Premium
Complications and risk factors in 2731 diagnostic mini‐laparoscopies in patients with liver disease
Author(s) -
Frenzel Christian,
Koch Johannes,
Lorenzen Victoria,
Werner Tobias,
Lohse Ansgar W.,
Denzer Ulrike W.
Publication year - 2012
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2012.02767.x
Subject(s) - medicine , cirrhosis , perforation , liver biopsy , gastroenterology , hepatology , laparoscopy , liver disease , portal hypertension , abdominal surgery , surgery , complication , biopsy , logistic regression , ascites , materials science , punching , metallurgy
Background/Aims Mini‐laparoscopy ( ML ) allows macroscopic assessment and biopsy under direct vision and therefore is a valuable technique in the diagnosis of liver disease. Herein we report procedure‐related complications and risk factors. Methods A total of 2731 consecutive patients underwent diagnostic ML at two university hospitals (June 1996–December 2007). ML was performed using standard technique with a 1.9mm optical instrument. Coagulation of the liver biopsy site was performed with APC . The following variables were analysed as risk factors for complications: platelet count (<50/ nL ), international normalized ratio ( INR ) (>1.5), Cirrhosis, signs of portal hypertension, prior abdominal surgery. Results Major complications occurred in 1.0% ( n =27) of patients and these were, delayed bleeding from the liver biopsy site or abdominal wall (in 0.7% of patients) and intestinal perforation (in 0.3% of patients). Two patients died after severe haemorrhage (mortality 0.07%); the other patients recovered without sequelae. Bleeding risk was increased in patients with low platelets ( OR =6.1), increased INR ( OR =8.9), cirrhosis ( OR =1.9) and portal hypertension ( OR =2.1). Logistic regression showed a significant correlation only for the concurrence of low platelets and increased INR ( P = 0.001; OR =14.1); bootstrap analysis identified INR >1.5 as significant predictor ( P = 0.0002). Prior abdominal surgery did not carry a significant risk for intestinal perforation ( OR =1.1; P = 0.142), unless abdominal adhesions were present ( OR =9.5; P = 0.0002). None of the patients required surgery for intestinal perforation. Conclusion Mini‐laparoscopy is a diagnostic technique with a low complication rate. However, in patients with increased INR , low platelets or after extensive abdominal surgery, complications may occur in up to 5%.