Abstract
Background
Transient transaminitis has been identified following laparoscopic abdominal surgery. However, the importance of posture, duration of surgery, and mechanical retraction in its etiology remain unclear.
Methods
Liver function was assessed preoperatively then at 8, 24, 48 and 72 h following laparoscopic surgery including the following procedures: Nissen fundoplication (LN: n = 10); cholecystectomy (LC: n = 10); inguinal herniorrhaphy (LH: n = 10); and gastrectomy (LG: n = 5).
Results
Aspartate aminotransferase (AST) levels in LN patients exhibited a rapid rise within 8 h, peaking at 48 h before returning toward baseline. In the LN group, AST levels were significantly higher at 8 h and 24 hours compared to all other groups and compared to LG at 48 h and 72 h. At 6-week follow-up all AST levels were normal. No significant differences were seen in other hepatic parameters, and no correlation between AST and duration of operation, gender, or age was identified.
Conclusions
Antireflux surgery is associated with transaminitis related to hepatic retraction, which is independent of patient posture or duration of observation, and it resolves spontaneously with no clinical consequences.
Similar content being viewed by others
References
Halevy A, Gold-Deutch R, Negri M et al (1994) Are elevated liver enzymes and bilirubin levels significant after laparoscopic cholecystectomy in the absence of bile duct injury? Ann Surg 219:362–364
Andrei VE, Schein M, Margolis M et al (1998) Liver enzymes are commonly elevated following cholecystectomy: is elevated intra-abdominal pressure the cause? Dig Surg 15:256–259
Jakimowicz J, Stultiss G, Smulders F (1998) Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc 12:129–132
Morino M, Giraudo G, Festa V (1998) Alterations in hepatic function during laparoscopic surgery. An experimental clinical study. Surg Endosc 12:968–972
Saber AA, Laraja RD, Nalbandian HI et al (2000) Changes in liver function tests after laparoscopic cholecystectomy: not so rare, not always ominous. Am Surg 66:699–702
Sato K, Kawamura T, Wakusawa R (2000) Hepatic blood flow and function in elderly patients undergoing laparoscopic cholecystectomy. Anesth Analg 90:1198–1202
Glantzounis GK, Tselepis AD, Tambaki AP et al (2001) Laparoscopic surgery-induced changes in oxidative stress markers in human plasma. Surg Endosc 15:1315–1319
Kotake Y, Takeda J, Matsumoto M et al (2001) Subclinical hepatic dysfunction in laparoscopic cholecystectomy and laparoscopic colectomy. Br J Anaesth 87:774–777
Tan M, Xu F-F, Peng J-S et al (2003) Changes in the level of serum liver enzymes after laparoscopic surgery. World J Gastroenterol 9:364–367
Hasukic S, Kosuta D, Muminhodzic K (2005) Comparison of postoperative hepatic function between laparoscopic and open cholecystectomy. Med Princ Pract 14:147–150
Sakorafas G, Anagnostopoulos G, Stafyla V et al (2005) Eleveation of serum liver enzymes after laparoscopic cholecystectomy. NZ Med J 118:1522
Glantzounis GK, Tsimaris I, Tselepis AD et al (2005) Alterations in plasma oxidative stress markers after laparoscopic operations of the upper and lower abdomen. Angiology 56:459–465
Saranita J, Soto RG, Paoli D (2003) Elevated liver enzymes as an operative complication of gastric bypass surgery. Obesity Surg 13:314–316
Nguyen NT, Braley S, Fleming NW et al (2003) Comparison of postoperative hepatic function after laparoscopic versus open gastric bypass. Am J Surg 186:40–44
Clarke RS, Doggart JR, Lavery T (1976) Changes in liver function after different types of surgery. Br J Anaesth 48:119–128
Meierhenrich R, Gauss A, Vandenesch P et al (2005) The effects of intraabdominally insufflated carbon dioxide on hepatic blood flow during laparoscopic surgery assessed by transoesophageal echocardiography. Cardiovasc Anesth 100:340–347
Siest G, Schiele F, Galteau MM et al (1975) Aspartate aminotransferase and alanine aminotransferase activities in plasma: statistical distributions, individual variations, and reference values. Clin Chem 21:1077–1087
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Morris-Stiff, G., Jones, R., Mitchell, S. et al. Retraction Transaminitis: An Inevitable but Benign Complication of Laparoscopic Fundoplication. World J Surg 32, 2650–2654 (2008). https://doi.org/10.1007/s00268-008-9744-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-008-9744-0