Laparoscopic liver biopsy in patients with coagulopathy, portal hypertension, and ascites

The safety, reliability, and technique of laparoscopic liver biopsy were evaluated in 22 consecutive patients with coagulation abnormalities who were considered high risk for standard percutaneous liver biopsy. Fifty-eight biopsies were performed in 15 men and seven women. All patients had a prolonged prothrombin time (>13.5 seconds), bleeding time (>9 minutes), or thrombocytopenia (<100,000 TH/UL). Ten patients (45%) had more pronounced coagulation abnormalities defined as a prolonged PT >2.5 seconds or ≤30% control, platelet count <50,000 TH/UL, or bleeding time twice normal. Thirteen patients (59%) had both thrombocytopenia and a prolonged PT. Ascites was present in 19 patients (86%) and portal hypertension in 16 (73%). Laparoscopic liver biopsy was performed under general anesthesia, most commonly using two trocar sites and an open laparoscopic technique. Hemostasis was most effectively obtained by application of direct pressure and topical gelfoam and thrombin. A postoperative drop in hemoglobin of ≥1 gm per cent occurred in four patients. One patient required laparotomy for postoperative bleeding and was the only patient requiring transfusion of red blood cells. Other complications included two minor ascitic leaks, one small subcapsular hematoma, and one wound infection. In conclusion, laparoscopic liver biopsy can be performed safely and reliably in patients with conditions contraindicating percutaneous biopsy.