Study of the Incidence of Postoperative Liver Dysfunction Associated with Abdominal Surgery and its Clinical Significance in Terms of the Decisive Factors of Prognosis

Satoshi Ono, Shouetsu Tamakuma, Kazuo Hatsuse, Masayuki Nishida

National Defense Medical College Surgery 1

We reevaluated the morbidity and its clinical significance of postoperative liver dysfunction associated with abdominal surgery for the past 5 years, during which evaluation of both preoperative liver function and postoperative liver support was established. The incidence of postoperative liver dysfunction was 17.3% in 1393 patients receiving major operations with the diagnostic criterion of serum GPT≥100 or total bilirubin>2 mg/dl as liver dysfunction. Liver dysfunction was more frequently associated with upper G.I. tract operations, general anesthesia with halothane, blood transfusions and perioperative infection as has often been reported. Then we divided these cases with GPT elevation into 3 types, early (within 4 days), late (after 15 days), and intermediate. In the early type, GPT elevation was mild and transient and seemed to be without any definite clinical significance, whereas in the late type, GPT elevation was very marked and of long duration with frequent association with sepsis. Also we divided 41 cases of bilirubin elevation into 3 types, one in which bilirubin elevation precedes GPT elevation, second in which the two are elevated simultaneously, and the third in which GPT elevation is followed by bilirubin elevation. In the first type the patient did not show any clinical manifestations, whereas the patient of the third type was often seriously ill, sometimes with progression to multiple organ failure or liver failure. On the basis of this clinical analysis, we concluded that the simultaneous complication of hyperbilirubinemia or sepsis seemed to be the decisive factor in the prognosis of postoperative liver dysfunction. Experimental data about the effects of endotoxin on bile stasis and the difference in the rate of decrease of GPT according to the background factors are also discussed.

Key words
postoperative liver dysfunction, endotoxin, surgical sepsis, hyperbilirubinemia, multiple organ failure

Reprint requests
Satoshi Ono The First Department of Surgery, National Defense Medical College
3-2 Namiki, Tokorozawa, 359 JAPAN

Accepted
November 8, 1989

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