Preoperative Liver Function Tests Research Articles

Hepatic Hydatid cyst in children: An experience from East of Turkey

İntoduction: Hydatid cyst is a parasitic disease caused by the infection of Echinococcus granulosus and rarely Echinococcus alveolaris eggs, which are endemic in our country. Current treatment options for liver hydatid cysts; They can be listed as medical treatment, surgical treatment, percutaneous drainage and clinical follow-up only. In this study, the effectiveness of the WHO-IWGE protocol in terms of diagnosis and treatment strategies in our pediatric cases of liver hydatid cyst in a health institution in eastern Turkey was evaluated in the light of the literature. Material Method: Pediatric patients between the ages of 0-16 who were diagnosed with KcKH and followed up and treated were evaluated retrospectively. In pre-operative evaluation, lung radiography, abdominal ultrasonography, serological tests, hemogram and liver function tests were routinely performed. Results: 250 child patients between the ages of 0 and 16, whose data were fully available, were included in the study. 118 of the cases were girls and 132 were boys. The average age was 11.2 years. Most of the KcKH patients were admitted to the hospital for another reason and the cyst was detected incidentally. Of the 65 patients requiring surgery, 17 were patients who initially underwent primary intervention with PAIR. Patients who underwent PAIR were observed for one night and discharged in an average of 18 hours. Patients with free drainage were discharged in 2-4 days. The average length of stay for patients who underwent open surgery was found to be 9 days. In conclusion; The Gharbi classification updated by WHO is effective and reliable in determining the KcKH treatment strategy. In cases who are receiving chemotherapy and an intervention decision is made, a final USG is performed just before the procedure; It can provide both a change in treatment management and more patients benefiting from medical treatment.

Evaluation of hepatic and renal functional changes in patients undergoing laparoscopic cholecystectomy

Background: In this era of laparoscopic surgery, with the use of carbon dioxide insufflation in creating pneumoperitoneum for ease of trocar insertion and visualization of anatomy, it comes certain systemic changes in the patient due to the compression effect of the gas as well as resorption of it through peritoneum. Aims and Objectives: The aim of the study was to assess baseline standards of hepatic and renal functional status in pre-operative patients in comparison with post-operative patients undergoing laparoscopic cholecystectomy (LC). Materials and Methods: Cases were chosen among the persons who presented with chronic calculus cholecystitis to the surgical out-patient department of Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences, Kolkata. Pre-operative liver function tests (LFT) and renal function tests (RFT) values were recorded. Again, LFT and RFT values were evaluated on post-operative day 1 (POD1) and POD12. Results: Serum conjugated and unconjugated bilirubin, aspartate amino transaminase, alanine amino transaminase, urea, estimated glomerular filtration rate values increases immediate postoperatively on POD1 but returns to normal pre-operative levels on POD 12. Serum alkaline phosphatase, albumin, and creatinine values decrease on POD1 and return to normal pre-operative values in POD 12. Conclusion: Hepatic and renal function changes in the immediate post-operative period of 24 h following LC. This change is transient and returns to normal levels within POD 12.

Comparison of the LiMAx test vs. the APRI+ALBI score for clinical utility in preoperative risk assessment in patients undergoing liver surgery – A European multicenter study

