Laparoscopic Diagnosis Research Articles

Gastric Twist after Laparoscopic Sleeve Gastrectomy, Diagnosis and Management: A Case Series and Discussion

Gastric Twist after Laparoscopic Sleeve Gastrectomy, Diagnosis and Management: A Case Series and Discussion

High Prognostic Value of Mini-Laparoscopy for Advanced Liver Disease-Related Complications in Patients with HCV Infection

Background/Aim: The assessment of advanced chronic liver disease (ACLD) is a prerequisite for therapy and surveillance in patients with chronic hepatitis C infection. Mini-laparoscopy-assisted liver biopsies facilitate both histological and macroscopical evaluation of liver fibrosis. This study is aimed at investigating the prognostic significance of the laparoscopic assessment for the cumulative incidence of ACLD-related events. Patients and Methods: We performed a single center, retrospective analysis of 94 patients with either macroscopically or/and microscopically assessed advanced fibrosis/cirrhosis caused by chronic hepatitis C infection. The patients' data, the respective laboratory results, and follow-up period were evaluated in the outpatient clinic. Results: The group with both macro- and microscopic diagnosed ACLD showed a significantly higher number of decompensating events (n = 7) compared with the other 2 groups (n = 0 in the group with only histological and n = 1 in the group with only laparoscopic diagnosis of advanced liver disease). The results were not affected by the successful treatment of the hepatitis C virus. In the Cox-regression analysis, the spleen size (>120 mm) was significantly associated with the incidence of ACLD-related events. Conclusions: Assessment of ACLD in chronic hepatitis C by mini-laparoscopy-assisted liver biopsies may facilitate the selection of patients with a poor prognosis, irrespective of achieving a sustained virological response following treatment. Follow-up of these patients should be intensified to treat decompensation early.

An Evaluation of the Diagnostic Potential of CT Scans and Herniography for Inguinal Hernias

We evaluated and compared the diagnostic potential of computed tomography (CT) and herniography in the identification of inguinal hernias. Herniography is typically utilized in the diagnosis of inguinal hernias in our institute. We utilized transabdominal preperitoneal repair in the treatment of inguinal hernias since October 2010 and performed a laparoscopic diagnosis followed by single-incision laparoscopic surgery for totally extraperitoneal repair since November 2013. We herein evaluated and compared the diagnostic potential of CT and herniography. From February 2012 to March 2016, 46 patients (male/female: 43/3; median age: 70 years) with 63 inguinal hernias were investigated using CT and herniography. We classified each inguinal hernia according to the Japan Hernia Society classification using CT (prone position) and herniography, and evaluated the accuracy of each of the diagnostic methods. A total of 29 patients had unilateral hernias and 17 had bilateral hernias; 62% (39/63) and 84% (53/63) of the inguinal hernias were correctly diagnosed and classified by CT and herniography, respectively. A total of 87% (55/63) and 98% (62/63) of the inguinal hernias were detected by CT and herniography, respectively. Thus, herniography was found to be more sensitive than CT and the difference in the detectability of inguinal hernias by the 2 methods was statistically significant. Herniography appears to be superior to CT, for both the classification and detection of inguinal hernias.

Elevated Systemic Levels of Endocannabinoids and Related Mediators Across the Menstrual Cycle in Women With Endometriosis.

Cannabinoids and modulators of the endocannabinoid system affect specific mechanisms that are critical to the establishment and development of endometriosis. The aim of this study was to measure the systemic levels of endocannabinoids and related mediators in women with and without endometriosis and to investigate whether such levels correlated with endometriosis-associated pain. Plasma and endometrial biopsies were obtained from women with a laparoscopic diagnosis of endometriosis (n = 27) and no endometrial pathology (n = 29). Plasma levels of endocannabinoids (N-arachidonoylethanolamine [AEA] and 2-arachidonoylglycerol [2-AG]) and related mediators (N-oleoylethanolamine [OEA] and N-palmitoylethanolamine [PEA]), messenger RNA expression of some of their receptors (cannabinoid receptor type 1 [CB1], CB2, transient receptor potential vanilloid type [TRPV1]), and the enzymes involved in the synthesis (N-acyl-phosphatidylethanolamine-hydrolyzing phospholipase D [NAPE-PLD]) and degradation (fatty acid amide hydrolase 1 [FAAH]) of AEA, OEA, and PEA were evaluated in endometrial stromal cells. The systemic levels of AEA, 2-AG, and OEA were elevated in endometriosis in the secretory phase compared to controls. The expression of CB1 was higher in secretory phase endometrial stromal cells of controls versus endometriosis. Similar expression levels of CB2, TRPV1, NAPE-PLD, and FAAH were detected in controls and endometriosis. Patients with moderate-to-severe dysmenorrhea and dyspareunia showed higher AEA and PEA levels than those with low-to-moderate pain symptoms, respectively. The association of increased circulating AEA and 2-AG with decreased local CB1 expression in endometriosis suggests a negative feedback loop regulation, which may impair the capability of these mediators to control pain. These preliminary data suggest that the pharmacological manipulation of the action or levels of these mediators may offer an alternative option for the management of endometriosis-associated pain.

