Laparoscopic observations of hepatic capsular abnormalities: non-postoperative adhesions and hepatic capsular thickening

Background: Hepatic capsular abnormalities (adhesions or thickening) are of ten striking at laparoscopy. However, their diagnosis is difficult because capsular abnormalities can also be caused by several pathologic conditions. The aim of this study was to systematically investigate the associated fac tors and prevalence of laparoscopically observed non-postoperative adhesion s and hepatic capsular thickening. Methods: We reviewed all data and studied laparoscopically observed hepatic capsular abnormalities (non-postoperative adhesions and thickening) in 250 0 consecutive patients who underwent laparoscopy from 1981 to 1997. Results: Non-postoperative adhesions were observed in 14.6% of cases and th eir frequency increased with age. Although several types of adhesions, from band-like to membrane-like, were seen, there were no correlations between type and underlying pathologic conditions, except tuberculous peritonitis w ith membrane-like adhesions and Fitz-Hugh-Curtis syndrome with violin strin g-like adhesions. Hepatic capsular thickening was observed in 9.7% of cases . The main associated factor was viral hepatitis followed by other liver di seases. Conclusions: Hepatic capsular abnormalities are observed relatively frequen tly (21.5%) during laparoscopy. Initial laparoscopic diagnosis of non-posto perative adhesions may help in selecting patients with tuberculous peritoni tis and Fitz-Hugh-Curtis syndrome for appropriate treatment.