Laparoscopy indications

On the basis of the chnical results, indications for diagnostic laparoscopy are as follows ... 

In terms of ultrasonography, various liver diseases appear as diffuse changes in the parenchyma. They usually exhibit uncharacteristic findings. In cases where the diagnosis is uncertain, particularly after employing CT, liver biopsy (or laparoscopy) is then indicated ... 

Tab. 7.11 Indications for (exploratory) laparoscopy — where no definitive diagnosis is guaranteed by other procedures. The diagnostic significance of an indication is individual and different in each case and can be categorized in steps ranging from of little significance through to "very important or absolutely necessary ...

Laparoscopy is always indicated if an abdominal clinical picture has not been clarified or a hepatobiliary disease could not be defined by non-invasive or minimally invasive procedures (such as sonography, CT, ERC, scintigraphy, MRI). (S. tab. 7.12) (245, 253, 276, 294)... 

Once the indications have been drawn up and critically considered, and possible contraindications weighed up, the briefing of the patient follows (on the day prior to laparoscopy) and the patient s written consent is obtained. All further measures are then taken, (s. tab. 7.14)... 

Kameda, Y., Shinji, Y. Early detection of hepatocellular carcinoma by laparoscopy yellow nodules as diagnostic indicators. Gastrointest. Endosc. 1992 38 554-559... 

The indications for sonography- or CT-guided flne-needle biopsy (FNB) are (i.) contraindications to the use of laparoscopy (s. p. 149) or (2.) if it seems unlikely that previously unresolved findings will be clarified by laparoscopy. In consideration of all relevant findings from sonography or CT as well as the patient s condition, it may be necessary in individual cases to resort to FNB as the primary approach instead of biopsy or laparoscopy, (s. fig. 9.4) The non-availability of laparoscopy or insufficient experience with this technique are in themselves not an indication for percutaneous fine-needle biopsy, (s. fig. 9.4)... 

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 ... 

The final morphological diagnosis is reached by means of laparoscopy with photographic documentation (s. figs. 28.7, 28.13) as well as targeted biopsies, (s. fig. 28.14) Laparoscopy is strongly indicated when hepatocellular carcinoma is suspected due to an increase in the ai-foetoprotein value and/or sonographic peculiarities. 

Both the risks and the possibility of obtaining uncertain results are far greater with percutaneous biopsy than with laparoscopically directed biopsy. The latter produces a detailed diagnosis in 97-100% of cases, a result also confirmed by our own observations. (46, 90, 123, 129) Insufficient training in laparoscopy or the non-availability of this examination technique do not constitute an indication for percutaneous biopsy in liver cirrhosis, at least for initial diagnosis, (s. figs. 7.8, 7.15 16.5 28.13 35.2-35.4) (s. pp 160, 161, 408)... 

Protein degradation products may also trigger a febrile episode aetiological differentiation of the fever caused by such metabolic products is usually impossible. There are no effective therapeutic measures. Differential diagnosis of fever of unexplained origin (R.G. Petersdorf et af, 1961) can be very difficult in cirrhosis, a situation which presents an additional risk to the patient. In unexplained fever, laparoscopy is indicated, (s. tab. 7.10) (s. p. 156)... 

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)... 

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