Alterations In Liver Function Tests Following Laparoscopic Cholecystectomy

Abstract

Background: The pneumoperitoneum and the resulting high intraabdominal pressure may have several systemic effects including splanchnic ischemia. Disturbances of liver function tests following laparoscopic cholecystectomy have been previously reported although their etiology still remains uncertain. This prospective study was planned to explore further the incidence and significance of this alteration. Materials and Methods: Over a two-year period, laparoscopic cholecystectomy was performed in 262 consecutive patients with symptomatic cholelithiasis. Total and indirect bilirubin (TB and IB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and a-glutamyl-transpeptidase (γ-GT) were tested preoperatively as well as 24 hours following surgery. Strict exclusion criteria were adopted in order to eliminate any known cause of possible liver function disturbances. Results: Totally 198 patients fulfilled the criteria and were included in the study. A statistically significant increase of TB, IB, ASP, ALT and a significant decrease of ALP were noted postoperatively, whereas γ-GT showed slight not significant elevation. A 48.4% mean increase of TB value, duplication of IB in 16% of cases, and an up to 100% mean increase of both ASP and ALT values were seen. Conclusion: Transient alterations of hepatic enzymes are frequently observed after uneventful laparoscopic cholecystectomy, presumably attributed to the elevated intraabdominal pressure of the pneumoperitoneum. Further studies could enlighten the exact pathogenetic mechanism.