Lack of Corellation between Liver Enzymes and the Presence of a Bile Leak Following Laparascopic Cholecystectomy

Abstract

Purpose: Biliary tract leak following laparoscopic cholecystectomy occurs in approximately 1–5% of all patients. Most bile leaks are restricted to the gall bladder bed and perihepatic region; retained calculi may or may not be present, causing potential elevations in liver function tests (LFTs). Common symptoms indicating bile leak are abdominal pain, vomiting, and abdominal distension. Many surgeons routinely obtain LFTs after all laparoscopic cholecystectomies, but it is unclear whether liver enzyme elevation is a predictor of bile leak following lap chole. The purpose of this study was to determine if routine postoperative LFTs can predict a post operative bile leak. Methods: All patients diagnosed as having ERCP documented postoperative bile leak from April 2003 to May 2007 were identified. Preoperative and post operative liver enzymes and patient symptoms were obtained through chart review and retrospective analysis. Results: Bile leak was observed in 25 patients (0.9%). Among the 25 patients found to have a bile leak, 9 (36%) had post operative evidence of elevations of AST, ALT, or Alk Phos (greater than 1.5× normal). Only 6 (24%) had post operative fever and 5 (20%) leukocytosis. All patients (100%) had evidence of post operative abdominal pain, nausea or both. There was a statistically significant difference in pre- and postoperative alanine aminotransferase and alkaline phosphatase (39 vs 66 U/L; P= 0.01 and 96 vs 133 U/L; P= 0.05, respectively). Conclusion: There was no correlation with liver enzyme elevation and presence of bile leak, with only 36% of patients with bile leak manifesting 1.5× elevations in Alk Phos, ALT or AST. Postoperative elevations in liver function tests are frequently seen after laparoscopic cholecystectomy; however, these elevations do not predict bile leak following laparascopic cholecystectomy. LFTs should be obtained only when clinically indicated.