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PubMedDate not supplied

[Acute abdomen: emergency laparoscopy or observation?].

Acute abdomen accounts for 13-40% of all emergency surgical admissions. The aim of this prospective randomised controlled study was to examine the role of early laparoscopy in the management of acute abdomen compared with the more traditional active observation approach. From July 1993 to August 2004, 522 patients consecutively admitted with acute abdomen were randomised to either early laparoscopy (260 patients) (group 1) or active observation and non-invasive investigation (262 patients) (group 2). Baseline investigations included a full blood count, a pregnancy test in women of child-bearing age, and chest and/or abdominal radiography, if indicated clinically. Sixty-two patients in the laparoscopy group underwent a total of 116 radiological investigations compared with a total of 558 investigations in all patients in the observation group (p < 0.05). In the observation group, 34.7% of patients remained without a clear diagnosis compared with 4.2% of patients in the early laparoscopy group (p < 0.0001). The morbidity rate was 1.1% in group 1 and 27% in group 2 (p < 0.0001). The duration of hospital stay was significantly shorter in group 1 (3.1 vs 7.3 days) (p < 0.01). Eight patients in group 1 required readmission (total readmission: 46 days) compared with 58 patients in group 2 with a total readmission of 201 days (p < 0.05). Early laparoscopy is valuable in the management of acute abdomen. It affords significantly higher diagnostic accuracy and a greater improvement in quality of life than the more traditional observation approach.

Abdomen, Acute↗

PubMed1991

Tuberculous peritonitis: the value of laparoscopy.

The laparoscopic and pathological diagnoses of 43 patients who underwent abdominal laparoscopy for various indications are presented. Major indications for the laparoscopy included hepatomegaly in 32 patients, ascites in 28, and pyrexia of unknown origin (PUO) in 18 patients. A combination of two or more of these indications was a more common feature. The most frequently encountered laparoscopic diagnoses were tuberculosis and chronic liver disease (16 patients each), followed by cancer (9 patients). However, on pathological examination of peritoneal or liver biopsy tissue and on follow-up, tuberculosis was confirmed in 12 patients, chronic liver disease in 14 patients and hepatocellular carcinoma in 11 patients. No complications were encountered during the laparoscopy. Our findings indicate that abdominal laparoscopy is a safe, quick and inexpensive diagnostic tool, particularly when appropriate and adequate tissue is taken for pathological examination. In such instances, laparoscopy would save an unnecessary laparotomy, especially where tuberculosis and cancer are considered in the differential diagnosis.

Adult↗

PubMed2006

The usefulness of laparoscopy and hysteroscopy in the diagnostics and treatment of infertility.

OBJECTIVES: The aim of the study was to analyze the use of endoscopic procedures in the group of infertile patients. MATERIAL AND METHODS: The study material consisted of 636 patients, aged 20-41. They all had endoscopic procedures performed (laparoscopy and/or hysteroscopy) due to infertility, and were qualified for the procedure after a gynecological examination and ultrasound scan. The study group was divided into subgroups of primary and secondary sterility and endoscopic procedures were then analyzed. RESULTS: A total of 724 endoscopic procedures were performed on 636 patients. Eighty eight women had both hysteroscopy and laparoscopy performed, 476 had only laparoscopy, while 72--only hysteroscopy. Women diagnosed due to primary sterility more often had no visible abnormalities in the pelvic region (30%) and patent oviducts than those with secondary sterility. The remaining 70% more often had ovaries typical for polycystic ovarian syndrome and endometriosis. However, periadnexal adhesions and tubal impotency were more common in the group of secondary sterility. As to hysteroscopy, women with primary sterility more often had congenital uterine malformations, while submucosal myomas and intrauterine adhesions were less common in that group. All the surgical procedures performed during laparoscopies were analyzed. Tubal patency assessment and ovarian drilling were significantly more often performed in the subgroup of primary sterility. All intrauterine pathologies were treated during hysteroscopy. CONCLUSIONS: Laparoscopy and hysteroscopy play an important role as both diagnostic and therapeutic tools in the infertility treatment centers.

