Laparoscopy: An answer to ascites of undetermined origin: Retrospective study

Background: Ascites, many of times remained unclassified by Clinical, laboratory and radiological tests. Laparoscopy provides answer to these cases as it has high diagnostic role, Pre therapeutic, Observation and staging of diseases & therapeutic roles. Diagnostic laparoscopy is a cost-effective procedure with overall high accuracy.

Methods: This was a Retrospective study including all the patients who have been explored for exudative ascites. The study was conducted at Amandeep Hospital Pathankot, Punjab, India in all patients admitted in the department of gastroenterology in collaboration with department of general surgery from June 2015 to June 2022. Fifty patients with low SAAG ascites were included for the study, who underwent laparoscopy to find out various etiologies of ascites.

Results: Most of the patients in our study were in age group of 21-40(50%) years with mean age of 38 years. 60% were females, while as 40% were males. Ascitic fluid analysis revealed a predominance of lymphocytes on cytological analysis in (75%), exudative (SAAG<1.1g/dl) in (95%) of patients. High Ascitic fluid ADA was found in (70%). Culture of ascitic fluid & ZN Staining was positive in none. Abdominal CT scan, Peritoneal and mesenteric thickening (60%) and mesenteric adenopathy (50%), peritoneal nodes in (26%) of cases. The predominant laparoscopic findings of the patients in our study were ascites (100%), peritoneal nodules (88%), adhesions (70%), and Congested peritoneum (64%). Cirrhosis was also noted in (10%) cases. Most common postoperative diagnosis of the patients were abdominal tuberculosis (60%), abdominal malignancy (24%). Cirrhosis was in (8%) cases and unremarkable in (8%) of patients.

Conclusion: It can be safely concluded that diagnostic laparoscopy is a safe, quick, and effective adjunct to diagnostic modalities, for establishing a conclusive diagnosis, but, whether, it will replace imaging studies as the primary modality for diagnosis, needs more evidence.