Impact of CO2 Pneumoperitoneum on LFTS in Laparoscopic Cholecystectomy Surgery: A Prospective Surgery

Abstract

Background: Transient abnormalities in liver function tests (LFTs) following uncomplicated laparoscopic cholecystectomy (LC) have been attributed to CO₂ pneumoperitoneum–related hepatosplanchnic perfusion changes, yet the magnitude and time course of these alterations remain clinically relevant in routine standard-pressure practice. Objective: To quantify perioperative changes in ALT, AST, bilirubin, and ALP after uncomplicated LC performed under 14 mmHg CO₂ pneumoperitoneum and to assess whether longer CO₂ insufflation duration is associated with greater postoperative enzyme elevation. Methods: In this prospective observational study conducted at Sandeman Provincial Hospital, Quetta (January–July 2025), 100 adults (20–70 years) with uncomplicated gallstone disease and normal baseline LFTs underwent standardized LC with CO₂ pneumoperitoneum maintained at 14 mmHg. ALT, AST, bilirubin, and ALP were measured preoperatively and on postoperative day 2 and day 10. Paired t-tests compared postoperative values with baseline. Results: On postoperative day 2, ALT increased from 28.19±5.29 to 51.11±13.06 U/L (p<0.001), AST from 31.23±5.51 to 53.79±12.92 U/L (p<0.001), and bilirubin from 0.8229±0.1378 to 1.3840±0.2727 mg/dL (p<0.001), while ALP showed no clinically meaningful rise. Enzyme elevations were more pronounced with longer CO₂ insufflation duration and returned near baseline by day 10. Conclusion: Uncomplicated LC under standard-pressure CO₂ pneumoperitoneum is associated with reversible elevations in ALT, AST, and bilirubin that normalize by postoperative day 10, with greater changes observed after prolonged insufflation exposure.