ARE ELEVATED LIVER-ENZYMES AND BILIRUBIN LEVELS SIGNIFICANT AFTER LAPAROSCOPIC CHOLECYSTECTOMY IN THE ABSENCE OF BILE-DUCT INJURY

Objective Increased aspartate aminotransferase (AST), alanine aminotra nsferase (ALT), and bilirubin levels were noted incidentally after a l aparoscopic cholecystectomy. The percentage in which such elevation oc curs and its clinical significance in the absence of bile duct injury were investigated. Summary Background Data Bile duct injury is the mos t feared complication of laparoscopic cholecystectomy. Some laboratory tests may be indicative of this complication, such as increases in li ver enzyme (AST, ALT, and alkaline phosphatase ALP) and bilirubin. T hese parameters have not been investigated in patients who had laparos copic cholecystectomy and in whom no damage to the bile duct was noted . Methods Sixty-seven patients with normal results of preoperative liv er function test were entered into the study. Blood was collected 24 h ours after laparoscopic cholecystectomy, and AST, ALT, ALP, and biliru bin levels were measured. Results A mean 1.8-fold increase in AST occu rred in 73% of patients; 82% showed a 2.2-fold increase in ALT. A stat istically nonsignificant increase was noted in 53% of patients (ALP re mained within normal limits), and in 14% of patients bilirubin levels were increased (they were primarily of the unconjugated type). Conclus ions In many patients a significant increase in AST and ALT levels occ urred after laparoscopic cholecystectomy, but they returned to normal values within 72 hours. The cause of this is unclear, and these elevat ions appear to have no clinical significance.