Changes in Liver Enzymes during Laparoscopic Cholecystectomy under Low and Standard Pressure Pneumoperitoneum (original) (raw)
Related papers
European Surgery, 2019
Background The aim of this study was to evaluate the effects of pneumoperitoneum on liver function during and after laparoscopic cholecystectomy. Methods This prospective study comprised a total of 165 patients, who were divided into two groups: The first group had low-pressure pneumoperitoneum (12 mm Hg; N = 78) and the second group had highpressure pneumoperitoneum (14 mm Hg; N = 87). A detailed statistical analysis included sex, age, operation time, and liver function tests including total bilirubin, gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, fibrinogen, and lactate dehydrogenase (LDH), which were obtained preoperatively and 24 h, 7 days, and 30 days postoperatively. The statistical hypotheses were tested with a t test, Mann-Whitney test, chi-square test, Friedman test, and Wilcoxon's test. Results There was no statistical difference between the two groups considering age, gender, and operation time (p = 0.740, p = 0.255, and p = 0.480, respectively). There was also no statistical difference in the median values of bilirubin, AST, GGT, LDH, albumin, and fib
Background: Pneumporeitoneum at 14 mmHg causes dangerous hemodynamic disturbances in some patients, leading to splanchnic ischemia. Laparoscopic cholecys-tectomy (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 phospha-tase (ALP), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were obtained preop-eratively, 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 biliru-bin, ALP, and GGT levels remained unchanged from baseline in both groups, without a significant difference between the two groups. Conclusions: Because LPLC minimizes adverse hemo-dynamic effects on hepatic function, a low-pressure pneumoperitoneum should be considered for patients with compromised liver function, particularly those undergoing prolonged laparoscopic surgery.
Effect of CO2 Pneumoperitoneum on Liver Function Following Laparoscopic Cholecystectomy
2020
Background: Laparoscopic provides access to abdominal cavity for both diagnostic and therapeutic surgical interventions which were previously only possible through laparotomy. Recent studies have shown marked rise in serum liver enzymes after laparoscopic surgeries which is considered to be related to the impaired liver and splanchnic perfusion. The present study has been carried out with the aim to comprehend changes in liver enzymes after laparoscopic vs conventional cholecystectomy and the effects of these on outcomes of surgery. Subjects and Methods: Between January 2018 and June 2019, 100 patients with symptomatic gall stones which were eligible for cholecystectomy were enrolled in this prospective clinical observational trial. Randomisation to laparoscopic or open cholecystectomy was performed by using a sealed envelope technique just before surgery. All cases were operated by the same consultant surgeon with a standard anaesthetic protocol. Liver function tests were performed before surgery, at 24 hours and day seven postoperatively. Results: In the laparoscopic group, a statistically significant rise in liver enzymes both aspartate aminotransferase and alanine aminotransferase was observed after 24 hrs of surgery as compared to preoperative values (p<.001) and then again touching normal serum level on 7 th day postoperatively. Whereas in open cholecystectomy patients, only a slight variation in the liver enzymes was observed, which was not significant compared to preoperative level (p>.05). No statistically significant changes in serum level of GGT, ALP and bilirubin was seen in either group. No mortality or bile duct injury was observed in this study. Conclusion: Transient elevation in level of liver enzymes occurs after cholecystectomy in both open and laparoscopy group but more in laparoscopic arm attributed to CO2 pneumoperitoneum with possibly some other factors contributing to this. These changes return to normal in a week time after the procedure, and no major complication is generally seen in these patients with normal preoperative liver function, but these temporary derangements at times may be of concern to surgeons for its implication to the integrity of biliary tract.
Effect of Carbon Dioxide Pneumoperitoneum on Liver Function Tests After Laparoscopic Cholecystectomy
International journal of scientific research, 2021
Introduction: Laparoscopic cholecystectomy (LC) is the gold standard treatment option for symptomatic gall stones. Changes in liver function tests (LFT) following laparoscopic cholecystectomy has been documented by several studies in the past. Altered splanchnic circulation leading to pan-hepatic hypoperfusion secondary to carbon dioxide (CO) pneumoperitoneum is attributed as the probable cause. The present study was 2 conducted to observe the changes in LFT after laparoscopic cholecystectomy. The study was also intended to observe the relationship of postoperative changes in LFT with the duration of CO insufation and its clinical signicance. 2 Methods: Blood samples of 142 patients who underwent LC were collected pre-operatively and at 6 hours, 24 hours and 48 hours interval postoperatively. The collected samples were analysed for serum Bilirubin (total), serum Aspartate Transaminase (AST), serum Alanine Transaminase (ALT) and serum Alkaline phosphatase. The pre-operative and post-operative values of the above mentioned LFT values were compared. Duration of CO pneumoperitoneum required during LC was recorded to analyse the relationship between the changes in LFT and the duration of 2 CO insufation. 2 Results: A statistically signicant change in the post-operative levels of serum Bilirubin (total), serum AST, serum ALT and serum alkaline phosphatase was observed after LC. The elevation from the baseline values in LFT observed after 6 hours and 24 hours of surgery was weakly associated with the duration of pneumoperitoneum required during LC. The changes in LFT had no apparent effect on the clinical outcome of the patient as measured in terms of post-operative hospital stay duration. Conclusion: After LC an elevation from pre-operative value is observed in the LFT for a short duration of time post-operatively, having a weak association with the duration of CO insufation and no apparent clinical signicance.
