Liver Function Following Carbon-Di-Oxide Pneumoperitoneum in Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic surgery is performed by the insufflation of gas like carbon di oxide (CO2) into the peritoneal cavity by artificial port which is called creating pneumoperitoneum. The CO2 pneumoperitoneum causes changes in the splanchnic microcirculation and can affect liver physiology. Although laparoscopic cholecystectomy offered many advantages over laparotomy, new concerns arose regarding the effects of CO2 pneumoperitoneum on liver function. Knowledge of the effects of CO2 pneumoperitoneum on liver function can help minimize complications while profiting from the benefits of LC without concerns about its safety. It was noticed in many studies that following laparoscopic cholecystectomy (LC), liver function parameters were disturbed. Aims: To observe any alteration in liver function by carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy. Methods: Ninety-four patients with cholelithiasis having normal liver function enrolled in this study. Test obtained preoperatively including serum bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) then 24 &72 hour post operatively to compare and proceed. Statistical analyses of the results were obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS22). Results: The findings showed that mean duration of pneumoperitoneum was 43.8±9.1minutes. The mean serum bilirubin pre-operatively was 0.75±0.21 (mg/dL), post-operative 24 hours value was 0.77±0.23 (mg/dL) and post-operative 72 hours value was 0.73±0.18 (mg/dL). No significant difference was observed in pre-operative and postoperative values. The mean serum ALT preoperatively was 33.81±7.83 (IU/L), post-operative 24 hours value was 52.51±25.9 (IU/L) and postoperative 72 hours value was 46.3±21.33 (IU/L). The mean serum AST pre-operatively was 33.84±6.83 (IU/L), post-operative 24 hours value was 48.94±19.23 (IU/L) and post-operative 72 hours value was 44.36±15.7 (IU/L). The mean serum alkaline phosphatase pre-operatively was 72.57±25.95 (IU/L), post-operative 24 hours value was 88.26±41.69 (IU/L) and post-operative 72 hours value was 85.32±38.85 (IU/L). There were significant increase of post-operative 24 hours and 72 hours value of liver enzymes when compared to preoperatively. Conclusion: There was significant increase in, AST, ALT, ALP post-operative 24 hours and 72 hours after doing laparoscopic cholecystectomy when compared to preoperatively. There may be a transient elevation of hepatic enzymes after LC and the major causative factor seemed to be CO2 pneumoperitoneum.