Laparoscopic cholecystectomy in hepatic patients

Aim The aim of this study was to compare low-pressure with high-pressure pneumoperitoneum laparoscopic cholecystectomy in hepatic patients. Patients and methods This prospective study included 40 consecutive patients with calcular gall bladder and hepatitis C who were admitted in The Department of General Surgery, Minia University Hospital, between July 2016 and December 2016. We classified them into two groups, group I (high pressure) and group II (low pressure). Results In group I, aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyltransferase, and lactate dehydrogenase (LDH) were significantly increased 24 h postoperatively. AST and ALT were elevated three-fold, and AST, ALT, and LDH reached levels over upper normal limits after 24 h postoperatively. However, in group II patients the elevation of enzyme levels did not reach two-fold and remained within the normal limits. On comparing the two groups, the elevation of AST, ALT, and LDH was significant for group I (P=0.0001). Moreover, elevation of γ-glutamyltransferase was significant (P=0.041), whereas alkaline phosphatase level changes were nonsignificant. Conclusion We conclude that pneumoperitoneum 14 mmHg pressure decreased blood flow to the liver with increased postoperative serum enzyme levels, and pneumoperitoneum 10 mmHg pressure is superior to 14 mmHg pressure pneumoperitoneum in laparoscopic cholecystectomy. Therefore, we recommend this low-pressure pneumoperitoneum in hepatic patients.