Role Of Laparoscopy In Diagnosis Research Articles

Role of Laparoscopy in Diagnosis of Tuboperitoneal and Pelvic Factors of Female Infertility

Role of Laparoscopy in Diagnosis of Tuboperitoneal and Pelvic Factors of Female Infertility

Role of Laparoscopy in Diagnosis and Management of Acute Abdomen

Role of Laparoscopy in Diagnosis and Management of Acute Abdomen

Role of Laparoscopy in Diagnosis and Treatment of Endometriosis Associated with Infertility: A Prospective Analysis

Objective: Endometriosis is often considered as an enigma due to its varied clinical presentation and challenges in diagnosis. The objective of this study is to evaluate the role of laparoscopy in diagnosis and treatment of endometriosis associated with infertility.Materials and Methods: Infertile females diagnosed to have endometriosis during or before undergoing laparoscopic surgery from August 2018 to February 2020 were followed up for spontaneous conception for 6 months following laparoscopy. Revised American Fertility Society (r-AFS) scoring system was used to score endometriosis and stage the disease (stage I-IV). Surgical interventions were done on individual cases basis following ESHRE guidelines.Results: Fifty infertile females diagnosed with endometriosis during or before laparoscopy were recruited for the study. Mean age of patients was 28.58 (±4.21) years. Thirty-four (68%) patients had primary infertility and 16 (32%) has secondary infertility. Mean duration infertility was 3.33 (±1.43). Only 37 patients (74%) had evidence of endometriosis in pre-operative ultrasonography. During the follow up period of first 6 months after surgery 34 (68%) patients conceived spontaneously. Lower mean endometriosis score (p=0.00) and early stage of endometriosis (p=0.00) were associated with higher chances of conception. But, female age, duration and type infertility, USG findings, and type of surgical interventions did not affect pregnancy rate.Conclusion: Laparoscopy helps in diagnosis of endometriosis. Laparoscopic therapeutic interventions for endometriosis increase the probability of spontaneous conception in infertile females. Lower surgical score and early stages of endometriosis are associated with higher chance of conception.

Role of laparoscopy in diagnosis of acute nonspecific abdominal pain

Background Acute nonspecific abdominal pain (NSAP) is frequently encountered in the daily medical practice. This prospective study was performed to elucidate the role of early laparoscopy in the management of NSAP and to compare it with active clinical observation in such cases. Patients and methods A total of 100 cases with acute NSAP were randomly divided into two groups: early diagnostic laparoscopy (EDL) group included 50 cases who underwent EDL, and observational group included the remaining 50 cases who were closely observed. Outcome measures included the definitive diagnosis, operative time, duration of hospitalization, and postoperative morbidity. Results No statistically significant difference was noticed between the study groups regarding demographics. However, the duration of symptoms showed significant prolongation in the observation group. Regarding the final definitive diagnosis, no significant difference was noticed between the two groups (P Conclusion Diagnostic laparoscopy appears to be a reliable tool to reach a definite diagnosis in patients with NSAP because of its superior diagnostic ability, better visualization, low complications, and the ability to manage the pathology in the same setting.

The role of laparoscopy in the management of patients with isolated blunt abdominal trauma

