Liver Function, Quantified by LiMAx Test, After Major Abdominal Surgery. Comparison Between Open and Laparoscopic Approach

• Published in: World journal of surgery Vol. 42; no. 2; pp. 557 - 566
• Main Authors: Kaffarnik, Magnus, Stoeger, Gabriel, Liebich, Julia, Grieser, Christian, Pratschke, Johann, Stockmann, Martin
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-02-2018; Springer Nature B.V
• Subjects: Abdomen; Abdominal Surgery; Blood flow; Cardiac Surgery; Delivery scheduling; Females; General Surgery; Inflammation; Inflammatory response; Laparoscopy; Liver; Liver diseases; Males; Medicine; Medicine & Public Health; Original Scientific Report; Surgery; Surgical instruments; Thoracic Surgery; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-017-4170-9

Introduction
Major abdominal surgery may lead to a systemic inflammatory response (SIRS) with a risk of organ failure. One possible trigger for a postoperative hepatic dysfunction is an altered hepatic blood flow during SIRS, resulting in a decreased oxygen delivery. This pilot study investigated the role of liver dysfunction measured by the LiMAx test after major abdominal surgery, focussing on open and laparoscopic surgical approaches.
Methods
We prospectively investigated 25 patients (7 females and 18 males, age range 55–72 years) scheduled for upper abdominal surgery. The LiMAx test, ICG-PDR and duplex sonography were carried out preoperatively, followed by postoperative days (PODs) 1, 3, 5 and 10. Laboratory parameters and clinical parameters were measured daily. Clinical outcome parameters were examined at the end of treatment. The population was divided into group A (laparotomy) versus group B (laparoscopy).
Results
LiMAx values decreased significantly on POD 1 (290 µg/kg/h,
P
 < 0.001), followed by a significant increase at POD 3 (348 µg/kg/h,
P
 = 0.013). Only INR showed a significant increase on POD 1 (1.26,
P
 < 0.001). Duplex sonography and ICG-PDR revealed a hyper-dynamic liver blood flow. No differences between group A and B were found.
Conclusions
Hepatic dysfunction after major abdominal surgery is evident and underestimated. The LiMAx test provides an adequate tool to determine liver dysfunction. Open and laparoscopic approaches appeared similar in terms of liver dysfunction and postoperative SIRS.