SPARE THE NEEDLE, DISCHARGE THE CHILD - TRENDING POST-OP LABS AFTER LAPAROSCOPIC COMMON BILE DUCT EXPLORATION (LCBDE) IN PEDIATRIC PATIENTS IS NOT HELPFUL

Objectives: Post-operative liver function tests (POST-LFTs) are often collected to assess the success of laparoscopic common bile duct exploration (LCBDE). Yet, uptrending POST-LFTs often lead to additional testing and longer stays despite clinical improvement. As the influence of ductal manipulation during LCBDE on POST-LFT trends remains unclear, the utility of POST-LFTs is worth investigating because additional lab draws increase length of stay (LOS) and patient distress. Our aim was to examine POST-LFT trends for patients undergoing successful laparoscopic cholecystectomy with LCBDE (LC+LCBDE) to determine whether a predictable POST-LFTs trend emerged. We hypothesized that POST-LFTs would not consistently downtrend.

Methods: A retrospective analysis of all patients undergoing LC+LCBDE at a single children’s hospital was conducted. Successful LC+LCBDE was defined as common duct clearance on fluoroscopy without the need for subsequent ERCP. POST-LFTs were classified as increased or decreased from PRE values with Wilcoxon signed-rank testing to assess for differences between PRE and POST-LFTs. Post-op LOS between successful LC+LCBDE with and without POST-LFTs was also compared.

Results: Thirty-nine patients underwent LC+LCBDE over 4 years, with 25 complete records. In patients who underwent successful LCBDE, there was no significant difference between PRE and POST-LFTs for total bilirubin, AST, ALT, or Alk Phos. Among successful LCBDE cases with post-op LFTs, the following lab parameters (T. Bili, AST, ALT, Alk Phos) increased in 32%, 40%, 40%, and 32% of patients respectively. Post-op LOS was shorter in patients with no POST-LFTs (16hrs vs 26 hrs, p=0.03).

Conclusion: POST-LFTs after successful pediatric LC+LCBDE do not consistently downtrend. Intraoperative surgical judgment and the patient's post-op status may be better criteria for discharge. While further research is necessary, it appears safe to discharge pediatric patients without post-op LFTs after a clinically successful LC+LCBDE.