title: What is the role of the abdominal perfusion pressure for subclinical hepatic dysfunction in laparoscopic cholecystectomy?
abstract: BACKGROUND
  Subclinical hepatic dysfunction after laparoscopic cholecystectomy (LC) has been described in the literature. However, this alteration is not encountered in all patients. In order to address this situation, a prospective study was conducted to investigate the effect of abdominal perfusion pressure (APP) on liver function tests after LC performed under constant intra-abdominal pressure (IAP).
  
  
  METHODS
  Of 78 patients who underwent LC between May 2007 and October 2007, 40 patients were eligible for the study. In all the patients, six parameters of liver function (aspartate aminotransferase, alanine aminotransferase, direct bilirubin, indirect bilirubin, alkaline phosphatase, and gamma-glutamyltransferase) were assessed before and 24 hours after surgery. Patients who showed more than a 100% increase in at least one parameter (group 1) were compared to those who did not (group 2) regarding age, sex, body weight, body height, operation time, pneumoperitoneum time, IAP, preoperative, and intraoperative APP.
  
  
  RESULTS
  Of the patients, 37.5% showed more than a 100% increase in at least one parameter of liver function. No significant difference was found between the two groups with regard to age, sex, body weight, body height, operation time, pneumoperitoneum time, and IAP. There were significant increase in AST and ALT at 24 hours postoperatively in group 1, as compared with group 2 (P = 0.000, P = 0.001). In comparison of preoperative APP with intraoperative APP values, group 1 showed a statistically significant decrease (P = 0.000), while no difference was found in group 2.
  
  
  CONCLUSIONS
  Subclinical hepatic dysfunction after LC could mostly be attributed to the negative effects of the pneumoperitoneum on hepatic blood flow. For the evaluation of hepatic hypoperfusion, APP may be a new criterion as a determinant of interaction with mean arterial pressure (MAP) and IAP.
authors.affiliation: Department of Surgery, Dokuz Eylul University, School of Medicine, Izmir, Turkey. koray.atila@deu.edu.tr
authors.forename: Koray
authors.initials: K
authors.lastname: Atila
authors.forename: Cem
authors.initials: C
authors.lastname: Terzi
authors.forename: Sevda
authors.initials: S
authors.lastname: Ozkardesler
authors.forename: Tarkan
authors.initials: T
authors.lastname: Unek
authors.forename: Sanem
authors.initials: S
authors.lastname: Guler
authors.forename: Gul
authors.initials: G
authors.lastname: Ergor
authors.forename: Seymen
authors.initials: S
authors.lastname: Bora
authors.forename: Huseyin
authors.initials: H
authors.lastname: Gulay
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D011312:Pressure; D011446:Prospective Studies