A study of diagnostic laproscopy in intra abdominal malignancies

Manikandan, D M (2014) A study of diagnostic laproscopy in intra abdominal malignancies. Masters thesis, Stanley Medical College, Chennai.

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Abstract

BACKGROUND: 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. OBJECTIVES OF STUDY: 1. Role of diagnostic laparoscopy for staging of abdominal malignancy. 2. To study convalescence period & cost effectiveness of the patient. 3. To assess the ability to avoid unnecessary laparotomies. METHODS: The present study evaluated 30 patients of abdominal malignancies admitted to Stanley Medical College Hospital during the period of January 2013 to December 2013 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 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. RESULTS: 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 & Mean cost for study group was Rs 8,897. It was significantly lower compared to open exploration. INTERPRETATION AND CONCLUSION: A short SL 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 & resectional 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 & cost expenditure when compared to open exploration. Staging Laparoscopy should be a routine tool in the armamentarium of all surgeons.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Laparoscopic Surgery ; Staging ; Gastric ; Colorectal ; Gall bladder.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 05 Jul 2018 03:43
Last Modified: 05 Jul 2018 17:04
URI: http://repository-tnmgrmu.ac.in/id/eprint/8632

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