Diagnostic laparoscopy: indication and benefit.

Abstract

BACKGROUND: Patients with an obscure and unrelievable abdominal condition may be forced to receive open laparotomy for diagnosis. Diagnostic laparoscopy has been suggested as an alternative to diagnostic laparotomy in selected cases. The aim of this article is to evaluate the circumstances suitable for laparoscopic diagnosis of certain abdominal conditions and the possible advantages of that approach. METHODS: Among 256 patients undergoing elective laparoscopic operations using conventionally pneumoperitoneal techniques from January 1994 to June 1995, twenty patients received diagnostic laparoscopy. The correlation between preoperative diagnosis, laparoscopic diagnosis and pathologic diagnosis as well as the outcome of laparoscopic diagnosis and treatment have been assessed. RESULTS: Major indications for diagnostic laparoscopy included acute abdominal pain (n = 4), chronic abdominal pain (n = 6), differentiating intraabdominal tumor (n = 4), staging known malignancy (n = 3) and evaluating intraperitoneal implantation (n = 3). Two of the four patients with acute abdominal conditions, one of the six patients with chronic abdominal pain. Four of the seven patients with undifferentiated/unstaged abdominal tumors and all of the three patients with intraperitoneal-implanted drainage tubes had no reasons for a further exploratory procedure, thus preventing the morbidity or mortality which might occur after unnecessary laparotomy. The duration of operation and hospitalization was shorter than the group without laparotomy. CONCLUSIONS: Diagnostic laparoscopy benefits patients by avoiding unnecessary surgery, avoiding unnecessary delay in diagnosis and treatment and shortening the operative and hospitalized period. However, it provides only an alternative not a substitute for traditional diagnostic procedures and will never lessen the importance of conventional laparotomy.