Impact of carbon-dioxide pneumoperitoneum on liver function in laparoscopic cholecystectomy – A prospective study

Open Access

Abstract

Background: Laparoscopic cholecystectomy has become the gold-standard surgical treatment for uncomplicated symptomatic cholelithiasis. Although carbon dioxide pneumoperitoneum used during laparoscopic procedures may influence hepatic physiology, these effects are generally considered transient and clinically insignificant in patients with normal liver function. This study aimed to evaluate the impact of pneumoperitoneum on biochemical liver function parameters in patients undergoing laparoscopic cholecystectomy. Objective: To assess alterations in liver function following laparoscopic cholecystectomy. Methods & Materials: This prospective observational study was conducted in the Department of Surgery, Dinajpur Medical College Hospital, Bangladesh, from July 2013 to June 2014. A total of 100 patients with uncomplicated symptomatic cholelithiasis were enrolled, including 70 patients undergoing laparoscopic cholecystectomy and 30 undergoing open cholecystectomy. Serum bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels were measured preoperatively and at 12, 48, and 72 hours postoperatively. A uniform anesthetic protocol was applied, and intra-abdominal pressure during laparoscopic procedures was maintained at ≤14 mmHg. Results: In the laparoscopic group, serum ALT, AST, and bilirubin levels showed a statistically significant increase 12 hours after surgery (ALT: 49.3 U/L, AST: 53.1 U/L, bilirubin: 1.38 mg/dL; P<0.001). These values gradually declined and approached baseline levels within 72 hours. In contrast, patients in the open cholecystectomy group demonstrated no significant postoperative elevation in liver function parameters at any time point (P>0.05). Conclusion: Laparoscopic cholecystectomy is associated with a transient and reversible elevation of liver enzymes and bilirubin, likely related to CO₂ pneumoperitoneum. These changes appear to have no lasting clinical significance in patients with uncomplicated cholelithiasis and normal preoperative liver function.