Morphology-based investigation of metachronous inguinal hernia after negative laparoscopic evaluation – is it acquired indirect inguinal hernia?

PurposePatients who developed apparent metachronous contralateral inguinal hernia (MCIH) after negative laparoscopic diagnosis have been reported. We performed this study to investigate the morphological characteristics and etiology of this phenomenon. Patients and MethodsA consecutive series of 1,747 patients (858 boys and 889 girls) with symptomatic unilateral inguinal hernia were studied. During laparoscopic percutaneous completely extraperitoneal closure, morphological appearances at the asymptomatic groin were inspected for contralateral patent processus vaginalis (CPPV) with definitive criteria. If positive CPPV was identified, it was closed by the same technique used for the affected side. The patients were reviewed for occurrence of metachronous contralateral hernia. ResultsA total of 755 patients (43.2%) had positive CPPV. Of the 992 patients whose CPPVs were evaluated as true negative, eight (seven boys, one girl) developed MCIH (time taken, three months to five years six months). During second-look operations, morphological appearances of the CPPV that was originally considered as true negative CPPV was found to be wide open. ConclusionsDespite a true negative evaluation by laparoscopy, there was a 0.8% chance of developing a MCIH. This phenomenon was male-oriented and may be acquired indirect inguinal hernia without preceding of CPPV.

Role of Laparoscopy - A Diagnostic Aid, its Indications & Benefits

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. It is a prospective descriptive study in which, thirty one patients under-going diagnostic Laparoscopy using conventional pneumoperitoneal techniques from January 2000 to June 2002 were included in this study. The correlation between preoperative diagnosis. laparoscopic diagnosis and pathologic diagnosis as well as the outcome of laparoscopic diagnosis and treatment have been assessed. Major indications for diagnostic Laparoscopy included acute abdominal pain (n=9). chronic abdominal pain (n=13), different intraabdominal tumor (n=7). All patients with acute abdominal conditions. 8 of the 13 patients with chronic abdominal pain and 4 of the 7 patients with abdominal tumors had no reasons for a further exploratory procedure, thus preventing the morbidity or mortality which might occur after unnecessary laparotomy. 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.

Association between ultrasound features of adenomyosis and severity of menstrual pain.

To investigate the association between the ultrasound features of adenomyosis and the severity of menstrual pain. This was a prospective observational study set in the general gynecology clinic of a university teaching hospital between January 2009 and January 2010. A total of 718 consecutive premenopausal women aged between 17 and 55 years attended the clinic and underwent structured clinical and transvaginal ultrasound examinations in accordance with the study protocol. Morphological features of adenomyosis on ultrasound scan were recorded systematically. A quantitative assessment of menstrual pain was made by completion of a numerical rating scale (NRS). One hundred and fifty-seven (21.9% (95% CI, 18.8-24.9%)) women were diagnosed with adenomyosis on ultrasound. Multiple linear regression analysis showed that an ultrasound diagnosis of adenomyosis and ultrasound and laparoscopic diagnoses of endometriosis were significantly associated with menstrual pain when measured by an NRS. In addition, there was a statistically significant positive correlation between the severity of menstrual pain and the number of ultrasound features of adenomyosis seen. Women with ultrasound features of adenomyosis have more severe menstrual pain than do women without these features. The positive correlation between the number of ultrasound features of adenomyosis and the severity of menstrual pain could form the basis of a clinically relevant grading system for adenomyosis. A classification of severity of adenomyosis based on the number of ultrasound features present is a novel concept that should be evaluated prospectively in different populations. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

A multivariate analysis of prognostic factors from assure (E2805): Adjuvant sorafenib or sunitinib for unfavorable renal carcinoma.

