Ascites

Presence of ascites is considered a contraindication to laparoscopic surgery because of the increased risk of port site metastasis.

Neoplasic ascites is usually secondary to primary hepatic neoplasms, metastases to liver or peritoneum, lymphomas, leukemias, or myeloid metaplasia. The differential diagnosis of ascites is shown in Table 3 (19).

The diagnosis of ascites is obtained by paracentesis and fluid analysis. Peritoneal effusion, like pleural effusion, can be subdivided as exudative or tran-sudative based on its characteristics. The serum-ascites albumin gradient (serum albumin level/ascitic fluid albumin level) correlates directly with portal pressure and can also be used to classify ascites. Patients with gradients >1.1 g/dL have portal hypertension, and those with gradients <1.1 g/dL do not; the accuracy of this method is in excess of 95% (20). A blood-ascitic fluid albumin gradient <1.1 g/dL is suggestive of malignant ascites. The characteristics of malignant ascitic fluid include a bloody appearance, high total protein levels (>2.0 g/dL), high LDH levels (>200 IU), low glucose (<60mg/dL), and high red blood cell contents. An ascitic fluid polymorphonuclear leukocyte count >500/ ^L is suggestive of spontaneous bacterial peritonitis (19).

Tsivian and Sidi recently reviewed published experimental and clinical studies on port site metastases after urological laparoscopy. Nine cases of port site metastases have been described before 2003 (21). Etiological factors included the presence of ascites, natural malignant disease behavior, host immune status, local wound factors, and insufficient technical experience of the surgeons and operating team. The authors suggested several preventive steps including avoiding laparoscopic surgery in patients with ascites.

The presence of ascites (irrespective of type) has been previously recognized as a significant and independent risk factor for early port site recurrences in the general surgery and gynecology literature (22,23).

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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