Hepatic Blood Flow and Function in Elderly Patients Undergoing Laparoscopic Cholecystectomy

Abstract

Laparoscopic cholecystectomy (LC) has been widely accepted as an alternative to laparotomy and has many advantages, including short hospital stay and very limited surgical invasion. However, this procedure may impair hepatic function in elderly patients because high pressure is maintained in the peritoneal cavity for an extended period. We observed the effect of pneumoperitoneum on the middle hepatic venous blood flow (MHVBF) in elderly patients undergoing LC. LC patients were anesthesized with inhaled and epidural anesthesia, after which MHVBF was continuously measured by transesophageal echocardiography. MHVBF decreased significantly during a period of high intraperitoneal pressure, and recovery of MHVBF after deflation was significantly lower in elderly patients (65-75 yr), but not in younger patients (24-62 yr). In contrast, MHVBF remained almost constant in elderly patients during open cholecystectomy, and thus was significantly different from that in patients who underwent LC with pneumoperitoneum. Laparoscopic cholecystectomy may impair hepatic function in elderly patients because high pressure is maintained in the peritoneal cavity for an extended period.

Surgery in the Patient with Liver Disease

“…Intermittent positive-pressure ventilation and pneumoperitoneum during laparoscopic surgery mechanically decrease hepatic blood flow (4). In addition, traction on abdominal viscera may cause reflex dilatation of splanchnic veins and thereby lower hepatic blood flow.…”

Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

“…In contrast, laparoscopic surgery usually requires a pneumoperitoneum, which can disrupt respiratory or cardiovascular performance during the operation [13][14][15], and these effects could be more significant in elderly patients with a higher likelihood of preoperative comorbidities and reduced functional capacities [16,17]. Although several studies found no significant difference in the incidence of postoperative complications between elderly and younger patients undergoing LAG [18][19][20][21], severity of complications was poorly defined in most of these studies.…”

Study of Effect of Pneumoperitoneum on Liver Function Following Laparoscopic Cholecystectomy

“…The primary mechanism for elevation of liver enzymes after laparoscopic abdominal surgery is likely due to the increased intra-abdominal pressure and its effects on portal venous flow. The 11-15 mm Hg of CO2 that is used is higher than the normal portal pressure of 7-10 mm Hg, resulting in reduced portal blood flow (11,12) . Free radicals are generated at the end of a laparoscopic procedure, possibly as a result of an ischemiareperfusion phenomenon induced by the inflation and deflation of the pneumoperitoneum (13) , which can damage the Kupffer and endothelial cells of the hepatic sinusoids resulting in increase in liver enzymes postoperatively.…”