Diagnostic laparoscopy in acute lower abdominal pain

The laparoscope once was a popular diagnostic tool. Advances in video imaging, instrumentation, and safety of pneumoperitoneum have re-aroused the potential of laparoscopy in diagnosis and therapy. Diagnostic laparoscopy was performed in 55 patients between January 1992 and February 1993, including 18 female and 37 male patients whose ages from 14 to 85, with a mean of 48. The clinical, sonographic (39/55), laparoscopic and final diagnoses were recorded and analysed. Laparoscopy had a high accuracy (94.5%), reaching statistical significance (p<0.005). The accuracy of clinical and sonographic diagnosis was 61.8% and 51.3%, with a statistical correlation of (p<0.005). But there was no significance in comparison with final diagnosis. After use of laparoscopy, 11 in 48 diagnosed as vermix disease were not related to appendix, and 7 diagnosed as non-vermix disease had new diagnoses. At the same time, therapeutic laparoscopy was performed in 33, with only diagnostic laparoscopy in 1 and exploration in others. No mortality or complication related to diagnostic laparoscopy was noted. Diagnostic laparoscopy seemed to be useful with patients with WBC < 10000/cumm (13/13), and in reproductive- aged females (12/12). In conclusion, laparoscopy is a safe procedure. In patients with acute lower abdomen, it could reduce unnecessary observation and examination and achieve more exact diagnosis. It also could change therapeutic process and the choice of proper surgical method. The role of this technique should not be underestimated by today's abdominal surgeon.