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Elevation of Liver Function Tests After Laparoscopic Gastrectomy Using a Nathanson Liver Retractor

World Journal of Surgery volume 35, pages 2730–2738 (2011)Cite this article

Abstract

Background

Although pneumoperitoneum has been suspected as a possible cause of transient elevation of liver function tests (LFTs) after laparoscopic surgery, liver damage by direct retraction could also influence postoperative LFTs. The aim of this study was to clarify whether laparoscopic gastrectomy (LG) using a Nathanson retractor was associated with the postoperative elevation of LFTs compared with open gastrectomy (OG).

Methods

A retrospective cohort study of 199 LG and 120 OG patients was conducted. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin were measured before operation and at postoperative days 1, 3, and 7. Abnormal elevation of LFTs was defined as a grade 2 or greater elevation in any parameter. To assess the possible effect of pneumoperitoneum, patients who underwent laparoscopic (n = 324) and open (n = 56) colectomy for colorectal cancer were also compared.

Results

In both LG and OG groups, LFTs were significantly elevated postoperatively compared with baseline values. Mean ALT and total bilirubin levels on days 1, 3, and 7 were significantly higher in the LG than OG group. Abnormal elevation of LFTs was more frequent in the LG than OG group (50 vs. 12%). In multivariate analysis, LG was significantly associated with postoperative liver dysfunction (odds ratio [OR] = 7.99; 95% confidence interval [95% CI] = 3.69–18.85). No significant difference in the elevation of the LFTs was observed between laparoscopic and open colectomy (6% and 9%, respectively).

Conclusions

LG resulted in frequent elevation of LFTs. Care should be taken to minimize intraoperative liver damage when performing LG using a Nathanson retractor.

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Abbreviations

ALHA:

Aberrant left hepatic artery

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

ASA:

American Society of Anesthesiologists classification

CI:

Confidence interval

LFTs:

Liver function tests

LG:

Laparoscopic gastrectomy

LC:

Laparoscopic colectomy

NCI-CTCAE:

National Cancer Institute Common Terminology Criteria for Adverse Events

OC:

Open colectomy

OG:

Open gastrectomy

OR:

Odds ratio

References

  1. Yano H, Monden T, Kinuta M et al (2001) The usefulness of laparoscopy-assisted distal gastrectomy in comparison with that of open distal gastrectomy for early gastric cancer. Gastric Cancer 4:93–97

    PubMed  Article  CAS  Google Scholar 

  2. Shimizu S, Noshiro H, Nagai E et al (2003) Laparoscopic gastric surgery in a Japanese institution: analysis of the initial 100 procedures. J Am Coll Surg 197:372–378

    PubMed  Article  Google Scholar 

  3. Adachi Y, Suematsu T, Shiraishi N et al (1999) Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg 229:49–54

    PubMed  Article  CAS  Google Scholar 

  4. Katai H, Sasako M, Fukuda H, Group JGCSS et al (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–244

    PubMed  Article  Google Scholar 

  5. Etoh T, Shiraishi N, Tajima M et al (2007) Transient liver dysfunction after laparoscopic gastrectomy for gastric cancer patients. World J Surg 31:1115–1120

    PubMed  Article  Google Scholar 

  6. Jeong GA, Cho GS, Shin EJ et al (2011) Liver function alterations after laparoscopy-assisted gastrectomy for gastric cancer and its clinical significance. World J Gastroenterol 17:372–378

    PubMed  Article  Google Scholar 

  7. Shinohara T, Kanaya S, Yoshimura F et al (2011) A protective technique for retraction of the liver during laparoscopic gastrectomy for gastric adenocarcinoma: using a Penrose drain. J Gastrointest Surg 15(6):1043–1048

    PubMed  Article  Google Scholar 

  8. Bickel A, Weiar A, Eitan A (2008) Evaluation of liver enzymes following elective laparoscopic cholecystectomy: are they really elevated? J Gastrointest Surg 12:1418–1421

    PubMed  Article  Google Scholar 

  9. Guven HE, Oral S (2007) Liver enzyme alterations after laparoscopic cholecystectomy. J Gastrointest Liver Dis 16:391–394

    Google Scholar 

  10. Kotake Y, Takeda J, Matsumoto M et al (2001) Subclinical hepatic dysfunction in laparoscopic cholecystectomy and laparoscopic colectomy. Br J Anaesth 87:774–777

    PubMed  Article  CAS  Google Scholar 

  11. Morino M, Giraudo G, Festa V (1998) Alterations in hepatic function during laparoscopic surgery. An experimental clinical study. Surg Endosc 12:968–972

