Effect of Age of Patient and Duration of Laparoscopic Cholecystectomy on Liver Function Tests

Background: Laparoscopic Cholecystectomy is one of the most commonly performed general surgical procedures and entails creation of pneumoperitoneum with pressures averaging 12 mmHg. It is known that creation of pneumoperitoneum artificially increases the intra-abdominal compartment pressure. Increased intraperitoneal pressure exerts several undesirable effects on visceral perfusion. The present study was conducted to observe the effects of Laparoscopic cholecystectomy, performed at pneumoperitoneal pressure of 12 mmHg, on liver function tests in Cholelithiasis patients depending on age and duration of surgery. All patients enrolled in the study had normal liver functions preoperatively. Aims and objectives: To statistically compare preoperative levels of Serum Bilirubin, SGOT, SGPT and Serum Alkaline phosphatase with post operative levels of These parameters 24 and 72 hours after surgery in three groups of patients defined as young, elderly, and middle aged. LFT data of patients were also compared by grouping them into two categories defined by duration of surgery being less than or exceeding 1 hour. Materials and methods: The present study was conducted at the Department of Surgery, of a zonal hospital in Pune, India. A total of 100 patients diagnosed with Cholelithiasis who underwent Laparoscopic cholecystectomy were studied from 26 Oct 2022 till 31 Oct 2023. The studied population consisted of patients from both genders, between 18 and 75 years of age. Patients were preoperatively grouped for comparison into three categories, vis. young (18-39 years), middle aged (40-59 years) and elderly (60-75 years). Post operatively patients were further grouped and compared based on whether their surgery took longer than 1 hour or less than an hour. All patients underwent LC at pneumoperitoneal pressure of 12 mmHg after recording normal LFT values preoperatively. LFT consisting of Serum Bilirubin, SGOT, SGPT and Serum Alkaline phosphatase was conducted on the day prior to LC and repeated 24 hours and 72 hours after Surgery. The results were statistically compared using ANOVA and post hoc analysis. The studied population had no evidence of obvious or suspected bile duct injury or bile spillage during surgery. Patients with preoperative diagnosis of choledocholithiasis / biliary strictures, serologically proven hepatitis and pregnant patients were excluded from the study. Results: After 24 hours of the procedure elevation of the levels of all four tested parameters was observed to an extent of double their preoperative values. All Four parameters showed a declining trend at 72 hours post-surgery. Serum Bilirubin levels were significantly greater when the procedure took more than 1 hour. Post operative S Bil levels were greater among elderly patients than among young patients. SGOT levels were significantly greater among elderly patients than among middle aged patients on POD3. SGPT levels on POD 1 were higher among patients whose surgery took longer than 1 hour. Age and duration of surgery did not affect Serum ALP levels significantly. Conclusions: Transient increase in Serum Bilirubin, SGOT, SGPT and Alkaline phosphatase is observed after uncomplicated laparoscopic cholecystectomy and may be attributed to CO2 pneumoperitoneum, Surgical manipulation, and diathermy. Elderly patients more than 60 years of age were found to have significantly higher Serum Bilirubin values on POD 1 and POD 3 as compared to patients aged between 18 and 39 years, although these values were consistently within the normal physiological range. Serum Bilirubin values were significantly higher (though within normal range) among patients whose surgery took more than an hour as compared to those whose procedure took less than 1 hour. SGOT levels on POD 3 and SGPT levels on POD 1 were significantly higher among the elderly and among those patients whose surgery took longer than 1 hour, respectively. Serum alkaline phosphatase levels fell back within normal range by POD 3 in all patients enrolled in the study. The study indicates that patients aged more than 60 years appear to have significant subclinical derangements in LFT values after LC. The same is true for LC of more than 1 hour duration. The afore mentioned derangements do not translate to deterioration in clinical status.