618 Background: Previous post-surgical prognostic nomograms for clear cell RCC are based upon TNM stage, PS, Fuhrman grade, and sometimes presence of necrosis. 1943 patients (pts) with locally advanced renal cell carcinoma (RCC) participated in the ASSURE trial of one year of sunitinib daily for 4 wks of a 6 wk cycle, sorafenib daily, or placebo, then treated for up to 9 cycles. Of these, 1541 pts had clear cell predominant features. There were no significant differences in DFS (median 5.7 years) between either of the experimental arms and placebo, in the total or clear cell population. We investigated site-reported clinical and surgical factors associated with prolonged DFS. Methods: Patients were staged according to the AJCC 2007 version. Factors considered in addition to those in the final model shown below were age, race/ethnicity, histology, risk category and PS as stratified, and 10 other specific baseline symptoms. A Cox proportional hazards model was built including factors that significantly changed the -2 log likelihood ratio (Collett). Results: Shorter DFS was associated with higher age, stage and Fuhrman grade, male sex, PS > 0, open vs. laparoscopic surgical approach, low hemoglobin and diagnosis based on presence of symptoms. Conclusions: The association of stage, grade, age, and PS with outcome confirms previous analyses in resectable disease. The same factors which predict outcome in metastatic disease now clearly confer relapse risk in the postoperative setting. Clinical trial information: NCT00326898. [Table: see text]

A Multivariate Analysis of Correlation between Severity and Duration of Symptoms, Patient Profile and Stage of Endometriosis

Background: Endometriosis is an important cause of infertility and chronic pelvic pain. Our study aims to understand the cause and effect relationship of endometriosis with these two clinical presentations. Objectives: 1) To study the correlation between stage of endometriosis with pain and infertility; 2) To evaluate role of transvaginal ultrasound for diagnosis of endometriosis using laparoscopic diagnosis as gold standard. Methodology: Total of 89 women presenting with infertility and or pain and with laparoscopic findings of endometriosis were included in the study. The results were analysed by logistic regression. Results: The mean age of women was 29.67 years. Seventy three percent of patients had moderate to severe disease while 31.46% of patients with endometriosis were infertile. Symptom of pain could be categorised as dysmenorrhea (71.47%), dyspareunia (41.5%) and dyschezia (15.7%). There was no association of endometriosis stage with the pain type, duration of symptoms. Transvaginal ultrasound seems a reliable test for diagnosis of ovarian endometriosis and advanced stage disease. 87.5% of patients with ovarian endometrioma had advanced disease (higher than Stage II rAFS). Conclusion: No correlation was found between the stage of endometriosis and severity of symptoms. Presence of endometrioma on USG was associated with advanced stage of endometriosis.

Results of Laparoscopic Management of Infertility in Dakar Teaching Hospital: About 101 Cases

Background: Define the epidemiological and clinical profile of patients with infertility and evaluate the laparoscopy assessment at Dakar Teaching Hospital. Methods: This is a prospective, descriptive and analytic study on a series of 101 patients followed for infertility and supported by laparoscopy from June1st, 2009 to December 31, 2011. For each patient, the socio-demographic and clinical data of operation and the scalable suites were studied. Results: Laparoscopy assessements were performed on 39.5% of patients followed for infertility representing 78.9% of laparoscopy indications. The average age of patients was 29 years and mean parity was 1.2. Infertility type was primary in 39.6% of cases and secondary in 60.4% of patients. Sexually transmitted diseases background was found in 51% of cases. Pathologies encountered were dominated by tubal abnormalities (70% of cases). The operative procedures which were performed were adhesiolysis (35.1%), tubal plasty (30.4%) and methylene blue dye test for tubal patency. Conversion was necessary in 4.9% of cases motivated by the importance of adhesions (3 cases) or technical difficulties (2 cases). The main complications were represented by a vascular wound and uterine perforation. The post-operative course was uneventful in 96% of cases. We observed a pregnancy rate of 5.9% of cases beside an indication of medically assisted procreation in 28.7% of cases. Conclusion: The development of the endoscopic approach becomes a necessity due to the importance of tubal infertility caused by infections. Its laparoscopic diagnosis and treatment at an early stage may improve the prognosis.

