Diagnostic laparoscopy in ascites of unknown origin: Chang Gung Memorial Hospital 20-year experience

Background: Ascites may appear with well-recognized disease but, in some situations, ascites is of unknown cause in spite of comprehensive study. The aim of this study was to assess the diagnostic accuracy of laparoscopy in patients with ascites of unknown origin, and evaluate the role of laparoscopy in this population after the advent of ultrasonography and computed tomography. Methods: We collected 20 years' data of diagnostic laparoscopy from retrospective chart review at Chang Gung Memorial Hospital in Linkou and Taipei. We compared the first 10 years' data with the latter 10 years, in respect of surgical technique evolution and the different contributions of ascites. Results: One hundred and seventy six patients who underwent laparoscopy for ascites of unknown origin were enrolled. They included: (1) carcinomatosis peritonei in 99 cases (56.2%); (2) tuberculous peritonitis in 31 cases (17.6%); (3) cirrhosis in 19 cases (10.8%); and (4) miscellaneous diagnoses in 27 cases (15.4%). Comparing the first 10 years' data with the latter 10 years', the distribution was nearly the same. Carcinomatosis peritonei accounted for the majority of cases and, with the evolution of anti-tuberculosis medicine, the number of tuberculosis cases is decreasing. Liver cirrhosis cases increased during the latter 10 years. Conclusion: Laparoscopy in combination with biopsy can clarify the causes of unexplained ascites in the majority of cases: it failed to reveal any gross abnormality in only 15% of cases. Therefore, laparoscopy is a valuable tool for the detection of the cause of unexplained ascites.