Role Of Laparoscopy In Patients Research Articles

A prospective observational study on role of laparoscopy in patients presenting with abdominal trauma in a tertiary care government medical college in Uttar Pradesh

Background: Laparoscopic surgery, also called minimal access surgery or key hole surgery, is a modern surgical technique, in which operations are performed far from their location through small incisions (usually 0.5–1.5 cm). Aims and Objectives: The aim of the study was to study the role of diagnostic laparoscopy (DL) in reassessing solid organ injury, diagnosing occult injuries, and selecting patients for conservative or operative line of management in cases of abdominal trauma with equivocal findings on CT scan And to study the role of therapeutic laparoscopy in a select group of cases where it can follow the initial DL and avoid laparotomy. Materials and Methods: The prospective study source of data will be from patients a presenting with abdominal trauma in the emergency at M.L.B. Medical College Jhansi (Trauma Centre). The duration of study will be from May 2021 till December 2022. We concluded that total study size of 152 patients for the assessment of diagnostic and therapeutic laparoscopy. Results: Among this, 130 (85.53%) were male patients. Females were 22 (14.47%). Most of the abdominal trauma caused by road traffic accidents 116 (76.32%). Other mode of injuries are assault, fall from height, gunshot injuries, and working machine-related injuries. Most commonly involved age groups are young adults between 21 and 30-year age group (42.76%). Most commonly injured organ is the spleen, i.e., 45 cases (30%) followed by liver, i.e., 23 cases (18.63%). Conclusion: In our study, we concluded that laparoscopic surgery can be considered an alternative option over conventional laparotomy.

Role of laparoscopy in patients with abdominal trauma: Rashid Hospital Trauma Center experience

Background: Exploratory laparotomy has been the standard intervention for surgical evaluation or treatment of abdominal trauma. Laparoscopic surgery with its proposed favorable surgical outcome may provide a reliable and accurate diagnosis of the injury. In this study, we aim to define the diagnostic role of laparoscopy in abdominal trauma and define the proposed advantages of reducing nontherapeutic laparotomies. Methodology: The study is a cohort retrospective study conducted at a level I trauma center – Rashid Hospital, United Arab Emirates. All patients from January 2016 to May 2019 with a history of abdominal trauma requiring surgical intervention fulfilling the inclusion criteria were included. The outcome of this study was to look at the rate of reduction of nontherapeutic laparotomies and the rate of missed injury. Results: The rate of reduction of nontherapeutic laparotomy in patients with abdominal trauma using diagnostic laparoscopy was 19.4%. Post-operative complications were higher in the open exploration group (p-value = 0.04). No missed injury was reported among the laparoscopy group. The mean hospital stay was higher in the laparotomy group compared to the laparoscopy group (13.6 vs 17.1). Laparoscopy was successful in 68.4% of the patients and the conversion rate was 31.6%. Conclusions: Laparoscopy has a role in the diagnosis of intra-abdominal injuries of hemodynamically stable patients with suspected abdominal injury to reduce unnecessary laparotomies, thereby decreasing postoperative complications.

EVALUATION OF THE ROLE OF DIAGNOSTIC LAPAROSCOPY IN PATIENTS PRESENTING WITH NON SPECIFIC ABDOMINAL PAIN AND ITS CORRELATION WITH CLINICAL AND RADIOGRAPHIC FINDINGS

Background: The present study was planned to evaluate the role of diagnostic laparoscopy in patients presenting with non-specific abdominal pain and its correlation with clinical and radiographic findings.
 Methods: Prospective descriptive study conducted on 50 patients, who fulfill the inclusion and exclusion criteria was included in the study.
 Results: 60% cases laparoscopy provide diagnostic & therapeutic or both. After laparoscopy 92% cases pain were resolve.
 Conclusion: Diagnostic laparoscopy can identify abnormal findings and improve the outcome in patients with chronic abdominal pain. However, it should be considered only after a complete diagnostic evaluation has been carried out.
 Keywords: Laparoscopy, diagnostic, therapeutic

Role of diagnostic laparoscopy in patients with large cell neuroendocrine carcinoma of the ovary with cancerous peritonitis: case report and review of the literature

