Role of diagnostic laparoscopy in chronic abdominal pain

Abstract

Background: Chronic idiopathic pain syndromes are amongst the most challenging and demanding conditions to treat across the whole age spectrum. Despite these patients having undergone numerous diagnostic work-ups, their pain remains a challenge to all known diagnostic and treatment methods.Methods: To evaluate role of diagnostic laparoscopy in chronic abdominal pain a prospective observational study was done. The present study was conducted on patients with undiagnosed chronic abdominal pain coming to the Department of Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune. 75 patients with chronic abdominal pain who attend the General Surgery Department (OPD) were included in the study. Patients were included in the study after taking their voluntary informed consent. The categorical variables were assessed using Pearson chi-square. The quantitative variables were assessed using T-test. The test was considered significant only if the p value comes out to be less than 0.05.Results: Based on the findings of the study after performing diagnostic laparoscopy for 75 patients with chronic abdominal pain it was found that most common finding was of appendicitis (32%) followed by abdominal Koch’s (24%) and post-operative pain relief using VAS showed p value of less than 0.05 at 3 months of follow up post diagnostic laparoscopy.Conclusions: The present study concluded that laparoscopy is an effective diagnostic role in evaluating patients with chronic abdominal pain, in whom conventional methods of investigations have failed to elicit a certain cause. The advantage of diagnostic laparoscopy over non-invasive methods is the ability to perform therapeutic procedure at the same time in cases of chronic abdominal pain. Diagnostic laparoscopy is safe, cosmetically better and having less morbidity.

Exploratory laparotomy in chronic non-specific pain abdomen in lieu of therapeutic and diagnostic aspect: a prospective non randomized trial on 40 patients

“…The most affected age in appendicular and tubercular pathology (first four decades of life) followed by adhesions and bands were exactly the same as described by text books study of world literature. 1,2,4,[10][11][12][13][14] Present study also shows that females have always outnumbered the males. 2,3,4,10,14 Paradoxically in this series abdominal tuberculosis and appendicular pathology was more common in males, cause of which remain unexplained.…”

“…1,7 The Koch's abdomen and appendicular pathology patients present within one year of first appearance of pain so these patients warrants surgery earlier. 2,10,12,13 Surprisingly patients having adhesions and bands present mainly after the second year of life, means that they can tolerate the disease for quite a long time. 2,14 Patients of appendicular pathology and Koch's abdomen mainly complained of pain in right half of abdomen, while in centre of abdomen in adhesions/bands/stricture of small gut and complained of colicky pain and is also a most common variety of pain abdomen.…”

“…2,10,12,13 Surprisingly patients having adhesions and bands present mainly after the second year of life, means that they can tolerate the disease for quite a long time. 2,14 Patients of appendicular pathology and Koch's abdomen mainly complained of pain in right half of abdomen, while in centre of abdomen in adhesions/bands/stricture of small gut and complained of colicky pain and is also a most common variety of pain abdomen. 3,4,14 It was also observed that patients having psychological aspects usually describe more specifically and accurately the character of pain.…”

“…9 Relevance of exploratory laparotomy was proved by the fact that at the time of discharge 80% of patients had complete relief from pain abdomen. 1,2,4,7,8,15 It proves that if the psychiatric aspect has been ruled out exploratory laparotomy is must in all cases of CNSPA, thus it is not only an important investigation but also has great therapeutic value.…”