Diagnostic Laparoscopy: Is It Being Overused?-Reply

Arch Surg. 1992;127(10):1256. doi:10.1001/archsurg.1992.01420100122024.
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In Reply.—Your critical reading of the article is simultaneously flattering and embarrassing! Table 1 indeed contains two numerical errors. One patient with ascites and a macronodular small liver (which is why he was removed from the hepatomegaly category) was omitted during the penultimate revision of the table; the correct number of patients is 120. The number of positive examination results is indeed 66, as you have correctly tabulated.

The approach to diagnosing patients with "significant adhesions" is certainly subjective. In this series of patients, "significant" means that adhesions were traumatic (not congenital), more than trivial in number or size, and somehow conceivably related to the presenting symptoms. That more attempts at adhesiolysis were not performed represents not only early inexperience with "therapeutic laparoscopy," but also some bias in suggesting that if a large area of the abdomen is affected, one may be creating as many future adhesions as one


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