Page 10 - World Journal of Laparoscopic Surgery

A Rubbia et al

Diagnostic laparoscopy has a role in many acute abdominal Acute nonspecific abdominal pain was defined as
conditions including acute appendicitis, acute intes- abdominal pain of less than 6 days duration for which
tinal obstruction, acute salpingitis, pelvic inflammatory no cause was elucidated after thorough clinical exami-
disease (PID), ovarian torsion, ruptured ovarian cysts, nation and investigations. Chronic NSAP was defined
acute gut perforation, penetrating/blunt trauma to abdo- as vague abdominal pain/discomfort lasting more than
men. Also, it has an important role in obtaining diagnosis, 6 months which remained undiagnosed after repeated
allowing therapeutic intervention where needed and evaluations and investigations. Main outcome measure
establishing histopathologic diagnosis of chronic causes in the series was diagnostic yield of laparoscopy in
of abdominal pain, especially in cases of abdominal tu- the setting of NSAP. Other outcomes were length of
berculosis, endometriosis, adhesions due to inflammation hospital stay, symptom control on follow-up, readmi-
and/or surgery. ssions and time lapse between presentation and DL.
Our study aims to establish the role of laparoscopy After all essential investigations patients with NSAP
as a diagnostic tool investigating its effectiveness in the fulfilling the inclusion criteria were then subjected to
setting of acute as well as chronic abdominal pain. DL in 12 to 24 hours in acute abdominal cases and 12 to
72 hours in those with chronic abdominal pain. Laparos-
MATERiALS AnD METHoDS copy was performed under general anesthesia and
A total of 168 patients were included in our study who comprised of a thorough exploration of all abdominal
presented with either acute abdominal pain (n = 81) or quadrants and the pelvic viscera.
chronic abdominal pain (n = 87) over a 12 months period. An attempt was made to treat all surgical pathologies
Only the patients who fulfilled our inclusion criteria were diagnosed at laparoscopy without the need for conver-
included in our study. ting to open. In cases where no clear pathology could be
identified peroperative and there was clinical suspicion of
inclusion Criteria appendicitis, appendicectomy was done on the basis that
symptomatic appendicitis is not always evident macro-
• Patients between ages of 12 and 65 years 5
• Abdominal pain lasting less than 6 days in acute cases s copically. Biopsy was taken of suspicious nodules and
and more than or equal to 6 months in chronic cases in free peritoneal fluid if any was aspirated. All specimens
whom there was no definitive diagnosis after thorough were sent for histopathological, cytological, biochemical
clinical examination (including gynecological and microbiological analysis.
examination) and relevant investigations. Follow-up was done at 10 days, 1 and 3 months
postoperative. Patients were followed for:
Exclusion Criteria • Results of biopsy specimen
• Improvement or worsening of symptoms
• Precise diagnosis established after evaluation and • Readmissions and indications for readmission
investigations. • Early and late complications of laparoscopy necessi­
• Patients with clinical evidence of peritonitis and/or tating open intervention
hemodynamic instability requiring urgent surgical • Patient compliance if post­laparoscopy medical
intervention. management was initiated.
• Pediatric cases.
• The elderly in whom a surgical and/or anesthetic RESuLTS
intervention outweighed the theoretic benefits of a
diagnostic laparoscopy. Patient demographics are summarized in Table 1. There
• Local signs of peritonitis. were a total of 123 females included as against 45 males
• Previous major abdominal surgery. patients. The majority of the patients were young adults
• Prior diagnosis of malignancy or any other chronic aged 16 to 30 years.
disease. Out of 168 cases of DL performed, on table diagnosis
• Patients with any contraindication to pneumoperi­ and therapeutic management was possible in 112 (66.6%)
toneum. cases. Eighty-one (48.2%) of these 168 patients had pre-
• Accidents/trauma patients. sented acutely whereas 87 (51.7%) presented with long
• Uncorrectable coagulopathy. standing complaint of NSAP.
• Patients undergoing any elective abdominal/pelvic Out of these 112 cases of positive on-table diagnoses, a
surgical procedure. majority, i.e. 66 (39.2%) cases showed a macroscopic involve-
• Those who did not give consent. ment of appendix and appendectomy was done. Sixty­four
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