Adult↗

PubMed1991

Hysterosalpingography, laparoscopy and hysteroscopy in infertility. A comparative study.

The accuracy and significance of hysterosalpingography (HSG) during an infertility evaluation were assessed by comparing the radiologic findings on HSG to the operative findings during laparoscopy and hysteroscopy. One hundred ninety-three patients underwent a complete infertility evaluation at our center. HSG was performed during the proliferative phase and was followed by laparoscopy and hysteroscopy, when indicated, during the same or next cycle. False-positive findings on HSG were noted in 5.1% of the patients. In 21%, adnexal adhesions and pelvic endometriosis were identified during surgery in spite of normal HSG. HSG is as accurate as laparoscopy in the diagnosis of tubal disease. However, laparoscopy excels HSG in the diagnosis of pelvic pathology. HSG should remain an integral part of the female infertility investigation and must be performed before laparoscopy and hysteroscopy.

Evaluation Studies as Topic↗

PubMed1990

Ureteral injuries at laparoscopy: insights into diagnosis, management, and prevention.

The increasing use of laparoscopy as a therapeutic method mandates a reappraisal of the risks involved. Complications frequently described include injuries to the large and small bowels, bladder, and blood vessels. The world literature reports only eight cases of ureteral injury at laparoscopy. In this report, we present five additional cases of ureteral injury occurring at laparoscopy, in addition to a summary of those previously reported. Patients tend to present in the early postoperative period (48-72 hours) with low back pain, abdominal pain, leukocytosis, and peritonitis. The diagnosis should be made by intravenous pyelography; if possible, the injury should be stented by either the retrograde or percutaneous route. The injuries, except for one apparent trocar injury, involved the use of electrocoagulation, both unipolar and bipolar. The injuries occurred most commonly near the uterosacral ligaments. In 38% (five of 13) of the cases, the laparoscopy was performed for treatment of endometriosis. Three of the 13 patients eventually lost renal function of the affected side; two of these underwent a nephrectomy. Because visualization of the ureter near the cervix at the time of laparoscopy is difficult, especially in the presence of disease, laparoscopic procedures in this area must be carried out with caution.

Adult↗

PubMed1990

American Association of Gynecologic Laparoscopists 1988 Membership Survey on Operative Laparoscopy.

The American Association of Gynecologic Laparoscopists' (AAGL) 1988 Membership Survey on Operative Laparoscopy had a response rate of 24%. A total of 880 respondents reported performing 36928 operative laparoscopy procedures. A total of 75% of the respondents reported performing 47 or fewer operative laparoscopy procedures. A total of 75% of the respondents reported performing 47 or fewer procedures. The most frequently conditions managed by operative laparoscopy were endometrial implants, extensive adhesions, and ovarian cysts. Most operative laparoscopies were performed because of infertility (40%) or pelvic pain (41%). The overall serious complication rate was 15.4 per 1,000 procedures. Complications which occurred in more than 1 per 1,000 procedures included hospitalization greater than 72 hours, persistent HCG titer elevation after ectopic pregnancy, hospital readmission, and unintended laparotomy to manage bowel injury, urinary tract injury, and hemorrhage. Two deaths (5.4 per 100,000 procedures) were reported.

Female↗

PubMed1989

A comparative study of postoperative adhesions following laser surgery by laparoscopy versus laparotomy in the rabbit model.

In this study, we tested the null hypothesis that intraperitoneal adhesion formation and reduction after laser surgery are the same whether the surgery is performed by laparoscopy or laparotomy. Twenty rabbits were randomly assigned to either laparoscopy or laparotomy and subjected to standardized laser incisions over one uterine horn and over the peritoneal surface of either lower quadrant. Three weeks later, five animals from each group underwent laparoscopy and the other five received laparotomy to score the extent of postoperative adhesions formed and to carry out laser adhesiolysis. The same power density was delivered to tissues in both procedures. Three weeks after the second operative intervention, the animals were killed and the intraperitoneal adhesions blindly scored (scale of 0-3). After the initial procedure, adhesions were absent in the laparoscopy group, but in the laparotomy group, adhesions were frequently present not only at the operative sites of the peritoneal surfaces and uterine horn, but also on the bowel, bladder, and opposite uterine horn where no apparent injury had been inflicted (P less than .005). Three weeks after adhesiolysis, a significant reduction was observed in the mean adhesion scores in the laparoscopy group, but not in the laparotomy group (P = .001). These results lead to the rejection of the null hypothesis and confirm the clinical observation that besides reducing operative trauma, discomfort, and cost, laparoscopic laser surgery is very effective in reducing intraperitoneal adhesions and causes significantly less postoperative adhesion formation than does laparotomy.

Abdomen↗

PubMedDate not supplied

The diagnostic value of hysterosalpingography and laparoscopy in infertility investigation.

Four hundred and twenty infertile patients had hysterosalpingography (HSG) and laparoscopy as a part of their infertility workup. A comparison of HSG and laparoscopy findings was carried out to study the diagnostic value of each of these two procedures. It was found that the accuracy in the diagnosis of tubal patency or tubal blockage was quite similar for both procedures. However, laparoscopy revealed peritubal adhesions in 29.8% of patients, whereas HSG made an accurate diagnosis in only 8.8%. It is concluded that HSG is as accurate as laparoscopy in the diagnosis of tubal patency or blockage, and should remain an integral part of female infertility investigation. Laparoscopy excels HSG in the diagnosis of pelvic pathology and thus should always be performed whenever a pelvic factor is suspected in female infertility.

Adolescent↗

PubMedDate not supplied

Second-look laparoscopy in the treatment of endometriosis.

The results of second-look laparoscopy were compared with subjective symptomatology and findings at pelvic exploration in 36 patients who had received conservative treatment for endometriosis. In the 14 patients given pharmacologic treatment, second-look laparoscopy demonstrated active endometriosis in 57.1%, whereas pelvic pain was present in 64.3% and gynecologic examination was positive in 28.6%. In the 22 patients who underwent surgery, active endometriosis was detected by second-look laparoscopy in 31.8%, whereas 40.9% reported pelvic pain and pelvic examination was positive in 31.8%. Thus clinical signs and symptoms were unreliable in the diagnosis of endometriosis recurrence, whereas laparoscopy was indispensable. It should be programmed for 6 months from the end of medical treatment and 12 months after surgery; however, if the pain symptomatology recurs, then laparoscopy is performed immediately.

Adult↗

PubMed1987

Second laparoscopy after treatment of acute pelvic inflammatory disease.

We used second laparoscopy with dye insufflation to evaluate tubal findings in 20 women 15-45 weeks after treatment for acute pelvic inflammatory disease. Eight women had pelvic adhesions, including all six women with adhesions seen at first laparoscopy. However, in five of the six women, adhesions were milder or had disappeared unilaterally. Dye insufflation revealed tubal occlusion in five of eight women with adhesions and one of 12 women without adhesions. Thus, nine women (45%) had pelvic adhesions or tubal occlusion at second laparoscopy. Second laparoscopy is useful to objectively assess posttreatment tubal and peritubal morphology. Larger studies are needed to evaluate the cost-effectiveness of the procedure and the correlation of second laparoscopy findings to future infertility.

Biopsy↗

PubMed1987

[Current indications of laparoscopy].

The authors illustrate the indications of laparoscopy by reporting their clinical experience in a Department of gastroenterology between 1982 and 1984. In addition to the clinical indications which remain valid, new indications of laparoscopy are described in cases of failure of ultrasonography and/or computerised tomography, and of direct opacification of the biliary and pancreatic ducts. Laparoscopy has been practically abandoned in the diagnosis of obstructive jaundice and pancreatic pathology. It is irreplaceable in peritoneal pathology. The role of laparoscopy in hepatic tumours, hepatitis, cirrhosis, certain abdominal emergencies, unexplained abdominal pain and pelvic disease is discussed. Some rare indications may be considered only when the technical possibilities of laparoscopy are understood.

Gastrointestinal Diseases↗

PubMed1987

The diagnostic value of laparoscopy in women with chronic pelvic pain.

Laparoscopy was performed in 130 patients with chronic pelvic pain. Laparoscopy confirmed the preoperative diagnosis of pelvic inflammatory disease (PID) in 41 of 63 women with preoperative diagnosis of chronic PID (65%), whereas in 8 (13%), no pathologic findings were revealed. Laparoscopy directed the management in all 67 women who underwent the procedure to establish a diagnosis; in 16 (24%) of these, no pathologic findings were revealed. Of the total group, laparoscopy prevented laparotomy in 20 cases. These results are in accord with those of previous studies and emphasize the importance of laparoscopy in the management of women with chronic pelvic pain.

Adolescent↗

PubMed1988

Early laparoscopy after pelvic operations to prevent adhesions: safety and efficacy.

Laparoscopy 12 days after 256 consecutive operations for infertility allowed early diagnosis and treatment of postoperative adhesions that might otherwise have jeopardized the result. Despite scrupulous microsurgical techniques, complete absence of adnexal adherences was present in only 31 of 73 (42.5%) patients without initial adhesions and in 15 of 183 (8.2%) patients who had adhesions lysed. New or reformed adhesions usually were easily separable, often without bleeding, and often with much apparent improvement in fimbrio-ovarian anatomy. There were no significant complications and the safety of early postoperative (second-look) laparoscopy seems established. A modification of the 1979 American Fertility Society endometriosis scoring system was used to quantitate adhesions in 38 patients who subsequently underwent an additional (third-look) pelvic procedure. Adhesions were worse as a result of the laparoscopy in no patients, unchanged in 5 patients, and improved in 33 patients; overall, there was a significant reduction in median adhesion scores from 8 at laparoscopy (95% confidence limits of median, 6 to 10) to 2 at final observation (95% limits, 0 to 4; P less than 0.001, rank sum test). Laparoscopy between the time of serosal healing (8 days) and established adhesion fibrosis (21 days) is a safe and effective way of reducing peritoneal adhesions after pelvic operations in young women.

Adult↗

PubMed1988

Laparoscopy for pancreatic cancer: does it benefit the patient?

The findings in 73 patients undergoing laparoscopy for pancreatic cancer have been reviewed. The procedure was performed immediately prior to a proposed laparotomy which was undertaken in 51 patients. In this subgroup, 42 patients were correctly staged as having incurable/inoperable disease by laparoscopy but only four out of nine patients judged to be resectable were found to be operable at laparotomy. Laparoscopic target biopsy/fine needle cytology of the primary or its secondary deposits confirmed the diagnosis of pancreatic cancer in 61 out of 65 patients (92%). Whereas the majority of hepatic deposits visualized by laparoscopy had been detected by the prelaparoscopic imaging tests, peritoneal and omental deposits were only identified by laparoscopy. Laparoscopy is a useful procedure in the staging of patients with pancreatic cancer and establishes the diagnosis of advanced disease thereby, obviating a laparotomy in all those patients in whom surgical palliation is not indicated. The procedure should be performed in those patients in whom a laparotomy is contemplated.

Adult↗

PubMed1987

Trocar introduction performed during laparoscopy of the obese patient.