Potential Markers of Endometriosis: Latest Update

Endometriosis is a complicated chronic disease that is characterized by the presence of ectopic lesions commonly located in the ovaries, peritoneum, and rectovaginal septum. It can cause irregular bleeding, pain, and infertility in the millions of affected women globally. While it is associated with abnormal mechanisms of retrograde menstruation, inflammation, and oxidative stress, but its etio-pathogenesis is not clearly characterized. Previous and recent literature supports the presence of altered levels of immunological signaling molecules growth factors, oxidants, and antioxidants in patients with endometriosis. This article reviews such literature regarding these biomarkers in four biological windows: serum, peritoneal fluid, follicular fluid, and relevant endometrial tissue samples. The investigation of changes in the proteome expression and oxidative stress markers in endometriosis has been shown to reflect the presence and severity of the condition, suggesting these molecules may possess the relevance and capability to function as early diagnostic markers. Current standard of laparoscopic diagnosis can delay detection by approximately nine years; therefore, establishing a non-invasive, inexpensive diagnostic methodology could simplify detection, reduce the use of invasive procedures, improve management, and address worldwide public health concerns. Characterization of multiple highly specific and sensitive biomarkers is necessary to create a reliable testing panel for early detection of endometriosis. The focus of the review is to summarize the relevant biomarkers as potential diagnostic tools for endometriosis and understand the roles of immunological and chemical modulators in this pathology. Our review also suggests that future research direction regarding diagnostic potential of biomarkers should further showcase reproducible results to establish the credibility of associated molecules.

Surgical Planning in Pan Facial Trauma Using Additive Manufacturing Medical Model-A Case Study

Introduction: Stump appendicitis is a very rare complication after appendectomy with possible serious complications in the absence of a correct diagnosis. Case Presentation: We present the laparoscopic diagnosis and treatment of an extremely rare complication after open appendectomy (remnant stump appendicitis). We report a female patient with a history of open appendectomy performed 7 months ago in another unit. She presented now with persistent typical signs of acute appendicitis, identical with those encountered before the open appendectomy. Repeated US and CT scans were normal. Due to the persistent complaints, a decision for exploratory laparoscopy was made. Intra-operatively we found some adhesions in the right iliac fossa and a 20 mm length appendicular stump which was adherent to the anterior abdominal wall. The stump was dissected, ligated at the base and removed using a 3 trocars approach and standard laparoscopy instruments. The postoperative course was favorable, resolution of the pain and no recurrence at a 3 years follow-up. The pathologic examination showed the typical histologic structure of an inflamed appendix. Discussions: The diagnostic of stump appendicitis is a difficult one in the absence of a high index of suspicion. The case is interesting due to the rarity and the use of a laparoscopic approach to treat an incomplete open appendectomy. Conclusions: Laparoscopy is useful in patients with persistent abdominal symptoms after open appendectomy. If an appendicular stump is present, it allows its identification and safe removal.

Laparoscopic Diagnosis and Treatment of Superficial Endometriosis in a Teenage Patient

Laparoscopic Diagnosis and Treatment of Superficial Endometriosis in a Teenage Patient

Waddlia chondrophila and Chlamydia trachomatis antibodies in screening infertile women for tubal pathology

Since Waddlia chondrophila is closely related to Chlamydia trachomatis, we hypothesise that W. chondrophila may also be associated with tubal factor infertility (TFI) in women, a major complication of chronic C. trachomatis infection. Five hundred twenty serum samples were tested for anti-Waddlia antibodies by ELISA. Among the 520 investigated women, a total number of 142 (27.3%) has had laparoscopic diagnosis performed, and were either classified TFI positive or negative. Presence of high titres of W. chondrophila antibodies was linked to TFI (p < 0.0001; OR: 7.5; 95% CI: 3.3–17). Moreover, antibody positivity to both W. chondrophila and C. trachomatis-MOMP was strongly associated with TFI (p < 0.0001; OR: 21; 95% CI: 3.8–12E1). This association was much stronger than the statistical association of C. trachomatis-MOMP antibodies only (p < 0.0001; OR: 7.1; 95% CI: 3.7–14), suggesting that co-infection with W. chondrophila and C. trachomatis may lead to more severe reproductive sequelae and immune responses than single infection with either Chlamydiales members.

