title: Complications and risk factors in 2731 diagnostic mini-laparoscopies in patients with liver disease.
abstract: OBJECTIVE
  Mini-laparoscopy (ML) allows macroscopic assessment and biopsy under direct vision and therefore is a valuable technique in the diagnosis of liver disease. Herein we report procedure-related complications and risk factors.
  
  
  METHODS
  A total of 2731 consecutive patients underwent diagnostic ML at two university hospitals (June 1996-December 2007). ML was performed using standard technique with a 1.9mm optical instrument. Coagulation of the liver biopsy site was performed with APC. The following variables were analysed as risk factors for complications: platelet count (<50/nL), international normalized ratio (INR) (>1.5), Cirrhosis, signs of portal hypertension, prior abdominal surgery.
  
  
  RESULTS
  Major complications occurred in 1.0% (n=27) of patients and these were, delayed bleeding from the liver biopsy site or abdominal wall (in 0.7% of patients) and intestinal perforation (in 0.3% of patients). Two patients died after severe haemorrhage (mortality 0.07%); the other patients recovered without sequelae. Bleeding risk was increased in patients with low platelets (OR=6.1), increased INR (OR=8.9), cirrhosis (OR=1.9) and portal hypertension (OR=2.1). Logistic regression showed a significant correlation only for the concurrence of low platelets and increased INR (P = 0.001; OR=14.1); bootstrap analysis identified INR >1.5 as significant predictor (P = 0.0002). Prior abdominal surgery did not carry a significant risk for intestinal perforation (OR=1.1; P = 0.142), unless abdominal adhesions were present (OR=9.5; P = 0.0002). None of the patients required surgery for intestinal perforation.
  
  
  CONCLUSIONS
  Mini-laparoscopy is a diagnostic technique with a low complication rate. However, in patients with increased INR, low platelets or after extensive abdominal surgery, complications may occur in up to 5%.
authors.affiliation: Medical Department, University Hospital, Hamburg-Eppendorf, Hamburg, Germany. c.frenzel@uke.de
authors.forename: Christian
authors.initials: C
authors.lastname: Frenzel
authors.forename: Johannes
authors.initials: J
authors.lastname: Koch
authors.forename: Victoria
authors.initials: V
authors.lastname: Lorenzen
authors.forename: Tobias
authors.initials: T
authors.lastname: Werner
authors.forename: Ansgar W
authors.initials: AW
authors.lastname: Lohse
authors.forename: Ulrike W
authors.initials: UW
authors.lastname: Denzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D019934:International Normalized Ratio; D007416:Intestinal Perforation / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects* / Q000401:mortality; D008099:Liver / Q000473:pathology* / Q000601:surgery*; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult