Comparison of pre-operative and post-operative liver function tests in patients undergoing laparoscopic cholecystectomy at different intra-peritoneal pressures

Background: Establishing pneumoperitoneum is a pre-requisite for any laparoscopic procedure. However, its adverse effects are not uncommon. Increased intra-peritoneal pressure during laparoscopic cholecystectomy is expected to alter the liver function test (LFT) in immediate post-operative period, which may raise concerns in surgeons’ mind regarding integrity of biliary tract. The aim of our study was to compare the post-operative LFT with pre-operative values in patients undergoing laparoscopic cholecystectomy at different pneumoperitoneal pressures and to assess its clinical significance. Methods: It was a prospective observational study in which the enrolled patients were divided into 2 groups. Group 1 patients underwent laparoscopic cholecystectomy at 12 mm Hg pressure and group 2 underwent the surgery at 15 mmHg pressure. Pre-operative LFT was compared with post-operative LFT done 24 hours and 2 weeks after surgery. Results: Among 73 included patients, 41 constituted group 1 and 32 were included in group 2. Statistically significant difference was observed in hepatic transaminases between pre-operative and post-operative (1st POD) values. Mean AST in group 1: 34.7 versus 51.4 U/l; in group 2, the values were 35.1 versus 50.9 U/l respectively. Mean ALT in group 1: 36.3 versus 50.1 U/l; in group 2, values were 32.9 versus 45.6 U/l respectively. However, the enzymes normalized in all patients in 2 weeks without any adverse clinical outcome. Conclusions: Early post-operative transient elevation of hepatic transaminases after laparoscopic cholecystectomy is not associated with any adverse clinical outcome.

Non-Valvular Atrial Fibrillation: A Systematic Review

Non-Valvular atrial fibrillation is defined as the one which develops in the absence of moderate to severe rheumatic mitral stenosis ,a mechanical or bioprosthetic valve or mitral valve repair. Atrial fibrillation is the most common pathological cardiac arrhythmia and major cause of ischemic stroke. There are many major risk factors for development of atrial fibrillation. Among these advanced age, hypertension, ischemic heart disease, chronic lung disease and consumption of alcohol are the major causes. Aim of treatment is to control the rate, rhythm and anticoagulation so as to prevent tachycardia induced cardiomyopathy, heart failure and stroke. This review article gives a comprehensive and systematic approach for the management of Non-valvular atrial fibrillation. Keywords: Atrial fibrillation (AF), Stroke, Anticoagulation