A Study of Alteraton in Liver Function Tests Following Laparoscopic Cholecystectomy

Authors : Dr. Kunal Malhotra; Dr. Amit Bhambri; Dr. Subhash Sharma; Dr. Ashok Kaundal; Dr. Anil Malhotra

Volume/Issue : Volume 5 - 2020, Issue 11 - November

Google Scholar : http://bitly.ws/9nMw

Scribd : https://bit.ly/2VI5rab

Minimally invasive surgery, especially laparoscopic surgery, has changed the face of general surgery. Cholecystectomy is the commonest abdominal surgical procedure in Western world. & laparoscopic cholecystectomy (LC) is accepted as gold standard. LC is usually considered to be a safer procedure than open cholecystectomy (OC) in terms of metabolic, hormonal and immunological changes. In the last decade, several studies have shown ‘unexplained’ changes in postoperative liver function tests (LFTs) in patients undergoing laparoscopic procedures. It has been observed that, following laparoscopic surgery, the level of certain serum liver enzymes rose markedly in most patients who had shown normal LFT preoperatively, & may be due to hepatocellular dysfunction secondary to one or combination of CO2 pneumoperitoneum, diathermy use on liver, manipulation of liver, hepatic artery branch injury and general anaesthesia. Due to all these observations, gasless laparoscopy has been proposed by some surgeons. Nevertheless, some studies indicate that, if the patient's preoperative liver function was very poor, laparoscopic surgery might not be the optimal choice for treating certain abdominal diseases. There have been few studies in tertiary care hospital to evaluate the potential harmful effects of laparoscopic surgery on hepatic function. This study was intended to assess the alteration and clinical significance of unexplained disturbances in liver enzymes following laparoscopic cholecystectomy. And to correlate the duration of laparoscopic surgery and the causes and clinical significance of unexplained disturbances in liver enzymes. The study was conducted in Indira Gandhi Medical College, Shimla and comprised of 200 patients, of symptomatic cholelithiasis & in all patient laparoscopic cholecystectomy (LC)was done between 1st May 2012 to 30th April 2018.In all the patients, liver function tests were done pre -operatively and post operatively (within 24 hrs.). The obtained data was analysed for effect of laparoscopy cholecystectomy on liver function test. The elevation of liver enzymes was more with advancing age & were more common in females (87.5%). Liver enzymes were found elevated in immediate postop. period (after 24 hrs.). However, we observed that the levels of S. ALP were decreased in 52% of patients after 24 hours of surgery. This rise in the liver enzyme level was seen more pronounced in patients who had prolonged CO2 insufflation time. The transient elevation of liver enzymes showed no apparent clinical implication in most patients who underwent laparoscopic surgery. Transient mild abnormality in liver function tests is a usual finding after LC without clinical significance & without any consequences in healthy patients. But it can deteriorate the liver function in patients with severe liver disease, in which the low-pressure pneumoperitoneum or gasless laparoscopy can be an alternative.

Keywords : Laparoscopic Cholecystectomy (LC), C02 Pneumoperitoneum, Liver Function Tests (LFT).


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