significance of elevations of serum and urinary amylase levels after biliary surgery

ABSTRACT

Eighty patients were exposed to different operation of biliary tract in Department of Surgery, Zagazig University. Their mean age were 51.4 years and they were 52 females and 28 males. The control group included 40 patients, performing non abdominal surgery, 24 females and 16 males with mean age 48.5 years. Serum and urinary amylase were measured preoperatively and 6, 24 and 48 hours postoperatively in patients undergoing biliary surgery as well as the control group. The amylase creatinine clearance ratio [ACCR] was also calculated in all 120 patients pre-and postoperatively. The serum and urinary amylase as well as ACCR were exhibited a highly significant changes preoperatively and post-operatively in patients undergoing cholecystectomy with exploration for common bile duct [CBD], choledecoduodenostomy and biliary duct reconstruction. However the urinary amylase and ACCR were highly significantly changed post-operatively in emergency cholecystectomized patients, while serum amylase level was not changed significantly in them.Two patients [25%] from 80 patients performing biliary surgery, developed postoperative pancreatitis. The diagnosis was detected by elevations in serum and urinary amylase as well as ACCR and was confirmed by computed tomography [CT]. One of them died and the other respond to supportive measures. It was evident that the measurement of urinary amylase as well as the calculation of ACCR can give a better reliable diagnosis if it is combined with serum amylase estimation. Moreover, we advice to measure serum and urinary amylase as well as ACCR preoperatively and post-operatively in all patients undergoing biliary surgery, being they are susceptible to develop post-operative pancreatitis.The diagnosis of pancreatitis early depending on the screening method of serum amylase, urinary amylase and ACCR can improve its mortality and morbidity