Introduction

Liver biopsies can provide clinicians valuable information about a patient’s underlying liver function that simply cannot be supplied by blood work or imaging alone. Biopsies of the liver can be performed by multiple methods either through an open laparotomy or laparoscopically.^1–3 Laparoscopic liver biopsies have the advantage of decreased morbidity and are recommended when only liver biopsies are required.⁴ Minimally invasive liver biopsies without the use of laparoscopic equipment can also be performed. Liver biopsies taken through an open (traditional laparotomy) approach are easy to perform, and this procedure is often added to other procedures when abnormalities are seen during an abdominal explore.

Indications/Pre‐operative Considerations

Liver biopsies are one of the most useful procedures a clinician can perform to determine specific prognostic information for owners regarding their pet’s liver function. Understanding that agreement between ultrasound‐guided fine needle aspirate and open surgical wedge biopsy is often suboptimal (30–40%), surgical biopsies are frequently considered essential. The most common reasons for liver biopsies in the author’s practice are increasing liver enzymes in the face of medical treatment, persistent, or worsening changes to the architecture of the liver on ultrasound imaging, cases in which an ultrasound‐guided biopsy is contraindicated, and visualization of hepatic abnormalities during abdominal exploratory (Table 24.1).

The most important preoperative consideration before proceeding with a liver biopsy is the possibility of hemorrhage. The liver is a highly vascular organ; therefore, clinicians should have access to hemostatic agents (Gelfoam^®, Surgicell^®, Vetigel^®) to aid in hemostasis depending on the technique utilized. Patients undergoing liver biopsy for presumed liver disease may have inappropriate clotting function due to reduced synthesis of clotting factors; therefore, prothrombin time (PT) and partial thromboplastin time (PTT) should be evaluated before surgery. If coagulation function is abnormal, the procedure should be delayed while plasma is provided. A preoperative PCV/TP should always be performed to allow for a comparison postoperatively to monitor for bleeding. Depending on the illness of the patient and the number and type of biopsies, blood products should be available when performing these procedures. Patients with liver disease may present with anemia (from coagulopathies, gastric ulceration), hypoglycemia (with severe hepatic insufficiency), hypoalbuminemia (which may decrease wound healing), and ascites (which may decrease tidal volume and make anesthesia more challenging). Anesthetic considerations for patients suffering from hepatic disease are discussed in detail in multiple references^1,5 and can be consulted if necessary.

Surgical Procedure

General liver biopsy tenets include the following:

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