title: Effects of varying intraperitoneal pressure on liver function tests during laparoscopic cholecystectomy.
abstract: BACKGROUND
  Laparoscopic cholecystectomy at standard-pressure pneumoperitoneum uses a pressure of 12-14 mm Hg, which may cause a variety of adverse physiological changes involving the respiratory, cardiovascular, and hepatorenal systems reflected as subclinical abnormalities in biochemical parameters. The use of low-pressure pneumoperitoneum in the range of 8-10 mm Hg has been shown to reduce the adverse physiological changes without affecting the outcome of surgery.
  
  
  METHODS
  This study was done in a randomized controlled manner. Patients with gallstone disease (n=101) underwent laparoscopic cholecystectomy. Patients were randomly assigned to high-pressure laparoscopic cholecystectomy (HPLC) (n=51) and low-pressure laparoscopic cholecystectomy (LPLC) (n=50) and underwent surgery at pressures of 14 mm Hg and 8 mm Hg, respectively. Liver function tests, including total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase, were obtained preoperatively and on postoperative Days 1 and 7.
  
  
  RESULTS
  The two study groups had similar demographic profiles, and there were no significant differences in the operative time (HPLC, 47.25 ± 6.73 minutes; LPLC, 48.00 ± 7.76 minutes; P=.6071) and pneumoperitoneum time (HPLC, 34.02 ± 5.29 minutes; LPLC, 34.60 ± 6.13 minutes; P=.6115). On postoperative Day 1, the total bilirubin levels were 1.0684 ± 0.4108 mg/dL and 0.8926 ± 0.3162 mg/dL for HPLC and LPLC (P=.0179), respectively, AST levels were 66.0810 ± 25.5868 IU/L and 42.2420 ± 14.7301 IU/L (P=.0001), respectively, and ALT levels were 68.1410 ± 31.4572 IU/L and 42.7460 ± 17.9405 IU/L (P=.0001), respectively. Thus, liver enzyme activities were significantly elevated in the HPLC group compared with the LPLC group.
  
  
  CONCLUSIONS
  LPLC causes less abnormality in liver function tests in the postoperative period compared with HPLC. LPLC should be considered in all patients undergoing laparoscopic cholecystectomy, especially those patients with compromised liver functions.
authors: Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors: Ranjan
authors: R
authors: Gupta
authors: Lileswar
authors: L
authors: Kaman
authors: Divya
authors: D
authors: Dahiya
authors: Niraj
authors: N
authors: Gupta
authors: Rajinder
authors: R
authors: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011312:Pressure; D011446:Prospective Studies; D055815:Young Adult