Not all patients will have elevated total bilirubin after surgery. First of all, what is total bilirubin? Total bilirubin is the sum of indirect bilirubin and direct bilirubin. Therefore, an increase in indirect bilirubin or an increase in direct bilirubin can cause an increase in total bilirubin. If the increase in total bilirubin is caused by an increase in indirect bilirubin, it is often seen when the patient has hemolytic jaundice. This is a time when a large number of red blood cells are destroyed, exceeding the liver’s ability to convert them, allowing indirect bilirubin to remain in the blood, thus causing an increase in total bilirubin. Increased indirect bilirubin is usually seen in conditions such as hemolytic jaundice, blood transfusion reactions due to blood group incompatibility, and neonatal jaundice. If the total bilirubin is elevated due to elevated direct bilirubin, it often occurs when there is a problem with the bile duct, where the direct bilirubin is not excreted into the intestinal tract and instead flows back into the bloodstream, resulting in an increase in the direct bilirubin in the serum. This type of elevated total bilirubin is commonly seen in obstructive biliary tract disease caused by cholecystitis or gallbladder stones. The third type of elevated total bilirubin is caused by elevated both direct and indirect bilirubin and is often seen in cases of hepatocellular damage. When the liver is damaged, the ability to convert indirect bilirubin into direct bilirubin decreases, causing both direct and indirect bilirubin to rise, which occurs in patients with acute hepatitis, hepatocellular necrosis, and cirrhosis. As patients need to use a large amount of various drugs for surgery, these drugs need to be metabolized by liver, which will cause damage to liver cells, so some patients with elevated total bilirubin after kidney cancer surgery are often caused by these reasons, and of course, there are also patients with congenital hepatitis.