Objective To assess the role of laparoscopy in diagnosis and management of patients with isolated blunt abdominal trauma (IBAT). Patients and methods This was a prospective study of 50 patients who were hemodynamically stable (systolic blood pressure ≥90 mmHg) experiencing IBAT who underwent diagnostic and/or therapeutic laparoscopy at the emergency department of Sohag University Hospital. Inclusion criteria were hemodynamically stable patients with IBAT. Exclusion criteria were marked hemodynamic instability, penetrating abdominal trauma, polytraumatized patients, increased intracranial tension, and contraindications for laparoscopy. After a primary survey according to Advanced Trauma Life Support principles, all patients were investigated by pelvi-abdominal ultrasound, computed tomography, chest and abdominal plain radiograph, and other routine laboratory investigations. Results A total of 50 stable patients with IBAT underwent urgent laparoscopy. Of them, 32 (64%) patients had therapeutic laparoscopy, whereas 18 (36%) patients had diagnostic laparoscopy. A total of 18 (36%) patients were converted to therapeutic laparotomy. Severely damaged spleen, liver, small intestinal, colon, and stomach injuries were the causes of conversion. Road traffic accident (24%) was the commonest cause of injury. Spleen was the commonest affected organ [18 (36%) patients], followed by the liver [10 (20%) patients]. Pain (visual analog scale of pain) and hospital stay were significantly increased (P˂0.0001and 0.001, respectively) in converted (laparotomy) cases in comparison with nonconverted (completed laparoscopy) cases. Postoperative complications, such as wound infection, hematoma, intra-abdominal hemorrhage, wound dehiscence, and reexploration were significantly increased in converted cases in comparison with nonconverted cases (P=0.002, 0.01, 0.01, 0.01, and 0.001, respectively). Conclusion Laparoscopy in blunt abdominal trauma is safe, accurate, and feasible. Hemodynamic stability of the patient and surgical expertise in advanced laparoscopy are the prerequisites. The most important advantages of laparoscopy are reduction of nontherapeutic laparotomy rate, reduction of operative period, shortening of hospital stay, and reduction of postoperative pain and postoperative complications.

WHY DIAGNOSTIC LAPAROSCOPY.

Abdominal pain requires rapid diagnosis and treatment, especially in emergency circumstances. Sometimes the diagnosis of the disease cannot be accomplished with laboratory and imaging methods, and an invasive procedure such as diagnostic laparoscopy may be required to obtain a diagnosis. Diagnostic laparoscopy is also performed therapeutically, but laparotomy is inevitable in some cases. The aim of the study is to evaluate the role of diagnostic laparoscopy in diagnosis and treatment and to retrospectively examine the factors that force the surgeon to perform a laparotomy. Patients over the age of 18 who underwent diagnostic laparoscopy in the general surgery clinic of Sakarya University Training and Research Hospital between January 2013 and December 2019 were retrospectively evaluated. Patients under 18 years of age and patients diagnosed before surgery were excluded. Demographic data of the patients, whether there was a conversion from laparoscopy to laparotomy, postoperative morbidity, and mortality were recorded. The data of 347 patients in total were evaluated retrospectively between the specified dates. 216 of the patients were previously diagnosed, laparoscopic procedures performed for staging purposes and they were not included in the study. The remaining 131 patients were included in the study. 68 of the patients were women and 63 were men. 79.4% of the patients were diagnostic laparoscopies performed due to emergency circumstances, and 20.6% for abdominal pain evaluation. While the procedure was concluded laparoscopically in 64.9% of the patients, the operation was continued by performing laparotomy in 35.1%. Despite the increase in the variety and frequency of use of imaging modalities, a laparoscopic intervention is an essential approach in both diagnosis and treatment when the diagnosis is doubtful, especially in emergency cases in appropriate cases.

ROLE OF LAPAROSCOPY IN CHRONIC PELVIC PAIN

Background/purpose: The purpose of the present study was to evaluate the role of laparoscopy in diagnosis the cases of chronic pelvic pain. Methods: This prospective study was conducted among 100 women who had been suffering from chronic pelvic pain for ≥6 months at Department of Obstetrics & gynaecology, Muzaffarnagar Medical College, Muzaffarnagar from December 2017 to December 2018. After proper selection of cases, a detailed history followed by general, systemic and pelvic examination, diagnostic laparoscopy of the patient was done and noted as per the following protocol. Diagnostic laparoscopy was performed under general anaesthesia using a 5-mm Karl Stortz 30° angle double port laparoscope. The data was collected and subjected to statistical analysis using SPSS version 22.00 Results: Majority (70%) of patients with CPP were in the age group between 26 – 30 years and 31 – 35 years. Two most common causes of CPP detected clinically were endometriosis and chronic PID which together constituted about 56% of the cases with CPP in our study group. Laparoscopy findings revealed that 90% of patients with CPP have one or more positive findings, the commonest being endometriosis in various pelvic sites with or without endometrioma (34%) Conclusion: It can be concluded that ideally hysteroscopy should be performed simultaneously to identify intrauterine pathologies, which can be associated with CPP and which are missed by laparoscopy. Hence combined laparohysteroscopy is the ideal method for diagnosis of CPP.

