LAPAROSCOPY IN UNEXPLAINED ABDOMINAL PAIN: SURGEON’S PERSPECTIVE
Abstract
Background: Unexplained abdominal pain is a common but difficult presenting feature faced by the clinicians. Such patients can undergo a number of investigations with failure to reach any diagnosis. The objective of this study was to evaluate the use of laparoscopy in the diagnosis and management of patients with unexplained abdominal pain. Methods: This cross-sectional study was conducted at Pakistan Institute of Medical Sciences Islamabad from January 2009 to December 2013. This study included 91 patients of unexplained abdominal pain not diagnosed by routine clinical examination and investigations. These patients were subjected to diagnostic laparoscopy for evaluation of their conditions and to confirm the diagnosis. These patients presented 43% of patients undergoing investigations for abdominal pain. Patients diagnosed with gynaecological problems were excluded to see surgeon’s perspective. The findings and the outcomes of the laparoscopy were recorded and data was analyzed. Results: Unexplained abdominal pain is common in females than in males. The most common laparoscopic findings were abdominal tuberculosis followed by appendicitis. Ninety percent patients achieved pain relief after laparoscopic intervention. Conclusion: Laparoscopy is both beneficial and safe in majority of patients with unexplained abdominal pain. General surgeons should acquire training and experience in laparoscopic surgery to provide maximum benefit to these difficult patients.Keywords: Diagnostic laparoscopy, unexplained abdominal pain, abdominal tuberculosis, appendicitisReferences
References:
Kumar A, Sarwar MY, Pandey NK. Role of diagnostic laparoscopy in nonspecific chronic abdominal pain: experience of 100 cases. Journal of Evolution of Medical and Dental Sciences 2013; 48(2): 9361-66.
El-labban GM, Hokkam EN. The efficacy of laparoscopy in the diagnosis and management of chronic abdominal pain. J Minim Access Surg. 2010; 6: 95-9.
Galili O, Shaoul R, Mogilner J. Treatment of Chronic Recurrent Abdominal Pain: Laparoscopy or Hypnosis? J Laparoendosc Adv Surg Tech A. 2009; 19: 93–6.
Yousuf F, Haider G, Haider A, Naseeruddin M. laparoscopic evaluation of chronic pelvic pain: experience at a public sector university hospital. Isra Medical Journal 2009; 1(1): 02-07.
Asha S, Liaquat HB, Nagina F, Sidra L, Anwar MA. Chronic Pelvic pain: a dilemma. J Pak Med Assoc 2010; 60: 257-60.
Richardson WS, Stefanidis D, Chang L, Earle DB, Fanelli RD. The role of diagnostic laparoscopy for chronic abdominal conditions: an evidence-based review. Surg Endosc. Sep 2009; 23(9):2073-7.
Ikard RW. There is no current indication for laparoscopic adhesiolysis to treat abdominal pain. South Med J. 1992; 85: 939–40.
Swank DJ, Swank-Bordewijk SC, Hop WC, van Erp WF, Janssen IM, Bonjer HJ, et al. Laparoscopic adhesiolysis in patients with chronic abdominal pain: A blinded randomized controlled multi-centre trial. Lancet. 2003; 361: 1247–51.
Marana R, Paielli FV, Music L, Mancusol J. The role of laparoscopy in evaluation of chronic abdominal pain. Minerva Gynecology 1993; 45(6): 281-6.
Qasim M, Hassan H. Laparoscopy: Indications in the diagnosis of abdominal pain. Professional Med J 2009; 16(1): 109-115.
Baloch S, Khasakheli MN, Malik AM. Diagnostic Laparoscopic Finding in chronic pelvic pain. JCPSP 2013; 23: 190-3.
Kontoravdis A, Hassan E, Hassiakos D, Botsis D, Kontoravdis N, Creatsas G. Laparoscopic evaluation o f chronic pelvic pain. Clin Exp Obstet Gynecol 1999; 26: 76-7.
Rodriquez de Lope C, San Miquel Joglar G, Pons Romero F. Laparascopic diagnosis of tuberculous ascites. Endoscopy. 1982; 14: 178–9.
