Elevation of Liver Enzymes and Bilirubin Levels after Laparoscopic Cholecystectomy in the Absence of Biliary Duct Injury

ABSTRACT

Elevated levels of aspartate aminotrasferase(AST), alanine aminotransferase(ALT) and bilirubin were noted incidentally after laparoscopic cholecystectomy(LC). This study was attempted to investigate the elevation of AST, ALT and bilirubin after laparoscopic cholecystectomy without bile duct injury and it,s clinical significance. Bile duct injury is most feared complication of laparoscopic cholecystectomy. Increased liver enzymes and bilirubin levels may be indicative of this complication. But, these parameters have not been investigated in patients who had laparoscopic cholecystectomy and in whom no damage to the bile duct was noted. 906 patients with normal results of preoperative liver function test were entered into the study. Blood was collected at 24 hours, 48-72 hours and 6-8 days after laparoscopic cholecystectomy, and AST, ALT, Alkaline phosphatase(AlkP) and bilirubin levels were observed. In AST, a mean 2.33-fold increase was observed. In ALT, a mean 2.10-fold increase was observed. A mean 1.42-fold and a mean 1.73-fold increase were observed in total and direct bilirubun levels. But, AlkP was not increased. In many patients a significant increase in AST, ALT and bilirubin levels occured after laparoscopic cholecystectomy. But they returned to normal values within several days without any specific treatments. These elevations of AST & ALT without increasing of AlkP, and slight elevation of bilirubin without increasing of AlkP appear to have no obvious clinical significance, the exact cause of these elevations is unclear, and need further investigation.