IntroductionPosthepatectomy liver failure (PHLF) remains the main reason for short-term mortality after liver surgery. APRI+ALBI, aspartate aminotransferase to platelet ratio (APRI) combined with albumin-bilirubin grade (ALBI), score and the liver function maximum capacity test (LiMAx) are both established preoperative (preop) liver function tests. The aim of this study was to compare both tests for their predictive potential for clinically significant PHLF grade B and C (B+C). Materials and methods352 patients were included from 4 European centers. Patients had available preop APRI+ALBI scores and LiMAx results. Predictive potential for PHLF, PHLF B+C and 90-day mortality was compared using receiver operating characteristic (ROC) curve analysis and calculation of the area under the curve (AUC). Published cutoffs of ≥ −2.46 for APRI+ALBI and of <315 for LiMAx were assessed using chi-squared test. ResultsAPRI+ALBI showed superior predictive potential for PHLF B+C (N = 34; AUC = 0.766), PHLF grade C (N = 20; AUC = 0.782) and 90-day mortality (N = 15; AUC = 0.750). When comparing the established cutoffs of both tests, APRI+ALBI outperformed LiMAx in prediction of PHLF B+C (APRI+ALBI ≥2.46: Positive predictive value (PPV) = 19%, negative predictive value (NPV) = 97%; LiMAx <315: PPV = 3%, NPV = 90%) and 90-day mortality (APRI+ALBI ≥2.46: PPV = 12%, NPV = 99%; LiMAx <315: PPV = 0%, NPV = 94%) ConclusionIn our analysis, APRI+ALBI outperformed LiMAx measurement in the preop prediction of PHLF B+C and postoperative mortality, at a fraction of the costs, manual labor and invasiveness.

Effects of Livact Granule on Liver Function Recovery After Donor Right Hemi-Hepatectomy

BackgroundLiving donor liver transplantation (LDLT) is currently widespread due to organ shortage. LDLT is basically a high-risk surgery for the donor. Therefore, the safety of the donor is the most important issue in LDLT. In adult LDLT, right lobe grafts are usually used, which pose a greater risk for the donor than using a left lobe. There have been reports that taking branched chain amino acids (BCAAs) helps patients recover after hepatectomy. This study is performed to evaluate effect of Livact granule for donor safety and recovery. Patients and methodsFrom January 2016 to December 2021, LDLT was performed on 258 patients at our center. Among them, 148 were in the non-Livact group and 110 were in the Livact group. Six of 110 patients in the Livact group stopped taking Livact due to nausea and vomiting, so 104 patients in the Livact group were analyzed. To assess the donor safeties and recovery, various preoperative and postoperative factors were evaluated. ResultsThe donor age was 35.8 years in the non-Livact group and 40.0 years in the Livact group. Other than that, there was no difference between the two groups in preoperative liver function tests, and there was no difference in future liver remnant or steatosis. There was no difference in total bilirubin level between the two groups at 5 days postoperatively, but PT INR was lower in the Livact group and albumin was higher in the Livact group. The days taken for total bilirubin to normalize were the same in both groups, but the Livact group took less days for INR to normalize. More patients in the non-Livact group were discharged with Jackson-Pratt (JP) drain because JP drainage did not decrease. ConclusionsIn donor right hepatectomy patients, taking Livact granules, BCAAs, helps donor recovery. For donor safety, administration of Livact granules during the perioperative period may be considered.

Laparoscopic liver resection versus radiofrequency ablation for caudate lobe solitary hepatocellular carcinoma: A propensity score matching study.

This study aimed to compare the clinical efficacy of laparoscopic liver resection (LLR) and radiofrequency ablation (RFA) in treating solitary hepatocellular carcinoma (HCC) of the hepatic caudate lobe. Patients with hepatic caudate lobe HCC who underwent LLR or RFA at three hospitals in China between February 2015 and February 2021 were included. In total, 112 patients met the inclusion criteria, of whom 52 underwent RFA and 60 underwent LLR. The outcomes of the two groups were compared and analyzed using propensity score matching (PSM) method. There were no significant differences between the two groups in terms of sex, HBV/HCV positivity, AFP positivity (>100 ng/mL), tumor position, Child-Pugh score, or preoperative liver function tests (ALT, AST, TBIL, ALB, and PT) (p > 0.05). Compared to the LLR group, the RFA group had a shorter operation time, less intraoperative bleeding, and shorter postoperative hospital stay (p < 0.05). There was no statistically significant difference in overall postoperative complications between the two groups (p > 0.05). Despite the larger tumor size, the LLR group had better postoperative recurrence-free survival (RFS) (p = 0.00027) and overall survival (OS) (p = 0.0023) than the RFA group. After one-to-one PSM, 31 LLR patients and 31 RFA patients were selected for further analyses. The advantages of LLR over RFA were observed in terms of RFS (p < 0.0001) and OS (p = 0.00029). LLR should probably be recommended as the preferred method for solitary caudate lobe HCC.

