Functional liver damage during laparoscopic cholecystectomy as the sign of the late common bile duct stricture development.
OBJECTIVE
Thermal trauma is hypothesized as a major cause of late common bile duct stricture. Dispersion of electric energy through the tissues during electrocautery is not controlled and may cause necrosis even in remote tissues. Changes in liver enzymes may be used as indirect indicators of common bile duct damage, because of the close proximity of these structures in the liver porta.


METHODS
Laparoscopic cholecystectomy was performed in 20 patients using a monopolar cutter (thermal device), and in another 20 patients using a harmonic scalpel (non-thermal device). Changes in liver enzymes, as well as histology of gallbladder wall were assessed.


RESULTS
There was a significant rise in liver enzymes (AST and ALT) after surgery in both groups, but postoperative values of these two enzymes were significantly higher in patients operated using the monopolar cutter. There were no significant differences in postoperative levels of hemoglobin and red blood cell count between these two groups.


CONCLUSIONS
Thermal trauma of the liver parenchyma was significantly greater in patients operated using the monopolar cutter, suggesting possible detrimental effects to the common bile duct.
Hochstädetr
Hrvoje
H
Department of Surgery, Clinical Hospital, Sestre Milosrdnice, Zagreb, Croatia. hrvoje.hochstadter@inet.hr
Bekavac-Beslin
Miroslav
M
Doko
Marko
M
Kopljar
Mario
M
Cupic
Hrvoje
H
Glavan
Elizabet
E
Mijic
August
A
Zovak
Mario
M
Salic
Dubravka
D
D000328:Adult; D000368:Aged; D002056:Burns / Q000175:diagnosis / Q000209:etiology*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000295:instrumentation; D002764:Cholecystitis / Q000473:pathology / Q000601:surgery*; D002769:Cholelithiasis / Q000473:pathology / Q000601:surgery*; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis / Q000209:etiology*; D002908:Chronic Disease; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology*; D004564:Electrocoagulation / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005704:Gallbladder / Q000293:injuries / Q000473:pathology; D006801:Humans; D008099:Liver / Q000293:injuries*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D012306:Risk; D013525:Surgical Instruments