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Related Experiment Videos

Routine preoperative laboratory analyses are unnecessary before elective laparoscopic cholecystectomy.

T N Robinson1, W L Biffl, E E Moore

  • 1Department of Surgery, Denver Health Medical Center/University of Colorado Health Sciences Center, Denver, CO, USA.

Surgical Endoscopy
|November 19, 2002
PubMed
Summary
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Routine liver function tests (LFTs) before elective laparoscopic cholecystectomy (LC) are not cost-effective. History and physical (H&P) and ultrasound (US) are sufficient for preoperative evaluation, as LFTs provide no additional useful information.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Clinical Pathway Development

Background:

  • A clinical pathway (CP) for elective laparoscopic cholecystectomy (LC) was developed, incorporating history and physical (H&P), right upper quadrant ultrasound (US), and liver function tests (LFTs).
  • The hypothesis was that routine LFTs do not alter management beyond H&P and US findings and could be excluded from the CP.

Purpose of the Study:

  • To evaluate the necessity and cost-effectiveness of routine liver function tests (LFTs) in the preoperative assessment for elective laparoscopic cholecystectomy (LC).
  • To determine if LFTs provide additional diagnostic value beyond history and physical (H&P) and ultrasound (US) in identifying choledocholithiasis or other unexpected outcomes.

Main Methods:

  • A study of 387 consecutive patients undergoing elective LC was conducted.

Related Experiment Videos

  • Preoperative evaluation abnormalities from H&P, US, and LFTs were compared with intraoperative findings of choledocholithiasis or unexpected outcomes.

    • Main Results:

    • Abnormalities were detected in 48% of patients: H&P (n=7), US (n=13), and LFTs (n=177).
    • Only 2% of patients (n=7) had documented choledocholithiasis, with findings distributed across H&P (2), US (3), and LFTs (4).
    • No patient with choledocholithiasis presented with abnormal LFTs alongside normal H&P and US findings.

    Conclusions:

    • Routine liver function tests (LFTs) are not cost-effective for preoperative evaluation before elective laparoscopic cholecystectomy (LC).
    • History and physical (H&P) and ultrasound (US) are valuable components of the preoperative assessment for LC.
    • LFTs do not contribute significant additional information and should not be routinely included in the preoperative evaluation for elective LC.