BackgroundLarge cell neuroendocrine carcinoma is a very rare ovarian neoplasm that has a poor clinical outcome even in the early stage, and there is as yet no established treatment. Diagnostic laparoscopy has been used to determine the possibility of primary optimal cytoreductive surgery or neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer. However, the role of diagnostic laparoscopy is still unclear in large cell neuroendocrine carcinoma due to its rarity.Case presentationA 31-year-old woman with abdominal distention was referred to our hospital. She was strongly suspected of having advanced ovarian cancer because of a huge pelvic mass, massive ascites, and their appearance on medical imaging. However, cytological examinations from ascitic fluid by abdominal paracentesis did not show any malignant cells. She underwent diagnostic laparoscopy to evaluate the possibility of primary optimal cytoreductive surgery, and only tissue sampling was performed for pathological diagnosis because of the countless disseminated lesions of various sizes in the intraperitoneal organs. The patient had no postoperative complications, leading to the early start of postoperative chemotherapy.ConclusionsTo date, there have been no systematic reviews that focused on determining the treatment strategy using laparoscopy. Diagnostic laparoscopy can be helpful to determine the optimal treatment, including primary debulking surgery, neoadjuvant chemotherapy, or best supportive care, assisting in decision-making particularly for patients with advanced large cell neuroendocrine carcinoma with carcinomatous peritonitis.

ACUTE ABDOMEN;

Objectives: To assess the role of laparoscopy in patients presented with acute abdomen, to know the extent of its diagnostic and therapeutic role. And to know that how frequent the laparoscopic procedure is converted into open surgical procedures. Study Design: Prospective cross sectional study. Setting: Department of surgery Khyber Teaching Hospital, Peshawar. Period: July 2015-july 2017. Methodology: A total of 240 patients who fulfilled inclusion criteria were selected randomly for study. Data was collected by using pre designed questionnaire after informed consent from patient and analyzed by SPSS 17. Results: Out of our total sample, 155(64.6%) were males while 85(35.4%) females. Mean age of patients was 32±11 years. 52(21.6%) were diabetics, 45(18.7%) were hypertensive while 37(15.4%) were smokers. Laparoscopy was successful in diagnosing all cases. After diagnosis 212(88.3%) patients were managed primarily by laparoscopy at the same procedure while 28(11.7%) patients were subjected to open procedure. All patients were followed post operatively till time of discharge. Average hospital stay was 6±4 days. Outcome showed that 3(1.2%) patients were expired in which 2 were having mesenteric ischemia and 1 had ruptured ectopic pregnancy while 237(98.7%) were discharged. Conclusion: Laparoscopy in cases of acute abdomen was noted as safe and accurate procedure with decrease mortality and morbidity. Moreover it is an authentic tool for diagnosis with high diagnostic accuracy. It also helps in management at same time and aid in further curse of management.

Role of Laparoscopy in Patients With Abdominal Trauma at Level-I Trauma Center.

Abdominal trauma is one of the preventable causes of death in polytrauma patients. Decision and timing of laparotomy is a major challenge. Rate of nontherapeutic laparotomy is still high. Laparoscopy can avoid nontherapeutic laparotomy and also provide a reliable and accurate diagnosis of injury. This ambispective observational study was conducted in the division of Trauma Surgery and Critical Care, JPN Apex Trauma Centre, All India Institute Medical Sciences, New Delhi. Retrospective analysis of prospectively maintained data of cases from January 1, 2008 through April 30, 2013 and prospective analysis of cases from May 1, 2013 through March 31, 2015 was done using appropriate measures. Hemodynamically stable or responders fulfilling inclusion criteria were included. Selected patients underwent the laparoscopic procedure and if required converted to laparotomy. Of the 3610 patients of abdominal trauma, laparotomy was done in 1666 (46.14%) patients and laparoscopy was done in 119 (3.29%) patients. Rate of reduction of nontherapeutic laparotomy in patients with abdominal trauma using diagnostic laparoscopy was 55.4%. However laparotomy could be avoided in 59.7%. Laparoscopy was 100% accurate in identifying injuries in our study. No injuries were missed in these patients. Fever and wound infection were significantly higher in laparotomy group. Chest infection and sepsis were also higher in laparotomy group but the difference was not statistically significant. Median length of hospital stay in laparoscopy group was 4 days (range: 1 to 28 d) and in laparotomy group was 9.5 days (range: 2 to 55 d) with P-value of 0.001. Laparoscopy has a role in management of hemodynamically stable patients with suspected abdominal injury to prevent nontherapeutic laparotomies, and thereby decreasing postoperative complications.

