Diagnostic laparoscopy is a very important tool in the armamentarium of Pediatric surgeon, when the diagnosis is not clear and all investigation modalities have failed to give a diagnosis or added to the confusion of the whole pathology. Diagnostic laparoscopy is well established procedure for clarifying recurring pain of the lower abdomen in children, and especially in young girls.
It has the advantage of confirming the disease existence, taking a biopsy for confirming the pathology and sometimes may be therapeutic in removing the lesion and curing the disease process.
The most common indication for Diagnostic laparoscopy in children is the presence of chronic pain abdomen when ultrasound and CT scan have failed to give a diagnosis. In such a situation, doing a diagnostic laparoscopy and inspecting the whole abdomen in a systematic fashion from one quadrant to the other may be helpful in establishing the diagnosis. If there are no findings, we resort to appendicectomy if the pain is localized to the right side of abdomen. Though it is a controversial topic whether to remove the appendix or not, but we have found it useful in large number of patients where the symptoms have improved post appendicectomy following diagnostic laparoscopy and removal of appendix.
The second common indication in Paediatric surgery is having a biopsy of the lesion. Mostly persistent mesenteric node enlargement or any tubercles on the serosa or peritoneal surface may confirm the lesion to be Koch’s. Recently laparoscopy is being increasing used for diagnosing and taking biopsy from solid tumors like Neuroblastoma, Wilm’s tumor, Lymphoma etc where the diagnosis is not clear and tissue sampling is required before starting chemotherapy. Laparoscopic biopsy is done when ultrasound or CT guided biopsy is not feasible due to presence of important structure on the path between the lesion and abdominal wall.
Diagnostic laparoscopy is considered 100% confirmative in cases of non palpable testis. It is the gold standard where no other diagnostic modality has 100% sensitivity and specificity. Similarly for the presence of hernia and patent processus vaginalis, diagnostic laparoscopy plays a big role. Girls may have varying degree of pathology in the pelvis e.g; Primary peritonitis, corpus luteal cyst, ovarian torsion, ovarian cyst etc which can be diagnosed by laparoscopy with 100% accuracy. In cases of Disorders of sexual differentiation, diagnostic laparoscopy may be very handy in diagnosing the presence or absence of mullerian structures and gonads inside the peritoneal cavity.
Advantage of laparoscopy is it gives a real time image of the lesion which is magnified even though it may be a small lesion which may not be picked up in routine radiological investigations.