Alterations in Hepatic Function after Laparoscopic Assisted Distal Gastrectomy: A Prospective Study.
- Author:
Sung Geun KIM
1
;
Kyo Young SONG
;
Seung Nam KIM
;
Cho Hyun PARK
Author Information
1. Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. chpark@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Laparoscopy assisted distal gastrectomy;
Pneumoperitoneum;
Hepatic function
- MeSH:
Alanine;
Alkaline Phosphatase;
Aspartic Acid;
Bilirubin;
Body Mass Index;
Gastrectomy*;
Humans;
Laparoscopy;
Liver;
Liver Failure;
Mortality;
Operative Time;
Pneumoperitoneum;
Prospective Studies*;
Stomach Neoplasms;
Transaminases;
Transferases
- From:Journal of the Korean Surgical Society
2007;72(1):46-50
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: There is concern about the potential adverse effects on hepatic function due to increased intraabdominal pressure during pneumoperitoneum. The changes in hepatic function following a laparoscopy assisted distal gastrectomy (LADG) and conventional open distal gastrectomy (ODG) for gastric cancer were compared. METHODS: Between July 2004 and May 2005, 60 patients diagnosed with early gastric cancer at Kangnam St' Mary's hospital; 30 each having undergone LADG and ODG were studied. The levels of alkaline phosphatase (ALP), total bilirubin (TB), aspartate transferase (AST) and alanine transferase (ALT) between the two groups were compared at 24 and 72 hours postoperatively. RESULTS: The age, sex, body mass index and preoperative hepatic function were not different between the two groups. The operative times were significantly longer in the LADG than the ODG group (298 vs. 184 minutes, P < 0.000). There was no postoperative hepatic failure or mortality in either group. The levels of ALP decreased, but those of total bilirubin remained unchanged from the preoperative baselines in both groups, with no significant difference between the two groups. After a LADG, the levels of AST and ALT increased 3.7 and 3.5 fold 24 hours after surgery, whereas after an ODG, the levels of AST and ALT increased 1.9 and 1.5 fold. In the LADG group, the levels of AST and ALT were significantly increased compared to the ODG group (P < 0.05), but returned close to the baseline levels within 72 hours. On the third postoperative day, there were no significant differences in the levels of AST and ALT between the two groups (P > 0.05). CONCLUSION: After a LADG, the levels of hepatic transaminases were immediately elevated, but returned to normal levels within 72 hours. A LADG with prolonged pneumoperitoneum is considered safe in patients with normal liver function prior to the operation. In addition, to evaluate the safety of a LADG in the patients with decreased hepatic function, a large scaled randomized prospective trial will be required.
