Subclinical hepatic dysfunction in laparoscopic cholecystectomy and laparoscopic colectomy

Citation
Y. Kotake et al., Subclinical hepatic dysfunction in laparoscopic cholecystectomy and laparoscopic colectomy, BR J ANAEST, 87(5), 2001, pp. 774-777
Citations number
10
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
BRITISH JOURNAL OF ANAESTHESIA
ISSN journal
0007-0912 → ACNP
Volume
87
Issue
5
Year of publication
2001
Pages
774 - 777
Database
ISI
SICI code
0007-0912(200111)87:5<774:SHDILC>2.0.ZU;2-9
Abstract
Laparoscopic surgery causes a reduction in hepatic blood flow due to a numb er of factors, including raised intra-abdominal pressure, the neurohumoral response to surgical stress and the effect of patient position. The clinica l significance of the phenomenon is not fully understood. Plasma concentrat ions of alcohol dehydrogenase (AD) and glutathione S-transferase (GST), whi ch are concentrated in the centrilobular acinus of the liver, sensitively r eflect hepatic hypoperfusion, and can be used to monitor reductions in hepa tic blood flow. We compared perioperative AD, GST, aspartate aminotransfera se (AST, normal range 14-32 IU litre(-1)) and alanine aminotransferase (ALT , normal range 8-41 U litre(-1)) concentrations in patients undergoing lapa roscopic cholecystectomy or laparoscopic colectomy to study how patient pos ition and surgical manipulation of the liver affect hepatocellular integrit y during laparoscopy. There were significant postoperative increases in AD and GST in the cholecystectomy group [mean (SD) peak concentration 10.8 (4. 7) U litre(-1) and 113 (55) mu litre(-1) respectively]. Although the durati on of pneumoperitoneum was longer in the colectomy group, there were no com parable perioperative increases in AD and GST in this group [peak concentra tion 4.0 (4.0) U litre(-1) and 33 (35) mug litre(-1) respectively]. AST and ALT on the first postoperative day were significantly higher in the laparo scopic cholecystectomy group (41 and 34 U litre(-1) respectively) than in t he laparoscopic colectomy group (24 and 18 U litre(-1); P<0.05 for each). T hese results indicate that patient position and the effects of surgical man ipulation of the liver affect perioperative hepatic perfusion significantly .