RECOVERY OF LIVER FUNCTIONS FOLLOWING SURGICAL BILIARY DECOMPRESSION IN OBSTRUCTIVE-JAUNDICE

BACKGROUND/AIMS: Derangement of liver functions in obstructive jaundic e has been known to influence surgical outcome. The pattern and time f rame of liver function recovery in patients with surgical obstructive jaundice undergoing a bilioenteric anastomosis has not been comprehens ively defined in human beings. METHODOLOGY: Fifty patients of obstruct ive jaundice who underwent a bilioenteric anastomosis had their liver function evaluated done by biochemistry (pre-operatively and postopera tively on day 1,4,7 and 6 weeks) and radionuclide mebrofenin scan (pre operatively and 6 weeks postoperative). RESULTS: The results have show n a constant and significant decline in serum bilirubin levels by day 4 (p=0.04), however the decline in serum levels was not uniformly prog ressive in 54% patients. The decline in serum alkaline phosphatase lev els has been constant and progressive reaching significant levels by d ay 4(p=0.01). Serum transaminases showed an initial rise followed by a rapid fall, again achieving significant levels by day 4 (p=0.003 & 0. 009). Serum albumin decreased on day 1 itself but remained static afte r that. On isotope scanning hepatic uptake showed uniform improvement with 92% of patients having achieved a normal uptake after 6 weeks. Ga strointestinal excretion of the isotope however was still delayed in 2 6% patients at 6 weeks. Almost all these patients had an abnormal bili rubin level decline in the immediate postoperative period.CONCLUSIONS: Hepatic functional recovery has been seen to start immediately follow ing bilioenteric anastomosis and has usually completed itself by 6 wee ks. Patients who show an abnormal recovery pattern based on bilirubin levels need to be observed for a longer time.