The effect of cholecystectomy for symptomatic gall stone disease on hepatic steatosis using transabdominal...

Hepatic steatosis and gallstones are common in the general population, with risk factors being multifactorial. Experimental studies have shown that cholecystectomy increases hepatic steatosis and leads to non-alcoholic fatty liver disease (NAFLD). In order to evaluate this, the current study was carried out in the department of general surgery at a medical school, in the north of India.

One hundred and three patients awaiting cholecystectomy were selected after written informed consent. Their baseline characteristics were captured preoperatively and thereafter followed at 3^rd month with liver function test (LFT), lipid profile and ultrasound (USG) abdomen.

Average age of the patients enrolled was 41.62 ± 13.62 years and mean body mass index (BMI) was 25.96 ± 1.73 kg/m² . Total bilirubin (0.56 vs 0.76, p <0.0001) and direct bilirubin (0.15 vs 0.27, p <0.0001) decreased significantly post cholecystectomy as compared to preoperative values. Levels of serum glutamic-oxaloacetic transaminase (SGOT) (49.14 vs 34.98 IU/dL), serum glutamic-pyruvic transaminase (SGPT) (50.85 vs 35.46 IU/dL) and alkaline phosphatase (ALP) (101.16 vs 85.97 IU/dL) increased significantly post-surgery. Cholesterol values (146.28 vs 168.77 mg/dL), triglycerides (TGs) (119 vs 133.56 mg/dL), low density lipoprotein (LDL) (93.32 vs 113.05 mg/dL) and very low density lipoprotein (VLDL) (18.68 vs 27.45 mg/dL) decreased significantly while high density lipoprotein (HDL) (48.96 vs 42.42 mg/dL) increased significantly at three month follow-up. Prevalence of fatty liver increased post operatively with a rise in Grade 1 steatosis (75%). Severity of fatty liver increased with (8.73%) Grade 3 steatosis on USG post-surgery. Hence, new patients with formerly normal USG reports developed fatty liver and those with preexisting liver steatosis seemed to worsen.

The study concluded that the prevalence of fatty liver increased post-cholecystectomy. Lipid profile parameters improved favorably with a decline in total cholesterol, TG, LDL and VLDL versus increase in HDL. LFT parameters also changed significantly.