Page 55 - World Journal of Laparoscopic Surgery

Laparoscopy: A See- and -treat Modality for LAP in Females
Table 4: Final diagnosis after laparoscopy Table 6: Therapeutic laparoscopy
Laparoscopic diagnosis Number Percentage Laparoscopic treatment Number Percentage
Pelvic inflammatory disease 17 20.2 Adhesiolysis 35 41.7
Endometriosis 15 17.9 Cystectomy 15 17.9
Ectopic pregnancy 13 15.5 Fulguration of endometriotic plaques 15 17.9
Ovarian cyst 13 15.5 Cystotomy 8 9.5
Genital TB 6 7.1 Salpingectomy 8 9.5
Diagnostic dilemma 5 5.9 Salpingostomy 5 5.9
Only adhesions 5 5.9 Ovarian drilling 4 4.8
Polycystic ovarian disease 4 4.8 Myomectomy 3 3.6
Fibroid 2 2.4 Intrauterine contraceptive device 2 2.4
Misplaced intrauterine contraceptive 2 2.4 removed from peritoneal cavity
device with uterine perforation Salpingo-oophrectomy 1 1.2
Uterus didelphys with obstructed 1 1.2
hemivagina followed by other procedures given in Table 6. In 8.3% (n = 7) cases,
Pelvic abscess 1 1.2 the laparoscopy was converted into laparotomy and treatment
Total 84 100 was provided in the same sitting. No major intraoperative,
postoperative, or anesthetic complications were encountered.
Table 5: Correlation between provisional and laparoscopic diagnosis
of lower abdominal pain dIscussIon
Laparoscopic diagnosis
Diagnosed Undiagnosed Total Lower abdominal pain represents a significant problem in female
patients. It is a common problem faced not only by the gynecologists
Provisional Diagnosed 62 1 63 but by all practicing physicians. For the correct diagnosis of lower
diagnosis abdominal pathology, even a battery of investigations may not
Undiag- 17 4 21 reveal exact cause of pain. In the present study, on the basis of
nosed history, examination, and ultrasound a provisional diagnosis could
Total 79 5 84 be reached only in 75% (n = 63) of the cases and rest of the 25%
(n = 21) cases did not revealed any abnormality, which is similar
abdominal surgery without any gynecological problem were found to the study conducted by Morino et al., who diagnosed 73.4% of
in 5.9% (n = 5) of cases. Myoma was found in 2.4% (n = 2) of cases. patients on the basis of basic investigations and abdominal USG. 6
There were two (2.4%) cases of misplaced intrauterine contraceptive Although laparoscopy is an invasive modality, it allows the
device (IUCD) where the IUCDs were found in the Pouch of Douglas surgeon to survey the entire abdomen through a small puncture,
(POD). One patient (1.2%) was diagnosed as the didelphys uterus better than any other investigative modalities. It can be considered
with obstructed hemivagina with hematometra, hematocolpos, as the first-line interventional investigation for LAP. In the present
and hematosalpinx. There was one (1.2%) case of pelvic abscess study after laparoscopy, pathology was found in 94.1% (n = 79) of
where thick pus with adhesion was present. cases and no abnormality was noted in remaining 5.9% (n = 5) of
Correlation was done between the provisional diagnosis, made patients. Thus, laparoscopy increases the chances of diagnosing the
on the basis of clinical examination and abdominal ultrasound, with cause of LAP. This shows that laparoscopy is a very good diagnostic
the final diagnosis made after laparoscopy and histopathology tool for the LAP. Our finding is quite similar to Arya and Gaur, Bareeq
(Table 5). There were 73.8% (n = 62) cases where the cause of LAP and Dayna, Ali et al., and Baria, who also reported pathology on
was diagnosed both by clinical examination with USG and by laparoscopy in 90, 98, 93.3 and 90% of cases, respectively. 7–10
laparoscopy. In 20.2% (n = 17) of cases, no abnormality was detected Moussa et al., Kang et al., and Morino also found abnormality in
on clinical examination and USG; diagnosis was in dilemma. Only nearly same frequency, 78.6, 79.2, and 80%, respectively. 6,11,12
after laparoscopy, the cause of LAP was established. There were Besides diagnosis, laparoscopy can also help in the management
7.1% (n = 6) cases of genital TB, 5.9% (n = 5) cases of endometriosis, of both acute, subacute, and chronic LAP. Therapeutic intervention
5.9% (n = 5) cases of intra-abdominal adhesions, and 1.2% (n = 1) like adhesiolysis, fulguration of endometriotic lesions, cystectomy,
cases of PID. There was one case (1.2%) of chronic cervicitis where no and salpingectomy can be done at the same sitting, thus avoiding
abnormality was found on either laparoscopy or ultrasound. It was unnecessary laparotomy. Therefore, it can be considered as a “see
found on clinical examination. No abnormality was detected in 4.8% and treat” modality. In the present study, therapeutic laparoscopy
(n = 4) cases either on clinical examination, USG, or laparoscopy. On was performed in 82.1% of woman. Moussa, Arya and Gaur, Bareeq
applying the McNemar’s test, the p value was less than 0.05, which and Dayna, Baria, and Kumar et al. also have performed therapeutic
shows laparoscopy is statistically significant for the diagnosis of laparoscopy in the same sitting in 64.3, 75.5, 78, 90, and 69%
LAP. So, when history, examination, noninvasive investigations, patients, respectively. 7,8,10,12,13
and laparoscopy are combined the diagnosis rate is increased. Not Sometimes, though no abnormality is detected on laparoscopy,
only that, the patients are treated in the same sitting when the it helps in giving reassurance to the patients and removes the
pathology was noted. psychological concern, which is associated with chronic pelvic pain.
Diagnostic as well as therapeutic laparoscopy was performed in If laparoscopic exploration is not sufficient, the surgeon should
82.1% (n = 69) of women. Adhesiolysis was done in 41.7% (n = 35), not hesitate to convert into laparotomy. In the present study, 8.3%

World Journal of Laparoscopic Surgery, Volume 13 Issue 1 (January–April 2020) 53