Normal laparoscopic anatomy of the caprine pelvic cavity

Due to the several advantages over conventional procedures, the laparoscopic disease diagnosis and surgery has now started receiving attention in small ruminants. The normal laparoscopic anatomy needs to be described for comparison with the findings in animals with various diseases. The objective of the present study was therefore to describe the laparoscopic anatomy of the caprine pelvic cavity. Adult Bakerwal and Pashmina goats (n=25) of both the sexes were included in this laparoscopy study. All the animals were restrained in dorsal recumbency and Trendelenburg position under lumbosacral epidural anesthesia and sedation. After creating the pneumoperitoneum, the primary port for 5 mm laparoscope was placed at linea alba (3.0 cm cranial to mammary glands in does), and at right paramedian (3.0 cm cranial to the rudimentary teat in the bucks) site. Secondary port was placed under direct laparoscopic observation 5-6 cm away from the primary port in horizontal plane, to allow insertion of the grasping forceps. Scan was performed first at the primary port and subsequently through the secondary port for orientation and exploration of the pelvic cavity. The ventral laparoscopic approach provided satisfactory exposure of the pelvic cavity in goats. Comprehensive description of the pelvic organs could be obtained. However, dorsal aspect of the urinary bladder neck and accessory genital organs of male animals could not be visualized. Major complications were not encountered during or after laparoscopy. Laparoscopy a minimally invasive procedure has several advantages over alternate methods of understanding anatomy, physiology and pathology of most of the intraperitoneal pelvic structures in goats. The technique has high pedagogic value. The procedure is safe in experienced hands.

Laparoscopic diagnostic findings in atypical intestinal malrotation in children with equivocal imaging studies

Background Atypical presentations of intestinal malrotation are more common in older children with a diagnostic and therapeutic challenge. Upper gastrointestinal (UGI) contrast study is essential for the diagnosis of the majority of cases. Recently, laparoscopy has been used in the management of malrotation. We present our experience with laparoscopic management of atypical presentations of intestinal malrotation in children, describing laparoscopic findings in these cases. Patients and methods A total of 40 patients with atypical presentations of malrotation were included in this study. The main presentations were recurrent abdominal pain, intermittent intestinal obstruction, recurrent bilious vomiting, and failure to thrive. They all were subjected to thorough history taking, clinical examination, routine laboratory investigations, and UGI contrast study. No preoperative definitive diagnosis of malrotation was performed and all patients underwent laparoscopic evaluation. Results Forty patients (25 males and 15 females) with a mean age of 7± 2.8 years were subjected to laparoscopy. Thirty-six patients (90%) were found to have definite laparoscopic findings in the form of markedly dilated stomach and first part of duodenum, ectopic site of cecum, medial and low position of duodenojejunal junction, congested mesenteric veins with lymphatic ectasia, generalized mesenteric lymphadenopathy, reversed relation of superior mesenteric artery and vein, and rightsided small bowel and narrow mesenteric base. Four patients had differed laparoscopic diagnosis. All the procedures were completed laparoscopically. All the patients achieved full recovery without intraoperative or postoperative complications. Conclusion Laparoscopy permits direct evaluation and treatment of undocumented malrotation in children, with equivocal UGI contrast study. These newly described laparoscopic findings are the key for the diagnosis of malrotation with atypical presentation. Keywords : Ladd’s procedure, laparoscopy, mesenteric lymphadenopathy, undocumented malrotation

Quality of life outcomes in women with endometriosis are highly influenced by recruitment strategies.

