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In some cases, a laparoscopy may be necessary to confirm the diagnosis [16]. Laparoscopy was systematically used in Sweden to ensure the accuracy of the diagnosis of salpingitis in the 1960s – 1970s and during this period the poor accuracy of the clinical diagnosis became apparent (Jacobson and Weström 1969). Microbiologic sampling also enabled laparoscopically and it became the gold standard for the diagnosis. In the 1980s, videolaparoscopy introduced a completely new surgical vision, and laparoscopy could serve not only for diagnosis but also for therapeutic procedures. Both conservative and radical laparoscopic procedures were now possible also in the management of PID patients [17].
DIAGNOSIS WITH LAPAROSCOPY
When the diagnosis is remain unclear after other tests are done or when antibiotic treatment is not working; diagnostic is the definitive test [10,18]. Failure to identify pelvic inflammatory disease (PID) at an early stage may lead to tubo-ovarian abscess (TOA) and added morbidity. Observational studies suggest that delaying treatment by 3 days can impair fertility. Missing a TOA when present or mistakenly treating one on an outpatient basis can lead to a ruptured TOA and the requirement for major abdominal surgery. Diagnostic laparoscopy is usually used [5,10].
In reproductive ages, early diagnosis is essential to prevent future sequelae causing infertility [19]
Azziz et al, 2003, in his study investigated 92 patient cases over an eight-year period concluded that laparoscopy continues to be a useful tool in the workup of an infertile couple. Using together with a set of predictors for intrapelvic disease may help many couples avoid months of needless therapies [19].
Laparoscopy also allows the gynecologist to look for signs of ectopic pregnancy or infection and scar tissue, and make repairs if necessary [18].
