| ORIGINAL ARTICLE
|Year : 2007 | Volume
| Issue : 1 | Page : 14-18
Laparoscopic biopsy in patients with abdominal lymphadenopathy
DS Bhandarkar1, RS Shah2, AN Katara1, M Shankar1, VA Chandiramani3, TE Udwadia1
1 Department of Minimal Access Surgery, P. D. Hinduja National Hospital, Veer Savarkar Road, Mahim, Mumbai, India
2 Department of Pediatric Surgery, P. D. Hinduja National Hospital, Veer Savarkar Road, Mahim, Mumbai, India
3 Department of General Surgery, P. D. Hinduja National Hospital, Veer Savarkar Road, Mahim, Mumbai, India
Background: Abdominal lymphadenopathy (AL) - a common clinical scenario faced by clinicians - often poses a diagnostic challenge. In the absence of palpable peripheral nodes, tissue has to be obtained from the abdominal nodes by image-guided biopsy or surgery. In this context a laparoscopic biopsy avoids the morbidity of a laparotomy.
Aim: This retrospective analysis of prospectively collected data represents our experience with laparoscopic biopsy of abdominal lymph nodes. Materials and Methods: Between October 2000 and November 2005, 28 patients with AL underwent laparoscopic biopsy. Pre-operative radiological imaging studies had identified a nodal mass in 20, a solitary node in 1, a cold abscess in 1 and a mesenteric cystic lesion in 1 patient. In five patients with chronic right lower abdominal pain and normal ultra-sonographic findings mesenteric nodes were identified and biopsied during diagnostic laparoscopy. Results: The sites of biopsied lymph nodes included para-aortic (10), mesenteric (8), external iliac (3), left gastric (2), obturator (1), aorto-caval (1) and porta hepatis (1). One patient with enlarged peripancreatic nodes mass and another with a mesenteric cystic mass had cold abscesses drained in addition to biopsy. There were no perioperative complications and the median postoperative stay was 2 days (range 1-4 days). Histopathology revealed tuberculosis in 23 patients, reactive adenitis in 2, lymphoma in 1 metastatic carcinoma in 1, and a retroperitoneal sarcoma in 1. Conclusions: In patients with AL, laparoscopy provides a safe and effective means of obtaining biopsy. It is of particular value in patients in whom (a) the nodes are small or present in locations unsuitable for image-guided biopsy, (b) adequate tissue cannot be obtained by image-guided biopsy or (c) previously undiagnosed lymphadenopathy is encountered during diagnostic laparoscopy.
D S Bhandarkar
India House No. 2, Kemps Corner, Mumbai - 400 036
Source of Support: None, Conflict of Interest: None
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