World Journal of Laparoscopic Surgery

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VOLUME 8 , ISSUE 1 ( January-April, 2015 ) > List of Articles

RESEARCH ARTICLE

Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain

A Rubbia, GA Faryal, I Javeria, M Roohul

Citation Information : Rubbia A, Faryal G, Javeria I, Roohul M. Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain. World J Lap Surg 2015; 8 (1):7-12.

DOI: 10.5005/jp-journals-10033-1237

Published Online: 01-04-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim

The aim of our study was to evaluate and establish the role of diagnostic laparoscopy (DL) in unexplained/nonspecific abdominal pain (NSAP) in this era of therapeutic laparoscopy, and thus to analyze and support the theory of minimal access surgery in diagnosing and treating abdominal conditions.

Materials and methods

In this prospective study included patients with abdominal pain of (i) more than 6 hours and less than 6 days duration (acute) and (ii) more than or equal to 6 months duration (chronic) were included whether presenting as a surgical emergency or coming to surgical outpatient department (OPD) in whom a DL was performed after failure to achieve a diagnosis with conventional methods. The study included a total of 168 consecutive patients who fulfilled our inclusion criteria and underwent DL for NSAP. Their demographic and clinical data, admission dates and dates of surgery were noted. Outcome of surgery was recorded and the data were analyzed to ascertain the role and diagnostic yield of laparoscopy in our department, both in acute and chronic abdominal pain of nonspecific nature. Patients were followed postoperative for 3 months for any recurrence of symptoms.

Results

Laparoscopy yielded diagnoses in 161 of these patients giving a diagnostic yield of 95.8%. Appendicitis (39.2%), gynecological pathology (16%) and abdominal tuberculosis (8.9%) were the major findings. Therapeutic procedures were performed in 112 cases (66.6%) where peroperative pathology was identified. In 38 cases (22.6%) where there was strong clinical suspicion of appendicitis and no pathology could be identified peroperative, an appendectomy was performed. Twenty-eight (73.6%) of these appendix specimens were found inflamed on subsequent histologic examination. There were no complications in this series.

Conclusion

This study establishes the role of early DL as a safe procedure with high efficacy. Hence, it is an effective investigative tool in undiagnosed abdominal pain of both acute and chronic nature.

How to cite this article

Rubbia A, Faryal GA, Javeria I, Roohul M. Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain. World J Lap Surg 2015;8(1):7-12.


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  1. Emergency laparoscopic surgery. Br J Surg 1993;80(3):279-283.
  2. Randomized study of the value of laparoscopy before appendectomy. Br J Surg 1993;80(7):922-923.
  3. Acute nonspecific abdominal pain: a randomized, controlled trial comparing early laparoscopy vs clinical management. Ann Surg 2006;244(6):881-888.
  4. Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience. J Trauma 1997;42(5):825-829.
  5. Should the normal appendix be removed at operations for appendicitis? J R Coll Surg Edinb 1993;38(3):158-160.
  6. Nonspecific abdominal pain: the resource implications. Ann R Coll Surg Engl 1992;74(3):181-185.
  7. Abdominal pain: a surgical audit of 1190 emergency admissions. Br Jr Surg 1989;76(11):1121-1125.
  8. Has misdiagnosis of appendicitis decreased over time? A populationbased analysis. JAMA 2001;286(14):1748-1753.
  9. Computed tomography and ultrasonography in the diagnosis of appendicitis: when are they indicated? Arch Surg 2001;136(6):670-675.
  10. Diagnostic laparoscopy. Semin Laparosc Surg 2002;9(1):10-23.
  11. The role of minimal access surgery in the acute abdomen. Surg Clin N Amer 1197;77(6):1333-1353.
  12. Laparoscopic diagnosis of acute lower abdominal pain in women of reproductive age. Intl J Gyn Obstet 2002;76(2):149-158.
  13. Impact of adjunctive testing on the diagnosis and clinical course of patients with acute appendicitis. Am J Surg 1993;166(12):660-665.
  14. Early laparoscopy for abdominal pain. Correspondence. The Lancet 2005 Jun;355(ISS 9222):2251.
  15. Right iliac fossa pain in women: conventional diagnostic approach versus primary laparoscopy: a controlled study (65) cases. Ann Chir 1993;47(4):316-319.
  16. Randomized clinical trial of early laparoscopy in the management of acute non-specific abdominal pain. Br J Surg 1999;86(11):1383-1386.
  17. Early laparoscopy as a routine procedure in the management of acute abdominal pain: a review of 1,320 patients. Surg Endosc 2005;19(7):882-885.
  18. Laparoscopy in patients admitted for acute abdominal pain. Acta Chir Scand 1985;151(6):521-524.
  19. The role of laparoscopy in the diagnosis and treatment of abdominal pain syndromes. Surg Endosc 1998;12(7):911-914.
  20. Laparoscopy: a tool in diagnosis of lower abdominal pain. Ind J Surg 2004;66(4):216-220.
  21. The utility of diagnostic laparoscopy for abdominal disorders: audit of 120 patients. Arch Surg 1992;127(4):379-383.
  22. Laparoscopy for questionable appendicitis. Can it reduce the negative appendectomy rate? Ann Surg 1980;191(4):410-413.
  23. A normal appendix found during diagnostic laparoscopy should not be removed. Br J Surg 2001;88(2):251-254.
  24. Managing gynaecological emergencies with laparoscopy. Bmj 1989;299(6695):371-374.
  25. Treatment of nonendometriotic benign adnexal cysts: a randomized comparison of laparoscopy and laparotomy. Obstet Gynecol 1995;86(5):770-774.
  26. A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol 1997;177(1):109-114.
  27. Endometriosis and endosalpingiosis. In: Howard FM, Perry CP, Carter JE, et al, editors. Pelvic pain diagnosis and management. Philadelphia, PA: Lippincott Williams and Wilkins; 2000:125-149.
  28. medical and surgical therapies for pain associated with endometriosis. J Women's Health Gend Based Med 2001;10(2):137-162.
  29. Laparoscopy for oncology. In: Moussa A, et al, editor. Comprehensive textbook of oncology. Baltimore: Williams and Wilkins 1991. p. 210-219.
  30. Diagnosis of significant abdominal trauma after road traffic accidents: preliminary results of a multicentre clinical trial comparing minilaparoscopy with peritoneal lavage. Ann R Coll Surg Engl 1988;70(3):153-155.
  31. Diagnostic laparoscopy in abdominal stab wounds: a prospective, randomized study. J Trauma 2003;55(4):636-645.
  32. Negative laparotomy in abdominal gunshot wounds: potential impact of laparoscopy. J Trauma 1995; 38(2):194-197.
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