Assessing the Prognostic Value of NLR, PLR, APRI, SII, and Liver Function Tests for Fistula Formation after Colorectal Cancer Surgery.

Background: This study evaluates the predictive value of preoperative inflammatory markers (NLR, PLR, APRI, SII) and liver function tests in determining the risk of fistula development postcolorectal cancer surgery. The objective was to determine the association between elevated marker levels and fistula risk and establish thresholds for preoperative risk stratification. Methods: A retrospective cohort study was conducted at the "Pius Brinzeu" Clinical Emergency Hospital from 2018 to 2023, analyzing data from 219 patients undergoing colorectal cancer surgery. Results: Among the markers studied, the Systemic Inflammation Index (SII) with a cutoff 460.5 showed the highest sensitivity (75.6%) and specificity (71.3%), resulting in an AUC of 0.774 (p=0.001). Albumin levels 2.9 g/dL also significantly predicted fistula occurrence with 77.3% sensitivity and 73.8% specificity (AUC 0.788, p 0.001). Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) presented cutoffs of 3.95 and 191.6 respectively, demonstrating substantial predictive value with AUCs of 0.732 and 0.746 (p 0.001 and p=0.001, respectively). Conclusions: Elevated levels of specific preoperative inflammatory markers and liver function tests are significantly associated with the risk of developing fistulas in patients undergoing colorectal cancer surgery. These findings support the integration of these biomarkers into preoperative evaluations to enhance patient risk stratification and optimize surgical outcomes, providing a valuable tool for clinical decision-making in colorectal surgery settings.

Rationale for routine preoperative liver function tests before elective cholecystectomy

Preoperative work-up before elective cholecystectomy often undergoes a range of routine investigations that includes liver function tests (LFTs). There is fear of concomitant common bile duct stones (CBDs) in patients with negative ultrasonography (USG) findings, i.e. with no dilatation of bile ducts or presence of stones in it or clinical features of hepatitis or jaundice. Studies show that clinical practice of preoperative workup of routine liver function tests for every elective cholecystectomy patient is questionable, possibly because of peer pressure or defensive medicine practices or simply a ‘copy-paste’ from the practices of seniors.1,2 Preoperative blanket tests on the pretext of ‘finding any abnormalities’ has poor scientific merits. The preoperative LFTs for uncomplicated, elective cholecystectomy patients rarely add value and do not alter the already planned decision based on symptomatology, history, physical examination, and ultrasound diagnosis of cholelithiasis. The clinical pathway for the management in most cases remains unchanged. The practice of menu-style routine tests adds to the cost and rarely adds further useful information sufficient enough to alter the planned clinical pathway.3

Pancreatic duct filling during cholecystectomy intraoperative cholangiogram and incidence of postoperative pancreatitis

AbstractBackground and AimLaparoscopic cholecystectomy (LC) with intraoperative cholangiography (IOC) is a commonly performed surgical procedure in most hospitals. Anecdotal evidence suggests that when the pancreatic duct (PD) inadvertently fills during IOC, there may be an increased risk of postoperative pancreatitis (POP). However, there is a paucity of information in the literature about both the incidence of pancreatitis post LC and the incidence of PD filling on IOC and any potential relationship between the two.MethodsA retrospective review was performed of all LC performed in our institution over a 10‐year period. IOC images were reviewed and clinical data collated.ResultsOf the 1243 procedures identified, 952 had IOC images available for review and were included in the study. The incidence of POP was 0.7%. The incidence of PD filling was 13.4%. Patient's age, sex, urgency of surgery, preoperative liver function tests (LFTs), history of pancreatitis, contrast leakage, and preoperative endoscopic retrograde cholangiopancreatography (ERCP) were not statistically related to the incidence of POP. Of those with PD filling, 2% had POP versus 0.5% who had no PD filling. This trended toward significance on univariate analysis (P = 0.05). However, on logistic regression, POP was the only significant independent risk factor (P = 0.02).ConclusionThe incidence of pancreatitis post LC and IOC is low. PD filling is associated with increased incidence of pancreatitis in this scenario and it is crucial for clinicians to be aware of this potential risk. This retrospective study was based on the review of saved images, and therefore PD filling might have been underestimated. Prospective studies would be useful to ascertain any definitive clinical association.

