{"paper_id":"c65de417-369f-4500-9260-f5fb7492b7a9","body_text":"The role of diagnostic laparoscopy in the era of modern imaging techniques: a study from a single center\nDOI:\nhttps://doi.org/10.18203/2349-2902.isj20191873Keywords:\nDiagnosis, Diagnostic laparoscopy, Modern investigationsAbstract\nBackground: Despite the tremendous progressive evolution in the field of medicine, wherein, most of the diseases can be diagnosed based on history, clinical examination and investigations, there are quite a number of diseases which remain undiagnosed. It is here, where the role of diagnostic laparoscopy becomes important to reach to a conclusion for further management of patients.\nMethods: This study comprising of 70 patients undergoing diagnostic laparoscopy at SKIMS over a period of 4 years. This study was done to evaluate the role of diagnostic laparoscopy in patients with acute and chronic abdominal conditions wherein final diagnosis could not be achieved after all necessary imaging, serological, cytological, and microbiological investigations.\nResults: Out of 70 patients subjected to diagnostic laparoscopy in our study, the commonest indication was as cites of undetermined etiology (42.9%) followed by chronic abdominal pain (25.7%) diffuse liver disease (11.4%) acute abdominal pain (SAIO, cholecystitis, acute appendicitis, PID, endometriosis) (5.7%) abdominal tuberculosis (4.3%) focal liver disease (2.9%) bleeding per rectum (2.9%) abdominal malignancy (2.9%) and primary infertility (1.4)%. The post diagnostic laparoscopy outcome (final diagnosis) were abdominal malignancy 22 (31.4%) followed by abdominal tuberculosis 16 (22.9%) diffuse liver disease 6 (8.6%) focal liver disease 6 (8.6%) PID 4 (5.7%) SAIO 4 (5.7%) post-operative pelvic adhesions 3 (4.3%) Meckel’s diverticulum 2 (2.9%) abdominal plus pulmonary tuberculosis 1 (1.4%), endometriosis 1 (1.4%), ovarian cyst 1 (1.4%), pseudomyxoma peritonei 1 (1.4%), chronic appendicitis 1 (1.4%) and inconclusive 2 (2.9%). Diagnostic laparoscopy confirmed pre-operative diagnosis in 10 (14.3%) patients. In 29 (41.4%) patients pre-operative diagnosis was corrected by diagnostic laparoscopy. In 29 (41.4%) patients diagnosis was made only after diagnostic laparoscopy.\nConclusions: Diagnostic laparoscopy is a safe, quick, and effective adjunct to non surgical diagnostic modalities, for establishing a conclusive diagnosis with high percentage of accuracy in diagnosis and impact in further management in selected patients.\nMetrics\nReferences\nTrujillo NP. Peritoneoscopy and guided biopsy in the diagnosis of intraabdominal diseases. Gastroenterol. 1976;71:1083-6.\nVander Velpen GC, Shimi SM, Cuschieri A. Diagnostic yield and management benefit of laparoscopy. A prespective audit. GUT. 1994;35(11):1617-21.\nSalky BA, Edye MB. Role of laparoscopy in diagnosis and treatment of abdominal pain syndromes. Surg endosc. 1998;12(7):911-4.\nCuschieri A. The spectrum of laparoscopic surgery. World J Surg. 1992;16:1089-97.\nBoyd Jr. WP, Nord HJ. Diagnostic laparoscopy. Endoscopy. 2000;32:153-8.\nEaster DW, Cuschieri A, Nathanson LK, Lavelle-Jones M. The utility of diagnostic laparoscopy for abdominal disorders: audit of 120 patients. Arch Surg. 1992;127:379-83.\nSchrenk P, Woisetschlager R, Wayand WU, Rieger R, Sulzbacher H. Diagnostic laparoscopy: a survey of 92 patients. Am J Surg. 1994;168:348-51.\nLuo K, Li JS, Li LT, Wang KH, Shun JM. Operative stress and energy metabolism after laparoscopic cholecystectomy compared to open surgery. World J Gastroenterol. 2003;9:845-50.\nAmarapurkar DN, Kalro RH, Desai HG. Peritoneoscopy in diagnosis of ascites. J Assoc Physicians India. 1991;29:933-5.\nRole of diagnostic laparoscopy in doubtful abdominal and pelvic pathologies, Int. J. Modn. Res. Revs. 2014;10:374-8.