Role of Laparoscopy in Diagnosis and Treatment of Acute Abdominal Pain

Background: Abdominal pain is a common presentation at the surgical department. Emergency laparoscopy in patients with "acute abdomen" is a part of common surgical practice. Aim: Evaluation of the role of laparoscopy in management of acute abdominal pain Methods: 100 patients with acute abdominal pain presented to the Department of Surgery, Al-Azhar University, El-Hussein and El Minia Health Insurance Hospitals were included in the study during the period from April 2018 to April 2019. They were divided into two groups: known preoperative diagnosis (therapeutic n= 67 patients) and unknown (diagnostic and therapeutic n= 33 patients). Their ages ranged between 12 and 60 years old (35 patients were males and 65 patients were females). Laparoscopy was performed for all patients under general anesthesia. Results: The definitive diagnosis was established in 99 % of cases. 64 % of those cases were managed successfully by use of laparoscopy and conversion rate was 33 %. Time required for each operation varied according to the procedure, intraoperative morbidity was 7 %, post-operative complications were 11 %. The mortality of study was 1%. Conclusions: laparoscopic intervention for abdominal emergencies is as safe, feasible and effective. It results in minor trauma, has a rapid postoperative recovery, and reduces morbidity. Laparoscopy can help to avoid unnecessary non- therapeutic laparotomies. It can also help to guide the operating surgeon for choosing the proper targeted incision.

Role of Laparoscopy in Diagnosis and Treatment of Acute Abdominal Pain

Background: Abdominal pain is a common presentation at the surgical department. Emergency laparoscopy in patients with abdomen is a part of common surgical practice. Aim: Evaluation of the role of laparoscopy in management of acute abdominal pain Methods: 100 patients with acute abdominal pain presented to the Department of Surgery, Al-Azhar University, El-Hussein and El Minia Health Insurance Hospitals were included in the study during the period from April 2018 to April 2019. They were divided into two groups: known preoperative diagnosis (therapeutic n= 67 patients) and unknown (diagnostic and therapeutic n= 33 patients). Their ages ranged between 12 and 60 years old (35 patients were males and 65 patients were females). Laparoscopy was performed for all patients under general anesthesia. Results: The definitive diagnosis was established in 99 % of cases. 64 % of those cases were managed successfully by use of laparoscopy and conversion rate was 33 %. Time required for each operation varied according to the procedure, intraoperative morbidity was 7 %, post-operative complications were 11 %. The mortality of study was 1%. Conclusions: laparoscopic intervention for abdominal emergencies is as safe, feasible and effective. It results in minor trauma, has a rapid postoperative recovery, and reduces morbidity. Laparoscopy can help to avoid unnecessary non- therapeutic laparotomies. It can also help to guide the operating surgeon for choosing the proper targeted incision.

Role of Laparoscopy in Management of Nonpalpable Undescended Testis in Children

Abstract Background Normal testicular descent relies on a complex interplay of numerous factors. Any deviation from the normal process can result in an undescended testis (UDT). UDT is a common abnormality that carries fertility and malignancy implications. Aim of the Work The aim of this study is Evaluation of the role of laparoscopy in diagnosis and management of clinically impalpable testis. Patients and Methods Nineteen male patients were included in this study with twenty two non-palpable testes. All these patients were subjected to diagnostic laparoscopy & the subsequent decision was then based on the laparoscopic finding. There was no age limit for the procedure. The procedure was carried in Ain Shams University teaching hospital and El-mataria teaching hospital. Results The study included nineteen patients with twenty two non-palpable testes. Age at presentation was averaging 18.5 ± 12.5 months. Our study may present convincing evidence that laparoscopy has significant advantage over imaging procedures. Preoperative imaging proved inaccurate in determining testicular position in 10 of the 22 testes (45.5%) this is in agreement with many studies which reported that ultrasonography helped to identify only 45% of non palpable testis. Conclusion This study tried to assess roughly the effectiveness of laparoscopy as a diagnostic tool and treatment of non-palpable undescended testis. This study dealt with a very small number of patients and this issue still needs more researches to study all the benefits and disadvantage and shall need further study on a wide range of patients.

