The impact of elective diagnostic laparoscopy in chronic abominal disorders.
OBJECTIVE
Diagnostic laparoscopy has become an integral part of general surgical procedures with the recent advancements in laparoscopic technology. Since surgeons are more oriented in viewing and dissection of different intra-abdominal areas and are proficient in the definitive management of complications in the procedures, diagnostic laparoscopy may be better off in the hands of surgeons. Laparoscopy has proved to be an important tool in final minimally invasive exploration for selected medical patients with chronic abdominal disorders, the diagnosis of which remains uncertain despite employing the requisite laboratory and non-invasive imaging investigations. This retrospective study was done to evaluate the accuracy of elective diagnostic laparoscopy in patients with chronic abdominal disorders and its impact on the management of these patients.


METHODS
The records of 35 patients, admitted to Riyadh Medical Complex with chronic abdominal disorders and referred to the author by physicians for elective diagnostic laparoscopy from 1999 through 2004, were evaluated for the accuracy and impact of this procedure in the further management of these patients. All 35 patients were investigated by the referring physician. Investigations included hematology, biochemistry, radiology, ascitic fluid analysis, endoscopic and imaging studies and the Mantoux test. These investigations suggested abdominal tuberculosis in 22 patients and intra-abdominal malignancy in 13 patients. They were referred for elective diagnostic laparoscopy and tissue biopsy.


RESULTS
Diagnostic laparoscopy confirmed the diagnosis in all patients suspected of malignancy. In patients with suspected abdominal tuberculosis, the laparoscopic diagnosis and biopsy revealed tuberculosis (16 patients), liver cirrhosis (2 patients), Crohn's disease (1 patient), and metastatic carcinoma of terminal ileum (1 patient). In 2 patients the procedure did not reveal any specific pathology. The accuracy of the preoperative investigations for those suspected to have abdominal tuberculosis was 71 %. There was 100% impact of diagnostic laparoscopy on the management of all 35 patients since, in the 2 patients with negative laparoscopy, at least tuberculosis and malignancy were excluded.


CONCLUSIONS
Diagnostic laparoscopy in the hands of surgeons proved to have an impact as an investigation technique, where the diagnosis remained uncertain after the laboratory and non-invasive investigations, of selected medical patients with chronic abdominal disorders. It is a minimally invasive procedure which has a high percentage of accuracy in diagnosis and impact in the further management of selected patients.
Department of Surgery, 37 College of Medicine, Riyadh, Saudi Arabia.
Mohammed Hamad
MH
Al-Akeely