Impact of carbon dioxide pneumoperitoneum on hepatic function in laparoscopic cholecystectomy: a prospective study on hepatic enzyme alterations and comorbidity influence

Abstract

Background: Laparoscopic cholecystectomy, the standard treatment for symptomatic gallstone disease, utilizes carbon dioxide (CO₂) pneumoperitoneum for intra-abdominal visualization. However, CO₂ insufflation may transiently impair hepatic function. This study evaluates the impact of CO₂ pneumoperitoneum on hepatic enzyme alterations and assesses the influence of comorbidities on postoperative outcomes.

Methods: A prospective observational study was conducted on 120 patients undergoing laparoscopic cholecystectomy, stratified into two groups: with comorbidities (n=60) and without comorbidities (n=60). Liver function tests (ALT, AST, ALP, GGT, and total bilirubin) were analyzed preoperatively and postoperatively. Intraoperative complications (hepatic hypoperfusion, hypercarbia, hemodynamic instability) and postoperative outcomes (transient LFT elevation, bile leak, hepatic encephalopathy, hospital stay) were assessed. Statistical analysis included paired t-tests and chi-square tests, with p<0.05 considered significant.

Results: Postoperative elevations in ALT, AST, ALP, GGT, and bilirubin were statistically significant (p<0.001) but transient. Comorbid patients exhibited higher LFT elevations, though not statistically significant (p=0.108). Intraoperative complications included hepatic hypoperfusion (16.7%), hypercarbia (15%), and hemodynamic instability (12.5%), with no significant differences between groups (p>0.05). Postoperatively, transient LFT elevation (29.2%) was the most common complication, occurring more frequently in comorbid patients (p=0.108). Prolonged hospital stay (>3 days) was observed in 11.7% of comorbid patients (p=0.322). Rare complications included bile leak (4.2%) and hepatic encephalopathy (1.7%).

Conclusions: CO₂ pneumoperitoneum during laparoscopic cholecystectomy induces transient but significant hepatic enzyme elevations, with comorbid patients showing higher, albeit non-significant, changes. The procedure remains safe and effective, even in patients with comorbidities, though careful perioperative monitoring is recommended.