Transient liver enzyme elevations following laparoscopic cholecystectomy: a comprehensive review

Laparoscopic cholecystectomy (LC) has become the standard management for gallstones. However, it is associated with postoperative elevations in liver enzymes. This scoping review of 52 studies involving over 28,000 patients was undertaken to evaluate the frequency, causes, and clinical significance of these conditions. Levels of ALT and AST increased in 75% to 82% of patients 24 to 48 h after surgery and returned to baseline by day 7. ALP, GGT, and bilirubin levels exhibited mild elevation in 10% to 30% of patients. Adverse events resulting from elevated pneumoperitoneum pressure (> 14 mmHg) and protracted surgical duration were markedly associated with enzyme-level imbalances. The transient alterations did not result in adverse clinical outcomes, suggesting that routine monitoring of liver enzymes may not be necessary for low-risk patients. The present review advocates for individualized perioperative assessment of high-risk patients and indicates the need for further research to optimize patient management strategies.