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The purpose of this research article was to determine the contribution of performing laparoscopy first in the etiological diagnosis of isolated exudative ascites. Our retrospective descriptive study had been performed over 15 years and included 46 patients who had undergone exploratory laparoscopy for exudative ascites. The average age of the patients was 52 years. Biological and morphological examinations contributed to making the etiological diagnosis. Therefore, diagnostic laparoscopy was indicated. Peritoneal carcinomatosis and tuberculosis were the most common causes seen in 34.2% and respectively 65.8% of cases. Visual laparoscopic diagnosis was peritoneal carcinomatosis in 16 cases and peritoneal tuberculosis in 28 cases, indecisive in one case and biliary ascites in one case. The histological diagnosis was peritoneal tuberculosis in 24 cases and peritoneal carcinomatosis in 12 cases and there were 9 cases of rare diagnoses. Peritoneal biopsies were negative in 2 cases for which the etiological diagnoses were kidney failure in one case and hypothyroidism in the other case. The postoperative recovery was simple in 42 cases (91.3%). The complications were: an accidental rupture of the left diaphragmatic dome in one case (2.1%), gastrointestinal bleeding in the immediate postoperative period in two cases (4.2%) and infected ascites in one case (2.1%). The post-operative scapular pain was reported in 4.2% of our patients. Operative mortality in our patients was nil. The overall care had an average cost of 1685.7 dinars for each of our patients, with extremes ranging from 1055.7 to 3605.7 dinars. For patients with isolated exudative ascites that should have been explored through laparoscopy first, the average cost would be 130.1 dinars, with a material gain for each of 1555.6 dinars. This attitude could also allow a reduction in the mean hospital stay (which was 27 days to few days) associated with early treatment. Our study confirms the interest in laparoscopy first with peritoneal biopsies as part of the etiological diagnosis of isolated exudative ascites.