Recovery of liver functions following surgical biliary decompression in obstructive jaundice.
OBJECTIVE
Derangement of liver functions in obstructive jaundice has been known to influence surgical outcome. The pattern and time frame of liver function recovery in patients with surgical obstructive jaundice undergoing a bilioenteric anastomosis has not been comprehensively defined in human beings.


METHODS
Fifty patients of obstructive jaundice who underwent a bilioenteric anastomosis had their liver function evaluated done by biochemistry (pre-operatively and postoperatively on day 1,4,7 and 6 weeks) and radionuclide mebrofenin scan (preoperatively and 6 weeks postoperative).


RESULTS
The results have shown a constant and significant decline in serum bilirubin levels by day 4 (p=0.04), however the decline in serum levels was not uniformly progressive in 54% patients. The decline in serum alkaline phosphatase levels has been constant and progressive reaching significant levels by day 4(p=0.01). Serum transaminases showed an initial rise followed by a rapid fall, again achieving significant levels by day 4 (p=0.003 & 0.009). Serum albumin decreased on day 1 itself but remained static after that. On isotope scanning hepatic uptake showed uniform improvement with 92% of patients having achieved a normal uptake after 6 weeks. Gastrointestinal excretion of the isotope however was still delayed in 26% patients at 6 weeks. Almost all these patients had an abnormal bilirubin level decline in the immediate postoperative period.


CONCLUSIONS
Hepatic functional recovery has been seen to start immediately following bilioenteric anastomosis and has usually completed itself by 6 weeks. Patients who show an abnormal recovery pattern based on bilirubin levels need to be observed for a longer time.
Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, India.
V
V
Singh
V K
VK
Kapoor
R
R
Saxena
S P
SP
Kaushik
D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D000814:Aniline Compounds; D001219:Aspartate Aminotransferases / Q000097:blood; D001659:Biliary Tract / Q000000981:diagnostic imaging; D001662:Biliary Tract Surgical Procedures; D001663:Bilirubin / Q000097:blood; D002648:Child; D002779:Cholestasis / Q000097:blood / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012709:Serum Albumin / Q000032:analysis
D000814:Aniline Compounds; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D012709:Serum Albumin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; C034837:technetium Tc 99m mebrofenin; D001663:Bilirubin; D005998:Glycine