injection into the biliary tract during intraoperative cholangiogram on postoperative liver function tests

“…Transient elevation of LFT, particularly ALT and AST (Aspartate transaminase), has been observed in previous studies, and the causative factor was thought to be pneumoperitoneum . The argument is that intraperitoneal pressure of 12–14 mmHg during pneumoperitoneum exceeds portal venous pressure of 7–10 mmHg and could result in alteration of portal blood flow.…”

Association between Duration of Carbon Dioxide Pneumoperitoneum during Laparoscopic Abdominal Surgery and Hepatic Injury: A Meta-Analysis

“…Of these, 19 were selected for full-text examination. Eight of these were then excluded for the following reasons: raw data could not be extracted in an appropriate format ( n  = 5) [20], [21], [22], [23], [24], the comparator was not of interest ( n  = 1) [12], or no full text was available ( n  = 2) [25], [26]. Eleven studies fulfilled the inclusion criteria and were included in the meta-analysis [6], [7], [8], [9], [10], [11], [13], [14], [15], [16], [27].…”

“…Among the eight studies that described the inclusion criteria for patients [6], [7], [8], [9], [10], [11], [13], [14], seven of them presented preoperative normal serum liver enzyme values as the most common reason for inclusion [6], [7], [8], [9], [10], [11], [14]; the remaining studies included patients with any disease that might cause liver enzymes to be elevated preoperatively [13]. In the eight studies describing the exclusion criteria for patients, the most common reason for exclusion was the presence of any condition that might cause serum liver enzymes to be elevated in the preoperative period [6], [7], [8], [10], [14], [15], [16], [21], [27]. The outcome measures of these studies varied and included some index of postoperative liver function from days 1 to 7.…”