The role of laparoscopy in the diagnosis of ascites of unknown etiology

INTRODUCTION: Ascites is a pathological accumulation of detectable fluid in the peritoneal cavity. The standard procedure for diagnosis includes laboratory examinations and imaging methods. Diagnostic laparoscopy is a method that has been used for many years in patients whose etiology cannot be determined. The aim of this study was to define the value of diagnostic laparoscopy and histology in revealing the etiology of ascites of unknown origin.
METHODS: This retrospective study was completed at İnönü University Turgut Özal Medical Center General Surgery Department between June 2010 and July 2020. The study was approved by the ethics committee. Patients were diagnosed with ascites by gastroenterology and hepatology. All patients with open heart surgery, kidney or advanced liver disease, and patients younger than 18 years of age were excluded.
RESULTS: Six of the 23 patients in our study were male. The final diagnosis after laparoscopy was made by biopsy and laparoscopic fluid cytology. The pathology of specimens indicated 11 had tuberculosis, three had malignancy, four had mesothelioma, one had a malignant epithelial tumor, one had a gastrointestinal stromal tumor, and one had lymphoma. The etiology was unknown in two patients. Preoperative imaging and laparoscopic exploration were not possible in three patients. In this study, the accuracy of laparoscopy in the diagnosis of ascites of unknown origin was 91%.
DISCUSSION AND CONCLUSION: Laparoscopy has had an important role in the diagnosis, staging, and treatment of peritoneal and other abdominal diseases in recent years. The cause of ascites of unknown etiology varies according to the location of the study. Although different results have been reported in the literature, diagnostic laparoscopy is a successful diagnostic method in cases that cannot be diagnosed with preoperative imaging and laboratory methods. According to these data, diagnostic laparoscopy is a fast and reliable method for ascites cases of unknown etiology.