• Lubna Habib
  • Masoom Raza Mirza
  • Muhammad Ali Channa
  • Wajahat Hussain Wasty


Background: Cholelithiasis is a common problem in west as well as in developing nations and itsincidence is continuously rising. It has become routine to order LFT’s in every patient undergoingcholecystectomy for symptomatic cholelithiasis. Objective: To evaluate the usefulness of routineLiver Function Tests (LFT’s) in patients with symptomatic cholelithiasis. Methods: This prospectivedescriptive study was conducted from August 2006 to July 2007 at Department of Surgery, HamdardUniversity Hospital and other private hospitals. All patients presenting with symptomatic cholelithiasiswith no past and present history of jaundice, pancreatitis, cholangitis and normal calibre common bileduct on ultrasonography. The relevant data regarding history, clinical examination, LFT’s andultrasound findings were recorded and analysed. Results: Out of 124 patients, 102 (82.25%) werefemale and 22 (17.74%) were male with the mean age 43 years (range 20 to 76 years). Majority ofpatients, 110 (88.71%) presented as chronic calculous cholecystitis, 12 (9.68%) as acute calculouscholecystitis and 2 (1.61%) with biliary colic. In 108 (87.10%) patients, labelled as group A, LFT’swere with in normal range. In this group most of the patients, 103 (95.37%) were those who presentedas chronic calculous cholecystitis. Rest of the 5 patients (4.63%) with normal LFT’s were those whopresented as acute calculous cholecystitis. In 16 patients (12.90%), labelled as group B, LFT’s werefound deranged. In this group 7 (43.75%) patients presented as acute calculous cholecystitis, 7(43.75%) as chronic calculous cholecystitis and 2 (12.5%) with biliary colic. Bilirubin was foundelevated in 2, AST in 4 and alkaline phosphatase in all patients. None of these patients in either grouphad dilated CBD on preoperative ultrasound examination and per operatively (in open surgery) CBDdilatation or palpable stones were not found. Conclusion: A routine LFT’s in preoperative assessmentof uncomplicated symptomatic cholelithiasis usually comes out normal and it is not a good predictivemarker for the detection of silent CBD calculi.Keywords: Cholelithiasis, Gall stones, Choledocholithiasis, Common bile duct, Liver functiontest, Cholecystectomy, Laparoscopic, Symptomatic, Uncomplicated


Cushieri A. Disorder of the biliary tract. In: Cushieri A, Steele

RJC, Moosa AR, eds. Essential surgical practice, 4th ed. London:

Butterworth Heinemann; 2002.p.375–454.

Cranley B, Logan H. Exploration of the common bile duct- the

relevance of the clinical picture and the importance of

preoperative cholangiography. Br J Surg 1980;67:869–72.

Ishizaki Y, Miwa K, Yoshimoto J, Sugo H, Kawasaki S.

Conversion of elective laparoscopic to open cholecystectomy

between 1993 and 2004. Br J Surg 2006;93:987–91.

Barkun AN, Barkun JF, Fried GM, Ghitulescu G, Steinmetz O,

Pham C, et al. Useful predictors of bile duct stones in patients

undergoing laparoscopic cholecystectomy. Ann Surg


Robinson TN, Biffl WL, Moore EE, Heimbach JK, Calkins CM,

Burch J. Routine preoperative laboratory analysis are

unnecessary before elective cholecystectomy. Surg Endosc


Shamim M, Dahri MM, Memon AS. Complications of

laparoscopic cholecystectomy. Pak J Surg 2006;22(2):70–5.

Menezes N, Marson LP, deBeaux AC, Muir IM, Auld CD.

Prospective analysis of a scoring system to predict

choledocholithiasis. Br J Surg 2000;87:1176–81.

Collins C, Moguire D, Ireland A, Fitzgerald E, O’Sullivan GC. A

prospective study of common bile duct calculi in patients

undergoing laparoscopic cholecystectomy. Ann Surg


Livingston EH, Miller JA, Coan B, Rege RV. Indication for

selective intraoperative cholangiography. J Gastrointest Surg


Contractor QQ, Boujemla M, Contractor TQ, el-Essawy OM.

Abnormal common bile duct sonography: the best predictor of

choledocholithiasis before laparoscopic cholecystectomy. J Clin

Gastroenterol 1997;25:429–32.

Koo KP, Traverso LW. Do preoperative indicators predict the

presence of common bile duct stones during laparoscopic

cholecystectomy? Am J Surg 1996;171:495–9.

Kim KH, Kim W, Lee HI, Sung CK. Prediction of common bile

duct stones: its validation in laparoscopic cholecystectomy.

Hepatogastroenterology 1997;44:1574–9

Saltzstein EC, Peacock JB, Thomas MD. Preoperative bilirubin,

alkaline phosphatase and amylase levels as predictors of common

duct stones. Surg Gynecol Obstet 1982;154:381–4.

Fahlke J, Ridwelski K, Manger T, Grote R, Lippert H. Diagnostic

workup before laparoscopic cholecystectomy: which diagnostic

tool should be used? 2001;48:59–65.

Dholia KR, Memon AA, Shaikh MS, Shaikh SA. Laparoscopic

Cholecystectomy experience of 100 cases at a teaching hospital

of Sindh. J Liaquat Uni Med Health Sci 2005;4:105–8.

Cheema AM, Munir A, Zahid M. An experience of laparoscopic

cholecystectomy at Lahore General Hospital. Biomedica


Nugent N, Doyle M, Mealy K. Low incidence of retained

common bile duct stones using a selective policy of biliary

imaging. Surgeons 2005;3:352–6.

Abbasi SA, Azmi R, Haleem A, Tariq GR, Iqbal A, Almas D,

Majeed N. An audit of laparoscopic cholecystectomies

performed at PNS Shifa. Pak Armed Forces Med J


Peng WK, Sheikh Z, Paterson-Brown S, Nixon SJ. Role of liver

function tests in predicting common bile duct stones in acute

calculous cholecystitis. Br J Surg 2005;92:1241–7.

Frossard JL, Hadengue A, Amouyal G, Choury A, Marty O,

Giostra E, et al. Choledocholithiasis: a prospective study of

spontaneous common bile duct stone migration. J Gastrointest

Endosc 2000;51(2):175–9.

Topal B, De Moortel M. Van, Fieuws S, Vanbeckvoort D, Van

Steenbergen W, Aerts R, et al. The value of magnetic resonance

cholangiopancreatography in predicting common bile duct stones

in patients with gallstone disease. Br J Surg 2003;90:42–7.

Andrew CF Taylor, Andrew FL, Oliver FH, Simon WB, Peter

JS, Paul VD. Prospective assessment of magnetic resonance

cholangiopancreatography for noninvasive imaging of the biliary

tree. Gastrointest Endosc 2002;55:17–22.

Ohtani T, Kawai C, Shirai Y, Kawakami K, Yoshida K,

Hatakeyama K. Intraoperative ultrasonography versus

cholangiography during laparoscopic cholecystectomy: a

prospective comparative study. J Am Coll Surg 1997;185:274–82.

Del Santo P, Kazarian KK, Rogers JF, Bevins PA, Hall JR..

Prediction of operative cholangiography in patients undergoing

elective cholecystectomy with routine liver function chemistries.

Surgery 1985;98:7–11.

Quershi A, Browne A, Leahy AL, Courtney G, Osborne H, Broe

PJ. ERCP in the management of patients having laparoscopic

cholecystectomy: Re-appraising current indications. Ir J Med Sci