Role of diagnostic laparoscopy in patients with non-specific abdominal pain and its correlation with clinical and radiographic findings

Aim/Objectives This study aims to evaluate the role of laparoscopy in patients presenting with chronic non-specific abdominal pain and also correlate the laparoscopic findings with clinical and radiographic findings in all such patients.

Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain

Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain

Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain

Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain

Role of laparoscopy in patients with peritoneal metastases considered for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC).

BackgroundWe hypothesized that diagnostic laparoscopy (DL) was feasible for the evaluation of patients with peritoneal carcinomatosis (PC) undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC).MethodsA retrospective review of PC patients treated from January 2010 to April 2013 was conducted. Data on tumor characteristics, treatment details and survival outcomes were extracted and analyzed.ResultsOf the 101 PC patients (mean age 52.9 ± 14.1 years), 73 diagnostic laparoscopies DL (61 concurrent with CRS + HIPEC) were performed in 70 patients whereas 31 patients underwent direct exploratory laparotomy (EL). Complete laparoscopic assessment was possible in 63 cases (86.3%), resulting in 18 exclusions (27.7%) while 10 cases were converted to open due to inadequate laparoscopic visualization. Subsequently, CRS + HIPEC was performed in 85.4% (of 55 selected for HIPEC, DL) versus 74.2% (EL, P value = 0.20). Among those excluded from HIPEC at the initial operation, delayed HIPEC after conversion chemotherapy was achieved in 6 (of 11 with extensive disease, DL). The incidence of grade 3 to 5 complications was 0% DL versus 10% EL (P value = 0.2). There were no port site recurrences at mean follow up of 9.1 ± 8 months.ConclusionsLaparoscopy is a feasible technique for selecting patients with PC for CRS + HIPEC, and can help select patients for conversion chemotherapy in the setting of high peritoneal carcinomatosis index (PCI) score.

English

BACKGROUND: Chronic idiopathic pain syndromes are among the most challenging and demanding conditions to treat across the whole age spectrum. Potentially it can be unrewarding for both the patients and the medical team. Patients with chronic abdominal pain (CAP) can undergo numerous diagnostic tests with failure to detect any structural or biochemical abnormality. This study was undertaken to assess the diagnostic and therapeutic role of laparoscopy in patients with unexplained chronic abdominal pain (UCAP). PATIENTS AND METHODS: Diagnostic laparoscopy was performed for 100 patients with UCAP not diagnosed by usual clinical examination and investigations. The pain in all patients was of unclear etiology despite all the investigative procedures. All patients were subjected to laparoscopic evaluation for their conditions. The findings and outcomes of the laparoscopy were recorded and analyzed. RESULTS: UCAP is common in females (62%) than in males. The most frequent laparoscopic findings detected were abdominal adhesions (30%), followed by pelvic inflammatory disease (25%), abdominal tuberculosis (12%), chronic appendicitis (8%), mesenteric lymphadenitis (5%) and diverticulosis (2%). In 18% of cases no identifiable cause could be found. Follow after 2 months revealed pain relief in 84% irrespective of cause of pain. CONCLUSION: Laparoscopy is an effective diagnostic and therapeutic modality in the management of patients with chronic abdominal pain.