Husain M, Sachan PK, Khan S, Lama L, Khan RN. Role of diagnostic laparoscopy in chronic and recurrent abdominal pain. Tropical Gastroenterology 2013; 34(3): 170–173.
Gowri V, Krolikowski A. Chronic pelvic pain. Laparoscopic and cystoscopic findings. Saudi Medical J 2001; 22(9): 769-70.
From the American people (USAID) Pakistan. Tuberculosis profile-WHO global TB report. Islamabad: USAID; 2009.
Memon SR, Memon MR, Shaikh AA, Memon NY. Role of Laparoscopy in the diagnosis of chronic pelvic pain. Rawal Medical Journal. 2013; 38(4): 397-400.
Shah SS, Gaffiney RR, Dykes TM, Goldstein JP.Chronic Appendicitis: An Often Forgotten Cause of Recurrent Abdominal Pain. The American Journal of Medicine 2012; 126(1): e7-e8.
Raymond PO, Elizabeth AM, Cleveland OH. Role of laparoscopy in patients with chronic abdominal pain and assessment of late outcome. Digestive disease week 2001; 23(4): 241-46.
Majeski J. Diverticulum of the vermiform appendix is associated with chronic abdominal pain. Am J Surg 2003; 186(2): 129- 31.
Fayez JA, Toy NJ, Flanagan TM. The appendix as the cause of chronic lower abdominal pain. Am J Obstet Gynecol 1995; 172: 122-26.
Pandza H, Custović S, Cović R, Delibegovic S. Laparoscopic treatment of lower abdominal pain related to chronic appendicitis. Med Arh. 2008; 62(5-6): 268-70.
Lamvu G, Tu F, As-Sanie S, Zolnoun D, Steege JF. The role of laparoscopy in the diagnosis and treatment of conditions associated with chronic pelvic pain. Obstet Gynecol Clin N Am 2004; 31: 619– 630.
Swank DJ, Van Erp WF, Repelaer OJ, Hop WC, Bonjer HJ. A prospective analysis of predictive factors on the results of laparoscopic adhesiolysis in patients with chronic abdominal pain. Surg Laparosc Endosc 2003; 13(2): 88-94.
Iwari A, Peters JC. Laparoscopic adhesiolysis in patients with chronic abdominal pain. Lancet 2003; 28(361): 2243-2247.
Di lorenzo N, Coscarella G, Lirosi F, Faraci L, Rossi P. Impact of laparoscopic surgery in the treatment of chronic abdominal pain syndrome. Chir Ital 2002; 54(3): 367- 78.
Miklos JR, O’Reilly MJ, Saye WB. Sciatic hernia as a cause of chronic pelvic pain in women. Obstet Gynecol 1998; 91: 998–1001.1. Kumar A, Sarwar MY, Pandey NK. Role of diagnostic laparoscopy in nonspecific chronic abdominal pain: experience of 100 cases. J Evol Med Dent Sci 2013;48(2):9361–6.
El-labban GM, Hokkam EN. The efficacy of laparoscopy in the diagnosis and management of chronic abdominal pain. J Minim Access Surg 2010;6(4):95–9.
Galili O, Shaoul R, Mogilner J. Treatment of Chronic Recurrent Abdominal Pain: Laparoscopy or Hypnosis? J Laparoendosc Adv Surg Tech A 2009;19(1):93–6.
Yousuf F, Haider G, Haider A, Naseeruddin M. laparoscopic evaluation of chronic pelvic pain: experience at a public sector university hospital. Isra Med J 2009;1(1):2–7.
Santosh A, Liaquat HB, Fatima N, Liaquat S, Anwar MA. Chronic Pelvic pain: a dilemma. J Pak Med Assoc 2010;60(4):257–60.
Richardson WS, Stefanidis D, Chang L, Earle DB, Fanelli RD. The role of diagnostic laparoscopy for chronic abdominal conditions: an evidence-based review. Surg Endosc 2009;23(9):2073–7.
Ikard RW. There is no current indication for laparoscopic adhesiolysis to treat abdominal pain. South Med J 1992;85(10):939–40.
