Eﬀect of CO2 Pneumoperitoneum on Liver Function Following Laparoscopic Cholecystectomy
Liver Function Change Following Laparoscopic Cholecystectomy
Background: Laparoscopic provides access to abdominal cavity for both diagnostic and therapeutic surgical interventions which were previously only possible through laparotomy. Recent studies have shown marked rise in serum liver enzymes after laparoscopic surgeries which is considered to be related to the impaired liver and splanchnic perfusion. The present study has been carried out with the aim to comprehend changes in liver enzymes after laparoscopic vs conventional cholecystectomy and the effects of these on outcomes of surgery. Subjects and Methods: Between January 2018 and June 2019, 100 patients with symptomatic gall stones which were eligible for cholecystectomy were enrolled in this prospective clinical observational trial. Randomisation to laparoscopic or open cholecystectomy was performed by using a sealed envelope technique just before surgery. All cases were operated by the same consultant surgeon with a standard anaesthetic protocol. Liver function tests were performed before surgery, at 24 hours and day seven postoperatively. Results: In the laparoscopic group, a statistically significant rise in liver enzymes both aspartate aminotransferase and alanine aminotransferase was observed after 24 hrs of surgery as compared to preoperative values (p<.001) and then again touching normal serum level on 7th day postoperatively. Whereas in open cholecystectomy patients, only a slight variation in the liver enzymes was observed, which was not significant compared to preoperative level (p>.05). No statistically significant changes in serum level of GGT, ALP and bilirubin was seen in either group. No mortality or bile duct injury was observed in this study. Conclusion: Transient elevation in level of liver enzymes occurs after cholecystectomy in both open and laparoscopy group but more in laparoscopic arm attributed to CO2 pneumoperitoneum with possibly some other factors contributing to this. These changes return to normal in a week time after the procedure, and no major complication is generally seen in these patients with normal preoperative liver function, but these temporary derangements at times may be of concern to surgeons for its implication to the integrity of biliary tract.
Hasukic S, Kosuta D, Muminhodzic K. Comparison of Postoperative Hepatic Function between Laparoscopic and Open Cholecystectomy. Med Princ Pract. 2005;14(3):147–150. Available from: https://dx.doi.org/10.1159/000084630.
Schilling MK, Redaelli C, Krahenbuhl L, Signer C, Buchler MW. Splanchnic microcirculatory changes during CO2 laparoscopy. J Am Coll Surg. 1997;184(4):378–382.
Tauro LF, Sheetal CM, Aithala P, Shetty SR, D“souza CS, Rao B. Evaluation of effects of laparoscopic surgery on hepatic function. J Clin Diagn Res. 2008;2(6):1155–62.
Berger M, Junemann K, Schramm H. Danger of monopolar current in laparoscopic gallbladder surgery. Zentralbl Chir. 2001;126(8):591–595. Available from: https://doi.org/10.1055/s-2001-16571.
Halevy A, Gold-Deutch R, Negri M, Lin G, Shlamkovich N, Evans S, et al. Are Elevated Liver Enzymes and Bilirubin Levels Significant After Laparoscopic Cholecystectomy in the Absence of Bile Duct Injury? Ann Surg. 1994;219(4):362–364. Available from: https://dx.doi.org/10.1097/00000658-199404000-00006.
Saber AA, Laraja RD, Nalbandian HI, Pablos-Mendez A, Hanna K. Changes in liver function tests after laparoscopic cholecystectomy: not so rare, not always ominous. Am Surg. 2000;66(7):699–702.
Giraudo G, Contul RB, Caccetta M, Morino M. Gasless laparoscopy could avoid alterations in hepatic function. Surg Endosc. 2001;15(7):741–746. Available from: https://dx.doi.org/10.1007/s004640090020.
Sakorafas G, Anagnostopoulos G, Stafyla V, Koletis T, Kotsifopoulos N, Tsiakos S, et al. Elevation of serum liver enzymes after laparoscopic cholecystectomy. N Z Med J. 2005;118(1210):1317–1317.
Al-Jaberi TM, Tolba MF, Dwaba M, Hafiz M. Liver Func- tion Disturbances Following Laparoscopic Cholecystectomy: Incidence and Significance. JJ Laparoendosc Adv Surg Tech. 2002;12(6):407–410. Available from: https://dx.doi.org/10.1089/109264202762252668.
Ibrahim AS, Bhargava V, Boppana M, Palani. Evaluation of the Effects of Laparoscopic Surgeries on Hepatic Enzymes. IOSR- JDMS. 2017;16(8):22–28.
Guven HE, Oral S. Liver enzyme alterations after laparoscopic cholecystectomy. J Gastrointestin Liver Dis. 2007;16(4):391– 395.
Singal R, Singal RP, Sandhu K. Evaluation and compari- son of postoperative levels of serum bilirubin, serum transam- inases and alkaline phosphatase in laparoscopic cholecystec- tomy versus open cholecystectomy. J Gastrointest Oncol. 2015;6(5):479–486. Available from: https://doi.org/10.3978/j.issn.2078-6891.2015.058.
Arora B. Liver enzymes Alterations after laparoscopic cholecystectomy. J Medical Science Clin Res. 2016;4(3):9765– 9773.
Naikoo ZA, Hakeem V, Akhter G. Effect of laparoscopic cholecystectomy on liver function: a single institution study at a district level hospital. Glob J Res Anal. 2018;7(2):647–656.
Brahma KS, Gogoi M, Das N, Bhuyan S. Changes in Liver Enzymes during Laparoscopic Cholecystectomy under Low and Standard Pressure Pneumoperitoneum. J Evol Med Dent Sci . 2019;8(49):3657–3660. Available from: https://dx.doi.org/10.14260/jemds/2019/791.
Copyright (c) 2020 Author
This work is licensed under a Creative Commons Attribution 4.0 International License.