Variations in total serum bilirubin and alkaline phosphatase in the normal postoperative cholecystectomy course

Total serum bilirubin and serum alkaline phosphatase were studied in eighty-seven patients who underwent simple cholecystectomy and radiomanometry without complications. It was found that in most patients a rise in serum bilirubin occurred early in the postoperative course with return to normal preoperative values in approximately two days. A similar rise in alkaline phosphatase was noted later, reaching its peak by the fifth or sixth postoperative day and returning to normal shortly thereafter. These variations all occurred within the limits of normal. Similar variations, but beyond upper normal limits, are found in bile peritonitis. It is unlikely that peritoneal absorption of bilirubin and alkaline phosphatase is responsible for all these changes. Elevation of total serum bilirubin and alkaline phosphatase to normal limits can be expected in the postoperative course of patients undergoing uncomplicated cholecystectomy. Any rise beyond this point should alert the surgeon to the possibility of a complication due to bile leakage into the peritoneal cavity.