Comparison of serum aminotransferase between gas and gasless laparoscopy cholecystectomy

Abstract

Carbondioxide (CO2) insufflations in laparoscopy with gas will increase intraabdominal pressure that influences the
hemodynamic, lungs, and kidneys. One of important hemodynamic changes is temporary reduction of hepatic blood
flowbecause of pneumoperitoneum. Pressure caused by pneumoperitoneumcan influence ischemia degree of hepatic
cell and cause hepatic enzymes increase. Enzyme that includes in hepatic enzyme is aminotransferase,which consists
of: transaminase (AST) or glutamic oxaloacetic transaminase serum and alanine transaminase (ALT) or glutamic
pyruvic transaminase serum. Laparoscopy method by lifting abdomen wall (gasless laparoscopy) without CO2
insufflations can decrease the damaging effects of high intraabdominal pressure. This research was an experimental
research with single blind randomized clinical trial (RCT) plan, with observation of symptomatic cholelithiasis patients
who underwent cholecystectomy laparoscopic cholecystectomy with gas or CO2 (pneumoperitoneum) or without
gas (gasless). Hepatic function tests were then held at 24 hours and 72 hours after operation. Research subjects
were symptomatic cholelithiasis patients who fulfilled inclusion and exclusion criteria. Samples needed were 24
people in each group. The independent variable was patients with symptomatic cholelithiasis who underwent
cholecystectomy laparoscoped with gas compared to those being cholecystectomy laparoscoped without gas. The
dependent variable was aminotransferase enzyme value before operation, and 24, 72 hours postoperation. The data
were analyzed using Kolmogorov Smirnov, independent t-test, pair t-test, and MannWhitney test. It was obtained
21 cases for men (43.75%), 27 cases for women (56.25%). The average age of the group laparoscopy with gas
was 47.16±10.76 years old and the group laparoscopy without gas was 45.3±11.48 years old (p>0,05). The
average values of AST and ALT 24 hours postoperation of the group laparoscopy without gas were 21.9±7.6 U/L
(increase 24%) and 26.3±5.2 U/L (increase 46%) compared to 65.8±18.4 U/L (increase 206%) and 62.8±14.3
U/L (increase 280%) in the group laparoscopy with gas (p< 0,05). The average values of AST and ALT 72 hours
postoperation of the group laparoscopywithout gaswere 24.7±8.3 U/L (increase 33%) and 28.9±7.3 U/L (increase
17%) compared to 71,5±28,6 U/L (increase 250%) and 75.8±16.9 U/L (increase 360%) in the group laparoscopy
with gas (p< 0,05). In conclusion, there were significantly increases of serum aminotransferase values (AST and
ALT) in cholecystectomy laparoscopy with gas compared to in cholecystectomy laparoscopy without gas.
Key words: cholecystectomy laparoscopy – pneumoperitoneum - gasless – serum aminotransferase