الفهرس 
History of LaparoscopyOnly 14 pages are availabe for public view
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Abstract
The present study was carried out to evaluate laparoscopy as a diagnostic and therapeutic tool in management of acute abdomen.
Acute abdominal pain can present a diagnostic dilemma. It accounts for 13-40% of all emergency surgical admission. Clinical examination often fails to yield a diagnosis, particularly when the symptoms and signs are compounded by extremes of age or obesity. This problem is more common, in but not exclusive to, female patients. Blood investigations in most scenarios; simply indicate the presence of an inflammatory process. Radiology may suggest a diagnosis, but both radiography and ultrasound have a false-negative rate (Schietroma et al., 2005).
This study included one hundred patients from who a complete history was obtained, a thorough clinical examination was carried out. All the patients underwent routine preoperative workup, to see their fitness for general anesthesia.
In this study, diagnostic laparoscopy was successful in 99 cases. 75 patients (75%) completed the operation laparoscopically. Therapeutic laparoscopy performed successfully for 60 cases (60%), while in 15% of cases no significant pathology was found on laparoscopic examination, and these patients needed no therapeutic intervention. Even in cases converted to open surgery (25%), ”one of them for diagnostic purpose”, the initial diagnostic laparoscopy made us to fashion the incision of laparotomy in the proper site, also this helped us to perform minilaparotomy in 6 females (6%).
In this work, the postoperative hospital stay after laparoscopy (mean: 2.1 days) was less than that after laparotomy (mean: 4.55 days). Wound infections occurred in 3% after laparoscopy and in 20% after laparotomy.
All patients were followed up postoperatively for relief of complaints. One patient who had negative findings in diagnostic laparoscopy, continued to complain of the same preoperative symptoms. Later on, this patient was found to suffer from a Mediterranean fever, which confirmed by the use of specific serological tests.
Women of child-bearing age present a particular problem in the diagnosis of acute lower abdominal pain. Gynecological conditions may present with signs and symptoms that are indistinguishable from acute appendicitis, and traditionally diagnostic laparoscopy has been favored in this group, as it provides greater visualization of other intraabdominal organs and less postoperative adhesions, particularly when the additional advantages of therapeutic laparoscopy are considered.
Early diagnostic laparoscopy and treatment result in accurate, prompt and efficient management of acute abdominal pain. This technique reduces the rate of unnecessary laparotomy, and right iliac fossa incisions and increases the diagnostic accuracy in these patients. This treatment method is feasible where facilities are available to accommodate the workload and there are practitioners with the requisite expertise (Golash and Willson, 2005).
We appreciate that not all institutions have the facilities or scheduling to submit all patients with acute abdominal pain to diagnostic laparoscopy and that there may be fears that this policy would increase costs. However, we think that there are significant patient benefits in making an early diagnosis and initiating treatment. It is also our impression that the costs are balanced by the shorter hospital stay, and the reduction in complications rate. In addition the benefits in terms of laparoscopic training for junior staff have been so significant.
Early interventional laparoscopy is recommended as a diagnostic and therapeutic tool in acute abdominal pain, irrespective of the patient’s age or sex, to take advantage of the proven benefits of minimal-access surgery and to ensure that no diagnosis is missed.