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Diagnostic Lap in NCPA

AIms And objectIves Table 1: Age distribution of patients with nonspecific chronic pain
abdomen (NCPA)
The study was done to assess the accuracy of laparoscopy in the
diagnosis of NCPA (by comparing its findings with radiological Age-group (years) Number of patients Percentage (%)
investigations), its ability to avoid unnecessary exploratory 15–30 years 18 29.0
laparotomy with complications and limitations associated with 31–45 years 28 45.2
laparoscopy including failure rate. 46–60 years 16 25.8
Total 62 100.0
mAterIAls And methods Mean 37.37
This prospective descriptive study was conducted in a teaching Min–max 15–60
hospital in north India for a period of 1 year. Clinical material for
present study comprises the patients with NCPA for more than
3 months attending the outpatient department or emergency
department where other clinical symptoms and investigations are
not conclusive.
Inclusion Criteria
• Chronic pain abdomen of more than 3 months of uncertain
etiology unexplained by clinical symptoms and signs and other
investigations including CECT.
• Age-group of 15 to 60 years.

Exclusion Criteria
• ASA Grade III, ASA Grade IV.
• Uncorrected coagulopathy.
• Pregnancy.
Diagnostic laparoscopy was performed with standard method
after proper preanesthetic checkup and wherever biopsy or other
surgical intervention (laparoscopic/open) was required, it was done.
Fig. 1: Showing duration of pain abdomen before diagnostic laparoscopy
results
A total of 62 patients, who fulfill the inclusion and exclusion criteria
were included in the study. Table 2: Frequency and percentage distribution of patients according
to final diagnosis
Age and Sex Distribution
Final diagnosis Frequency Percentage (%)
In our study, youngest patient was 15 years and oldest was Appendicitis (recurrent appendicitis) 20 32.25
60 years. The mean age of presentation was 37.37 (Table 1). There Normal study 7 11.29
was predominance of female gender, who were 34 (54.8%) in
comparison to male gender 28 (45.2%). Reactive mesenteric lymphadenopathy 6 9.67
Duration of pain before diagnostic laparoscopy: patients with CA intestine 5 8.06
duration of 3 or more months of NCPA were included. Mean duration Bands and adhesions 4 6.45
was 4.6 months. (Fig. 1). Chronic cholecystitis 3 4.83
The final diagnosis reached in our study is shown in TB of IC junction 3 4.83
Table 2 showing the most common cause was recurrent appendicitis Normal appendix 1 1.61
(32.2%). Gallbladder carcinoma 2 3.22
In our total 62 cases, 54 (87.1%) cases were diagnosed by Diverticulitis 1 1.61
laparoscopic procedure (i.e., radiological given diagnosis totally
different from laparoscopic findings), rest 8 (12.9%) cases were Granulomatous pancreatitis 1 1.61
radiological as well as laparoscopically same diagnosis. Granuloma of parietal wall 1 1.61
Normal gallbladder 1 1.61
Conversion and Complications Pancreatic tuberculosis 1 1.61
In total 62 cases, 50 (80.6%) cases were treated completely Adrenal lipoma 1 1.61
with laparoscopic approach and in remaining 12 (19.4%) IC junction intususception 1 1.61
cases, laparoscopy was converted to laparotomy. In these 12 Mucormycosis 1 1.61
patients, 5 patients underwent lap-assisted right hemicolectomy Mesenteric cyst 1 1.61
[HPE-1 mucormycosis (Fig. 2), 3 adenocarcinoma of intestine, 1 Renal cyst 1 1.61
diverticulitis], 2 patients had resection of stricture followed by end-
to-end anastomosis, HPE revealed adenocarcinoma of intestine Ovarian cyst 1 1.61
with negative resected margins, 2 radical cholecystectomy for Total 62 100

82 World Journal of Laparoscopic Surgery, Volume 14 Issue 2 (May–August 2021)