Subclinical hepatic dysfunction in laparoscopic cholecystectomy and laparoscopic colectomy

Area of Science:

• Hepatology
• Surgical Physiology
• Minimally Invasive Surgery

Background:

• Laparoscopic surgery reduces hepatic blood flow due to increased intra-abdominal pressure, surgical stress, and patient positioning.
• The clinical impact of reduced hepatic perfusion during laparoscopy is not fully understood.
• Alcohol dehydrogenase (AD) and glutathione S-transferase (GST) are sensitive biomarkers for hepatic hypoperfusion.

Purpose of the Study:

• To compare perioperative liver enzyme concentrations in patients undergoing laparoscopic cholecystectomy versus colectomy.
• To investigate the influence of patient position and liver manipulation on hepatocellular integrity during laparoscopy.
• To assess the utility of AD, GST, AST, and ALT as indicators of hepatic perfusion changes.

Main Methods:

• Prospective study comparing laparoscopic cholecystectomy and colectomy patients.
• Measurement of perioperative plasma concentrations of AD, GST, AST, and ALT.
• Analysis of enzyme levels in relation to surgical procedure, duration of pneumoperitoneum, and patient position.

Main Results:

• Significant postoperative increases in AD and GST were observed in the laparoscopic cholecystectomy group.
• No comparable perioperative increases in AD and GST were found in the laparoscopic colectomy group, despite longer pneumoperitoneum.
• Postoperative AST and ALT levels were significantly higher in the cholecystectomy group compared to the colectomy group.

Conclusions:

• Patient position and direct surgical manipulation of the liver significantly affect perioperative hepatic perfusion during laparoscopy.
• Laparoscopic cholecystectomy, involving liver manipulation, leads to greater indicators of hepatic hypoperfusion than laparoscopic colectomy.
• AD and GST are valuable markers for monitoring hepatic perfusion changes in laparoscopic surgery.