Peritoneoscopy as an aid to diagnosis

Many incurable patients would be spared useless operations if their multiple metastases were iecognized at the outset. The use of the peritoneoscope to examine parts of the abdominal cavity has not gained in popularity, in spite of intermittent reports outlining the technique and indications for the procedure (Walker and Playfair, 1942; Handley, 1955; Handley and Nurick, 1956; Ruddock, 1957). The mortality from diagnostic laparotomy in patients with abdominal malignant disease and liver metastases is high and has been estimated at 12 to 19% (McHardy, Browne, and Edwards 1947; Cayer and Sohmer 1955). The morbidity from postoperative pain and complications is difficult to assess but is often severe enough to detract from the value of the operation. Peritoneoscopy provides the opportunity of examining parts of the abdominal cavity without the morbidity or mortality of laparotomy. A collected review of 8,000 patients examined by peritoneoscopy reports a mortality rate of0-2% (Handley and Nurick, 1956). Peritoneoscopy causes little discomfort and the patients can leave hospital within a few days. The limitations of the procedure must be emphasized. The anterior surface of the liver, the peritoneum of the anterior abdominal wall, and the omentum can nearly always be viewed. The spleen, the anterior surface of the stomach, and the gall bladder are sometimes visible. A systematic search of the intestine is not possible at peritoneoscopy and it is not a suitable way of examining the pelvic organs. Surgical manoeuvres through an operating peritoneoscope are difficult to perform, unsatisfactory in execution, and add to the risks of the procedure (Handley and Nurick, 1956). Patients with evidence of cirrhosis of the liver and portal hypertension fornm another group where peritoneoscopy can prove valuable, provided that the appearances of the liver are considered together with biochemical tests of liver function and the histopathological picture of biopsy material. The technique ofthe examination will be described.