Effect of Carbondioxide Pneumoperitoneum on Liver Enzymes Following Laproscopic Cholecystectomy In Rural Indian Population (original) (raw)
Related papers
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.
Liver enzymes Alterations after Laparoscopic Cholecystectomy: A Prospective Study
Journal of Medical Science And clinical Research, 2016
Background: In laparoscopic cholecystectomy, carbon dioxide gas is used for insufflation into peritoneum. The carboxy peritoneum which is used to create space in laparoscopic cholecystectomy is kept at pressure of 10-15mm of Hg. This high carboxy peritoneum pressure is likely to cause impedance in splanchnic perfusion and decrease the hepatic perfusion. This can lead to disturbances in liver functions. Material and Methods: This study was done on a total of fifty patients presenting with symptomatic gall stone disease. Liver function tests were done in all the patients in pre operative and post operative period after laparoscopic cholecystectomy. Results: Total serum bilirubin measured pre operative and post operative were compared, there was no significant change in the serum bilirubin levels. The serum AST levels were compared in preoperative and postoperative period and there was significant increase in level of serum AST. The serum ALT levels comparison between preoperative and postoperative values has shown significant change. The difference in serum alkaline phosphatase levels is also non significant. Conclusion: This study concludes that transient elevation of liver enzymes does occur after laparoscopic cholecystectomy.
Journal of Evolution of Medical and Dental Sciences, 2019
BACKGROUND Laparoscopic cholecystectomy (LC) requires the creation of a pneumoperitoneum {PNP) via insufflations of carbon dioxide, which may result in adverse haemodynamic disturbances leading to visceral organ ischaemia including hepatic dysfunction. The present study was undertaken to compare the changes in hepatic function during LC with standard and during LC with low pressure PNP and also to determine the clinical significances of such disturbances. METHODS A randomised prospective study was conducted among 60 patients from June 2017 to May 2018 for symptomatic gallstones who underwent LC, of which Group A (n=30) were subjected to standard pressure PNP (SPLC= 12 to 14 mmHg) and Group B (n=30) to low pressure PNP (LPLC= 7 to 10 mmHg). Blood samples for liver function test were taken preoperatively and postoperatively. All patients had normal values of preoperative liver function tests. RESULTS Twenty-four hours after the procedure, the mean liver enzymes in both groups were raised, however in SPLC group there was statistically significant elevation of AST (46.87±13.90, p<0.004) and ALT (78.88±13.86, p<0.001). But the raise was transient and fell off to normal or near normal levels in 7-10 days postoperatively. The changes in ALP and GGT measurements were found to be non-significant. CONCLUSIONS Low pressure pneumoperitoneum has minimal alterations in the liver enzymes thereby reducing the adverse effects on hepatic function, this approach can be considered for patients with compromised liver pathology, particularly in patients undergoing prolonged laparoscopic surgery.
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
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...
International Surgery Journal
Background: It has been shown that there is a transient elevation of serum liver enzymes after laparoscopic surgeries and major causative factor seemed to be the CO2 pneumoperitoneum. In most of the cases, it does not have any clinical significance in the patient with normal preoperative liver function. However, in patients with deranged liver function, these changes can have great significance.Methods: The present study was designed to determine and compare changes in liver function tests and renal function test following laparoscopic cholecystectomy and open cholecystectomy. This study was conducted on 100 patients admitted to Swaroop Rani Nehru Hospital, Allahabad, India from August 2017 to January 2019 who were having symptomatic cholelithiasis with a history of either acute cholecystitis, biliary colic or chronic cholecystitis. All patients were investigated for complete liver function tests and renal function test including serum bilirubin, SGOT, SGPT, alkaline phosphatase, LD...
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.
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.
2017
Background: Laparoscopic cholecystectomy (LC)is one of the commonly employed surgical procedures these days. It is indicated for the treatment of cholecystitis (acute/chronic), symptomatic cholelithiasis, biliary dyskinesia, acalculous cholecystitis, gallstone pancreatitis, and gallbladder masses/polyps. Studies from the past literature have shown significant alterations in the liver functional tests (LFT) in patients undergoing LC. Hence; we planned the present study to evaluate effect of carbon dioxide pneumoperitoneum (CDP) on liver functions following LC. We also aim to analyse the overall incidence of these alterations in same patients. Materials & methods: The present study included evaluation of alterations in LFT in patient undergoing LC. A total of 200 subjects were included in the present study. All the patients underwent LC for the treatment of gall stones. In all the patients, pre-operative assessment of LFT was done which included evaluation of SGOT (aspartate aminotran...