Laparoscopy indication+contra

Liver Biopsy
Overview
Use/Indications
The more common diagnostic indications include:

• Ascites of unknown etiology. In the majority of cases, bedside paracentesis should be performed first. If the ascites fluid is found to be exudative (but otherwise nondiagnostic), peritoneoscopy may be used to rule out occult malignancy, fungal peritonitis, tuberculosis, and other conditions.

• Diffuse or focal liver disease of unknown etiology. Direct inspection of the liver combined with a visually-directed liver biopsy can increase diagnostic accuracy. This may be particularly helpful in suspected cases of hepatocellular carcinoma, lymphoma metastatic to liver, granulomatous hepatitis, and tuberculosis. Even when diffuse liver disease is present, as in cirrhosis, laparoscopic liver biopsy and visual inspection of the liver appears to be more sensitive than “blind” liver biopsy.

• Suspected peritoneal carcinomatosis

• Cancer staging; peritoneoscopy may be used to determine the stage of malignancies such as ovarian cancer and Hodgkin disease when formal surgical laparotomy is contraindicated.

Additional indications for peritoneoscopy include:

• Evaluation of chronic abdominal pain syndromes. This procedure may occasionally be useful in diagnosing abdominal adhesions or endometriosis in patients with chronic pain. Some physicians may use laparoscopy as a means of avoiding a formal laparotomy in difficult cases. The precise role and efficacy of peritoneoscopy in this setting is unclear.

• Suspected ectopic pregnancy

• Suspected pelvic inflammatory disease

• Primary or secondary amenorrhea

• Fever of unknown origin; in selected cases to rule out lymphoma or granulomatous diseases

• Infertility evaluation (eg, diagnosis of tubal defects)

• Suspected appendicitis

• Emergency evaluation of abdominal trauma

Therapeutic uses for peritoneoscopy include:

• Tubal ligation

• Pancreatic biopsy by laparoscope through lesser sac

• Therapeutic wedge resection of the ovaries in polycystic ovary syndrome

• Lysis of adhesions

• Removal of foreign bodies (eg, intrauterine device which has perforated into the Cul-de-sac)

• Treatment of endometriosis with electrocautery or laser

• Laparoscopic cholecystectomy

• Laparoscopic colorectal surgery

Contraindications
Absolute contraindications to peritoneoscopy include:

• Acute peritonitis, particularly when surgical intervention is warranted

• Unstable cardiac or pulmonary status

• Acute intestinal obstruction; the presence of multiple dilated loops of bowel increases the risk of perforation by the needle or trocar

• Uncorrectable, severe coagulopathy

• Uncooperative patient

Relative contraindications are as follows:

• Presence of abdominal adhesions, usually from multiple abdominal surgeries or severe peritonitis. This increases the risk of bowel perforation. In each case, the risk-benefit ratio should be carefully considered (some authors consider this an absolute contraindication)

• Presence of an abdominal hernia. On rare occasions, a hernia can become incarcerated during peritoneal insufflation

• Infection involving the abdominal wall, such as cellulitis

• History of multiple abdominal surgeries (increased likelihood of dense adhesions

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