Alterations in Liver Enzymes in the Postoperative Period Following Laparoscopic and Open Cholecystectomy: A Prospective Study

Introduction: Laparoscopic Cholecystectomy (LC) is one of the most common procedures that is being performed by a general surgeon, and is the treatment of choice for symptomatic gallstone disease. Any abnormalities in the postoperative period because of the procedure is a thing of concern for the operating surgeon.

Aim: To compare the changes in the levels of liver enzymes in the immediate and delayed postoperative period following LC and following Open Cholecystectomy (OC) with respect to the preoperative values.

Materials and Methods: This was prospective interventional study carried out in the General Surgery wards of Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India, from February 2020 to August 2021. A total of 43 patients who underwent LC and 43 patients who underwent OC were randomly selected from the surgical wards. Their levels of Alkaline Phosphatase (ALP), Aspartate Transaminase (AST), Alanine Transaminase (ALT) and total bilirubin were noted in the preoperative period, 24 hours after the surgery and seven days after the surgery. The changes in the levels of the above-mentioned parameters were analysed using paired t-test via International Business Machines Statistical Package for the Social Sciences II (IBM SPSS II) software version 25.0.

Results: The mean age of the study participants who underwent OC was 40.98±12.46 years while the mean age for those who underwent LC was 36.42±10.53 years. There was a significant increase in the levels of AST (27.02±7.272 IU/L to 53.70±19.902 IU/L), ALT (26.21±7.399 IU/L to 50.21±14.410 IU/L) and total bilirubin (0.601±0.173 mg/dL to 0.782±0.261 mg/dL) in the immediate postoperative period (24 hours after surgery) (p-value<0.05) among the patients who underwent LC but returned to its baseline preoperative value within seven days of the surgery. No such significant change was noted in the levels of the liver enzymes (AST: 30.93±8.160 IU/L to 32.14±16.988 IU/L, ALT: 31.51±10.762 IU/L to 31.14±10.921 IU/L) among patients undergoing OC.

Conclusion: The transient increase in the liver enzymes (AST, ALT and total bilirubin) 24 hours after LC maybe related to the increased intra-abdominal pressure due to CO2 pneumoperitoneum which decreases the venous return and thereby cardiac output, thus leading to tissue ischaemia. Absence of this effect leads to no significant change in the liver enzymes in the postoperative period following OC.