Recovery of liver functions following surgical biliary decompression in obstructive jaundice.

BACKGROUND/AIMS: Derangement of liver functions in obstructive jaundice has been known to influence surgical outcome. The pattern and time frame of liver function recovery in patients with surgical obstructive jaundice undergoing a bilioenteric anastomosis has not been comprehensively defined in human beings.

METHODOLOGY: Fifty patients of obstructive jaundice who underwent a bilioenteric anastomosis had their liver function evaluated done by biochemistry (pre-operatively and postoperatively on day 1,4,7 and 6 weeks) and radionuclide mebrofenin scan (preoperatively and 6 weeks postoperative).

RESULTS: The results have shown a constant and significant decline in serum bilirubin levels by day 4 (p=0.04), however the decline in serum levels was not uniformly progressive in 54% patients. The decline in serum alkaline phosphatase levels has been constant and progressive reaching significant levels by day 4(p=0.01). Serum transaminases showed an initial rise followed by a rapid fall, again achieving significant levels by day 4 (p=0.003 & 0.009). Serum albumin decreased on day 1 itself but remained static after that. On isotope scanning hepatic uptake showed uniform improvement with 92% of patients having achieved a normal uptake after 6 weeks. Gastrointestinal excretion of the isotope however was still delayed in 26% patients at 6 weeks. Almost all these patients had an abnormal bilirubin level decline in the immediate postoperative period.

CONCLUSIONS: Hepatic functional recovery has been seen to start immediately following bilioenteric anastomosis and has usually completed itself by 6 weeks. Patients who show an abnormal recovery pattern based on bilirubin levels need to be observed for a longer time.