Evaluation of Role of Laparoscopy in Diagnosis and Treatment of Non-Traumatic Acute Abdomen

Background: abdominal pain is a common complaint seen in emergency departments in United States. Abdominal pain is the leading reason for visits to the emergency department (ED), accounting for 6.8% of all visits in 2006. Aim of the Work: this study aimed to evaluate the diagnostic role of laparoscopy in acute abdominal conditions and its therapeutic role in perforated peptic ulcer, acute cholecystits and acute appendicitis. Patients and Methods: this study was conducted prospectively on 40 patients presented with acute abdomen to AlAzhar University hospitals from March 2018 till August 2018. 24 (60%) of patients were females and 16 (40%) were males. The age ranged from 20 to 60. Results: we accomplished complete laparoscopic diagnosis in 90% of cases, and avoided negative laparotomy in 5% of cases. We converted about 10% of laparoscopically diagnosed cases to open surgery for therapeutic purposes with significant reduction in complications in laparoscopic cases and mean hospital stay 2.6 days in laparoscopic cases vs. 5.3 days in open cases. Conclusion: laparoscopy was an excellent diagnostic tool. It was a very good therapeutic tool in acute appendicitis, acute cholecystitis and perforated peptic ulcer. It was also safe and satisfactory; also it saved more hospital beds.

Evaluation of Role of Laparoscopy in Diagnosis and Treatment of Non-Traumatic Acute Abdomen

Evaluation of Role of Laparoscopy in Diagnosis and Treatment of Non-Traumatic Acute Abdomen

Role of Laparoscopy in Diagnosis of Abdominal Tuberculosis

Role of Laparoscopy in Diagnosis of Abdominal Tuberculosis

The role of laparoscopy in diagnosis and treatment of parenchymal organs injuries after abdominal trauma in own material

The role of laparoscopy in diagnosis and treatment of parenchymal organs injuries after abdominal trauma in own material

The Role of Laparoscopy in Diagnosis of Ascites of Obscure Etiology

Background: The role of diagnostic laparoscopy was markedly decreased with the advent of major developments in noninvasive imaging modalities such as ultrasonography, computed tomography, and magnetic resonance imaging. However, many reports suggest that imaging has a limited role in the diagnosis of exudative ascites. The aim of the present study was to answer the question if there still a place of laparoscopy in the diagnosis of ascites of obscure etiology?. Methods: We prospectively evaluated patients with undiagnosed exudative ascites seen in the internal medicine and general surgery departments in Sohag university hospital, Sohag, Egypt in the period from September 2014 till November 2016. Results: 32 patients were included in our study; 30 females(93.75%) and 2 males (6.25%) with a mean age of (range from 16 to 68 years. All patients were referred to surgery department due to ascites of obscure origin. No mortality was registered in this study; all patients were discharged from hospital the 2nd day after laparoscopy andreturned to their home activity. The final pathological diagnosis after examination of ascetic fluid and biopsies that weretaken by laparoscopy were carcinomatosis peritoneii in 24 (75%), tuberculous peritonitis in 6 (18.75%) and liver cirrhosis in 2 cases (6.25%). Conclusion: Despite great advances in noninvasive diagnostic imaging techniques; diagnostic laparoscopy is stilla valuable option for diagnosis of ascites of obscure etiology.

