LAPAROSCOPY-GUIDED BIOPSY IN DIAGNOSIS OF LIVER DISORDERS IN CHILDREN

To determine the safety and advantages of laparoscopic liver biopsy in pediatric liver disorders, we reviewed the medical records of XO chil dren affected by liver disease of various etiologies who underwent thi s procedure from 1986 to 1996. The main indicators for laparoscopic bi opsy were increased risk of bleeding (i.e., mild to moderate coagulati on abnormalities in patients probably affected by cirrhosis) and/or pr evious poorly informative blind needle liver biopsy (GS cases), and th e need for a large amount of liver tissue for biochemical assays (10 c ases). After inspection of the liver surface, at least two core biopsi es were performed using a Tru-cut needle. We encountered difficulties with the biopsy in only four cases, due to a hard consistency of the l iver. Bleeding lime from the liver orifice was greatly reduced by posi tioning a fibrin plug (50-120 s vs 5-10 s, on average). In 15 patients , a large excisional biopsy was also successfully performed. Our resul ts confirm an important role for laparoscopy in the diagnosis of cirrh osis (30% of bioptic false negative diagnoses in this series) and show that ill selected cases laparoscopy-guided needle or excisional biops y is an easy, useful and safe alternative to percutaneous blind Liver biopsy.