Explorative laparoscopy

Explorative laparotomy, as is occasionally recommended in the literature, is contraindicated in our opinion. All comparisons with respect to the degree of risk, stress or inconvenience to the patient, expenditure of time, material, staff and the costs involved, and particularly the diagnostic benefits, speak against laparotomy and in favour of explorative laparoscopy. 

Laparoscopy Laparoscopy should be used to confirm the diagnosis morphologically. This technique provides photodocumentary findings and also affords the possibility of targeted thick-needle, fine-needle or forceps biopsy. Tumour biopsy is only deemed necessary prior to palliative therapy. Moreover, explorative laparoscopy offers a much better overview of the whole abdominal area than does explorative laparotomy - and the risk involved is considerably lower. Carrying out laparotomy staging prior to liver transplantation is, in our opinion, also far less efficient and thus not indicated instead, laparoscopy should be the technique of choice, (s. pp 150, 155, 161, 781)... 

Liver biopsy In the case of a hitherto non-clarified differential diagnosis of cholestasis, thought should be given to percutaneous liver biopsy or laparoscopy. Although this is only indicated in isolated cases, it does promise to be successful, (s. tabs. 7.3, 7.10) (s. fig. 13.5) Explorative laparotomy should not be performed ... 

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