The Effect of Various Insufflation Pressures on Liver Function Test Postoperatively Following Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy means surgical removal of gallbladder based on minimally invasive approach utilizing the principle of pneumoperitoneum. Objective: Objective of the study is to compare the outcome of high-pressure laparoscopic cholecystectomy and low-pressure laparoscopic cholecystectomy on liver function test in immediate post-operative period. Materials and Methods: A prospective observational study of laparoscopic cholecystectomies performed during one year from May 2022 to April 2023 at Burdwan Medical College regarding the effect of various insufflation pressure on the changes seen in immediate post-operative liver function test. Results: A total of 100 laparoscopic cholecystectomies were performed during the study period. The male to female ratio was 25:75 (1:3). 63% patients had previous episode of acute calculous cholecystitis, while 37% cases had incidental gallstone disease. All had radiologically confirmed gallstone disease. Laparoscopic cholecystectomy was done and 1 hour postoperative liver function test was compared to preoperative liver function test after dividing patients in two groups; first group having laparoscopic cholecystectomy carried out at insufflation pressure of 10mmHg, and the other group having 14mmHg insufflation pressure. There was statistically significant difference between baseline and 1 hour postoperative values of serum AST, ALT and total bilirubin levels in patient undergoing laparoscopic cholecystectomy at 14mmHg insufflation pressure. Comparatively, patient undergoing laparoscopic cholecystectomy at 10mmHg insufflation pressure had no statistically significant difference between values of preoperative and postoperative levels of serum AST, ALT and total bilirubin. Serum alkaline phosphatase level showed no statistically significant difference in either of the two groups. Conclusion: In our study, statistically significant increase in 1 hour postoperative values of serum total albumin, AST and ALT levels were seen compared to pre-insufflation values in group thar underwent high pressure (14mmHg) laparoscopic cholecystectomy. The result show that 14mmHg pressure pneumoperitoneum decreased blood flow to the liver and increased postoperative 1st hour AST, ALT and total bilirubin levels. It is therefore concluded that 10mmHg pressure pneumoperitoneum is superior to 14mmHg pressure pneumoperitoneum in laparoscopic cholecystectomy.