Objective: To assess the diagnostic accuracy of laparoscopy in the study of patients with ascites of unknown cause, and the frequency of laparoscopy use for that indication after the advent of ultrasonography and computed tomography.
Design: A retrospective study of 4.536 laparoscopies performed in 16 years, in two periods of 8 years, and the correlation with the pathologic diagnosis.
Patients: 137 patients in whom laparoscopy was indicated for the study of ascites of unknown cause.
Results: 63.5% of laparoscopies were performed over the first 8-year period, and 36.5% in the second (p = 0.0001), and for the study of ascites 2.6 and 3.8% respectively. Laparoscopy and biopsy were diagnostic in 98.5% of cases; 51% carcinomatosis, 17.5% liver cirrhosis, 11.7% hepatic neoplasm and others. Two of five cases of peritoneal tuberculosis were considered carcinomatosis at laparoscopy. There were no serious complications.
Conclusions: The advent of new imaging method has reduced the use of laparoscopy, although it is still employed frequently for the study of ascites. Laparoscopy with biopsy when necessary has an excellent effectiveness and accuracy for the diagnosis of ascites of unknown cause.