| Abstract: | Background: Despite various preoperative imaging methods, unnecessary laparotomy is still quite common in upper gastrointestinal surgery. There have been some studies demonstrating the use of diagnostic laparoscopy and laparoscopic ultrasound in the detection of small peritoneal seedling and vascular encasement of major vessels respectively, and these are the findings often inadequately assessed by preoperative imaging. Objective: This is a study to evaluate the use of diagnostic laparoscopy and selective laparoscopic ultrasound in the management of upper gastrointestinal malignancy. Method: A prospective study was carried out during the period from January 1996 to December 1997. Patients with upper gastrointestinal malignancy underwent diagnostic laparoscopy and selective laparoscopic ultrasound before resection. The role of laparoscopic staging was evaluated according to the number of patients who avoided unnecessary laparotomy. Results: There were 159 patients of mean age 62.8 years diagnosed with upper gastrointestinal tumours during the study period. These patients had various upper gastrointestinal malignancies: gastric carcinoma (89), oesophageal carcinoma (27), hepatobiliary malignancy (26), peri‐ampullary carcinoma (15) and small bowel tumour (2). Routine diagnostic laparoscopy and selective laparoscopic ultrasound were carried out for these patients unless there were contraindications such as a history of previous upper gastrointestinal surgery or the patient required palliative procedure irrespective of resectability. There were 106 diagnostic laparoscopies and 42 laparoscopic ultrasounds performed. Unnecessary operations were avoided in 32 patients (30%) due to either diffuse carcinomatosis or locally advanced tumour with encasement of major vessels. The role of laparoscopic staging in avoiding unnecessary surgery was particularly pronounced in peri‐ampullary carcinoma (46%) and hepatobiliary malignancy (38%). Conclusion: In summary, diagnostic laparoscopy and selective laparoscopic ultrasound are useful in avoiding unnecessary laparotomy particularly in hepatobiliary and peri‐ampullary malignancy.       |
