Impact of the Laparoscopic Approach on Liver Function Tests: Comparison of Elective Biliary and Non-biliary...

This study aims to explore if laparoscopic surgery impacts liver function tests (LFTs). This study compares LFT changes following elective biliary and non-biliary laparoscopic procedures to determine if the laparoscopic approach itself, rather than underlying biliary pathology, contributes to these alterations.

This prospective, observational study (July 2023 to June 2024) included 116 American Society of Anesthetists (ASA) grades I and II patients undergoing laparoscopic procedures with normal preoperative LFTs. Exclusion criteria included pre-existing liver disease or conversion to open surgery. The LFTs (aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and bilirubin) were measured preoperatively, at 24 hours, and 72 hours postoperatively. Statistical analysis included Friedman ANOVA, t-tests, and repeated measures ANOVA to compare LFT changes between groups and assess the effect of surgical duration.

A total of 90 patients underwent a biliary procedure, while 26 patients had a non-biliary procedure. Significant postoperative changes in LFTs were observed, with total bilirubin (TB), AST, ALT, ALP, and GGT significantly increasing at 24 hours (p<0.001) before declining at 72 hours. Preoperative TB and GGT were higher in the biliary group (p=0.034 and p=0.023, respectively). The AST was significantly higher at 24 hours for biliary procedures (p <0.001), with a similar level at baseline. Procedure duration showed a significant association with GGT levels at 24 hours only (p=0.031).

Laparoscopic surgery results in transient derangement of LFTs, peaking at 24 hours postoperatively, irrespective of biliary or non-biliary indication. These findings underscore the importance of recognizing this transient effect and suggest routine intervention based solely on these changes may be unwarranted.