\nAl-Akeely MH. The impact of elective diaganostic laparoscopy in chronic abdominal disorder. Saudi J Gastroenterol. 2006;12:27-30.\nHossain J, Al-Aska AK, Al Mofleh I. Laparoscopy in tuberculous peritonitis. J R Soc Med. 1992;85:89-91.\nLal N, Soto-Wright V. Peritoneal tuberculosis colon diagnostic options. Infact Dis Obstet Gynecol. 1999;7:244-7.\nEl Abkari M, Benajah DA, Aqodad N, Bennouna S, Oudghiri B, Ibrahimi A. Peritoneal tuberculosis in the Fes University Hospital (Morocco). Report of 123 cases. Gastroenterol Clin Biol. 2006;30:377-81.\nMalik AM, Talpur KA, Soomro AG, Qureshi JN. Yield of diagnostic laparoscopy in abdominal tuberculosis: Is it worthattempting? Surg Laparosc Endosc Percutan Tech. 2011;21:191 3.\nUdwadia TE. Peritoneoscopy in the diagnosis of abdominaltuberculosis. Indian J Surg. 1978;1:91 5.\nLittell RD, Hallonquist H, Matulonis U, Seiden MV, Berkowitz RS, Duska LR. Negative laparoscopy is highly predictive of negative second look laparotomy following chemotherapy for ovarian, tubal and primary peritoneal carcinoma. Gyneco Oncol. 2006;10:570-4.\nVan Leeuwen DJ, Wilson L, Crowe DR. Liver biopsy in the mid-1990s: questions and answers. Semin Liver Dis. 1995;15:340-59.\nPoniachik J, Bernstein DE, Reddy R, Jeffers LJ. The role of laparoscopy in the diagnosis of cirrhosis. Gastrointest Endosc. 1996;43:568-71.\nAmarapurkar DN, Parikh SS, Kalro RH, Desai HG. Comparison of peritoneoscopy and phytate liver scan in diagnosis of liver cirrhosis and hepatic neoplasms. Bombay Hosp J. 1991;33:35-8.\nVargas C, Jeffers LJ, Bernstein D, Reddy KR, Munnangi S, Behar S, et al. Diagnostic laparoscopy: A 5 year experience in a hepatology training program. Am J Gastroenterol. 1995;90:1258 62.\nHerrera JL, Brewer TG, Peura DA. Diagnostic laparoscopy:A prospective review of 100 cases. Am J Gastroenterol. 1989;84:1051 4.\nKolts RL, Nelson RS, Park R, Heikenen J. Exploratory laparoscopy for recurrent right lower quadrant pain in a pediatric population. Pediatr Surg Int. 2006;22:247-9.\nHenry-Suchet J, Soler A, Loffredo V. Laparoscopic treatment of tuboovarian abscesses. J Reprod Med. 1984;29:579-82.\nSaggar VR, Krishna A. Laparoscopy in suspected Meckel's diverticulum: negative nuclear scan notwithstanding. Indian Pediatr. 2004;41(7):747-8.\nShalaby RY, Soliman SM, Fawy M, Samaha A. Laparoscopic management of Meckel's diverticulum in children. J Pediatr Surg. 2005;40(3):562-7.\nMcKay R. High incidence of symptomatic Meckel's diverticulum in patients less than fifty years of age: an indication for resection. Am Surg. 2007;73(3):271-5.\nPalanivelu C, Rangarajan M, Senthilkumar R, Madankumar MV, Kavalakat AJ. Laparoscopic management of symptomatic Meckel's diverticula: a simple tangential stapler excision. JSLS. 2008;12(1):66-70.\nEdiz A, Salih P, Emre G, Feridun S. Laparoscopy-assisted Resection of Complicated Meckel's Diverticulum in Adults. Surgical Laparoscopy, Endoscopy Percutaneous Techn. 2002;12(3):190-4.\nFernandez RN, Daly JM. Pseudomyxoma peritoni. Arch Surg. 1980;115:409-14.\nAsoglu O, Porter L, Donohue JH, Cha SS. Laparoscopy for the Definitive Diagnosis of Intra-abdominal Lymphoma Mayo Clin Proc. 2005;80(5):625-31.\nPsyrri A, Papageorgiou S, Economopoulos T. Primary extranodal lymphomas of stomach: clinical presentation, diagnostic pitfalls and management. Annals Oncol. 2008;19(12):1992-9.\nGhai S, Pattison J, Ghai S, O’Malley ME, Khalili K, Stephens M. Primary gastrointestinal lymphoma: spectrum of imaging findings with pathologic correlation. Radiographics. 2007;27(5):1371-88.\nEaster DW, Cuschieri A, Nathanson LK, Lavelle Jones M. Theutility of diagnostic laparoscopy for abdominal disorders. Audit of 120 patients. Arch Surg. 1992;127:379-83.","source_license":"CC0","license_restricted":false}