To what extent are outcome measures in endometriosis-related quality of life studies influenced by the setting in which patient recruitment is performed? Quality of life outcomes in women with endometriosis are highly influenced by recruitment strategies. Most studies on quality of life in women with endometriosis are conducted in tertiary care centres or patient associations. It is conceivable that the setting in which patient recruitment is performed influences the quality of life results. This has not been investigated before. Retrospective questionnaire based cohort study (part of the World Endometriosis Research Foundation (WERF) EndoCost study). The investigated women were recruited in three settings: a tertiary care centre for endometriosis (n = 135); five secondary care centres (n = 63); an endometriosis patient association (n = 291). The secondary and tertiary care population included women with a laparoscopic and/or histological diagnosis of endometriosis. The patient association population consisted of women with a self-reported diagnosis of surgically confirmed endometriosis. The populations did not differ in terms of age, co-morbidities and education level. Delay of diagnosis was the longest in the patient association (median 7 years) (tertiary care 2 years; secondary care 1.5 years) (P < 0.001). The tertiary care population reported more laparotomies (64%) than the other populations (secondary care 43%; patient association 47%) (P = 0.002). Affected job was least prevalent in the secondary care setting (35%) (patient association 64%; tertiary care 56%) (P < 0.001). Affected relationships were most prevalent in the patient association setting (52%) (tertiary care 38%; secondary care 22%) (P < 0.001). Chronic pain was least prevalent in patients in secondary care (44%) (tertiary care 65%; patient association 61%) (P = 0.009). Substantial differences in quality of life were detected between secondary care (median physical component 50.4, mental component 49.6); tertiary care (physical component 46.2, mental component 46.2) and the patient association (physical component 45.0, mental component 44.6) (P < 0.001, P = 0.018). The response rate was relatively low (35%). Analysis of the hospital populations revealed that non-responders and responders did not differ with respect to age or revised American Fertility Society classification, indicating that the non-responder bias is limited. However, other factors, such as social and marital status or symptomatology, might be different for non-responders. Missing values were analysed as if the symptom was not present. Missing values never exceeded 10%, except for one value. Therefore, it can be expected that the effect of missing data on the outcome is negligible. Twenty-five patients belonged to more than one category. A sensitivity analysis showed that the influence of assigning patients to another category was limited. Outcomes regarding quality of life are highly influenced by recruitment strategy. None of the groups appeared to be a representative selection of the total population of women with endometriosis. An alternative strategy for creating a representative population for cost and quality of life studies is probably to recruit women who live in a specific geographic area rather than women that visit a specific hospital or are a member of a patient association. The WERF EndoCost study was funded by the World Endometriosis Research Foundation. The sponsors did not have a role in the design and conduct of this study: collection, management, analysis, interpretation of the data; preparation, review, approval of the manuscript. L.H. is the chief executive and T.M.D. was a board member of WERF at the time of funding. T.M.D holds the Merck-Serono Chair and the Ferring Chair in Reproductive Medicine in Leuven, Belgium and has served as consultant for Merck-Serono, Schering-Plough, Astellas, and Arresto. Not applicable.

Laparoscopic diagnosis and treatment of enteric intussusception in children

Laparoscopic diagnosis and treatment of enteric intussusception in children

Laparoscopic diagnosis and treatment of early adhesive small bowel obstruction after gynecological surgery

It is presented the results of diagnostic and curative laparoscopic interventions in 33 patients with acute early adhesive small bowel obstruction. Ileus developed after surgical treatment (laparotomy) of different gynecological diseases. Laparoscopy appeared as the most informative diagnostic method to confirm diagnosis in all patients, to estimate state of abdominal cavity and small pelvis organs what can help to determine method of surgical treatment. Contraindications for laparoscopic surgery were identified in 12 (36.4%) patients and conversion to laparotomy was applied in this group. Postoperative complications were diagnosed in 1 (8.3%) patient. 2 (16.6%) patients died. Early adhesive ileus was resolved laparoscopically in 21 (63.6%) of 33 patients. Recurrent acute early adhesive ileus was detected in 1 (4.7%) patient.

Endometriosis in adolescents.

Background and Objectives:Women with endometriosis often report onset of symptoms during adolescence; however, the diagnosis of endometriosis is often delayed. The aim of this study was to describe the experience of adolescents who underwent laparoscopy for pelvic pain and were diagnosed with endometriosis: specifically, the symptoms, time from onset of symptoms to correct diagnosis, number and type of medical professionals seen, diagnosis, treatment, and postoperative outcomes.Methods:We reviewed a series of 25 females ≤21 years of age with endometriosis diagnosed during laparoscopy for pelvic pain over an 8-year period. These patients were followed up for 1 year after surgery.Results:The mean age at the time of surgery was 17.2 (2.4) years (range, 10–21). The most common complaints were dysmenorrhea (64%), menorrhagia (44%), abnormal/irregular uterine bleeding (60%), ≥1 gastrointestinal symptoms (56%), and ≥1 genitourinary symptoms (52%). The mean time from the onset of symptoms until diagnosis was 22.8 (31.0) months (range, 1–132). The median number of physicians who evaluated their pain was 3 (2.3) (range, 1–12). The adolescents had stage I (68%), stage II (20%), and stage III (12%) disease. Atypical endometriosis lesions were most commonly observed during laparoscopy. At 1 year, 64% reported resolved pain, 16% improved pain, 12% continued pain, and 8% recurrent pain.Conclusions:Timely referral to a gynecologist experienced with laparoscopic diagnosis and treatment of endometriosis is critical to expedite care for adolescents with pelvic pain. Once the disease is diagnosed and treated, these patients have favorable outcomes with hormonal and nonhormonal therapy.