What is the role of diagnostic laparoscopy in a gastroenterology unit?

Evaluation of diagnostic laparoscopy results in Turkish patients with unexplained ascites

BACKGROUND

Diagnostic laparoscopy is a minimally invasive surgical method to diagnose intra-abdominal diseases.

AIM

To evaluate patients with unexplained ascites who could not be definitively diagnosed via advanced radiological and endoscopic methods and serological, cytological, and microbiological examinations and, therefore, underwent diagnostic laparoscopy.

METHODS

This retrospective analysis evaluated 82 patients who underwent diagnostic laparoscopy due to unexplained ascites. Patients’ medical records were obtained from the hospital database. Their age, sex, complaints at admission, laboratory results, radiological imaging results, diagnostic laparoscopy reports, and pathology reports were analyzed.

RESULTS

The serum-ascites albumin gradient was < 1.1 in 96.3% of the patients (n = 79). Among patients, 22 (26.8%) had benign diagnoses and 60 (73.2%) had malignant diagnoses. In addition, 55 (67.1%) were deceased, and the median follow-up time from diagnosis to death was four months. The overall follow-up time ranged from 1 to 142 months, with a median of 14 months. Patients’ diagnoses were significantly associated with their survival (P < 0.05, χ² test). The mortality rate was 86.7% among patients with malignant diagnoses and 13.6% among patients with benign diagnoses.

CONCLUSION

Diagnostic laparoscopy is minimally invasive, has a low complication rate, and requires a short hospital stay. It can be safely performed to diagnose and treat ascites that remain unexplained after advanced radiological and endoscopic examinations.

A Case Report of Occult Breast Cancer Detected by Diagnostic Laparoscopy for Suspected Ovarian Cancer

Diagnostic laparoscopy is useful in the management of gynecological cancers; however, it can occasionally result in the detection of other malignancies. Occult breast cancer (OBC) is metastatic breast cancer without a recognized primary breast lesion. We report a rare case of OBC that was detected laparoscopically. A 64-year-old female presented to our hospital with back pain. Magnetic resonance imaging (MRI) revealed a 50 mm multicystic tumor with an internal nodule in the right ovary. Positron emission tomography/computed tomography showed abnormal accumulation in multiple lymph nodes, moderate accumulation in the ovarian tumor nodule, and no accumulation in the breasts. Ovarian cancer was suspected, and a diagnostic laparoscopy was performed. Laparoscopically, a cystic tumor in the right ovary and 10 mm nodule in the right round ligament were observed and partially resected. Immunohistopathologically, the nodules of the round ligament exhibited features consistent with those of breast cancer, but the ovarian tumor was a seromucinous borderline tumor. MRI revealed no breast lesions. Therefore, the malignancy was diagnosed as an OBC.

Feasibility and Safety of Transgastric Natural Orifice Transluminal Endoscopic Surgery in the Diagnosis of Ascites of Unknown Origin

Objective: The purpose of this study was to evaluate the feasibility and safety of transgastric natural orifice transluminal endoscopic surgery (TG-NOTES) combined with biopsy in the diagnosis of unknown ascites. Method: This retrospective study used data from the first affiliated hospital of Nanchang university on 51 patients who were diagnosed with ascites of unknown origin between January 2013 and May 2019 and experienced peritoneal biopsy through TG-NOTES. The outcome measures included diagnostic accuracy and procedure-related adverse events. Results: TG-NOTES was performed successfully in 46 of 51 patients, tuberculous ascites in 38 cases, carcinomatous ascites in 4 cases, cirrhotic ascites in 1 case, and 3 cases showed no obvious abnormalities in pathological result. Five cases failed to be diagnosed because of abdominal adhesions. The diagnostic rate of TG-NOTES was 84.3%. There were no severe procedure-related adverse events and no mortality. All patients had good wound healing and no complaint of discomfort on follow-up. Conclusion: The majority of ascites of unknown origin can be expounded through TG-NOTES combined with biopsy without severe complication, therefore, it is a feasible and safe method to detect the cause of unexplained ascites.

Iatrogenic diaphragmatic hernia as a late complication of laparoscopic excisional biopsy of peritoneal nodules: A case report

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We report a rare case of delayed diaphragmatic hernia caused by laparoscopic biopsy.

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Coagulation for hemostasis after biopsy could cause diaphragmatic hernia.

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The heat by soft coagulation might unexpectedly damage diaphragmatic muscle.

Introduction

Iatrogenic diaphragmatic hernias have been reported as a rare complication of abdominal surgery, and only a few reports have suggested minimal intraoperative injury to the diaphragm as a cause.

