Restoration of Liver Function in Cases of Surgical Obstructive Jaundice after Biliary Decompression: A Longitudinal Study

Abstract

Introduction: Surgical Obstructive Jaundice (SOJ) is caused by obstruction of bile duct with the resultant increase in serum bilirubin level with or without pruritus, biliary colic and cholangitis. Liver Function Tests (LFTs) can help the clinician in screening patients for presence of liver disease with probable cause, its severity with prognosis assessment and also monitor efficacy of therapy. Aim: To study the liver biochemical parameters with pattern and extent of restoration in cases of SOJ (benign and malignant), before and after biliary decompression, done either by definitive surgery or endoscopic procedure. Materials and Methods: This longitudinal study was carried out from October 2014 to May 2016 in 50 patients of obstructive jaundice at ESI PGIMSR and Hospital, Basaidarapur, New Delhi, India. All patients with benign as well as malignant conditions leading to SOJ, who were amenable to endoscopic or surgical decompression were included and patients of medical jaundice were excluded. Clinical examination and blood investigations (LFT) were done preoperative, postoperative on Day 3, Day 7, Day 14 and during follow-up at 4 week, 12 week. Collection of data was done from the patients included as per criteria, data included demographical data, presenting features, aetiology and therapeutic intervention carried out obstructive jaundice (endoscopic or surgical) and the preoperative parameters and postprocedure parameters (LFT) in a sequential manner. Data analysis was carried out on Statistical Package for the Social Sciences (SPSS) version 22.0. The statistical significance of difference in values of various biochemical and clinical parameters over the study period was assessed by using one-way Analysis of Variance (ANOVA). The p-value of <0.05 was considered significant. Results: A total of 50 patients were included in the study; of these 14 were males and 36 were females with a male to female ratio of 2:5. Age of patients in the present study ranged between 25-80 years with a mean age of 50±12 years. Total 33 patients were of Benign conditions (Group I) and 17 patients were of malignant conditions (Group II). Preoperative bilirubin levels in benign condition were 3 times the normal and 7 times in malignant condition, and they were significantly higher (p-value <0.001) in each group. The mean percent fall in Aspartate Aminotransferase (AST) levels were similar in both the groups i.e., 29% vs 30% on day 3, 49% vs 45% on day 7 and 53% vs 49.5% on day 14, 70% vs 64.6% on 4th week and on 12th week 76% vs 73% in Group I and II. Conclusion: The hepatic recovery after biliary decompression either by definitive surgery or endoscopic procedure was identical for both benign and malignant causes. However, the level of preoperative levels of bilirubin determines the total time taken for recovery.

Keywords

• bilirubin
• cholestasis
• endoscopic retrograde cholangiopancreatography
• liver function test