Page 9 - World Journal of Laparoscopic Surgery

WJOLS
WJOLS

10.5005/jp-journals-10033-1237
Role of Diagnostic Laparoscopy in Patients with Acute or Chronic Nonspecific Abdominal Pain
OriginaL articLe

Role of Diagnostic Laparoscopy in Patients with Acute or

Chronic Nonspecific Abdominal Pain

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1 A Rubbia, GA Faryal, I Javeria, M Roohul
ABSTRACT inTRoDuCTion
Aim: The aim of our study was to evaluate and establish the In surgical practice, we frequently come across patients
role of diagnostic laparoscopy (DL) in unexplained/nonspecific
abdominal pain (NSAP) in this era of therapeutic laparoscopy, with lower abdominal pain who despite frequent rou-
and thus to analyze and support the theory of minimal access tine examination and all major investigations remain
surgery in diagnosing and treating abdominal conditions. undiagnosed. Many undergo appendectomy, some are
Materials and methods: In this prospective study included put on antitubercular therapy (especially in our country)
patients with abdominal pain of (i) more than 6 hours and less while females mostly end up taking anti-androgens. A
than 6 days duration (acute) and (ii) more than or equal to vast majority are labeled functional. In short, patients
6 months duration (chronic) were included whether presen­
ting as a surgical emergency or coming to surgical outpatient with nonspecific abdominal pain (NSAP) continue be a
department (OPD) in whom a DL was performed after failure frustrating experience for the patient and pose a chall-
to achieve a diagnosis with conventional methods. The study enge to the diagnostic capability of the general surgeon.
included a total of 168 consecutive patients who fulfilled our
inclusion criteria and underwent DL for NSAP. Their demo­ The traditional three step approach to abdominal pain
graphic and clinical data, admission dates and dates of sur­ of nonspecific nature including: (i) history and clinical
gery were noted. Outcome of surgery was recorded and the examination including gynecological examination,
data were analyzed to ascertain the role and diagnostic yield (ii) investigations and (iii) therapeutic intervention is tedi-
of laparoscopy in our department, both in acute and chronic
abdominal pain of nonspecific nature. Patients were followed ous and lengthy. Patients are hospitalized, subjected to a
postoperative for 3 months for any recurrence of symptoms. battery of costly investigations and often end-up undergo-
Results: Laparoscopy yielded diagnoses in 161 of these ing a laparotomy which may prove unnecessary with no
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patients giving a diagnostic yield of 95.8%. Appendicitis therapeutic benefit. The end result is an unsatisfactory
(39.2%), gynecological pathology (16%) and abdominal tuber­ discharge from the hospital after a prolonged stay often
culosis (8.9%) were the major findings. Therapeutic procedures 3
were performed in 112 cases (66.6%) where peroperative without a precise clinical diagnosis.
pathology was identified. In 38 cases (22.6%) where there was Laparoscopy for diagnostic purposes was introduced
strong clinical suspicion of appendicitis and no pathology could for the 1st time by Kelling in 1902 and since then has
be identified peroperative, an appendectomy was performed. come a long way. Diagnostic laparoscopy (DL) is a mini-
Twenty­eight (73.6%) of these appendix specimens were found
inflamed on subsequent histologic examination. There were no mally invasive surgical procedure that allows the visual
complications in this series. examination and documentation of intra-abdominal
Conclusion: This study establishes the role of early DL as organs in order to detect any pathology. Elective DL refers
a safe procedure with high efficacy. Hence, it is an effective to the use of the procedure in chronic intra-abdominal
investigative tool in undiagnosed abdominal pain of both acute disorders. Emergency DL is performed in patients pre-
and chronic nature.
senting with acute abdomen.
Keywords: Acute appendicitis, Diagnostic laparoscopy, gyne­ With increasing the use of laparoscopy, the diagnostic
cological pathology.
yield in cases of NSAP has tremendously improved, it
How to cite this article: Rubbia A, Faryal gA, Javeria I,
Roohul M. Role of Diagnostic Laparoscopy in Patients with allows direct visualization of the peritoneal cavity with-
Acute or Chronic Nonspecific Abdominal Pain. World J Lap out the need for old fashioned open exploratory laparo-
Surg 2015;8(1):7­12. tomy. It is especially useful in patients with equivocal
Source of support: Nil signs and those who are hemodynamically stable not
Conflict of interest: None requiring urgent surgical intervention. 4
The rapidly increasing popularity of laparoscopy
may be attributed to several factors; including its appli-
1­4 Department of Surgery, Khyber Teaching Hospital cability in both emergency and elective setups, high
Peshawar, Pakistan diagnostic yield, therapeutic management in the same

Corresponding Author: gA Faryal, Department of Surgery setting (in cases where on-table diagnosis is possible),
Khyber Teaching Hospital, Peshawar, Pakistan, e-mail: faryal. ability to manage most coexisting conditions, low
afridi@yahoo.com, fafridi@gmail.com
patient morbidity, reduced hospital stay and expenditure.
World Journal of Laparoscopic Surgery, January-April 2015;8(1):7-12 7