Impact of Cholecystectomy on Serum Liver Enzyme Levels in Pediatric Patients with Gallstones: Focus on ALP Reduction and Influential Factors

Abstract

Background: Gallstones are relatively uncommon in children. Postoperative changes in liver function tests (LFTs) after abdominal surgeries, such as cholecystectomy, can lead to complications. There are mixed findings regarding the effect of cholecystectomy on LFTs. Objectives: The aim of this research was to investigate the changes in LFTs after cholecystectomy in children with gallstones. Methods: This cross-sectional study, conducted at Mofid Children’s Hospital (2012 - 2021), included children under 18 who underwent cholecystectomy for gallstones. Patients with alternative indications or underlying diseases affecting the liver, such as cystic fibrosis and Wilson’s disease, and those with non-gallstone-related conditions were excluded. Patients were categorized into two groups: (1) Open surgery, and (2) laparoscopic surgery. Preoperative and postoperative liver enzyme levels, along with demographic information, were recorded and analyzed using SPSS.22 software. Results: The study included 66 patients, comprising 32 boys and 34 girls. Among these, 27 patients underwent open cholecystectomy, and 39 underwent laparoscopic cholecystectomy. The most prevalent clinical symptom was abdominal pain (72.7%), followed by vomiting (37.8%). The decreases in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels following cholecystectomy were not statistically significant, with P-values of 0.65 and 0.36, respectively. However, alkaline phosphatase (ALP) levels significantly decreased post-intervention (P-value = 0.003), indicating a notable improvement in liver function after surgery. Conclusions: Cholecystectomy does not substantially alter ALT and AST levels, suggesting that routine monitoring of these liver enzymes post-surgery may be unnecessary. In contrast, the significant decrease in ALP levels suggests a resolution of cholestatic conditions, potentially reducing healthcare costs associated with unnecessary testing.