The role of laparoscopy in diagnosis of patients with chronic abdominal pain

Background: Chronic abdominal pain still remains one of the leading clinical problems presenting to physicians. Reaching a definitive diagnosis and prompt management is usually delayed because invasive investigations are frequently required to come to a conclusive diagnosis. The aim was to study the varied clinical picture of chronic abdominal pain and evaluate the role of laparoscopy in reaching a conclusive diagnosis in these patients.Methods: A prospective and retrospective study of 142 patients of chronic abdominal pain who underwent diagnostic laparoscopy in our surgery department from June, 2006 to December, 2015 was done. A descriptive analysis of data collected from case records of these patients was done to study the varied clinical picture, laboratory reports, radiological findings, laparoscopic findings and histological reports. The usefulness of laparoscopy to confirm the diagnosis and in clinical management of these patients of chronic abdominal pain was evaluated.Results:Laparoscopy was performed in 142 patients of chronic abdominal pain with unsettled diagnosis. A conclusive diagnosis could be made in 136 of these patients. The common causes of chronic abdominal pain were abdominal tuberculosis, adhesions, bands, small intestinal strictures, chronic appendicitis, abdominal malignancy and various gynecological diseases. Gynecological problems causing chronic abdominal pain were pelvic inflammatory disease, ovarian cyst, tubo-ovarian mass, hydrosalpinx, fibroid uterus, bulky uterus, endometriosis. Thus laparoscopy provided positive diagnosis of in 136 (95.77%) patients based on laparoscopic findings, histological reports, ascitic fluid analysis and cytology.Conclusions:In patients suspected to have abdominal pathology early laparoscopy may be useful to establish a conclusive diagnosis with acceptably low morbidity (<5 %). An early resort to laparoscopy can resolve the diagnostic dilemma and early treatment can be instituted.

Bilateral intrinsic ureteral fibrosis after pregnancy: role of laparoscopy in diagnosis and surgical management

Bilateral intrinsic ureteral fibrosis after pregnancy: role of laparoscopy in diagnosis and surgical management

The role of laparoscopy in diagnosis of abdominal tuberculosis

confirming the diagnosis of abdominal tuberculosis. Methods: A prospective and retrospective study of 114 patients who underwent diagnostic laparoscopy for chronic abdominal pain with unsettled diagnosis between July 2007 and December 2012 was done. Abdominal tuberculosis was diagnosed in 46 of these patients. A descriptive analysis of data collected from case records of the patients was done to study the clinical characteristics, laboratory, radiological and histological findings along with usefulness of laparoscopy to confirm the diagnosis of abdominal tuberculosis. Results: Laparoscopy was performed in 114 patients of chronic abdominal pain with unsettled diagnosis. Peritoneal tuberculosis was diagnosed in 46 of them, characterized by presence of ascites, multiple whitish tubercles, fibrous bands and adhesions, strictures of small intestine, hyperemic edematous bowel loops or dense adhesions etc. Peritoneal biopsy confirmed the diagnosis in 28 of the 46 (60.86 %) patients. In 18 patients due to clinical impression, radiological findings and raised ascitic fluid ADA a therapeutic trial with antituberculosis treatment was given. All patients showed good response to antitubercular treatment. Thus laparoscopy provided positive diagnosis of tuberculosis in 46 patients with positive histology in 28 (60.86 %) and inferred diagnosis in 18 (39.13%) patients of abdominal tuberculosis. Conclusions: Laparoscopy is safe and helpful in the diagnosis of peritoneal as well as intestinal tuberculosis. In patients suspected to have abdominal tuberculosis early laparoscopy may be useful to establish a histological diagnosis with acceptably low morbidity (<5 %). An early resort to laparoscopy can resolve the diagnostic dilemma and early treatment can be instituted.

Use of laparoscopy in the management of abdominal trauma: a center experience

Background The role of laparoscopy in diagnosis as well as therapeutic interventions has increased markedly in the last few years. In trauma, it has become a viable alternative for the diagnosis of intra-abdominal injury following penetrating and blunt trauma. The number of negative and/or nontherapeutic laparotomies performed has decreased since the use of laparoscopy in diagnosis and management. Patients and methods Sixty-five patients with abdominal trauma (21 blunt trauma, 44 penetrating trauma) were treated by the Trauma Team at the Emergency Unit of Zagazig University from November 2011 to August 2014 using laparoscopy for diagnosis. All patients underwent a physical examination, ultrasound, and computed tomography (abdomen and pelvis). Laparoscopy was used in the management of these patients through three trocars: one for 30° scope and two working trocars. Results In our series, we avoided laparotomy in 81.5% (53/65) of cases. Therapeutic laparoscopy was effective in 15 patients: six patients with stomach penetrations, four with liver lacerations, three with diaphragmatic injuries, and two with splenic lacerations. Conclusion Laparoscopy can be performed safely and effectively in stable patients with abdominal trauma.

Laparoscopic management of intra-abdominal infections: Systematic review of the literature.

To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections. A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically. Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controlling the source. Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections.