Hepatic blood flow and function in elderly patients undergoing laparoscopic cholecystectomy

• Published in: Anesthesia and analgesia Vol. 90; no. 5; pp. 1198 - 1202
• Main Authors: SATO, K, KAWAMURA, T, WAKUSAWA, R
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.05.2000
• Subjects: Adult; Aged; Aging - physiology; Alanine Transaminase - blood; Aspartate Aminotransferases - blood; Biological and medical sciences; Blood Flow Velocity; Cholecystectomy, Laparoscopic; Echocardiography, Transesophageal; Female; Hepatic Veins - diagnostic imaging; Hepatic Veins - physiology; Humans; Liver - physiology; Liver Circulation; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Pneumoperitoneum, Artificial - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Human; Cholecystectomy; Endoscopic surgery; Liver function; Artificial pneumoperitoneum; Digestive system; Liver; Laparoscopy; Hemodynamics; Elderly; Blood flow
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-200005000-00037

Laparoscopic cholecystectomy (LC) has been widely accepted as an alternative to laparotomy and has many advantages, including short hospital stay and very limited surgical invasion. However, this procedure may impair hepatic function in elderly patients because high pressure is maintained in the peritoneal cavity for an extended period. We observed the effect of pneumoperitoneum on the middle hepatic venous blood flow (MHVBF) in elderly patients undergoing LC. LC patients were anesthesized with inhaled and epidural anesthesia, after which MHVBF was continuously measured by transesophageal echocardiography. MHVBF decreased significantly during a period of high intraperitoneal pressure, and recovery of MHVBF after deflation was significantly lower in elderly patients (65-75 yr), but not in younger patients (24-62 yr). In contrast, MHVBF remained almost constant in elderly patients during open cholecystectomy, and thus was significantly different from that in patients who underwent LC with pneumoperitoneum. Laparoscopic cholecystectomy may impair hepatic function in elderly patients because high pressure is maintained in the peritoneal cavity for an extended period.