    PubMed  Article  CAS  Google Scholar 

  12. Morris LF, Ragavendra N, Yeh MW (2008) Evidence-based assessment of the role of ultrasonography in the management of benign thyroid nodules. World J Surg 32:1253–1263

    PubMed  Article  Google Scholar 

  13. 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

    PubMed  Article  Google Scholar 

  14. Sato K, Kawamura T, Wakusawa R (2000) Hepatic blood flow and function in elderly patients undergoing laparoscopic cholecystectomy. Anesth Analg 90:1198–1202

    PubMed  Article  CAS  Google Scholar 

  15. Lohlun JC, Guirguis A, Wise L (2004) Elevated liver enzymes following open Roux-en-Y gastric bypass for morbid obesity—does timing of liver retraction affect the rise in the levels of transaminases? Obes Surg 14:505–508

    PubMed  Article  Google Scholar 

  16. Okano S, Sawai K, Taniguchi H et al (1993) Aberrant left hepatic artery arising from the left gastric artery and liver function after radical gastrectomy for gastric cancer. World J Surg 17:70–73 discussion 74

    PubMed  Article  CAS  Google Scholar 

  17. Satoh S, Okabe H, Kondo K et al (2009) Video. A novel laparoscopic approach for safe and simplified suprapancreatic lymph node dissection of gastric cancer. Surg Endosc 23:436–437

    PubMed  Article  Google Scholar 

  18. 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

    PubMed  Article  CAS  Google Scholar 

  19. Okabe H, Obama K, Kan T et al (2010) Medial approach for laparoscopic total gastrectomy with splenic lymph node dissection. J Am Coll Surg 211:e1–e6

    PubMed  Article  Google Scholar 

  20. Association Japanese Gastric Cancer (1999) Japanese classification of gastric carcinoma, 13th edn. Kanehara Shuppan, Tokyo, pp 1–71

    Google Scholar 

  21. Sobin LH, Gospodarowicz MK, Wittekind C (eds) (2009) TNM classification of malignant tumours (UICC International Union Against Cancer), 7th edn. Wiley-Blackwell, New York

    Google Scholar 

  22. Meierhenrich R, Gauss A, Vandenesch P et al (2005) The effects of intra-abdominally insufflated carbon dioxide on hepatic blood flow during laparoscopic surgery assessed by transesophageal echocardiography. Anesth Analg 100:340–347

    PubMed  Article  Google Scholar 

  23. Shinohara T, Ohyama S, Muto T et al (2007) The significance of the aberrant left hepatic artery arising from the left gastric artery at curative gastrectomy for gastric cancer. Eur J Surg Oncol 33:967–971

    PubMed  Article  CAS  Google Scholar 

  24. Lee SW, Shinohara H, Matsuki M et al (2003) Preoperative simulation of vascular anatomy by three-dimensional computed tomography imaging in laparoscopic gastric cancer surgery. J Am Coll Surg 197:927–936

    PubMed  Article  Google Scholar 

  25. Covey AM, Brody LA, Maluccio MA et al (2002) Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients. Radiology 224:542–547

    PubMed  Article  Google Scholar 

  26. Kitagawa T, Iriyama K (1998) Hepatic infarction as a complication of gastric cancer surgery: report of four cases. Surg Today 28:542–546

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

The authors acknowledge the invaluable help with data management by the Division of Clinical Trial Design & Management, Translational Research Center, Kyoto University Hospital.

Conflict of interest

The authors no conflicts of interest to declare.

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Affiliations

  1. Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan

    Yousuke Kinjo, Hiroshi Okabe, Kazutaka Obama, Shigeru Tsunoda, Eiji Tanaka & Yoshiharu Sakai

Authors
  1. Yousuke Kinjo
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  2. Hiroshi Okabe
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  3. Kazutaka Obama
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  4. Shigeru Tsunoda
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  5. Eiji Tanaka
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  6. Yoshiharu Sakai
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Corresponding author

Correspondence to Hiroshi Okabe.

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Kinjo, Y., Okabe, H., Obama, K. et al. Elevation of Liver Function Tests After Laparoscopic Gastrectomy Using a Nathanson Liver Retractor. World J Surg 35, 2730–2738 (2011). https://doi.org/10.1007/s00268-011-1301-6

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  • DOI: https://doi.org/10.1007/s00268-011-1301-6

Keywords

  • Laparoscopic Colectomy
  • Laparoscopic Gastrectomy
  • Open Gastrectomy
  • Liver Retraction
  • Abnormal Elevation