Evaluation of Role of Diagnostic Laparoscopy for Staging in Abdominal Malignancies
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2014, Vol 2, Issue 2
Abstract
Abdominal malignancies are one of the most common malignancy affecting humans. Many patients with abdominal malignancies are found at exploration to be unable to undergo resection. Laparoscopy has been suggested as a sensitive method for detecting metastatic disease in this group of patients. Diagnostic laparoscopy effectively establishes a diagnosis, can be therapeutic, and causes less morbidity and mortality than a formal laparotomy. Also there is not much literature about cost effectiveness of the procedure & reduction in convalescence period. The objectives of the study was to find the role of diagnostic laparoscopy for staging of abdominal malignancy and to assess the ability to avoid unnecessary laparotomies. The present study evaluated 30 patients of abdominal malignancies admitted to the hospital, during the period of November 2008 to November 2010 fulfilling the inclusion and exclusion criteria. Diagnostic Laparoscopy was performed in all 30 patients after taking written consent. Diagnostic Laparoscopy was immediately followed by definitive or palliative surgeries when required. Categorical variables in the study were compared using Chi square test, contingency coefficient analysis, Independent sample t test, one sample t test using SPSS software. P value of < 0.05 was considered to be significant. Study included total of 30 patients comprising of stomach, biliary & colorectal malignancies with mean age of 53 years (21-70). 13 cases (43.3%) were found to be unresectable on staging laparoscopy and prevented from undergoing unnecessary laparotomy. 6 cases (20%) had liver metastases & 8 cases (26.7%) had peritoneal seedings on staging laparoscopy which were not revealed on preoperative imaging workup. Mean duration of Staging Laparoscopy was 18.83 min (10-30mins). Staging Laparoscopy had minimal major complication rates. Mean convalescence period was 8.2 days for study group. It was significantly lower compared to open exploration. A short Staging Laparoscopy performed just before the planned surgical procedure to certify the operability is found to be safe & very effective. It is very accurate in assessing peritoneal seedings, hepatic metastases which are not found on imaging modalities. Staging laparoscopy has a significant impact on decisions regarding the treatment plan, helps in more careful planning of palliative & resection procedure in advanced conditions, performing biopsy from sites of dissemination & having histological confirmation. It spares patients from unnecessary laparotomies and has been found to significantly decrease the hospital stay. Staging Laparoscopy should be a routine tool in the armamentarium of all surgeons.
Authors and Affiliations
Dr. Sreeharsha. M. V, Dr. Sanketh Shah, Dr. Siddesh. G, Dr. Mohammad Raza
Keywords
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