From January 1991 to June 1993 the authors performed 92 diagnostic lap
aroscopies when physical examination, laboratory tests, and noninvasiv
e imaging techniques failed to provide accurate diagnoses. Thirty-thre
e patients (36%) underwent laparoscopy to ensure or exclude diagnosis
in suspected intra-abdominal malignancy or to assess the operability i
n the cases of known cancer; 31 patients (34%) were evaluated for chro
nic abdominal pain; 15 patients (16%) were evaluated for acute abdomin
al pain; 9 trauma patients (10%) were evaluated to exclude or confirm
penetration of the peritoneum or laceration of intra-abdominal organs;
and 4 patients (4%) were operated on for miscellaneous conditions. Of
the 92 patients, laparoscopy led to diagnosis in 80 patients (87%), a
laparotomy was avoided in 78 patients (85%), and operative treatment
was done laparoscopically in 65 patients (71%). Diagnostic laparoscopy
will not replace laparotomy in every instance. However, in selected g
roups of patients, it may be used to yield diagnosis and help avoid un
necessary laparotomy.