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Functional liver damage during laparoscopic cholecystectomy as the sign of the late common bile duct stricture
Hrvoje Hochstädetr1, Miroslav Bekavac-Beslin, Marko Doko
1Department of Surgery, Clinical Hospital, Sestre Milosrdnice, Zagreb, Croatia. hrvoje.hochstadter@inet.hr
Background/Aims:
Thermal trauma is hypothesized as a major cause of late common bile duct stricture. Dispersion of electric energy through the tissues during electrocautery is not controlled and may cause necrosis even in remote tissues. Changes in liver enzymes may be used as indirect indicators of common bile duct damage, because of the close proximity of these structures in the liver porta.
Methodology:
Laparoscopic cholecystectomy was performed in 20 patients using a monopolar cutter (thermal device), and in another 20 patients using a harmonic scalpel (non-thermal device). Changes in liver enzymes, as well as histology of gallbladder wall were assessed.
Results:
There was a significant rise in liver enzymes (AST and ALT) after surgery in both groups, but postoperative values of these two enzymes were significantly higher in patients operated using the monopolar cutter. There were no significant differences in postoperative levels of hemoglobin and red blood cell count between these two groups.
Conclusions:
Thermal trauma of the liver parenchyma was significantly greater in patients operated using the monopolar cutter, suggesting possible detrimental effects to the common bile duct.
