Background: Patients with cirrhosis and portal hypertention are more at risk for bleeding during diagnostic laparoscopy either from the trocar site or at the biopsy site in the liver. Aim: The purpose of the study was to evaluate bleeding complications from the 5 mm trocar site during laparoscopy or any prolong bleeding from the biopsy site in the liver in patients with cirrhosis. Patients and methods: Retrospectively we reviewed the records of 50 patients with cirrhosis that underwent diagnostic laparoscopy with biopsy of the liver, from January 96 to October 97. The procedures were done by the same group of physicians. The study population consisted of 29 males / 21 females with a mean age of 53: the underlying risk factors were: HCV in 29 patients (58%), HBV in 4 patients (8%), Cryptogenic in 5 patients (10%) and HCC in 12 patients (24%). The procedure was done in the laparoscopy suite under local anaesthetic, conscious sedation and pneumoperitoneum was induced with nitrous oxide. A 5 mm laparoscope with a 30 degree angle was used (Storz, Germanyl and a 2 mm laparoscope with 0 degree optic lens (Auto Suture Company, Norwalk, CT) was utilized to observe the 5mm trocar site. Liver biopsy was done with a 16 gauge tru cut automatic needle (Mannan Medical, North Brook. IL.) Results: Bleeding from the 5 mm trocar site was observed in four patients (8%) 2 males / 2 females: one male with underlying HB. one male with HCV and 2 females both with HCV. Three patients required the use of one avitene plug, and one patient required the use of two avitene plugs. None of the patients showed prolonged bleeding from the biopsy site. Bleeding at the biopsy site was well controlled in a standard fashion by applying pressure with a probe. Blood transfusions were not required. Conclusion: The study population of 8% had bleeding complications from the trocar site, none of the patients had complications from the biopsy site. The 2 mm laparoscope was valuable in identifying the bleeding at the trocar site. It appears that laparoscopy can be safely performed in patients with cirrhosis and the 2mm laparoscope is useful to visualize the trocar site to rule out bleeding prior to termination of the procedure. Also, complications can be detected early and managed immediately without any further interventions.
|Publication status||Published - 1998|
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