Elevation of liver enzymes after laparoscopic cholecystectomy versus open cholecystectomy

ABSTRACT

Laparoscopic cholecystectomy [LC] has been accepted as an alternative to laparotomy, and has become the standard treatment of benign gall bladder diseases. However, it has been noticed that following LC, the serum level of certain liver enzymes rises markedly, in patients who had preoperatively normal liver enzyme value. We measured serum values of hepatic alcohol dehydrogenase [AD] and glutathione S-transferase [GST] alanine aminotransferase [ALT] and aspertase aminotransferase [AST], in 80 patients who underwent open cholecystectomy or laparoscopic cholecystectomy, they were divided randomly into two groups. Group 1[40 patients] underwent laparoscopic cholecystectomy [LC]. Group 11[40 patients] underwent open cholecystectomy [OC]. To assess the liver function, serum liver enzymes of AD, GST, ALT, and AST were measured before operations and at 1, 3, 7, and 10 days postoperative. Pre operative AD, GST, ALT, and AST were insignificantly different between the two groups. Twenty four hours after the procedure. AD, GST, ALT and AST increased significantly in the LC group [AD 8.1 +/- 2.2 U/L, GST 82.2 +/- 19.1 U/L, ALT 87.1 +/- 24.2 U/L, and AST 95.1 +/- 7.7 U/L but in [OC] group these enzymes were [AD 4.8 +/- 1.9 U/L, GST 35.3 +/- 3.9 U/L, ALT 27.8 +/- 11.9 U/L, and AST 5.3 +/- 0.9 U/L]. A further increase in serum AD, GST, ALT and AST value in LC group at the 3 [rd] day after the operation [AD 9.3 +/- 1.5 U/L, GST 103.5 +/- 21.6 U/L, ALT 99.3 +/- 19.4 U/L, and AST 120.9 +/- 10.4 U/L] but in [OC] group these enzymes were [AD 5.6 +/- 3.4 U/L, GST 47.9 +/- 1.4 U/L, ALT 38.6 +/- 3.4 U/L, and AST 17.9 +/- 1.4 U/L]. Slow return to normality occurred 7-10 days after the procedure in the LC group. Alterations in hepatic function occur after LC and appear to be clinically insignificant. These alterations in hepatic function return to normal levels within ten days. CO2 pneumoperitoneum seems to be the main reason for these changes but other factors may also contribute