Pre-Laparoscopic Liver Biopsy

Overview/Description

Laparoscopy is a general term used to describe surgical procedures in the abdominal cavity that are performed through small keyhole incisions. Another term that is often used to describe this form of procedure is minimally invasive surgery, an umbrella term, of which laparoscopy is one form. Laparoscopic procedures are usually performed by placement of surgical instruments through cannulae which are small plastic or metal tubes. Cannulae are placed through small 0.5-1cm incisions in the skin and muscle of the abdominal wall. A typical procedure might require the placement of one to four cannulae. To initiate a laparoscopic procedure, a working space has to be established. That space is necessary in order to visualize organs and perform procedures and is usually created by formation of what is known as a pneumoperitoneum. To create a pneumoperitoneum carbon dioxide gas is insufflated into the abdomen to create working space. After creation of the pneumoperitoneum and placement of the first cannula, a small telescope (or laparoscope) with a camera attached is placed through the cannula and gives a view of the contents of the abdominal cavity. The image obtained by the camera is displayed on a monitor from which the surgeon and the surgical assistants work. After placement of the telescope into the first cannula the remainder of the cannulae required to complete the procedure are placed. As the telescope is now positioned in the abdominal cavity, these “instrument” cannulae can be placed under direct visualization. Once all instrument ports are positioned the procedure can proceed. A liver biopsy is a procedure performed under general anesthesia employing this technique to take a few small tissue samples. These samples are then sent to a reference laboratory for evaluation by a pathologist. Other tests are also submitted to look for signs of damage and disease. Liver biopsies are the only way to definitively diagnose liver disease in dogs and cats, assess disease severity, and help determine treatment if indicated.

Indications

A liver biopsy is recommended for an unexplained elevation of liver enzymes for 8-12 weeks, unexplained changes in liver function tests, and abnormal structural changes in the liver that are unexplained. There are other disease that can look similar to liver disease and these will be excluded prior to a liver biopsy. The majority of dogs with the most common form of liver disease in dogs (chronic hepatitis) are asymptomatic.

Preparation

Before the liver biopsy, you will speak with Dr. Lawrence to discuss the procedure and expectations. This is a good time to ask questions about the procedure and make sure you understand the risks and benefits. Please complete a new patient questionnaire online after reading this document and an anesthesia consent form the night before the procedure. If you have any questions or concerns before or after completing these documents do not hesitate to contact me by phone (512) 591-8057 or email drlawrence@yardieinternalmedicine.com or text message (512) 591-8057.

Preoperative diagnostics and tests

Before your pet’s biopsy the following tests will be performed; coagulation testing, platelet count, packed cell volume, and a buccal mucosal bleeding time. These tests are done to make sure that any risk of bleeding is minimized given the liver contribution to hemostasis.

Day of Surgery

Give your pet no food by mouth after midnight the night before. This means that all food should be withheld but access to water is permitted. This is to prevent the reflux of stomach contents under anesthesia that can lead to aspiration and pneumonia. Please arrive for admission promptly at your scheduled arrival time. You will be asked to complete the anesthesia consent form if you have not already completed it online.

Risks/Complications

Risks and complications associated with a laparoscopic liver biopsy are rare (1-3%) but can include the following: bleeding, cramping, or infection.

Post-Procedure

Following the procedure, you will be given a phone call with an update on recovery. A scheduled discharge will be coordinated at that time. Please remove the bandage from the intravenous catheter site 10 to 15 minutes after arriving home, if it is still present. Some abdominal tenderness is common for 3-5 days following laparoscopic surgery. It is important to restrict activity for the next 5-7 days while the incision is healing. Walks should be short and always on a leash. Please no rough housing with other animals during this time. Many patients will not eat the night following anesthesia. If your pet has not eaten after 24 hours of returning home, please call Dr. Lawrence. Some patients may vomit or have diarrhea following anesthesia. If the vomiting or diarrhea persists more than 24 hours, please call Dr. Lawrence. In contrast, some patients may be constipated or may not have a bowel movement for up to 72 hours following anesthesia. If there has not been a bowel movement after 72 hours please call Dr. Lawrence. Please monitor the incision for any signs of heat, pain, swelling, or discharge. Should you notice any of these signs, please call Dr. Lawrence. Licking or scratching at the incision will dramatically increase the chances of an infection or that the incision will open up. To prevent this from happening, please watch closely for scratching or licking at the incision. If this occurs, an e-collar should be placed.

Results

The liver tissue and bile if obtained will be submitted to a specialized laboratory for evaluation. The final biopsy results can take up to 2 weeks. Once the final results have returned and a treatment plan has been devised, I will call to discuss the findings and recommendations.

Follow up

A recheck examination is required in 10 - 14 days to remove the skin sutures and discuss the results as the reporting of results tends to coincide with this appointment.

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