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Postoperative changes in liver function tests: randomized comparison of low- and high-pressure laparoscopiccholecystectomy

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Abstract

Background

Pneumporeitoneum at 14 mmHg causes dangerous hemodynamic disturbances in some patients, leading to splanchnic ischemia. Laparoscopic cholecystectomy (LC) using low-pressure pneumoperitoneum (7 mmHg) minimizes adverse hemodynamic effects on hepatic portal blood flow and hepatic function. This study evaluated the changes in liver function tests after high-pressure LC (HPLC; 14 mmHg) and low-pressure LC (LPLC; 7 mmHg).

Methods

For this study, 50 patients were randomly assigned to undergo either HPLC (n = 25) or LPLC (n = 25) Liver function tests including total bilirubin, gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were obtained preoperatively, then 24 and 48 h postoperatively. All patients had normal values on the preoperative liver function tests. The anesthesiologic protocol was uniform.

Results

The findings showed that ALT after 24 h (LPLC: 1473.72 ± 654.85; HPLC: 2233.74 ± 1247.33; p = 0.0096) and 48 h (LPLC: 1322.99 ± 601.51; HPLC 2007.80 ± 747.55; p = 0.0008) and AST after 24 h (LPLC: 1189.96 ± 404.79 i.j.; HPLC: 1679.40 ± 766.13; p = 0.0069) were increased in the patients who underwent HPLC. The AST levels after 48 h were statistically unchanged from baseline in both groups. Total bilirubin, ALP, and GGT levels remained unchanged from baseline in both groups, without a significant difference between the two groups.

Conclusions

Because LPLC minimizes adverse hemodynamic effects on hepatic function, a low-pressure pneumoperitoneum should be considered for patients with compromised liver function, particularly those undergoing prolonged laparoscopic surgery.

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Authors and Affiliations

  1. Department of Surgery, University Clinical Center Tuzla, Faculty of Medicine, University of Tuzla, Trnovac b.b, 75,000 , Tuzla, Bosnia-Herzegovina

    Š. Hasukić

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  1. Š. Hasukić
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Hasukić, Š. Postoperative changes in liver function tests: randomized comparison of low- and high-pressure laparoscopiccholecystectomy. Surg Endosc 19, 1451–1455 (2005). https://doi.org/10.1007/s00464-005-0061-5

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  • DOI: https://doi.org/10.1007/s00464-005-0061-5

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