Liver function and serum amylase alterations following laparoscopic and open cholecystectomy and its significance
Keywords:Cholecystectomy, Liver enzymes, Serum amylase
Background: Gall stone disease is the commonest gastro intestinal disease requiring surgical intervention, laparoscopic cholecystectomy (LC) which has replaced open cholecystectomy (OC). LC has more advantages over OC but has few drawback such as CO2 pneumoperitoneum leading to altered liver functions. The study was done with the aim to compare liver function tests in patients undergoing LC & OC and to compare these values in two groups preoperatively and postoperatively at 24 hrs, 48 hrs, 72 hrs.
Methods: A total of 151 patients were admitted with cholelithiasis, out of which 72 patients underwent surgery between January 2018 to January 2019. Patients were selected by block randomization method into 2 groups containing 28 in each (Group 1- OC and Group 2- LC). SGPT, SGOT, LDH, TB, DB, IB, ALP and S. amylase were studied pre-operatively and at intervals of 24 hrs, 48 hrs, 72 hrs postoperatively. Comparison was made between both groups.
Results: Pre and postoperatively stage, the level of LFT in Group 1 and Group 2 were similar except IB, which was significantly high in Group 1. At 24 hrs the difference in TB, DB, SGPT and S. amylase were statistically significant (p<0.05) between the groups. At 48 hrs difference between Group 1 and Group 2 in TB, DB, SGOT and SGPT were statistically significant (p<0.05). At 72 hrs difference between Group 1 and Group 2 in only SGPT was statistically significant (p<0.05).
Conclusions: Cholecystectomy (OC and LC) lead to transient but reversible significant hepatic enzymes alterations. These alterations are self limited and return to reference values within 10 days of operation. The cause of alteration might be liver tractions, electrocoagulation’s and manipulation of duct.
Odeberg-Wernerman S. Laparoscopic surgery - effects oncirculatory and respiratory physiology: an overview. Eur J Surg. 2000;585:4-11.
Jani K, Rajan P S, Sendhilkumar K, Palanivelu C. Twenty years after Erich Muhe; Persisting controversies with the gold standard of laparoscopic cholecystectomy. J Minimal Access Surgery. 2006;2(2):49-59.
Sakorafas G, Anagnostopoulos G, Stafyla V, Koletis T, Kotsifopoulos N, Tsiakos S, et al. Elevation ofserum liver enzymes after laparoscopic cholecystectomy. N Z Med J. 2005;118:U1317.
Hasukic S. Postoperative changes in liver function tests:randomized comparison of low and high-pressure laparoscopiccholecystectomy. Surg Endosc. 2005;19:1451-5.
Giraudo G, Brachet Contul R, Caccetta M, Morino M. Gaslesslaparoscopy could avoid alterations in hepatic function. Surg Endosc. 2001;15:741-6.
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;66:699-702.
Curro G, Iapichino G, Melita G, Lorenzini C, Cucinotta E. Laparoscopic cholecystectomy in Child-Pugh class C cirrhoticpatients. J Soc Laparoendosc Surg. 2005;9:311-5.
Morino M, Giraudo G, Festa V. Alterations in hepatic functionduring laparoscopic surgery. An experimental clinical study. Surg Endosc. 1998;12:968-72.
Jakimowicz J, Stultiens G, Smulders F. Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc. 1998;12(2):129-32.
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 Gastroenterol. 2003;9:364-7.
Pavlidis TE, Symeonidis NG, Psarras K, Skouras C, Kontoulis TM, Ballas K, et al. Laparoscopic cholecystectomy in patients with cirrhosis of the liver and symptomatic cholelithiasis. JSLS. 2009;13(3):342-5.
Andrei VE, Schein M, Margolis M, Rucinski JC, Wise L. Liverenzymes are commonly elevated following laparoscopiccholecystectomy: is elevated intra-abdominal pressure thecause? Dig Surg. 1998;15:256-9.