Presentation of case

We report a rare case of delayed diaphragmatic hernia caused by laparoscopic excisional biopsy of a peritoneal lesion on the diaphragmatic peritoneum. A 70-year-old woman with gastric gastrointestinal stromal tumor underwent laparoscopic partial gastrectomy and excisional biopsy for white nodules on the left diaphragmatic peritoneum using laparoscopic scissors. Slight bleeding that occurred after excisional biopsy was stopped using a soft-coagulation system. Six months after her first surgery, a left diaphragmatic defect and transverse colon migration into the thoracic cavity were detected on computed tomography. The patient subsequently underwent laparoscopic diaphragmatic hernia repair. The site at which the diaphragm defect occurred was consistent with the site of excisional biopsy. The defect was closed with interrupted suturing using non-absorbable threads, following which a composite mesh was applied above the suture site for reinforcement.

Discussion

This is the first report of an iatrogenic diaphragmatic hernia after diagnostic laparoscopy for peritoneal excision biopsy of the diaphragmatic surface. In the present case, the coagulation procedure for hemostasis after peritoneal resection was considered to be the cause of the diaphragmatic hernia. The heat generated by soft coagulation might have unexpectedly reached and damaged the deep areas of the diaphragmatic muscle.

Conclusion

Surgeons performing laparoscopic excisional biopsy of the diaphragmatic peritoneum should consider the potential risk for iatrogenic diaphragmatic hernias.

Role of transgastric natural orifice transluminal endoscopic surgery in the diagnosis of ascites of unknown origin (with videos)

BACKGROUND

Natural orifice transluminal endoscopic surgery (NOTES) has been established in animal models and human studies.

OBJECTIVE

The aim of this study was to assess the feasibility and efficacy of applying transgastric NOTES to diagnose patients with ascites of unknown origin.

DESIGN

Prospective study.

SETTING

Two university and teaching hospitals.

PATIENTS

Patients with ascites of unknown origin.

INTERVENTIONS

Diagnostic transgastric NOTES.

MAIN OUTCOME MEASUREMENTS

Characteristic of ascites cases, conditions of the abdominal cavity, diagnostic accuracy, adverse events, and follow-up time.

RESULTS

Transgastric NOTES was performed successfully in 78 patients with ascites of unknown origin, and 72 cases (92.3%) were clearly diagnosed. They included malignant tumors (39 cases), tuberculous peritonitis (28 cases), chronic hepatic inflammation (3 cases), necrotizing lymphadenitis (1 case), and eosinophilic serositis of the small intestine (1 case). In addition, there were 6 nondiagnostic cases, and no severe adverse events were found.

LIMITATIONS

Nonrandomized control analysis.

CONCLUSION

Transgastric NOTES in combination with biopsy can elucidate the causes of ascites of unknown origin in the majority of cases. Therefore, it is a feasible and effective approach to access the peritoneal cavity and also a valuable modality to detect the cause of diseases with ascites of unknown origin.

Gasless laparoscopy-assisted surgery for intraabdominal/retroperitoneal tumor of unknown origin: a bridge between total laparoscopic surgery and conventional open surgery

INTRODUCTION

Gasless laparoscopy-assisted surgery has been utilized in many abdominal diseases, and it has been proved to be effective and efficient compared with conventional open surgery. The study was conducted to evaluate the efficacy of gasless laparoscopy-assisted surgery in management of intraabdominal/retroperitoneal tumor of unknown origin.

METHODS

From June 2004 to April 2009, nine patients who underwent gasless laparoscopy-assisted surgery for intraabdominal/retroperitoneal tumor of unknown origin were recruited. Intraabdominal/retroperitoneal tumor of unknown origin was defined as (1) diagnosis of enlarged retroperitoneal lymph node; (2) evaluation of peritoneal or mesenteric lesion, or tumor of nondigestive systems; and (3) staging of intraabdominal malignancy.

RESULTS

Four patients underwent gasless laparoscopy-assisted surgery for retroperitoneal enlarged lymph nodes, four for evaluation of intraabdominal lesion, and two for staging of the malignancy. Sufficient tissue was obtained from all patients, and the diagnosis was as follows: three lymphomas, three peritoneal carcinomatoses, two chronic imflammations, and one benign tumor.

CONCLUSIONS

Three purposes can be achieved: a familiar method for the surgeon compared with total laparoscopic surgery, easy accessibility for further oncological management, and intraoperative miniconversion for peritoneal examination. It is a safe and effective way to obtain tissue for pathology and feasible in case of necessary sequential tumor resection.