Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#12 UTILITY OF LAPAROSCOPY FOR IDENTIFICATION OF HEPATIC DISEASE BEFORE AORTIC SURGERY
Thomas S. Huber, MD, PhD, Timothy C. Flynn, MD, C. Keith Ozaki, MD, and James M. Seeger, MD The University of Florida Gainesville, FL Paper Sponsored by Seth W. Wolk, MD
Introduction: Multiple organ dysfunction secondary to hepatic failure is a significant yet unpredictable cause of death after elective aortic surgery. Routine preoperative evaluation including patient history, physical examination, prothrombin time and serologic testing for albumin and hepatocellular enzymes is frequently insufficient to identify patients at risk. This study was designed to prospectively evaluate the utility of laparoscopy prior to aortic surgery in patients at a high risk for postoperative hepatic dysfunction.
Methods: A diagnostic laparoscopy was performed immediately prior to the planned aortic surgery in all patients suspected of having hepatic insufficiency despite a negative physical exam and laboratory tests. The laparoscopy was performed through a single umbilical incision using a Storz laparoscope and CO2 insufflation. Liver biopsies for frozen sections were obtained on patients with equivocal laparoscopic findings.
Results: Laparoscopy was performed in 9 patients (pts) immediately prior to the planned aortic surgery (indication: AIOD - 3; AAA - 4; renal artery stenosis (RAS) - 2) between 12/95 and 9/97. The indication for the laparoscope included alcoholism (9/9), hepatomegaly (1/9), and a history of esophageal varices (1/9). Laparoscopy revealed a normal liver in 2/9 pts, mild liver disease in 4/9 pts, cirrhosis in 2/9 pts, and the diagnosis was equivocal in 1/9 pts (frozen section biopsy showed normal liver). The planned aortic procedure (indication: AAA - 1; RAS - 1) was aborted after the laparoscopy in the 2 pts with evidence of cirrhosis while the other 7 pts underwent the planned aortic procedure (AIOD - ABF; AAA - aorto-aorto/ABI, RAS - bilat aortorenal bypass). The operative findings corresponded to the laparoscopy findings in all cases. Postoperative hepatic insufficiency with multiple organ dysfunction and death developed in 1/7 pts undergoing aortic surgery despite a normal appearing liver on laparoscopy. No specific complications resulted from the laparoscopy and it required a mean of 26 ± 14 min.
Conclusions: Diagnostic laparoscopy prior to aortic surgery is a safe, simple adjunct that may help further identify patients with hepatic insufficiency.
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Last updated January 10, 1999