Page 54 - World Journal of Laparoscopic Surgery

Laparoscopy: A See- and -treat Modality for LAP in Females
out in all the patients, which included complete hemogram, renal cervical motion tenderness 15.5% (n = 13), retroverted uterus 8.3%
function test, random blood sugar, urine examination, and culture (n = 7), and bulky uterus 8.3% (n = 7).
sensitivity, if required. Imaging methods included USG of the Transabdominal ultrasound was performed in all the patients.
abdomen and the pelvis, which was performed in all the patients, The collection in the pouch of Douglas was found in maximum
and X-ray, CT scan, or MRI whenever necessary. Laparoscopy was number of cases 34.5% (n = 29), followed by other abnormalities
performed in all the patients under general anesthesia; the Karl as shown in Table 2. After history, examination, and ultrasound,
Storz laparoscope (10 mm and 5 mm), both straight viewing 0° and a provisional diagnosis was established in only 75% (n = 63) of
oblique viewing 30°, was used. patients. In rest of 25% (n = 21), the diagnosis was in dilemma.
The methodical inspection of the upper and lower abdomen Most common cause was PID in 19.0% (n = 16) followed by other
was done. All the pathological findings were noted, and if required causes (Table 3).
the operative procedure was also done in the same sitting All the 84 patients underwent laparoscopy for confirmation.
like taking biopsies, performing adhesiolysis, cyst aspiration, After which diagnosis was established in 94.1% (n = 79) of patients.
cystectomy, salpingectomy, oophorectomy, etc. All the samples In 5.9% (n = 5) of patients, diagnosis of pain could not be established
were sent for histopathological examination and the final diagnosis as no pelvic pathology was observed on laparoscopy. The most
was confirmed. In cases where complication occurred or therapeutic cause of LAP after laparoscopy was PID present in 20.2% (n = 17)
laparoscopy was difficult, the laparoscopic procedure was converted of patients (Table 4).
into laparotomy. The gathered data were statistically analyzed. The second most common diagnosis was endometriosis
Descriptive statistics that included frequency, mean, percentage, present in 17.9% (n = 15) of cases. Ectopic pregnancy was present
and standard deviation were calculated. The McNemar’s test was in 15.5% (n = 13) of cases. Ovarian cyst was found in 15.5% (n = 13)
used to test the significance of difference for qualitative variables. of cases. About 7.1% (n = 6) of females were diagnosed as cases of
The Probability value (p value < 0.05) was considered statistically genital TB. Out of which, one case was of genital TB with fibroid.
significant. polycystic ovarian disease (PCOD) was found in 4.8% (n = 4) of cases.
Intra-abdominal adhesions formed secondary to past history of
results Table 2: Findings on transabdominal ultrasonography
The mean age of patients in the study was 28.0 ± 6.4 years (age
range 15–60 years). The other characteristics of the patients are Structure Abnormality Number Percentage
as shown in Table 1. We categorized the duration of pain as acute Uterus Fibroid 3 3.6
(duration of less than 1 week), which was present in 16.7% (n = 14), Perforation 1 1.2
as subacute (duration of 1 week to 6 months) in 26.2% (n = 22), Absent (post- 1 1.2
and as chronic (duration of more than 6 months) in 57.1% (n = 48) hysterectomy)
of patients. The maximum duration of pain was 36 months and the Didelphys with 1 1.2
minimum duration was 24 hours. hematometra
Along with LAP, the associated symptoms were dysmenorrhea hematocolpos
in 30.9% (n = 26), primary infertility in 22.6% (n = 19), dyspareunia Fallopian tubes Ectopic pregnancy 13 15.5
in 15.4% (n = 13), spotting in 14.3% (n = 12), secondary infertility Dilated 2 2.4
in 9.5% (n = 8), white discharge per vaginam in 7.2% (n = 6), Hydrosalpinx 2 2.4
oligomenorrhea in 7.2% (n = 6), and menorrhagia in 5.9% (n = 5) of Ovaries Ovarian cyst 13 15.5
patients. Per vaginal examination revealed tenderness in the fornix Ovarian endometriosis 10 11.7
34.5% (n = 29), adnexal mass 30.9% (n = 26), restricted mobility TO mass 4 4.8
of the uterus 19.0% (n = 16), fullness in the fornix 15.5% (n = 13), Polycystic ovaries 4 4.8
Pouch of Douglas Collection 29 34.5
Table 1: Characteristics of the patients Intrauterine 2 2.4
Number Percentage contraceptive device
Marital status
Married 76 90.5 Table 3: Provisional diagnosis on the basis of history, examination, and
Unmarried 08 9.5 ultrasound
Parity Diagnosis Number Percentage
Nulliparous 48 57.1 Diagnostic dilemma 21 25.0
Multiparous 36 42.9 PID 16 19.0
Past history Ovarian cyst 13 15.5
Abdominal surgery 22 26.1 Ectopic pregnancy 13 15.5
PID 20 23.8 Endometriosis 10 4 11.9
Polycystic ovarian disease
4.7
Pulmonary TB 2 2.4 Fibroid 3 3.6
Abdominal TB 1 1.2 Misplaced Intrauterine contraceptive 2 2.4
Duration of pain device
Acute 14 16.7 Cervicitis 1 1.2
Subacute 22 26.2 Didelphys uterus 1 1.2
Chronic 48 57.1 Total 84 100

52 World Journal of Laparoscopic Surgery, Volume 13 Issue 1 (January–April 2020)