DOI: http://dx.doi.org/10.18203/2349-2902.isj20191026

Comparative study of postoperative hepatic and renal function changes in laparoscopic and open cholecystectomy

Fazle Rab Malik, Ankur Dutt Tripathi, Santosh Kumar Singh, Anish Kola, Devendra Kumar Shukla

Abstract


Background: It has been shown that there is a transient elevation of serum liver enzymes after laparoscopic surgeries and major causative factor seemed to be the CO2 pneumoperitoneum. In most of the cases, it does not have any clinical significance in the patient with normal preoperative liver function. However, in patients with deranged liver function, these changes can have great significance.

Methods: The present study was designed to determine and compare changes in liver function tests and renal function test following laparoscopic cholecystectomy and open cholecystectomy. This study was conducted on 100 patients admitted to Swaroop Rani Nehru Hospital, Allahabad, India from August 2017 to January 2019 who were having symptomatic cholelithiasis with a history of either acute cholecystitis, biliary colic or chronic cholecystitis. All patients were investigated for complete liver function tests and renal function test including serum bilirubin, SGOT, SGPT, alkaline phosphatase, LDH, S. urea, S. creatinine, S. Na+, S. K+, S. Ca+ and urinary sodium (UNa+). The laboratory tests were carried out in the same laboratory using one type of instrument.

Results: In open cholecystectomy, bilirubin decreased by 11% (p value equals 0.191) and remained decreased to the preoperative value on day 1 and day 7. While, laparoscopic cholecystectomy at 14 mmHg pressure, mean bilirubin decreases by 14% immediately postoperatively (p value equals 0.1733) and returns to normal level in 7 days. These changes are clinically insignificant and statistically insignificant.

Conclusions: Enzyme elevations could mostly be attributed to the adverse effects of the pneumoperitoneum on the hepatic blood flow and renal blood flow and CO2 absorption in the blood. Though, these changes do not seem to be clinically significant, care should be taken before deciding to perform laparoscopic cholecystectomy. This study suggested that laparoscopic cholecystectomy is a safe operative procedure and have added advantages. The disturbances in the function of the kidney after laparoscopic cholecystectomy are self-limited and not associated with any morbidity in patients with a healthy kidney function.


Keywords


Laparoscopic cholecystectomy, Liver function test, Open cholecystectomy, Renal function test

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