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ORIGINAL ARTICLE
Role of Diagnostic Laparoscopy in Nonspecific Chronic Pain

Abdomen

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Subhash , Tanweer Karim , Atul Jain , Nabal K Mishra , Gaurav Patel , Subhajeet Dey 6
AbstrAct
Introduction: Laparoscopy has established its role (diagnostic as well as therapeutic role) in patients with nonspecific chronic pain abdomen.
In case of diagnostic dilemma and uncertainty, use of laparoscopy can help to avoid unnecessary laparotomy, provides accurate diagnosis,
and helps to plan for surgical intervention if required. However, the role of laparoscopy in nonspecific chronic pain abdomen is still debated.
Aims and objectives: To assess the accuracy of laparoscopy in the diagnosis of nonspecific chronic pain abdomen and its ability to avoid
unnecessary exploratory laparotomy with complications and limitations associated with laparoscopy including failure rate.
Materials and methods: This prospective descriptive study was conducted for a period of 1 year in patients with nonspecific chronic pain
abdomen for more than 3 months attending the outpatient department or emergency department when clinical features and investigations
are not conclusive.
Results: Sixty-two patients in age-group from 15 to 60 years were studied. Overall 85.48% of patients had resolution of pain after diagnostic
laparoscopy with diagnostic accuracy in our study of 88.7%.
Conclusion: Diagnostic laparoscopy should be considered as one of the gold standard tests for diagnosing the nonspecific chronic pain abdomen,
when noninvasive diagnostic modality failed in diagnosing cause.
Keywords: Diagnostic laparoscopy, Nonspecific chronic pain abdomen, NCPA, chronic pelvic pain.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1464

IntroductIon 1–6 Department of Surgery, ESI PGIMSR and Hospital, Delhi, India
Nonspecific chronic abdominal pain is a diagnostic challenge for Corresponding Author: Atul Jain, Department of Surgery, ESI PGIMSR
a clinician. These patients generally visit different physicians and and Hospital, Delhi, India, e-mail: docatuljain@gmail.com
many investigations are done for reaching the diagnosis in this How to cite this article: Subhash, Karim T, Jain A, et al. Role of
process. Chronic abdominal pain without any specific etiological Diagnostic Laparoscopy in Nonspecific Chronic Pain Abdomen. World
diagnosis at the end of diagnostic workup for more than 3 months J Lap Surg 2021;14(2):81–86.
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is called as nonspecific chronic pain abdomen (NCPA). It can lead Source of support: Nil

to poor quality of life with appearance of depressive symptoms Conflict of interest: None
with time. 4
Surgical consultation is often sought late after other modalities
have failed to reach a conclusion or provide relief in their
symptomatology. NCPA is a significant clinical problem which The role of laparoscopy for diagnosis in NCPA is still debated
accounts for 13 to 40% of all surgical admissions and can often by a number of authors who deny its value in adhesiolysis and
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lead to repeated laparotomies. Chronic pelvic pain has a consider it controversial and not evidence-based, and therefore,
prevalence of 3.8% in young females and it accounts for 10% of all do not recommend it as a part of evaluation and treatment in
outdoor patients visit to gynecologist and 40% of laparoscopy by patients with NCPA. 10
gynecologists. 6 Although laparoscopy is very frequently used by surgeons
The use of laparoscopy in the diagnosis and management in all fields for a wide spectrum of surgical procedures around
of NCPA has been tried in previous studies. The main aim of the globe, its utility for diagnosis in cases of chronic abdominal
laparoscopic evaluation in NCPA is to detect the presence or pain was not favored initially, either due to insufficient data
absence of intra-abdominal organic lesion and also it can diagnose on its effectiveness as a diagnostic modality, lack of training
as well as treat different intrabdominal pathologies that are or expertise, or lack of awareness among patients and even
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difficult to diagnose by other conventional methods. It is a safe doctors. 11
and effective tool which can establish the etiology and allows for Diagnostic laparoscopy when compared to open laparotomy
appropriate intervention at the same time or a better planning in is better in terms of visualization and access with minimal trauma
such cases. 7 except in some retroperitoneal lesions. Laparoscopy also has
Adhesions and bands are commonly seen findings, especially limitation of tactile sensations and lesions cannot be palpated as
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in patients with a past history of laparotomy or other abdominal compared to open laparotomy. However, procedure allows quick
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operations. Other findings such as appendicular pathology, and thorough inspection of whole peritoneal cavity and pelvic
hepatobiliary causes, and endometriosis can be discovered and cavity and it is an emerging tool in diagnosis of nonspecific chronic
dealt with laparoscopically. 9 pain abdominal. 13

© Jaypee Brothers Medical Publishers. 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
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