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Laparoscopic observations of hepatic capsular abnormalities: non-postoperative adhesions and hepatic capsular
1Department of Internal Medicine II, Shimane Medical University, Izumo, Japan.
Background:
Hepatic capsular abnormalities (adhesions or thickening) are often striking at laparoscopy. However, their diagnosis is difficult because capsular abnormalities can also be caused by several pathologic conditions. The aim of this study was to systematically investigate the associated factors and prevalence of laparoscopically observed non-postoperative adhesions and hepatic capsular thickening.
Methods:
We reviewed all data and studied laparoscopically observed hepatic capsular abnormalities (non-postoperative adhesions and thickening) in 2500 consecutive patients who underwent laparoscopy from 1981 to 1997.
Results:
Non-postoperative adhesions were observed in 14.6% of cases and their frequency increased with age. Although several types of adhesions, from band-like to membrane-like, were seen, there were no correlations between type and underlying pathologic conditions, except tuberculous peritonitis with membrane-like adhesions and Fitz-Hugh-Curtis syndrome with violin string-like adhesions. Hepatic capsular thickening was observed in 9.7% of cases. The main associated factor was viral hepatitis followed by other liver diseases.
Conclusions:
Hepatic capsular abnormalities are observed relatively frequently (21.5%) during laparoscopy. Initial laparoscopic diagnosis of non-postoperative adhesions may help in selecting patients with tuberculous peritonitis and Fitz-Hugh-Curtis syndrome for appropriate treatment.