Changes in Liver Enzymes Following Laparoscopic Surgeries Using Liver Retractors

Introduction Liver enzyme elevation, pain in the epigastric region or under the left rib arch are common after laparoscopic fundoplication, gastric resection, or gastrectomy. According to studies it is often due to liver blood flow disturbances caused by left lobe elevation with a retractor.[1–6] Factors like body mass index (BMI) and surgery duration may also contribute.[7] However, studies identifying risk factors for these changes remain limited. Comprehensive evaluation of these factors is crucial to prevent undiagnosed pathologies and ensure optimal care.[8] Aim To elucidate the principal factors contributing to transient postoperative liver enzyme elevations following laparoscopic surgeries involving a liver retractor. Methods This prospective cohort study included 120 patients who underwent laparoscopic surgery at the Surgery Department of Kaunas Clinics between 2023 and 2024. Patients were divided into two groups: a control group (undergoing laparoscopic cholecystectomy without liver retraction) and a retractor group (undergoing laparoscopic fundoplication, gastric resection, or cardiomyotomy involving liver retraction). Blood tests, including complete blood count, biochemistry, kidney function, coagulation, and liver markers, were conducted preoperatively, intraoperatively, and postoperatively. Additional variables, such as BMI, surgery duration, and demographic data, were collected for analysis. Preoperative non-invasive ultrasonography of the upper abdomen was performed to assess left liver lobe dimensions. Statistical analyses were conducted using IBM SPSS 29.0 software to evaluate associations with liver enzyme elevations and identify potential risk factors. Results An elevation in CRP levels was observed in the retractor group on the first postoperative day (p<0.05). Notable elevations in ALT, AST, and LDH levels were also detected on the day of surgery and the first postoperative day in the group where liver retractors were involved (p<0.05). No association between electrolytes, kidney function tests, coagulation profiles and postoperative liver enzymes elevation was found (p>0,05).The increase in liver enzymes was not dependent on BMI but correlated with the duration of surgery. Binary logistic regression analysis revealed that surgeries lasting longer than 75 minutes were associated with a sixfold increased risk of elevated liver enzymes. After the first postoperative day, liver enzyme levels in the retractor group returned to preoperative ranges, while no increase in liver enzymes was observed in the control group. Conclusions Our study identified liver retractor use and surgery duration as key factors in liver enzyme elevation, which do not impact short-term outcomes. BMI did not affect postoperative liver enzyme elevation. Intermittent breaks in retractor use are recommended during longer surgeries to reduce this risk.