International Surgery Journal
Background: In many studies it was noticed that following a laparoscopic cholecystectomy (LC), liver function parameters were disturbed. The carbon dioxide pneumoperitoneum causes changes in the splanchnic microcirculation and can affect cardiac, pulmonary, liver and kidney physiology. Alterations in intracranial pressure, blood acid- base control and the immune system have also been seen. This study was done to know the effects of carbon dioxide pneumoperitoneum on liver function tests in LC. Aim of the study was to study the significance of alterations in Liver function tests and procedure’s safetyMethods: Blood samples of 100 patients who underwent laparoscopic cholecystectomy preoperatively once and post operatively after 24 hours were collected. These blood samples were tested for LFT. The pre op and post op levels of these liver function test values were compared.Results: The level of serum AST, ALT, bilirubin (total) and ALP were increased significantly during the first 24 hr...
Effects of Prolonged Pneumoperitoneum on Hepatic Perfusion During Laparoscopy
Annals of Surgery, 2013
Objective: To assess the influence of prolonged pneumoperitoneum (PP) on liver function and perfusion in a clinically relevant porcine model of laparoscopic abdominal insufflation. Background: PP during laparoscopic surgery produces increased intraabdominal pressure, which potentially influences hepatic function and microcirculatory perfusion. Methods: Six pigs (49.6 ± 5.8 kg) underwent laparoscopic intra-abdominal insufflation with 14 mm Hg CO 2 gas for 6 hours, followed by a recovery period of 6 hours. Two animals were subjected to 25 mm Hg CO 2 gas. Hemodynamic parameters were monitored, and damage parameters in the blood were measured to assess liver injury. Liver total blood flow and function were determined by the indocyanine green (ICG) clearance test. Intraoperative hepatic hemodynamics were measured by simultaneous reflectance spectrophotometry (venous oxygen saturation StO 2 and relative tissue hemoglobin concentration rHb) and laser Doppler flowmetry (blood flow and flow velocity). Postmortem liver samples were collected for histological evaluation. Results: A decrease in microvascular perfusion was observed during PP. After 6 hours of PP, ICG clearance increased (P < 0.001), indicating a compensatory improvement of overall liver blood flow resulting in concomitantly improved microcirculatory perfusion (P = 0.024). Minimal parenchymal damage (aspartate aminotransferase) of the liver was seen after 6 hours of PP (P = 0.006), which seemed related to PP pressure. Minor histological damage was observed.
International Journal of Scientific Research in Science and Technology, 2022
Introduction: Laparoscopic cholecystectomy, a minimal-access procedure for removing the gallbladder, has various benefits, including a significantly shorter hospital stay ,lower cost and a low patient comorbidity Materials and Methods:- this was a prospective study. The study was conducted on 60 patients of cholecystectomy ,who underwent laparoscopic cholecystectomy under constant intraperitoneal pressure of 15mmhg in GEMS medical hospital, ragolu, Srikakulam, Andhra Pradesh. This study was designed to evaluate the complications of carbon dioxide pneumoperitoneum in laparoscopic cholecystectomy using the liver enzymes Results:- Total bilirubin pre-operative was 0.72±0.13 mg/dl, increased 24 h after surgery to 1.11 ± 0.30 mg/dl by 138% . Aspartate aminotransferase (AST) pre-operative was 19.523 ± 16 U/l increased 24 h after surgery to 30.12± 18.35 U/l by 154 %. Alanine aminotransferase (ALT) was 22.58 ± 5.09 U/l increased 24 h after surgery to 38.62 ± 12.15U/l by 171%. Alkaline phosphatase pre-operative values were 103.8 ± 23.32 U/ and after 24 h was 147.8 ± 36.54 U/l by 142 % Conclusion: laparoscopic operations produce a transient rise in serum liver enzymes ,our study too demonstrated bilirubin, AST, ALT, ALP elevated following laparoscopic cholecystectomy . when combined with data from earlier research These changes could be attributable to a decrease in portal venous flow caused by a pneumoperitoneum's high pressures.
Biomedicines
High intra-abdominal pressure (IAP) during laparoscopic surgery is associated with reduced splanchnic blood flow. It is uncertain whether a low IAP prevents this reduction. We assessed the effect of an individualized low-pneumoperitoneum-pressure strategy on liver perfusion. This was a single-center substudy of the multicenter ‘Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy II study’ (IPPCollapse–II), a randomized clinical trial in which patients received an individualized low-pneumoperitoneum strategy (IPP) or a standard pneumoperitoneum strategy (SPP). Liver perfusion was indirectly assessed by the indocyanine green plasma disappearance rate (ICG–PDR) and the secondary endpoint was ICG retention rate after 15 min (R15) using pulse spectrophotometry. Multivariable beta regression was used to assess the association between group assignment and ICG–PDR and ICG–R15. All 29 patients from the participating center were included. Median...