title: Elevation of serum liver enzymes after laparoscopic cholecystectomy.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) has been accepted as an alternative to laparotomy, and has become the standard treatment of benign gallbladder diseases. However, it has been noticed that (following LC) the serum level of certain liver enzymes raises markedly in patients who had preoperatively normal liver enzyme values.
  
  
  METHODS
  We measured serum values of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma glutamyl transferase, bilirubin, and international normalized ratio (INR) in 72 consecutive patients who underwent laparoscopic cholecystectomy and 36 consecutive patients who underwent open cholecystectomy (OC). During laparoscopic surgery, the intra-abdominal pressure was maintained at 14 mmHg of CO2. To assess liver function, serum liver enzymes were measured before operations and at 1,3,7, and 10 days postoperation.
  
  
  RESULTS
  Mortality was nil. Twenty-four hours after the procedure, ALT and AST increased statistically significantly in the LC group (ALTLC24: 87.1+/-24.2 U/L P<0.001; ASTLC24:82.8+/-19.1 U/L, p<0.001)--whereas in the OC group, 24 hours after the procedure, the serum value of ALT and AST was above the upper normal limits in only in one patient. A further increase in serum ALT and AST value was observed in the LC group (ALTLC72: 99.3+/-19.5 U/L, p<0.001; ASTLC72H: 103.5+/-21.6 U/L, p<0.001) 72 hours after the operation. The mean value of ALT and AST in the OC group was within normal limits 72 hours after the procedure. Slow return to normality occurred 7-10 days after the procedure in the LC group.
  
  
  CONCLUSIONS
  Alterations in hepatic function occur after laparoscopic cholecystectomy and appear to be clinically insignificant. CO2 pneumoperitoneum seems to be the main reason for theses changes but other factors may also contribute. We also measured the values of ALP, GGT, INR and bilirubin. No statistically significant increase was noticed in any groups between the preoperative and postoperative values of these enzymes.
authors.affiliation: Department of Surgery, Hellenic Air Force and Veterans General Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Sakorafas
authors.forename: George
authors.initials: G
authors.lastname: Anagnostopoulos
authors.forename: Vania
authors.initials: V
authors.lastname: Stafyla
authors.forename: Theofilos
authors.initials: T
authors.lastname: Koletis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kotsifopoulos
authors.forename: Stavros
authors.initials: S
authors.lastname: Tsiakos
authors.forename: George
authors.initials: G
authors.lastname: Kassaras
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D001663:Bilirubin / Q000097:blood; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin