Liver Function Tests after Laparoscopic Common Bile Duct Exploration Are Not Reliable

Abstract

INTRODUCTION: Laparoscopic common bile duct exploration (LCBDE) to manage choledocholithiasis at the time of cholecystectomy (LC+LCBDE) is gaining traction and requires examination of the role of postoperative laboratory data to guide clinical care. We examined postoperative liver function test (LFT) trends in the context of successful and failed LCBDE. METHODS: Retrospective review of all adult emergency general surgery (EGS) patients undergoing LCBDE over a 3-year period. Failed LC+LCBDE was defined as the subsequent need for endoscopic retrograde cholangiopancreatography (ERCP) for duct clearance. Postoperative LFTs from both successful and failed LCBDE attempts were analyzed. Postoperative laboratory values from all LC+LCBDE were classified as increased, decreased, or unchanged from preoperative. Procedure outcomes were analyzed. RESULTS: Sixty patients underwent LCBDE. Ten patients were excluded for not having preoperative laboratory tests or any postoperative laboratory tests. Thirty-three of the remaining 50 patients had 2 sets of postoperative laboratory tests. In patients who underwent successful LCBDE, there was no statistical difference (p > 0.05) between the preoperative and the 1st postoperative or 2nd postoperative laboratory tests regarding total bilirubin, aspartate/alanine aminotransferase, or alkaline phosphatase. For patients who had an unsuccessful LCBDE and required postoperative ERCP, this was also true. No patients with successful LCBDE with increased postoperative laboratory tests had complication. CONCLUSION: Despite the LCBDE outcome, postoperative laboratory tests do not provide reliable prognostication as would be expected in the given clinical context. Contrast flow into the duodenum and surgeon judgment are better indicators of duct clearance. It is safe to discharge patients without LFT after successful and uneventful LCBDE.