Establishing "Normal" Values for Liver Function Tests after Reconstruction of Biliary Injuries

Elizabeth A. Fialkowski, Emily R. Winslow, Mitchell G. Scott, William G. Hawkins, David C. Linehan, Steven M. Strasberg

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Abnormalities of liver function tests (LFT) are sometimes taken as evidence of a less than optimal result after repair of a biliary injury. Rather than indicating liver or anastomotic dysfunction, moderate LFT elevations can be "normal" for these patients. This study's aim was to determine LFT reference values after biliary-enteric anastomosis for biliary injury repair in persons who have had an excellent postoperative course for > 6 months. Study Design: Of 113 patients repaired, 73 were identified with the following characteristics: LFT available at ≥ 6 months after repair, no biliary tract symptoms, no underlying liver disease, and biliary injury sustained during cholecystectomy. Outside LFT results were standardized to Barnes-Jewish Hospital reference values. One set of LFT per patient was collected at the following times points after repair: 6 months to 2 years, 2 to 5 years, and > 5 years. Results: For each distribution, the 97.5th p97.5ercentile values for alkaline phosphatase (≥ 166 IU/L) and total bilirubin (≥ 1.3 mg/dL) were elevated relative to Barnes-Jewish Hospital standard values. Values for alanine aminotransferase and aspartate aminotransferase were more variable. Conclusions: Moderate LFT elevations exceeding standard reference values are common after repair of a biliary injury in patients who have had excellent results. Alkaline phosphatase values fall with time after repair so that comparisons should take into account time from repair. Values ≤ 97.5th percentile limits described here should not be taken as evidence of liver or anastomotic dysfunction.

Original languageEnglish
Pages (from-to)705-709
Number of pages5
JournalJournal of the American College of Surgeons
Issue number5
StatePublished - Nov 2008


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