Changes in Liver Function Tests after Laparoscopic versus Open Cholecystectomy in Sulaymaniyah Teaching Hospital

Abstract

Background: Despite increasing reports regarding the laparoscopic approach, there has been only one comparative study between laparoscopic and open surgery regarding effect of the procedure on the liver function tests. The choice between different surgical treatments for any given disorder is based on a joint assessment of risks, costs, and expected outcomes of each option. But such measures may be influenced by other factors beside the surgical technique. One of these factors is inbuilt surgical trauma of the procedure, i.e. traction, compression and retraction on the liver during conventional cholecystectomy, which may cause minor trauma to the retracted liver which causes only mild symptoms initially, but effectively, could be detected by simple liver function tests.

Objectives: Whether cholecystectomy causes change in the liver function tests and in which type of cholecystectomy open or laparoscopic these changes may be more frequent or prolonged?

Methods: A randomized, coherent and prospective clinical trial was carried out at a tertiary Al Sulaimaniyah Teaching Hospital to estimate the potential changes in the liver function tests in open cholecystectomy in comparison to laparoscopic cholecystectomy. One hundred and eighty two patients (who underwent cholecystectomy after signing informed consent, for uncomplicated symptomatic gall stones), from a total number of 994 patients, (476patients underwent open cholecystectomy from 2nd  of January 2000 to 1st of January 2010 and 518 patients underwent  laparoscopic cholecystectomy from  1st of June 2002 to 1st of January 2010) included in the study. All the operation were done by the same team and by the same surgeon, anesthetic technique and postoperative management were not modified during the study period. All the patients had normal aspartate aminotransferase, alanine aminotransferase, total bilirubin, alkaline phosphatase preoperatively, so any changes occurred after the operation was considered clinically important

Results: Patients, who were candidates for elective cholecystectomy, were mostly females with (Female : Male  ratio= 2.87:1), aged from 7 to 60 years with mean age of 28 years, the age incidence was 31-40 years.  The mean follow up period was 6 months (180days ± 10 days), one could notice that most of the patients who had abnormal value of liver function tests after the operations were males (22 males / 4 females).

Conclusion: Liver function test when ordered routinely may help in the detection of the changes which occur after cholecystectomy and helps in early management and further evaluation, as there are few or no early clinical features of liver dysfunction after cholecystectomy surgery. However, more controlled studies on larger groups of patients are needed to confirm these results.

Keywords: Open cholecystectomy, Laparoscopic cholecystectomy, Changes in liver function tests.