Title: Liver enzymes Alterations after Laparoscopic Cholecystectomy: A Prospective Study
Author: Bhavinder Arora
DOI: http://dx.doi.org/10.18535/jmscr/v4i3.33
Background: In laparoscopic cholecystectomy, carbon dioxide gas is used for insufflation into peritoneum. The carboxy peritoneum which is used to create space in laparoscopic cholecystectomy is kept at pressure of 10-15mm of Hg. This high carboxy peritoneum pressure is likely to cause impedance in splanchnic perfusion and decrease the hepatic perfusion. This can lead to disturbances in liver functions. Material and Methods: This study was done on a total of fifty patients presenting with symptomatic gall stone disease. Liver function tests were done in all the patients in pre operative and post operative period after laparoscopic cholecystectomy. Results: Total serum bilirubin measured pre operative and post operative were compared, there was no significant change in the serum bilirubin levels. The serum AST levels were compared in preoperative and postoperative period and there was significant increase in level of serum AST. The serum ALT levels comparison between preoperative and postoperative values has shown significant change. The difference in serum alkaline phosphatase levels is also non significant. Conclusion: This study concludes that transient elevation of liver enzymes does occur after laparoscopic cholecystectomy. Keywords: Laparoscopic cholecystectomy, Hepatic enzymes, Carboxy peritoneum 1. Hashikura Y, Kawasaki S, Munakat Y. Effect of peritoneal insuffulation on hepatic and renal blood flow. Surg Endosc 1994;8:759-61. 2. Tan M, Xu FF, Peng JS, Li DM, Chen LH, Lv BJ et al. Changes in the level of serum liver enzymes after laparoscopic surgery. World J Gstroenterol 2003;9(2):364-7. 3. Barrat C, Capello E, Champault G. Intraperitoneal thermal variations during laparoscopic surgery. Surg Endosc 1999;13:136-8. 4. Giraudo G, Brachet CR, Caccetta M. Gasless laparoscopy could avoid alterations in hepatic function. Surg Endosc 2001;15:74-6. 5. Ischinose K, Yanagi F, Higashi K. Recurrent transient increase in liver enzymes specifically after isoflurane anaesthesia. MASUI 1999;48:421-3. 6. Sakorafas G, Anagnostopoulos G, Stafyla V, Koletis T, Kotsifopoulos N, Tsikos S et al. Elevation of serum liver enzymes after laparoscopic cholecystectomy. N Z Med J 2005;118(1210):1317. 7. Schilling MK, Redaelli V, Krahenbuhi L. Splanchnic microcirculatory changes CO2 laparoscopy. J Am Coll Surg 1997;184: 378-82. 8. Hasukic S, Postoperative changes in liver function tests: Randomized comprision of low and high pressure laparoscopic cholecystectomy. Surg Endosc 2005;19 (11):1451-5. 9. Kotake Y, Takeda J, Matsumoto M. Subclinical hepatic dysfunction in laparoscopic cholecystectomy and laparoscopic colectomy. Br J Anaesth 2001;87:774-7. 10. Elefteriadis E, Kotzampassi K, Botsios D, Splanchnic ischemia during laparoscopic cholecystectomy. Surg Endosc 1996;10:324-6. 11. Sato K, Kawamura T, Wakasawa R. Hepatic blood flow and functions in elderly patients undergoing laparoscopic cholecystectomy. Anesth Analg 2000;90:1198-1202. 12. Hameed F, Ahmed B, Khan A. Impact of pneumoperitoneum on hepatic functions after laparoscopic cholecystectomy. APMC 2009;3:100-6. 13. Nishiyama T, Yokoyama T, Hanaoka K. Liver function after sevoflurane or isoflurane anaesthesia in neurosurgical patients. Can J Anesth 998;45:753-75. 14. Tauro LF, Sheetal CM, Aithala PSM. Evaluation of effects of laparoscopic surgery on hepatic functions. Journal of Clinical Diagnosis and Research 2008;2(6):155-62.Abstract
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