[The diagnosis of liver cirrhosis: a comparative evaluation of standard laparoscopy, mini-laparoscopy and histology].
BACKGROUND
The superiority of laparoscopy with guided biopsy over biopsy alone is established. It is still uncertain if this is also true for midi-/ and mini-laparoscopy.


OBJECTIVE
The aim of this study was to determine the diagnostic gain of laparoscopic-guided biopsy for standard laparoscopy and the use of midi-/mini-laparoscopies. Characteristics of the liver biopsies were investigated with regard to a missed diagnosis of cirrhosis.


METHODS
In a consecutive series of 425 patients clinical, laparoscopic and histological findings were investigated. The length and fragmentation of the liver biopsies were investigated with regard to a missed diagnosis of cirrhosis.


RESULTS
The sensitivity of laparoscopy in the diagnosis of cirrhosis was 96 %, that of histology 68 %. The sensitivity of histology alone was especially low in macronodular cirrhosis. The sensitivity of both laparoscopy and histology improved from Child A to C. When cirrhosis was apparent, liver biopsies were shorter and more frequently fragmented. However, the diagnosis of cirrhosis was independent of these parameters.


CONCLUSIONS
Mini-laparoscopy may replace standard laparoscopy and appears to be superior compared with histology alone.
Weickert
U
U
Medizinische Klinik C, Klinikum der Stadt Ludwigshafen gGmbH. weickeru@klilu.de
Siegel
E
E
Schilling
D
D
Eickhoff
A
A
Jakobs
R
R
Bohrer
M H
MH
Riemann
J F
JF
D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity