Tu1472 Diagnostic Laparoscopy in the Era of Modern Imaging

Abstract

Though first video diagnostic laparoscopy (VDL) was performed more than 100 years ago, role of diagnostic laparoscopy has significantly reduced in last 50 years. VDL allows the direct visual examination of intra abdominal organs including large surface areas of the liver, gallbladder, spleen, peritoneum, pelvic organs and reperitoneum. Biopsies, aspiration and cultures can be obtained. It is safe and well tolerated can be performed in day care setting. In last 5 years we subjected 90 patients for VDL when final diagnosis could not be achieved after all necessary imaging methods, serological cytological and microbiological investigations. VDL was performed under selection of local anesthesia and patients were discharged within 24 hours. Video documentations and along with guided biopsies/collection of the samples for culture and other tests were performed. Commonest indication was ascites (46/90) followed by diffuse liver disease 15, focal liver disease (9), intra-abdominal malignancies (10) & miscellaneous cases 10. Overall diagnostic accuracy diagnostic of laparoscopy was 91%. In 64% patients laparoscopy confirmed clinical diagnosis and 27% patients laparoscopy was useful in correcting diagnosis. VDL was extremely useful in patients with low serum ascetic fluid albumin gradient ascites and ascites when two etiologies e.g. liver cirrhosis with tubercular peritonitis or malignant peritonitis were suspected. All these patients had ascitic fluid adenosine De aminase levels, PCR for tuberculosis and cytological examination for malignant cell were negative. Laparoscopic diagnosis was incorrect in 3% on laparoscopy diagnosis of suspected to be tuberculosis on histology diagnosis was confirmed to be metastasis. In 6% patients' laparoscopy was in conclusive. In 3 patients there were extensive intraperitoneal adhesions and adequate examination was not possible. No serious complications were encountered. Minor complications were pain at the site of port insertion, ascitic fluid leakage and port site infection were seen in 3,2 & 1 patients respectively. VDL is useful in patients when diagnosis and extent of the disease were unclear. VDL with guided biopsies should be used when no other method gives a conclusive diagnosis and there is a reasonable hope of getting accurate diagnosis.