Percutaneous blind needle biopsy versus combined laparoscopic excisional and guided needle biopsy in the diagnosis of liver disorders in pediatric patients

AIMS: The authors retrospectively analyzed the results of their experience with combined laparoscopic excisional and guided needle biopsy in the determination of chronic liver disease in children. PATIENTS AND METHODS: Between January 1986 and January 1996, at the Division of Pediatric Surgery of the "Federico II" University of Naples, eighty patients underwent laparoscopic liver biopsy to evaluate a chronic liver disease. Patient ages ranged between 50 days and 16 years (mean 5.8 years). There were 41 girls and 39 boys. Fifteen of these children (18.7%) were addressed to a surgeon because the previously performed percutaneous blind needle biopsy was not sufficiently informative or because the specimens were too small to allow chemical or biochemical tissue studies. In these 15 patients, we performed a combination of laparoscopic guided needle biopsy using a 14-gauge tru-cut needle together with an excisional biopsy on the right lobe, using two additional 5-mm trocars. RESULTS AND CONCLUSION: The post-operative course was uneventful for all the patients. All patients were discharged from hospital after 24 hours. A precise histological diagnosis was made and biochemical tissue studies were possible after laparoscopic biopsy in all 15 children. In our opinion, a combination of laparoscopic-guided needle biopsy and laparoscopic excisional biopsy is more reliable than simple biopsy alone for the diagnosis of cirrhosis in children with chronic liver disease.