An Observational Study On Effect Of Carbon Dioxide Pneumoperitoneum On Liver Function Test In Laparoscopic Cholecystectomy

Abstract

Introduction:In 1985, Muhe performed the first laparoscopic cholecystectomy. For over 25 years, laparoscopic cholecystectomy has replaced open cholecystectomy in the management of benign gallbladder diseases and has become the gold standard for symptomatic cholelithiasis. In 1985, Muhe performed the first laparoscopic cholecystectomy.1Further development of this technique was done by Mouret and Dubois. The main advantages of laparoscopic cholecystectomy include the reduction of tissue trauma due to small skin incisions and reduction in adhesion formation, a reduction in patient morbidity, shortening in hospital stay, and early return to normal activity. The conversion rate and complications associated with LC depend on the experience of the surgeon and the degree of difficulty faced during surgery. Various centers have reported widely varying rates of conversion to open operation (range: 1.5% to 6%). The reported incidence of bile duct injury is between 0% to 1% in LC. Because of these distinct advantages, the procedure has gained worldwide popularity and has now become one of the most common operations performed in general surgical practice. LC is essentially a safe procedurewith low morbidity and mortality rate. It was noted that following a laparoscopic cholecystectomy (LC), liver function parameters were disturbed.4The introduction of carbon dioxide under pressure into the peritoneal cavity may cause changes in the splanchnic microcirculation, which may affect cardiac , pulmonary, liver and kidney physiology. Changes have also been found in intracranial pressure, blood acid-base control and the immune system.5 Aim of the study: To investigate the effect of laparoscopic cholecystectomy on liver function in humans and the possible mechanisms involved in such an effect. Methods: Blood samples of 100 patients undergoing laparoscopic cholecystectomy preoperatively once and post operatively on day 1 were collected. These blood samples were tested for liver function- serum bilirubin (total and direct), serum alanine amino transferase (ALT), serum aspartate aminotransferase (AST) , serum alkaline phosphatase, total proteins and serum albumin. 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 hrs. post operatively after laparoscopic cholecystectomy as compared to baseline values. The levels of serum albumin and total proteins were decreased during the first 24 hrs post operatively after laparoscopic cholecystectomy as compared to baseline values. Conclusion: There may be a transient elevation of hepatic enzymes after laparoscopic cholecystectomy and the major causative factor seemed to be CO2 pneumoperitoneum.