Post-Diagnostic Liver Laparoscopy

Description

Laparoscopy involves the placement of a port, usually 5 mm in diameter, into the abdomen to allow insertion of a camera (laparoscope). The camera is used to visualize the contents of the abdominal cavity. Typically, one or two additional ports are placed to allow insertion of instruments, such as a probe or biopsy forceps. These ports are even smaller than the initial port. I perform laparoscopy to further evaluate the liver and obtain liver biopsies. Many animals suffer from liver disease, and frequently a specific diagnosis cannot be attained until a liver biopsy is performed. Traditionally, a liver biopsy is obtained in a manner that involves a large incision to expose the organ for biopsy. Using the minimally-invasive laparoscopic technique, the liver can be visualized and samples can be taken for biopsy and other tests to obtain a specific diagnosis. Documented advantages of laparoscopy include decreased pain, hospitalization, faster return to function, improved cosmesis, lower infection rates, and improved visualization and magnification. Multiple studies found that dogs that were spayed laparoscopically were less painful than those spayed in the traditional open method.

Procedure Preparation

You will be asked not to feed your pet the morning of laparoscopy to reduce anesthetic risk. An intra- venous catheter will be placed to administer anesthesia, other drugs, as well as procedural fluids. An endotracheal tube is placed to provide a route for oxygen and inhaled anesthetic gas. The hair of the abdomen will be clipped and the scope and instrument insertion sites on the abdomen will be scrubbed to disinfect the skin surface. Your pet will be closely monitored by personnel that use state-of-the- art monitoring equipment to continuously evaluate heart rate and rhythm, blood pressure, oxygenation, and carbon dioxide levels.

Performing Laparoscopy

The laparoscopy procedure is performed in a surgery suite in a sterile environment. The doctor makes a small incision in the abdomen and inserts a special needle (Veress needle) through which carbon dioxide gas is used for inflating the abdomen. This lifts the abdominal wall from the abdominal organs so the best view can be obtained. Once sufficiently inflated, a second small incision is made in the abdomen through which a rigid scope and camera are inserted, allowing the doctor to visualize the internal organs in the abdomen. The scope is roughly the diameter of a pencil. The doctor will then remove the Veress needle and widen that incision enough to place an instrument port to allow insertion of a blunt probe, biopsy instrument, and occasionally endoscopic hemostats, scissors, or other specialized instruments. These instruments are also roughly the diameter of a pencil. Once adequately explored, the next step depends on the goal of the procedure. For example, the doctor may use a special biopsy instrument to take small pieces of the liver or any abnormal appearing tissue from any of the organs. These samples are sent out to the laboratory for microscopic analysis by a pathologist. Bacterial cultures may also be submitted at the same time. Once the biopsy is completed, and after any bleeding from the biopsies is managed if necessary, the doctor will then complete the procedure by removing the carbon dioxide from the abdomen, removing the camera port and instrument port(s), and suturing closed the incisions (usually just a one-stitch incision).

Recovery

The laparoscopic procedure is usually completed in about half an hour for a liver biopsy procedures but may last much longer for complicated surgical procedures. Your pet generally will wake up from the anesthesia within 30 minutes. A trained technician constantly monitors respiratory rates, heart rates, mucous membrane color and pulse quality while your pet is recovering. Once the endotracheal tube is removed, your pet is moved to a recovery ward for continued monitoring by trained staff. Red blood cell levels (packed cell volume or hematocrit) are usually checked after the laparoscopic procedure to assure that there is no evidence of internal bleeding from the biopsies.

Care at home

Environment and Activity

Please keep your pet warm and comfortable by providing a soft, clean bed, ideally in a quiet and draft-free room at a comfortable room temperature (68-75°F or 20-24°C) and should remain indoor, going outside only for short leash walks as needed to urinate and defecate. Activity should be restricted for 7-14 days. It is essential to avoid running, jumping, and other strenuous activity that could cause excessive strain on the incision(s).

Nutrition

A few hours after arriving at home, you may offer your pet approximately half of their normal diet. Some patients experience nausea after general anesthesia and fasting prior to the procedure may lead to overeating, so dividing the meal into smaller portions may decrease the risk of nausea and vomiting.

Sedation

Your pet was given a general anesthetic or a sedative. These drugs can take several hours to wear off and may cause some patients to appear drowsy for a day or so. Over the next 24-48 hours, your pet's behavior should gradually return to normal. However, if you are at all concerned, do not hesitate to contact me.

Shaved

If your pet has a shaved area on one of their legs, this is typically where the anesthetic or sedative was administered. Additionally, many pets receive intravenous (IV) fluids through an IV catheter during surgery and the hair must be removed to allow the area to be disinfected properly before inserting the catheter. Sometimes this area will be bandaged; if so, you can remove the bandage after returning home unless otherwise instructed.

Coughing

Your pet had a tube placed in the trachea (windpipe) during anesthesia, in order to administer oxygen and anesthetic gas. This can occasionally cause mild irritation and a slight cough. A mild post-surgical cough will typically diminish over the next few days. If coughing persists or worsens, contact me.

Incision

Your pet instinctively may try to clean the surgical site by licking. If this is occurring and you have been given an Elizabethan-type protective collar (often referred to as a “cone” or E-collar), please ensure it is used in order to prevent chewing. If you have not been given an E-collar and your pet begins licking or chewing the incision, please contact your veterinarian and request one. Not surprisingly, many pets find these collars strange at first and will attempt to remove them. However, after a short period most will settle down and tolerate wearing the collar. It is better to keep the collar on all the time, rather than to take it on and off. It only takes a few seconds of chewing for a patient to remove the stitches or damage the surgery site. If your pet does succeed in removing any stitches, please call a hospital as soon as possible.

The incision should normally be clean and the edges should be together. The skin surrounding the incision should be a normal or slightly reddish-pink color. In pale-skinned dogs, bruising is often seen around the surgical site. This may not appear until a few days after the operation and in some cases can seem excessive in comparison to the size of the incision. This is due to seepage of blood under the skin edges and is a normal occurrence. In some cases, a small amount of blood may seep intermittently from a fresh incision for up to twenty-four hours, especially if the animal is active.

You should be concerned and should contact your veterinarian immediately if you see any of the following at the surgical site:

1. Continuous or excessive blood draining.

2. Intermittent blood seepage that continues for more than twenty-four hours.

3. Excessive swelling or redness of the skin.

4. Unpleasant smells or discharge.

Reporting

The results of submitted tests can take from 7 - 14 business days to be reported and you will be contacted as soon as they are reported. While there is no way to predict the results of the liver biopsy in advance possible diagnoses includes copper-associated chronic hepatitis, idiopathic chronic hepatitis, auto-immune chronic hepatitis, drug/toxin-associated chronic hepatitis, reactive hepatitis, vacuolar hepatopathy, microvascular dysplasia, and reactive hepatitis among others. Any treatments would depend on the etiology or cause. There are no special foods or diets or supplements that are advised in the absence of appropriate clinical signs or a diagnosis. Furthermore, in humans supplements are a leading cause of liver injury.

If at any time you have any concerns about your pet’s health, please call your pet’s health care team to answer any questions you may have.

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