Obesity, especially morbid obesity, is reported to be a relative contraindication to laparoscopy. A technique for trocar introduction and laparoscopy of the obese patient to eliminate this contraindication is described. The technique presented herein differs from the traditional method by: 1, primary trocar entry at a 90 degree angle to the horizontal plane, and 2, confirmation for intraperitoneal position of the instruments before creating the pneumoperitoneum. A retrospective study was done to compare demographic, medical and surgical data of obese and non-obese patients. No important differences were found and it was also found that obesity was not a relative contraindication to laparoscopy. Obesity was defined by a ponderal index of less than 11.7. No operative complications were found for the 344 obese patients studied and all laparoscopy procedures were completed as intended. These differences in technique can avoid the pitfalls commonly reported concerning laparoscopy of the obese patient.

Adult↗

PubMed1983

Laparoscopy in the management of patients with ovarian carcinoma.

Since operative evaluations of patients undergoing therapy for ovarian cancer are necessary, the laparoscope will continue to play a role in the management of these patients. However, the sensitivity of the laparoscope for detecting disease either prior to or at the completion of chemotherapy is significantly less than that of laparotomy, and therefore its utility must be more narrowly defined. The morbidity of laparoscopy is low when performed correctly and utilizing techniques to avoid bowel perforation. Most patients require only a brief hospitalization, and those who cannot medically tolerate an extensive laparotomy might be able to undergo a laparoscopy. The major limitations of laparoscopy are the inability to adequately inspect the peritoneal cavity and pelvis in at least one-quarter of patients because of extensive adhesions, to assess retroperitoneal lymph nodes in all patients, and to resect tumour masses necessary to cytoreduce the tumour prior to therapy. The successful performance of interval laparoscopy, however, is predictive of survival and can select a group of patients whose likelihood of recurrence is relatively low (30 per cent) after more than three years. The observation that the majority of patients who have a negative laparoscopy following six months of chemotherapy remain free of disease for several years, suggests that sensitive tumours are most likely to respond during the initial courses of chemotherapy, and that consideration should be given to briefer and more intensive courses of therapy prior to operative evaluation of the patients.

Biopsy↗

PubMed1984

Ultrasonography versus laparoscopy in the diagnosis of hepatic tumors.

129 patients, with suspected primary or secondary benign or malignant liver neoplasm after clinical, biochemical and/or instrumental investigation underwent liver ultrasound and laparoscopy. Echographic findings were compared with laparoscopy when liver neoplasms were detected by the latter. When laparoscopy was negative, to evaluate the diagnostic accuracy of the two methods employed, the following variously associated parameters were analysed: clinical follow-up, liver biochemistry, computed tomography, liver selective arteriography and explorative laparotomy. In the 129 patients examined, echography showed 86.7% diagnostic accuracy and laparoscopy 89.4%. The association of the two methods led to a diagnosis of hepatic lesion in 98.4% with no further diagnostic investigations. The two procedures can be considered complementary to such an extent that, in case of suspected primary or secondary liver neoplasm, the association of ultrasound and laparoscopy represents a quick and ultimate diagnostic approach. Furthermore, the association of these two procedures seems the least expensive and the most feasible, even in not particularly well equipped units.

Adult↗

PubMed1981

Comparative study of hysterosalpingography and laparoscopy in infertile patients.

The diagnostic accuracy of hysterosalpingography (HSG) and laparoscopy was investigated in 168 consecutive patients with infertility of at least 2 years' duration. There was agreement between the results of both methods in 57.7 per cent of the patients. Among 54 patients having normal HSG, 16 (29.6 per cent) exhibited abnormalities at laparoscopy. Among 114 patients with abnormal HSG, 28 (24.6 per cent) had entirely normal internal genitalia at laparoscopy. The greatest discrepancy between the HSG and laparoscopic diagnoses was found in peritubal adhesions. Intrauterine abnormalities were diagnosed by HSG in only 2.4 per cent of the patients. Complications of laparoscopy were few and none was serious. For a conclusive evaluation of the tubal factor in infertility, one must consider abandoning HSG entirely in favor of laparoscopy.

Adult↗