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
Abstract :
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).
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).
