Comparison of postoperative hepatic function between laparoscopic and open cholecystectomy.
OBJECTIVE
In this prospective study, we evaluated the effects of pneumoperitoneum on hepatic function during laparoscopic (LC) and open cholecystectomy (OC).


METHODS
One hundred patients who underwent LC (n = 50) or OC (n = 50) were included in the study. The groups were similar in age, sex, weight and height. Following liver function tests (total bilirubin; gamma-glutamyltransferase, GGT; alkaline phosphatase, ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) were obtained preoperatively and at 24 and 48 h postoperatively. Similar anesthesiologic protocol was used for both LC and OC. During LC, the intra-abdominal pressure was maintained within the conventional range of 12-14 mm Hg.


RESULTS
Total bilirubin, ALP, GGT and LDH levels remained unchanged from baseline in both groups without significant difference between them. A higher number of patients had increased values of ALT (26/50 vs. 5/50) and AST (23/50 vs. 6/50) in LC compared to OC group. Although the difference was statistically significant (p < 0.000 for ALT and p = 0.0004 for AST) the increased level decreased at 48 compared to 24 h.


CONCLUSIONS
The results indicate that LC is associated with transient elevation of ALT and AST. The disturbances in the function of the liver after LC are self-limited and not associated with any morbidity in patients with a normal liver function.
Hasukic
Sefik
S
Department of Surgery, University Clinical Center, Faculty of Medicine, University of Tuzla, Tuzla, Bosnia-Herzegovina. shasukic@bih.net.ba
Kosuta
Dragutin
D
Muminhodzic
Kasim
K
D000328:Adult; D000410:Alanine Transaminase / Q000378:metabolism; D001219:Aspartate Aminotransferases / Q000378:metabolism; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase