Subclinical hepatic dysfunction in laparoscopic cholecystectomy and laparoscopic colectomy

Laparoscopic surgery causes a reduction in hepatic blood flow due to a number of factors, including raised intra-abdominal pressure, the neurohumoral response to surgical stress and the effect of patient position. The clinical significance of the phenomenon is not fully understood. Plasma concentrations of alcohol dehydrogenase (AD) and glutathione S-transferase (GST), which are concentrated in the centrilobular acinus of the liver, sensitively reflect hepatic hypoperfusion, and can be used to monitor reductions in hepatic blood flow. We compared perioperative AD, GST, aspartate aminotransferase (AST, normal range 14-32 IU litre^-1) and alanine aminotransferase (ALT, normal range 8-41 U litre^-1) concentrations in patients undergoing laparoscopic cholecystectomy or laparoscopic colectomy to study how patient position and surgical manipulation of the liver affect hepatocellular integrity during laparoscopy. There were significant post-operative increases in AD and GST in the cholecystectomy group [mean (SD) peak concentration 10.8 (4.7) U litre^-1 and 113 (55) μg litre^-1 respectively]. Although the duration of pneumoperitoneum was longer in the colectomy group, there were no comparable perioperative increases in AD and GST in this group [peak concentration 4.0 (4.0) U litre^-1 and 33 (35) μg litre^-1 respectively]. AST and ALT on the first post-operative day were significantly higher in the laparoscopic cholecystectomy group (41 and 34 U litre^-1 respectively) than in the laparoscopic colectomy group (24 and 18 U litre^-1; P<0.05 for each). These results indicate that patient position and the effects of surgical manipulation of the liver affect perioperative hepatic perfusion significantly.