Liver enzymes are commonly elevated following laparoscopic cholecystectomy: Is elevated intra-abdominal pressure the cause?

Background: A previous study disclosed 'unexplained' disturbances in postoperative liver function tests (LFTs) in up to 80% of 67 patients undergoing laparoscopic cholecystectomy (LC). No cause for these elevations was documented. Our objective was to assess the incidence, cause and clinical significance of 'unexplained' disturbances in liver enzymes following LC, Patients and Methods: A retrospective chart review of 270 patients who underwent LC and 64 patients undergoing open cholecystectomy (OC) was conducted. Exclusion criteria: any preoperative abnormality in bilirubin or liver enzyme levels, history of chronic liver disease, gallbladder empyema, gangrene or perforation, any evidence or suggestion of choledocholithiasis or other ductal pathology on preoperative or intraoperative imaging or surgical exploration. Preoperatively and on postoperative day 1, alanine transaminase (ALT), alkaline phosphatase and bilirubin levels were measured. There 'unexplained' disturbances were defined as a 50% increase from preoperative values and/or above the normal range. At LC the pneumoperitoneum was maintained at a pressure not exceeding 15 mm Hg. Results: In the groups undergoing OC and LC the respective early elevations in bilirubin occurred in 5 and 9% of patients (NS), and in alkaline phosphatase in 0 and 4% patients (NS). Postoperative ALT was elevated in 15% of patients following OC and in 34% after LC (p = 0.004). 'Unexplained' LFT disturbances were not associated with any morbidity. Conclusions: 'Unexplained' disturbances in ALT following LC occur in 34% of the patients and appear to be clinically nonsignificant, It is suggested that the reason for this phenomenon is the pneumoperitoneum-related intraabdominal hypertension; the only variable not present in the OC group.