Single-session endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) vs. Two-stage Endoscopic Stone Extraction during ERCP followed by LC: a multicenter experience

Background The best way to handle gallbladder stones and common bile duct stones that are present simultaneously is up for dispute. The combination of endoscopic ERCP stone extraction and laparoscopic cholecystectomy has been the standard of care since the development of endoscopic and laparoscopic methods. Objective The current study aimed to evaluate single-stage ERCP/laparoscopic cholecystectomy (LC) and two-stage ERCP/LC in terms of imaging frequency, length of anesthesia, mean operating time, length of stay, and expenditures. Patients and methods Between June 2020 and January 2023, this multicenter retrospective comparative analysis was carried out in Qena University Hospitals, South Valley University, Qena and Assiut University Hospitals, Assiut University, Assiut. Results This research covered 220 participants. At ERCP, all patients had their bile ducts cleared. Regarding baseline variables such as age, sex, abdominal pain, preoperative liver function test, bilirubin, and alkaline phosphatase level, there is no difference between the two groups. The length of hospital stay varies significantly. Conclusion When compared with two separate procedures, single-session ERCP/LC has been safely and successfully utilized in some circumstances and is related to a shorter hospital stay, a reduced frequency of imaging, and better patient satisfaction.

Win or lose, nighttime transcystic laparoscopic common bile duct exploration is a win

ObjectivesAlthough controversial, recent data suggest nighttime versus daytime laparoscopic cholecystectomy (LC) have comparable outcomes. Laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis decreases length of stay (LOS) as compared with...

Comparative Study of Liver Function Test in Cholelithiasis Patient Pre and Post Cholecystectomy

This study aimed to investigate the changes that occur in liver function tests in cholelithiasis and relate those changes to it. For this purpose, 38 blood specimens were collected from the patients with cholelithiasis undergoing/underwent Cholecystectomy at Azadi-teaching and Kirkuk hospital from January to June 2021, 19 pre-operative samples, and 19 four weeks post-operatively. Our study showed that the gallstone disease was more common in females 17 (89.46%) than males 2 (10.54%). Age was a major risk factor as the patients’ mean age was 39.26 years. Out of 19 patients undergoing cholecystectomy, pre-operative liver function tests (LFT) were normal in 11(61.11%) patients, and abnormal LFT was detected in 8 (44.44 %) patients. Eight (42.1%) patients had elevated alkaline phosphatase (ALK-P levels%), and also had an elevated of AST and ALT. In the serum, slight elevations in the level of total bilirubin 5 (26.3%), and direct bilirubin 3 (15.8) were also noticed in those patients. Following Cholecystectomy (after 4 weeks), in some cases, changes occur in liver function tests where the finding of ALT, AST, and ALK-P closely shows restoration to normal. However, some cases show no significant variation. Statistically, big distinctions between levels of ALK-P, AST, and ALT have been found before and after Cholecystectomy (p is less than 0.0050, p is less than 0.0124, and p is less than 0.0115). The statistical result shows no significance in total bilirubin (TBIL) and direct bilirubin (DBIL) in postoperative cases. At all, there were big distinctions between levels of ALK-P, AST, and ALT before and after Cholecystectomy (p is less than 0.0050, p is less than 0.0124, and p is less than 0.0115, respectively), but levels of total and direct bilirubin revealed no significant distinctions before and after Cholecystectomy.

