Laparoscopy: a tool for undiagnosed pain abdomen

Abstract

Background: Diagnostic laparoscopy has been in the armamentarium of the surgeon and gynaecologist for many years as a useful technique for evaluating pelvic pathology and it is now one of the most frequently performed laparoscopic procedures. The purpose of this study is to evaluate the role of diagnostic laparoscopy in undiagnosed pain abdomen. The Objectives of this study is to evaluate laparoscopy as a diagnostic tool in cases of undiagnosed abdominal pain where clinical symptoms and investigations are not conclusive and to evaluate benefits and complications of diagnostic laparoscopy.Methods: The study was done in 60 patients, presenting with chronic undiagnosed pain abdomen to a tertiary care hospital. All the patients were operated under general anesthesia in supine position. Diagnostic laparoscopy was done using 3 ports, one umbilical 10 mm, other two depending upon possible pathology. After the study, the data was analyzed to evaluate the role of laparoscopy in undiagnosed abdominal pain.Results: Out of 60 patients, 44 were female and 16 males. On diagnostic laparoscopy, findings were- chronic appendicitis - 31, chronic appendicitis with left ovarian cyst - 1, endometriosis with adhesions - 3, PID - 5, PID with adhesions - 3, suspected TB (GI/Genital) - 4, adhesions - 12, negative diagnostic lap - 1. So it may be concluded that diagnostic laparoscopy is a very useful tool to establish diagnosis in patients with undiagnosed abdominal pain with the following benefits are, superior diagnostic ability, better visualization of the abdominal cavity including the paracolic gutters and the pelvis, able to pin point the sites of adhesions with adhesiolysis during the same procedure, retrieval of specimen for histopathological examination, management of the pathology during the same procedure, avoiding unnecessary laparotomy, low complication rate.Conclusions: Laparoscopy is an efficient tool in the armamentarium of the surgeon to diagnose the patients of undiagnosed pain abdomen with numerous benefits and minimal complications.

Role of Laparoscopy in Diagnosing and Treating Acute Nonspecific Abdominal Pain

“…The underlying cause of NSAP was the appendix in 56% of cases, which falls into the prevalence of appendix-related vague pain reported by other studies (33% to 73%) [ 9 , 11 ]. We found a much lower incidence of PID and tuberculosis than previous reports [ 12 ].…”

“…In our study, most patients (95.1%) had positive findings on laparoscopy. , and a recent study from India also reported that laparotomy could be avoided in 96% of similar cases [15,12]. Our conversion rate is higher than the rates reported in the literature in similar studies.…”

“…Waclawiczek et al reported a conversion rate of 2.7% in 172 cases of acute abdomen requiring laparoscopy [ 14 ]. Onders et al reported a low conversion rate to laparotomy, and a recent study from India also reported that laparotomy could be avoided in 96% of similar cases [ 15 , 12 ]. Our conversion rate is higher than the rates reported in the literature in similar studies.…”

Laparoscopic Versus Open Appendicectomy: A Single Center Study

“…Open appendicectomy by Grid Iron incision had been gold standard for many years. Laparoscopy is an efficient tool in the armamentarium of the surgeon to diagnose the patients of undiagnosed pain abdomen with numerous benefits and minimal complications 2 . With the introduction of laparoscopic technique it provided an opportunity to explore new method of therapy in the management of the suspected cases of the acute appendicitis 3 .…”