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INDICATIONS

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It is not uncommon during an exploratory laparotomy to remove a small fragment of the liver for histologic study. Biopsy of the liver is indicated in most patients who have a history of splenic or liver disease, or in the presence of a metastatic nodule. The specimen should not be taken from an area near the gallbladder, since the vascular and lymphatic connections between the liver and gallbladder are such that a pathologic process involving the gallbladder may have spread to the neighboring liver, and as a result the biopsy would not give a true picture of the liver as a whole.

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DETAILS OF PROCEDURE

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Two deep 2-0 absorbable sutures, a and b, are placed about 2 cm apart at the liver border (figure 1a) using an atraumatic type of needle. The suture is passed through the edge of the liver and back through again to include about one-half the original distance (figure 1b). This prevents the suture from slipping off the biopsy margin with resultant bleeding. These sutures are tied with a surgeon’s knot, which will not slip between the tying of the first and second parts (figure 1b). The suture should be tied as snugly as possible without cutting into the liver, for the tension under which these knots are tied is the important factor in the procedure. Such sutures control the blood supply to the intervening liver substance. The two sutures are placed not more than 2 cm apart, deep in the liver substance; yet as they are tied, at least 2 cm of liver are included at the free margin to increase the size of the biopsy by making it triangular in shape. An additional mattress suture, c, may be taken at the tip of the triangular wound (figure 2). After the biopsy is removed with a scalpel (figure 3), the wound is closed by tying together the sutures, a and b, or by placing an additional mattress suture (2-0 absorbable), d, beyond the limits of the original sutures (figures 4 and 5). The area of biopsy is covered with some type of anticoagulant matrix and omentum.

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