Diagnostic laparoscopy for the evaluation of occult diaphragmatic injury following penetrating thoracoabdominal trauma

Occult diaphragmatic injury following penetrating thoracoabdominal trauma can be difficult to diagnose. Radiographic findings are often non-specific or absent. Undetected injuries may remain clinically silent, only to present later with life-threatening complications associated with diaphragmatic herniation. Diagnostic laparoscopy allows for the evaluation of trauma patients lacking clinical indications for a formal laparotomy. The purpose of this study was to evaluate the incidence of occult diaphragmatic injury and investigate the role of laparoscopy in patients with penetrating thoracoabdominal trauma who lack indications for exploratory laparotomy except the potential for a diaphragmatic injury. Haemodynamically stable patients with penetrating thoracoabdominal trauma without indications for laparotomy (haemodynamic instability, evisceration, or peritonitis on exam) and evaluated with diagnostic laparoscopy to determine the presence of a diaphragmatic injury were retrospectively reviewed. Thoracoabdominal wounds were defined as wounds bounded by the nipple line over the anterior and posterior chest superiorly and the costal margin inferiorly. One hundred and eight patients were evaluated for penetrating thoracoabdominal injuries (80 stabs and 28 gunshots) over the study period. 22 (20%) diaphragmatic injuries were identified. These were associated with injuries to the spleen (5), stomach (3) and liver (2). There was a greater incidence of haemopneumothorax (HPTX) in patients with diaphragmatic injury (32%) compared to those without injury (20%). 29% of patients with a HPTX had a diaphragmatic injury. However, 18% of patients with a normal chest radiograph were also found to have a diaphragmatic injury. The incidence of diaphragmatic injury associated with penetrating thoracoabdominal trauma is high. Clinical and radiographic findings can be unreliable for detecting occult diaphragmatic injury. Diagnostic laparoscopy provides a vital tool for detecting occult diaphragmatic injury among patients who have no other indications for formal laparotomy.

Role of laparoscopy in patients with previous negative exploration for impalpable testis

ObjectivesTo evaluate the impact of laparoscopy in the treatment of patients with previous negative inguinal exploration for impalpable undescended testes. MethodsA retrospective review was performed of patients who underwent laparoscopy after prior incomplete or “questionable” negative inguinal explorations for nonpalpable undescended testes. ResultsTwenty-seven males aged 1 to 22 years old, with 30 impalpable testes, underwent laparoscopy after prior negative open exploration. The operative notes were available for all patients. In 9 patients (33%), blind-ending spermatic vessels, vas deferens, and a closed ring were found. However, in the remaining 18 patients (67%), viable intra-abdominal or inguinal gonads (9 patients) and intra-abdominal remnants (9 patients) were identified. In 1 patient, seminoma of an intra-abdominal testis was present. ConclusionsWhen a patient is referred with an inconclusive previous open exploration for an impalpable gonad, laparoscopy has an important role in establishing or refuting the diagnosis of an absent testis. Moreover, therapeutic laparoscopy provides definitive options to standard open techniques when a viable testis or remnant is encountered. In this study, laparoscopy proved more accurate than open exploration with operative notes available defining the nature of the exploration.

The role of laparoscopy in patients with suspected peritonitis: experience of a single institution.

In this report, we retrospectively evaluate the effect of a laparoscopic approach in the diagnosis and treatment of acute abdominal pain in patients with suspected peritonitis. We evaluated the clinical records of patients admitted to our institution between January 1995 and July 2001 with a diagnosis of acute abdomen and suspected peritonitis. Ninety four of 229 patients underwent diagnostic laparoscopy. In this series, 83 (88.3%) of the cases were successfully treated by emergent laparoscopy for an acute abdomen. Eleven (11.7%) required conversion to an open laparotomy procedure. Overall, the preoperative diagnosis was confirmed by laparoscopy in 67 (71.27%) of the cases. It was not confirmed in 27 (28.73%). Postoperative mortality was 4.25%. Morbidity was 8.5%. Data reported in the literature establish that laparoscopy offers adequate visualization of the entire abdomen and pelvic cavity in the diagnosis of an abdomen acute secondary to peritonitis. In this series, laparoscopy confirmed the diagnosis in 97.8% of the patients, and minimally invasive treatment was achieved in 88.3% of the cases. Female patients with gynecologic disease particularly benefitted from a laparoscopic approach, which permitted the correct evaluation of this condition and may have prevented unnecessary laparotomy. We believe that laparoscopy is an accurate modality for the diagnosis and treatment of patients with an acute abdomen and suspected peritonitis when the diagnosis cannot be clearly made by physical examination and noninvasive methods.

