Postoperative liver enzyme abnormalities are related to staged restorative proctocolectomy.
BACKGROUND
Transient homeostatic derangements are found after major abdominal and pelvic surgery. We observed elevated liver function tests (LFTs) after restorative proctocolectomy (RPC). This study was undertaken to determine the etiology and implications of elevated LFTs before RPC and postoperatively.


METHODS
One hundred and thirty-four RPC-patients were prospectively evaluated for LFT abnormalities. Patients were assigned to two groups: hand-sewn ileal-reservoir after mucosoproctocolectomy (n=83) or stapled anastomosis (n=9), both with loop ileostomy and stapled anastomosis without loop ileostomy (n=42). Serum alanine-aminotransferase (ALAT) and alkaline phosphatases (ALP) were assessed preoperatively, 1-10 weeks postoperatively before loop ileostomy closure and 1-10 weeks after ileostomy closure. These findings were correlated with anesthesia time, transfused blood volume, perioperatively administered drugs, and length of the diverted bowel while having a loop ileostomy.


RESULTS
A large number of patients showed initial elevated serum ALAT and ALP levels, suggesting liver cell damage. There was a substantial and significant increase in ALAT and ALP in the first postoperative week. The values normalized within 2 weeks for the group without loop ileostomy, but not until after loop ileostomy closure in first group. A significant correlation as to length of diverted bowel (<0.05) while having a loop ileostomy was noted. When the length of diverted bowel was more than 105 cm, liver enzymes were higher than baseline levels (p<0.05) until after closure.


CONCLUSIONS
Patients may develop elevated LFTs after RPC; however, its etiology and significance remains unclear. A loop ileostomy with RPC seemed to delay the normalization. Consideration of further diagnostic imaging may be indicated to exclude other liver pathology such as sclerosing cholangitis.
M'Koma
Amosy E
AE
Department of Surgery, Center for Surgical Sciences (CFSS), Karolinska Institute, Karolinska University Hospital, Huddinge, Sweden. amosy.mkoma@vanderbilt.edu
Longo
Walter E
WE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D000469:Alkaline Phosphatase / Q000097:blood*; D002648:Child; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D008107:Liver Diseases / Q000097:blood* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D013536:Suture Techniques
D000410:Alanine Transaminase; D000469:Alkaline Phosphatase