P-O14 The predictive role of pre-operative liver function tests in outcomes following emergency appendicectomy

Abstract Background Acute appendicitis remains one of the most common diagnoses in emergency general surgery, with recent evidence from the COMMA trial confirming that appendicectomy is the cornerstone of definitive management in most patients. With a wide range of severity and of patient physiology, complications are a burden to patients and the health service. We hypothesised that liver function tests have predictive value for complications following emergency appendicectomy. Methods A multicentre retrospective observational study was carried out across 4 hospitals (2 teaching centres and 2 district general hospitals) for adult patients who underwent emergency appendectomy between August 2018 and November 2020. Patients were identified through pathology records and data was extracted from electronic case records for patient demographics, pre-operative routine laboratory results, operative details, and clinical outcomes. Peak perioperative liver function parameters were analysed using unpaired two-way T-tests, Pearson’s correlation coefficient, ANOVA and multivariate regression to determine their relationship with conversion to open surgery, superficial and deep surgical site infection (SSI), length of stay (LOS) and 30-day re-admission rates. Results Of 1131 patients included, 57.4% were male, 80.5% were laparoscopic, with 7.3% converted to open, 10.8% performed open, and 1.5% by laparotomy. Mean LOS was 3.81 (SD4.0) days, 6.3% readmission rate, with 2.3% superficial SSI and 5.0% deep SSI. ALP was higher in patients with superficial SSI (p &amp;lt; 0.001). Lower ALT was associated with wound dehiscence (p &amp;lt; 0.001). Bilirubin, AST and ALT were lower in patients with chest infections (p &amp;lt; 0.001). ALP correlated with increased LOS (p &amp;lt; 0.001). On multivariable regression, ALP was associated with superficial SSI (p &amp;lt; 0.001), and LOS (p &amp;lt; 0.001). ROC curve analysis demonstrated AUC of 0.655 for ALP and superficial SSI. Conclusions Emergency appendicectomy is completed laparoscopically in more than 80% of patients and complication rates are acceptable. Routine liver function tests were associated with important clinical outcomes including superficial SSI, wound dehiscence, chest infection, LOS and readmission rate. Patients who had superficial SSI, wound dehiscence, chest infection and readmission with 30 days had lower transaminase levels compared with those with uncomplicated recovery.

Preoperative Liver Function Test Abnormalities Were Associated With Short-Term and Long-Term Prognosis in Cardiac Surgery Patients Without Liver Disease.

Aims: To explore the value of preoperative liver function tests (LFTs) for the prognosis of cardiac surgery patients without liver disease.Methods: The Medical Information Mart for Intensive Care III (MIMIC-III) database was used to extract the clinical data. Adult cardiac patients (≥18 years) without liver disease in the database were enrolled. The association of LFTs with the time of hospital stay and ICU stay was analyzed with the Spearman correlation. Survival curves were estimated using the Kaplan-Meier method and compared by the log-rank test. Multivariable logistic regression was used to identify LFTs that were independent prognostic factors of mortality.Results: A total of 2,565 patients were enrolled in this study. Albumin (ALB) was negatively associated with the time of hospital stay and ICU stay, while alanine transaminase (ALT), aspartate aminotransferase (AST), and total bilirubin were positively associated with the time of hospital stay and ICU stay (all p < 0.001). Abnormal ALB, ALT, AST, and total bilirubin were associated with lower 90-day and 4-year survival (all p < 0.001) and could be used as independent risk factors for hospital mortality and 90-day mortality. However, only ALB and total bilirubin were independent risk factors for 4-year mortality.Conclusion: Preoperative LFT abnormalities were associated with short-term and long-term prognosis of cardiac surgery patients without liver disease.

Comparison of Primary Suture and T-Tube Drainage After Laparoscopic Common Bile Duct Exploration Combined with Intraoperative Choledochoscopy in the Treatment of Secondary Common Bile Duct Stones: A Single-Center Retrospective Analysis.