Swank DJ, Swank-Bordewijk SC, Hop WC, van Erp WF, Janssen IM, Bonjer HJ, et al. Laparoscopic adhesiolysis in patients with chronic abdominal pain: A blinded randomized controlled multi-centre trial. Lancet 2003;361(9365):1247–51.
Marana R, Paielli FV, Music L, Dell'Acqua S, Mancusol J. The role of laparoscopy in evaluation of chronic abdominal pain. Minerva Gynecol 1993;45(6):281–6.
Qasim M, Hassan H. Laparoscopy: Indications in the diagnosis of abdominal pain. Professional Med J 2009; 16(1):109–15.
Baloch S, Khasakheli MN, Malik AM. Diagnostic Laparoscopic Finding in chronic pelvic pain. J Coll Physicians Surg Pak 2013;23(3):190–3.
Kontoravdis A, Hassan E, Hassiakos D, Botsis D, Kontoravdis N, Creatsas G. Laparoscopic evaluation and management of chronic pelvic pain during adolescence. Clin Exp Obstet Gynecol 1999;26(2):76–7.
Rodriquez de Lope C, San Miquel Joglar G, Pons Romero F. Laparascopic diagnosis of tuberculous ascites. Endoscopy 1982;14(5):178–9.
Husain M, Sachan PK, Khan S, Lama L, Khan RN. Role of diagnostic laparoscopy in chronic and recurrent abdominal pain. Tropical Gastroenterology 2013;34(3):170–3.
Gowri V, Krolikowski A. Chronic pelvic pain. Laparoscopic and cystoscopic findings. Saudi Med J 2001;22(9):769–70.
World Health Organization. Global Tuberculosis Control: WHO Report 2009. WHO/HTM/TB/2009.411. 2009. Geneva, Switzerland: World Health Organization; 2009.
Memon SR, Memon MR, Shaikh AA, Memon NY. Role of Laparoscopy in the diagnosis of chronic pelvic pain. Rawal Med J 2013;38(4):397–400.
Shah SS, Gaffiney RR, Dykes TM, Goldstein JP. Chronic Appendicitis: An Often Forgotten Cause of Recurrent Abdominal Pain. Am J Med 2012;126(1):e7–8.
Onders RP, Mittendorf EA. Emerging role of laparoscopy in patients with chronic abdominal pain and assessment of late outcomes. Gastroenterology 2001;120(5):A400.
Majeski J. Diverticulum of the vermiform appendix is associated with chronic abdominal pain. Am J Surg 2003;186(2):129–31.
Fayez JA, Toy NJ, Flanagan TM. The appendix as the cause of chronic lower abdominal pain. Am J Obstet Gynecol 1995;172(1 Pt 1):122–3.
Pandza H, Custović S, Cović R, Delibegovic S. Laparoscopic treatment of lower abdominal pain related to chronic appendicitis. Med Arh 2008;62(5-6):268–70.
Lamvu G, Tu F, As-Sanie S, Zolnoun D, Steege JF. The role of laparoscopy in the diagnosis and treatment of conditions associated with chronic pelvic pain. Obstet Gynecol Clin N Am 2004;31(3):619–30.
Swank DJ, Van Erp WF, Repelaer Van Driel OJ, Hop WC, Bonjer HJ, Jeekel H. A prospective analysis of predictive factors on the results of laparoscopic adhesiolysis in patients with chronic abdominal pain. Surg Laparosc Endosc Percutan Tech 2003;13(2):88–94.
Twari A, Peters JC. Laparoscopic adhesiolysis in patients with chronic abdominal pain. Lancet 2003;361(9376):2243–7.
Di Lorenzo N, Coscarella G, Lirosi F, Faraci L, Rossi P, Pietrantuono M, et al. Impact of laparoscopic surgery in the treatment of chronic abdominal pain syndrome. Chir Ital 2002;54(3):367–78.
Miklos JR, O’Reilly MJ, Saye WB. Sciatic hernia as a cause of chronic pelvic pain in women. Obstet Gynecol 1998;91(6):998–1001.
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