Hepatic laparoscopy and biopsy in the diagnosis of hepatic cirrhosis

: 316 cases of proved hepatic cirrhosis (HC) which underwent Laparoscopy (L) were analysed. In 94 cases, hepatic biopsy by needle (HBN) was also practised under laparoscopic view, 96 cases were controlled until death, with a follow-up of almost 90 months. In 54 of these, there is a complete necropsy study. The performance in diagnosis of cirrhosis, L and HBN are compared separately. L gave the exact result of 96.6% and HBN 74.7%. HBN commonly practised with a Menghini needle (1.2 or 1.4 mm) as it is one that produces less complications, gives and insufficient sample, which determines that in 25.3% of the cases under biopsy, the HC diagnosis could not be proved, while L only fails in this aspect, in 3.38%. To this disadvantage of HBN, we must add another negative factor, the frequency which HBN can not be practised due to prothrombin under 50%, which nevertheless is not an obstacle for practising an L. In this series we have not reported any deaths with this two techniques. L has the additional advantage to contribute other useful data which can not be obtained with HBN alone. as revealing signs of portal hypertension, and hepatobiliary or peritoneal pathology which can coexist with HC. Due to this reasons, in the study of HC, we preferred as the first method of diagnosis, L, instead of HBN. When through this endoscopy we obtain the typical aspect, we omit adding HBN, which we only practised in doubtful cases of not very nodular livers (glabra cirrhosis) or when a probable post-hepatis, Wilson disease or hemochromatosis is being investigated. In the present conditions, we believe that the new methods of diagnosis "of non invasive images" can not substitute L or HBN in precising the diagnosis of HC.