Emerging role of laparoscopy in patients with chronic abdominal pain and assessment of late outcomes

Emerging role of laparoscopy in patients with chronic abdominal pain and assessment of late outcomes

Emerging role of laparoscopy in patients with chronic abdominal pain and assessment of late outcomes

Emerging role of laparoscopy in patients with chronic abdominal pain and assessment of late outcomes

Occult injuries to the diaphragm: prospective evaluation of laparoscopy in penetrating injuries to the left lower chest

Background: To evaluate the incidence of occult diaphragmatic injuries and investigate the role of laparoscopy in patients with penetrating trauma to the left lower chest who lack indications for exploratory celiotomy other than the potential for a diaphragm injury. Study Design: Patients with penetrating injuries to the left lower chest who were hemodynamically stable and without indications for a celiotomy were prospectively evaluated with diagnostic laparoscopy to determine the presence of an injury to the left hemidiaphragm. Diagnostic laparoscopy was performed in the operating room under general anesthesia. Results: One-hundred-ten patients (94 stab wounds, 16 gunshot wounds) were evaluated with laparoscopy. Twenty-six (24%) diaphragmatic injuries were identified (26% for stab wounds and 13% for gunshot wounds). Comparison of patients with diaphragmatic injuries with those without diaphragmatic injuries demonstrated a slightly greater incidence of hemo/pneumothoraces (35% versus 24%, NS). The incidence of diaphragmatic injuries in patients with a normal chest x-ray was 21% versus 31% for patients with a hemo/pneumothorax. An elevated left hemidiaphragm was associated with a diaphragmatic injuries in only 1 of 7 patients (14%). The incidence of diaphragmatic injuries was similar for anterior, lateral, and posterior injuries (22%, 27%, and 22% respectively). Conclusions: The incidence of occult diaphragmatic injuries in penetrating trauma to the left lower chest is high, 24%. These injuries are associated with a lack of clinical and radiographic findings, and would have been missed had laparoscopy not been performed. Patients with penetrating trauma to the left lower chest who do not have any other indication for a celiotomy should undergo videoscopic evaluation of the left hemidiaphragm to exclude an occult injury.

Role of laparoscopy in the evaluation of patients with suspected hepatic or peritoneal malignancy

The purpose of this study was to determine the role of laparoscopy in patients with suspected hepatic or peritoneal malignancy and a normal computerized tomograph (CT). Twenty-five consecutive patients with a normal liver and no peritoneal lesions on CT were evaluated. Patients with a documented primary neoplasm or a positive ascitic fluid cytology were excluded. At laparoscopy, malignancy was documented by biopsy in 12 patients for an incidence of 48%. Of the patients with exudative ascites, 75% had peritoneal metastases. In addition seven patients had benign liver disease documented by laparoscopic biopsy. Liver enzymes were not helpful in distinguishing benign and malignant disease in this group of patients. This study indicates that a negative CT does not exclude liver or peritoneal malignancy. Laparoscopy has a significant yield in patients with a negative CT suspected of having hepatic or peritoneal malignancy and is the procedure of choice in evaluating these patients.

The role of laparoscopy in the diagnosis of ectopic pregnancy: A plea for conservative management

This report evaluates the role of laparoscopy in patients admitted with the diagnosis of “Rule Out Ectopic”. There were 186 patients admitted to the Brookdale Hospital Medical Center in the 6-year period 1974–1979 inclusive with a diagnosis of “Rule Out Ectopic” or “Possible Unruptured Ectopic”. These patients were all laparoscoped. There were 157 satisfactory and 27 unsatisfactory laparoscopies. There were 71 ectopic pregnancies: 42 ruptured, 25 unruptured. Thirty-six cysts were diagnosed. The value of early laparoscopy is clearly established. Particular emphasis is placed on the diagnosis of the unruptured ectopic so that appropriate conservative management of the tube can be instituted in order to preserve potential reproductive capacity.