Objective: To compare the safety and feasibility of T-tube drainage and primary suture after laparoscopy combined with choledochoscopy in the treatment of secondary choledocholithiasis. Methods: The clinical data of patients who underwent laparoscopic choledochoscopy combined with choledochoscopic common bile duct exploration (LCBDE) for secondary choledocholithiasis from June 2015 to June 2020 were analyzed retrospectively. According to the different treatment method of common bile duct (CBD) incision, the patients were divided into a T-tube drainage group and a primary suture group. The preoperative clinical characteristics, results of preoperative liver function tests (LFTs), LFTs on the first day after the operation and the fourth day after the operation, operation time, intraoperative bleeding, postoperative complications, and times of postoperative hospital stay were compared between the two groups. Results: There was no significant difference in preoperative clinical data, preoperative LFTs, and postoperative complications between the two groups (P > .05). However, primary suture demonstrated significant advantages (P < .05) in terms of the operation time, intraoperative blood loss, postoperative hospital stay, and other related factors. Bilirubin levels on the first day after the operation and the fourth day after the operation between the two groups suggested that T-tube drainage reduces bilirubin in the short term, but that long-term bilirubin draining is similar between the two strategies. Univariate and multivariate analyses showed that choledochal diameter less than 8 mm was an independent risk factor for bile leakage. Conclusions: Laparoscopy combined with intraoperative choledochoscopic CBD exploration is superior to T-tube drainage in terms of the operation time, intraoperative blood loss, and postoperative hospital stay. The ability of reducing bilirubin by traditional T-tube drainage is indeed better than that of primary suture in the early stage after operation, but there is no difference in long-term outcome between the two groups. Choledochal diameter ≤8 mm was an independent risk factor for bile leakage. To summarize, LCBDEs primary suture for secondary choledocholithiasis is safe and feasible.

Treatment of Hepatic Hydatid Disease: Role of Surgery, ERCP, and Percutaneous Drainage: A Retrospective Study.

Failure to follow the World Health Organization's Informal Working Group on Echinococcosis guidance or having limited experience in the management of cystic echinococcosis (CE) in endemic or nonendemic areas of the world may lead to risky unnecessary procedures. Medical records of all patients undergoing surgery for hepatic hydatid disease at the gastroenterologic surgery and general surgery departments of our hospital between December 2014 and October 2019 were collected and reviewed retrospectively. Demographic characteristics, the size and number of the cysts preoperative liver function tests, surgical treatment, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage (PD), morbidity, and treatment outcomes were reviewed. Of 122 patients included in the study, 77 (63, 1%) were female and 45 (36, 9%) were male individuals and their mean age was 44.95 years. CE1 was identified in 13 patients (10.6%) CE2 in 66 patients (54.1%), CE3a in 7 patients (5.8%), CE3b in 28 patients (22.9%), and CE4 in 8 patients (6.6%). Twenty patients (16.4%) with a cystobiliary fistula in the liver, obstructive jaundice, and postoperative bile leak underwent ERCP. PD was performed in patients with fluid in the hepatic hydatid cyst pouch, increased pouch size because of bile collection, and clinical symptoms postoperatively. Patients presenting with persistent bile leak despite PD underwent ERCP and were treated with endoscopic sphincterotomy and stent placement. Patients with PD were followed by keeping the percutaneous drain open and closed for a while to create pressure difference in the cyst pouch after ERCP. The percutaneous drain was removed in the next 14 to 21 days after checking the pouch size, whereas the common bile duct stents were removed 2 months later after performing a follow-up cholangiography. ERCP should be the primary method for the diagnosis and treatment for hepatic hydatid cysts ruptured into the ducts. İn some cases, high-flow hydatid cysts with rupture into the bile ducts or persistent biliary fistulas can be treated with ERCP and endoscopic sphincterotomy, biliary stent, PD, and nasobiliary drainage without the need for surgical intervention.

Comparison of Patient Outcomes and Safety between Overlapping and Nonoverlapping Surgeries in Patients Undergoing Laparoscopic Common Bile Duct Exploration

Purpose Overlapping surgery or double-booking is a vital yet disputed issue in healthcare field. However, safety of the overlapping surgery during laparoscopic common bile duct exploration (LCBDE) remains unclear. This study aimed to assess the clinical outcomes and safety of overlapping surgery during laparoscopic cholecystectomy and LCBDE for gallbladder and common bile duct stones (CBDS). Material and Methods This study retrospectively reviewed 2736 laparoscopic cholecystectomy and LCBDE surgeries during 2013–2020. One thousand, two hundred eighty patients underwent LCBDE through cystic duct, including 867 receiving overlapping procedures, while 1456 underwent LCBDE through laparoscopic choledochotomy (LC), including 981 who underwent overlapping procedures. Data regarding patient sex, age, body mass index, the American Society of Anesthesiology grade, comorbidities, preoperative liver function test, previous upper abdominal surgery, presence of acute cholecystitis, cholangitis, pancreatitis, or jaundice, common bile duct (CBD) or CBDS diameter, CBDS number, LCBDE operation time, procedure duration, length of stay, stone clearance, CBD closure methods, conversion to open surgery, and complications were collected. Results Differences in demographics and clinical variables between both groups were not significant, and the unadjusted outcomes were comparable, except for the total procedure duration (transcystic: p < .001; LC: p < .001). After adjusting for demographics and clinical variables, overlapping surgery showed an extended total surgical procedure duration (transcystic: standardized coefficient = 0.084, p = .004; LC: standardized coefficient = 0.072, p = .015). Other effects of overlapping surgery were also comparable. Conclusions Overlapping surgery in laparoscopic cholecystectomy and LCBDE was safe at our institution. However, the association of patient outcomes with overlapping laparoscopic cholecystectomy and LCBDE should be further investigated.

Changes in Hematological Parameters and Liver Enzymes During Laparoscopic Cholecystectomy.

BackgroundChanges in hematological parameters, such as neutrophils, leukocytes, neutrophil-lymphocyte ratio, platelet lymphocyte ratio, and mean platelet volume, have been observed during laparoscopic surgeries.ObjectivesThe objectives of this research were to assess the changes in hematological parameters and liver enzymes during laparoscopic cholecystectomy (LC).MethodsThis prospective observational study included patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis. Patients with comorbidities, including hepatitis, diabetes, and where laparoscopic cholecystectomy was converted to open cholecystectomy, were excluded. Preoperative and postoperative baseline hematological parameters and liver function tests (LFTs) were recorded. Characteristics like age, gender, body mass index (BMI), indication for surgery, duration of surgery, the pressure of pneumoperitoneum, and the duration of hospital stay were noted. A paired sample t-test was applied to assess the difference between the mean pre and postoperative values of different hematological parameters.ResultsIt was observed that hemoglobin (Hb), hematocrit (Hct), platelets, and alkaline phosphatase (ALP) decreased postoperatively. However, mean corpuscular volume (MCV), mean platelet volume (MPV), leukocytes, and alanine transaminase (ALT) increased postoperatively. The difference in mean Hb, MCV, Hct, leukocytes, MPV, and ALT was statistically significant (p<0.05).ConclusionThere were significant changes in the levels of hematological parameters and liver enzymes during LC.

Is Routine MRCP Needed in Symptomatic Gallstone Disease? - A Single Center Experience

Objectives: To assess the role of magnetic resonance cholangiopancreatography (MRCP) in the detection of choledocholithiasis in patients with symptomatic gallstone disease and to determine the anatomical variations of extra hepatic biliary tract and their relation to bile duct injury during laparoscopic cholecystectomy. Methods: This is a retrospective observational study of 80 patients from a prospectively maintained database from October 2017 to September 2019. On the basis of findings from Preoperative liver function test and Ultrasound abdomen, patients were divided into 3 groups as per ASGE guidelines for the risk of choledocholithiasis[high risk(n=14),medium risk(n=13),low/no risk(n=53)]. MRCP was performed in all patients routinely. Results: MRCP detected choledocholithiasis in 14 patients. 9 out of 14 patients had dilated CBD on Ultrasound and 7 had elevated ALP. Among 66 patients without CBD stone, ALP was elevated in 4 patients. Patients with MRCP detected stones were subjected to ERCP which was successful in 9 patients. From remaining 5 patients with unsuccessful ERCP, two patients underwent laparoscopic CBD exploration/T tube drainage, one patient underwent bilioenteric anastomosis, two patients with biliary pancreatitis were managed with laparoscopic cholecystectomy alone in view of passed out stone. MRCP diagnosed extrahepatic biliary tract variations in 15% cases(n=12). No patient suffered bile duct injury in this study. Conclusion: In view of high sensitivity to detect choledocholithiasis even in normal LFT and USG abdomen and to delineate extrahepatic biliary anatomy, we suggest routine MRCP in all cases of symptomatic gallstone disease to aid in preoperative management and prevention of bile duct injury.

Hepatic function assessment to predict post-hepatectomy liver failure: what can we trust? A systematic review.

Post hepatectomy liver failure (PHLF) could occur even though an adequate liver volume is preserved. Liver function is not strictly related to the volume and the necessity to pre-operatively predict the future liver remnant (FLR) function is emerging, together with the wide spreading of techniques, aiming to optimize the FLR. The aim of this study was to systematically review all the available tests, to pre-operatively assess the liver function and to estimate the risk of PHLF. A systematic literature research of Medline, Embase, Scopus was performed in accordance to thepreferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, to identifyall the studies available for pre-operative liver function tests to assess the risk of PHLF and/or complications. From the 1122 references retrieved, 79 were included in the review. Dynamic functional tests, such as indocyanine green test (ICG), could evaluate only global liver function, with no definition of functional capacity of the remnant. Magnetic resonance imaging (MRI) with liver-specific contrast agents enables both liver function and volume evaluation; the absence of ionizing radiation showed a better patient's compliance. Nuclear imaging studies ashepatobiliary scintigraphy (HBS) present the unique ability toallow a precise evaluation of the segmental liver function of the remnant liver. Liver volume could overestimate liver function. Several liver function tests are availableto evaluate the risk of PHLF in the pre-operative setting. However, no single test alone could accurately predict PHLF. Pre-operative combination between a dynamic quantitative test, such as ICG, with MRI or HBS, should enable a more complete functional evaluation. Functional tests to predict PHLF should be chosen according to patient's characteristics, disease, and center experience.

Evaluation of preoperative liver function test efficacy in patients with symptomatic cholelithiasis.

The present study aimed at investigating the necessity of preoperative liver function tests (LFTs) in patients with uncomplicated gallstone disease before laparoscopic cholecystectomy. Significant relationship between common bile duct (CBD) stones and acute cholecystitis is reported. There are contradictory reports about the effect of CBD stones on liver function tests in patients (LFTs). In the current study, patients with symptomatic cholelithiasis who referred to hospitals during January 2015 and May 2016 were enrolled. Routine tests and ultrasonography were performed on all patients before surgery. Data were presented as means ± SD and qualitative variables as frequency (percentage) were considered. Statistical analyzes were performed with SPSS software. A consecutive series of 270 patients (58 males and 212 females) who referred for laparoscopic cholecystectomy were enrolled in this retrospective study. Pre- operative LFTs were normal in 249 patients (85%) and abnormal LFT was detected in 41 patients (15 %). This study showed that 15 % of patients with cholelithiasis without dilated CBD had impaired LFTs. Routine LFTs in preoperative evaluation of symptomatic cholelithiasis usually reveals normal findings and is not helpful in uncomplicated cholelithiasis.