Validity of laparoscopy after abdominal surgery.

The authors carried out a retrospective study to investigate the effect of previous abdominal surgery on the validity of laparoscopy. Laparoscopy was done in 2,000 patients with liver disease, between 1976 and 1985. Of these, 250 (12.5%) had undergone abdominal operations, and all presented with intraperitoneal adhesions. The whole surface of the liver was visible in 45.3%, but only in part in 46.2% of patients with upper abdominal operations (cholecystectomy, gastric surgery). Lower abdominal surgery (appendectomy, gynaecological operations) was associated with complete visibility of the liver in 97.5% of the cases. Laparotomy was followed by the highest incidence of non-visibility of the liver (28.5%). In the other 1,750 patients without abdominal operations, adhesions were detected only in 83 (4.1%) and the liver was entirely observable in 83.1% of these. In conclusion, previous abdominal surgery does not represent an absolute contraindication to laparoscopy, since risks are not as great as one might suppose. Although the view of the liver is sometimes impaired, laparoscopy retains its role in the assessment and therapy of liver disease, and avoids complications related to blind biopsy of the liver.