Background: Ascites, the accumulation of fluid in the peritoneal cavity, poses diagnostic challenges when its etiology remains obscured despite comprehensive clinical, laboratory, and radiological evaluation. This study aims to evaluate the diagnostic accuracy of laparoscopy in elucidating the causes of ascites of obscured origin, emphasizing the distinction between tubercular ascites and malignant ascites. Materials and Methods: A longitudinal observational study was conducted on 20 patients with ascites of obscured origin, who underwent diagnostic laparoscopy at the Department of General Surgery, AIIMS Patna, between June 2019 and March 2021. Inclusion criteria comprised patients over 15 and under 80 years of age, fit for general anesthesia, with ascites of obscured origin. Ascitic fluid analysis, ultrasonography, CT scans, and histopathological examination of biopsy specimens obtained during laparoscopy were employed for diagnosis. Results: Of the 20 patients, 50% were diagnosed with tubercular ascites, 30% with peritoneal carcinomatosis, 10% with liver cirrhosis, and 10% remained undiagnosed. Diagnostic laparoscopy revealed distinctive omental and peritoneal features correlating with the underlying etiology. The sensitivity and specificity of laparoscopy in identifying tubercular ascites were high, with granulomas and tubercles as key findings. Peritoneal carcinomatosis was characterized by nodular omentum and macronodular patterns on the peritoneum. Conclusion: Diagnostic laparoscopy significantly enhances the accuracy of diagnosing ascites of obscured origin, facilitating the differentiation between tubercular ascites and peritoneal carcinomatosis. Its use should be considered in cases where non-invasive methods fail to provide a conclusive diagnosis, allowing for timely and appropriate management.