Research Article: The role of laparoscopy in the propaedeutics of gynecological diagnosis1

Date Published: February 14, 2019

Publisher: Sociedade Brasileira para o Desenvolvimento da Pesquisa em
Cirurgia

Author(s): Gislaine Laperuta Serafim Argentino, Flávia Neves Bueloni-Dias, Nilton José Leite, Gustavo Filipov Peres, Leonardo Vieira Elias, Vitória Cristina Bortolani, Carlos Roberto Padovani, Daniel Spadoto-Dias, Rogério Dias.

http://doi.org/10.1590/s0102-865020190010000010

Abstract

To evaluate agreement between pre- and post-laparoscopy gynecological
diagnosis in order to demonstrate the rationality of this minimally invasive
technique use in gynecological propaedeutics.

Retrospective chart review study conducted between March 2010 and October
2016 based on a convenience sample. 315 patients undergoing surgical
laparoscopy at the Center of Gynecologic Endoscopy and Family Planning of
Botucatu Medical School/UNESP. Pre- and postoperative diagnoses were
compared by the diagnosis agreement test considering the proportions of
events.

Laparoscopy contributed to diagnosis in 59.6% of infertility cases
(P>0.05), in 93.7% of chronic pelvic pain of undetermined origin
(P<0.01) and conclusively elucidated the diagnosis of acute abdomen and the ruling out of tubo-ovarian abcess (P<0.05). Laparoscopy also increased the diagnosis of pelvic-abdominal adhesions in 76.7% (P>0.05).

The use of laparoscopy considerably contributed to diagnostic elucidation,
especially in cases of undetermined chronic pelvic pain.

Partial Text

Diagnosis plays a crucial role in clinical practice. It is the basis for developing
an adequate treatment plan and establishing effective patient management
strategies1. Accurate diagnosis reduces the risk of unnecessary therapies and optimizes
the use of resources, particularly when they are limited, bringing benefits
throughout the medical assistance process1,2. In the field of Gynecology, a careful diagnosis is especially critical
because a great part of the symptoms and diseases that affect women may directly
correlate with other specialties. Thus, misdiagnosis can shortly lead to the
worsening of a patient’s condition, aggravating morbidity and causing higher costs
to the healthcare system3,4.

Patient mean age was 35 years. The majority of women were overweight (BMI= 26.94
±5.52) and in reproductive age (84.1%) (Table
1). Hormone contraceptives were used by 34.6%, and history of treatment
for uterine infection was reported by 11.4% of the patients. The most frequently
reported complaint was chronic pelvic pain (34%), followed by dysmenorrhea (15.9%),
desire for definitive contraception (15.6%), and desire for reproduction (13%)
(Table 2). Eleven per cent of the women
complained of significantly increased menstrual flow, while 14.3% had no clinical
complaint and were referred to surgery due to incidental image findings, notably
regarding adnexal formations. Nineteen per cent of the patients reported more than
one clinical complaint of relevance.

Compared to conventional open surgery, laparoscopy has numerous advantages, such as
(1) less postoperative pain, (2) shorter hospital stay, (3) lower rates of
postoperative complications, (4) early return to daily activities, and (5) better
esthetic effect. These benefits combined decrease the direct and indirect costs
related to the surgical procedure3,5,7,11. In cases where the etiology of the condition is not fully clear,
laparoscopy has been shown to be a safe and reliable adjunct to gynecological
diagnosis that may spare patients an exploratory laparotomy and its greater risks of
complications14-19.

 

Source:

http://doi.org/10.1590/s0102-865020190010000010

 

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