Changes in liver function tests after laparoscopic cholecystectomy with low- and high-pressure pneumoperitoneum

  • Zagor Zagorac
  • Rastko ZivicEmail author
  • Miljan Milanovic
  • Berislav Vekic
  • Branislav Dakovic
  • Zoran Bukumiric
  • Dragan Radovanovic
original article



The aim of this study was to evaluate the effects of pneumoperitoneum on liver function during and after laparoscopic cholecystectomy.


This prospective study comprised a total of 165 patients, who were divided into two groups: The first group had low-pressure pneumoperitoneum (12 mm Hg; N = 78) and the second group had high-pressure pneumoperitoneum (14 mm Hg; N = 87). A detailed statistical analysis included sex, age, operation time, and liver function tests including total bilirubin, gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, fibrinogen, and lactate dehydrogenase (LDH), which were obtained preoperatively and 24 h, 7 days, and 30 days postoperatively. The statistical hypotheses were tested with a t test, Mann–Whitney test, chi-square test, Friedman test, and Wilcoxon’s test.


There was no statistical difference between the two groups considering age, gender, and operation time (p = 0.740, p = 0.255, and p = 0.480, respectively). There was also no statistical difference in the median values of bilirubin, AST, GGT, LDH, albumin, and fibrinogen between the two groups. There was a significant statistical difference between the two groups in the median values of ALT on the 30th postoperative day (p = 0.045). There was a statistical difference for all hematochemical parameters as a function of time, independent of the level of intra-abdominal pressure (IAP).


There were no statistically significant differences in the values of parameters of structural damage to the liver between the two groups, but within the groups themselves. From this we conclude that both values of elevated IAP cause microstructural and functional damage to the liver.


Liver function Cholecystectomy Pneumoperitoneum Capnoperitoneum Laparoscopy Anti-Trendelenburg position 


Conflict of interest

Z. Zagorac, R. Zivic, M. Milanovic, B. Vekic, B. Dakovic, Z. Bukumiric, and D. Radovanovic declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Zagor Zagorac
    • 1
  • Rastko Zivic
    • 1
    • 2
    Email author
  • Miljan Milanovic
    • 1
  • Berislav Vekic
    • 1
    • 3
  • Branislav Dakovic
    • 1
  • Zoran Bukumiric
    • 2
  • Dragan Radovanovic
    • 1
    • 2
  1. 1.Surgical ClinicClinical Center Dr. Dragiša Mišović—DedinjeBelgradeSerbia
  2. 2.Faculty of MedicineUniversity of BelgradeBelgradeSerbia
  3. 3.Faculty of MedicineUniversity of KragujevacKragujevacSerbia

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