title: Laparoscopic approach to fever of unknown origin.
abstract: BACKGROUND
  Fever of unknown origin (FUO) is difficult to diagnose. Laparotomy is needed to establish the etiologic diagnosis in some patients. The aim of this study was to analyze the feasibility, safety, and success rate of a protocolized laparoscopy in patients with FUO.
  
  
  METHODS
  An extensive clinical evaluation was performed before surgery. Laparoscopy included inspection of the abdominal cavity, wedge and tru-cut liver biopsies, lymph node biopsy, splenectomy, and bone marrow biopsy. Histologic analysis, permanent section analysis, and cultures were obtained.
  
  
  RESULTS
  The study involved 15 patients with a mean age of 43.6 +/- 14.5 years. The mean operative time was 122 +/- 60 min. Minor complications occurred in 9% of the patients. One patient bled after surgery and underwent reoperation. There was no operative mortality. An etiologic diagnosis was made in 66% of the patients, and laparoscopy helped to rule out intraabdominal pathology in four additional patients, giving a total success rate of 93%.
  
  
  CONCLUSIONS
  Protocolized laparoscopy in patients with FUO is safe, feasible, and accurate.
authors.affiliation: Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan 14000, México, DF Mexico.
authors.forename: J E
authors.initials: JE
authors.lastname: Arch-Ferrer
authors.forename: D
authors.initials: D
authors.lastname: Velázquez-Fernández
authors.forename: J
authors.initials: J
authors.lastname: Sierra-Madero
authors.forename: X
authors.initials: X
authors.lastname: López-Karpovitch
authors.forename: A
authors.initials: A
authors.lastname: Angeles-Angeles
authors.forename: R
authors.initials: R
authors.lastname: Gamino
authors.forename: M F
authors.initials: MF
authors.lastname: Herrera
mesh_terms: D005240:Feasibility Studies; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008223:Lymphoma / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D013156:Splenectomy / Q000379:methods; D016706:Still's Disease, Adult-Onset / Q000150:complications / Q000175:diagnosis; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis