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Diagnostic Lap in NCPA
appendectomy was done in all of them. In a study by Ahmad et al., machinery, the morbidity of laparoscopy is much less and not, and
appendicular pathology was present in 32.9% of cases and in a study with improved skills, conversion rates should be low.
by Ates et al., 47.2% of patients were diagnosed with appendicitis. 18
19
In a study by Fayez et al., records of chronic abdominal pain conclusIon
undergoing appendectomy were reviewed; 92% of patient’s
appendices had abnormal histological findings and the 95% DL should be considered as one of the gold standard test for
20
of patients had resolution of pain. Raymond et al. reported diagnosing the NCPA, when noninvasive diagnostic modality
improvement of pain in 74% of patients with chronic right lower failed in diagnosing cause. It can prevent the delay in definitive
abdominal pain. diagnosis and negative laparotomies in these cases. It has
In our study, out of 62 patients, 21 (33.87%) patients who diagnostic, therapeutic use and in some cases can have placebo
underwent appendectomy for NCPA, in that 20 (95.23%) patient’s effect as well.
HPE revealed as recurrent appendicitis, in these patient’s pain was
resolved, one (4.76%) patient HPE revealed as normal appendix; in references
this patient, pain was not resolved. So our study also correlating 1. Camilleri M. Management of patients with chronic abdominal pain
with study by Fayez et al. and Raymond et al. in alleviating pain in in clinical practice. Neurogastroenterol Motil 2006;18(7):499–506.
patients with NCPA. DOI: 10.1111/j.1365-2982.2005.00744.x.
For comparison of therapeutic efficiency of laparoscopy, 2. Townsend CO, Sletten CD, Bruce BK, et al. Physical and emotional
Raymond et al. study reported that more than 70% of patients had functioning of adult patients with chronic abdominal pain:
long term pain relief and Paajanen et al. in their study reported comparison with patients with chronic back pain. J Pain 2005;6(2):
75–83. DOI: 10.1016/j.jpain.2004.10.009.
that laparoscopy alleviates the symptoms in more than 70% of 3. Paajanen H, Julkunen K, Waris H. Laparoscopy in chronic abdominal
patients. In our study out of 62 patients, 53 (85.48%) patients had pain. A prospective nonrandomized long-term follow-up study.
pain relief after DL. Remaining nine patient pain was not relieved J Clin Gastroenterol 2005;39(2):110–114. DOI: 10.1097/01.
(in that seven patient’s final diagnosis revealed as normal study, mcg.0000150174.88953.6e.
one patient appendicular pathology revealed normal, another 4. Magni G, Rossi MR, Rigatti-Luchini S, et al. Chronic abdominal pain
one patient diagnosed case of abdominal tuberculosis). These two and depression. Epidemiologic findings in the United States. Hispanic
studies correlate well with our study and it should be considered if health and nutrition examination survey. Pain 1992;49(1):77–85.
DOI: 10.1016/0304-3959(92)90191-D.
other diagnostic tests are inconclusive (Table 8). 5. Irvin TT. Abdominal pain: a surgical audit of 1190 emergency
21
In a study by Palanivelu et al. out of 230 patients diagnosed admissions. Br J Surg 1989;76(11):1121–1125. DOI: 10.1002/
to have abdominal TB by DL, 132 (57.4%) were males and 98 (42.6%) bjs.1800761105.
females. The peritoneal TB cases were treated by DL, peritoneal 6. Reiter RC. Chronic pelvic pain. Clin Obstet Gynaecol 1990;33(1):
biopsy, followed by antitubercular treatment. In a study by Rai 130–136. DOI: 10.1097/00003081-199003000-00018.
22
et al. on the role of DL on abdominal TB, 36 patients were included 7. Onders RP, Mittendorf EA. Utility of laparoscopy in chronic
in which 24 (66.6%) patients were male and 12 (33.4%) female. In abdominal pain. Surgery 2003;134(4):552–554. DOI: 10.1016/s0039-
our study, four patients diagnosed to have abdominal TB out of 6060(03)00277-0.
which three (4.83%) are female and one (1.61%) male. All patients 8. Szomstein S, Lo Menzo E, Simpfendorfer C, et al. Laparoscopic lysis
of adhesions. World J Surg 2006;30(4):535–540. DOI: 10.1007/s00268-
were managed with CAT—1 ATT. 005-7778-0.
Our study report revealed improvement or resolution of pain 9. Salky BA, Edye MB. The role of laparoscopy in the diagnosis and
abdomen in patients with abdominal tuberculosis is 75%. treatment of abdominal pain syndromes. Surg Endosc 1998;12(7):
Arya and Gaur study revealed out of 49 patients, bands and 911–914. DOI: 10.1007/s004649900744.
adhesions in 4 (8.16%) patients, no organic cause found in 5 (10.20%) 10. Swank DJ, Swank-Bordewijk SC, Hop WC, et al. Laparoscopic
patients, and diverticulitis in 1 (2.04%) patient. 23 adhesiolysis in patients with chronic abdominal pain: a blinded
In our study out of 62 patients, no organic cause found in 7 randomised controlled multi-centre trial. Lancet 2003;361(9365):
1247–1251. DOI: 10.1016/s0140-6736(03)12979-0.
(11.29%) patients, diverticulitis in 1 (1.61%) patient, and 4 (6.45%) 11. Nar AS, Bawa A, Mishra A, et al. Role of diagnostic laparoscopy in
patients had bands and adhesions for that adhesiolysis done as a chronic abdominal conditions with uncertain diagnosis. Niger J Surg
definitive procedure, and all 4% patients had resolution of their pain 2014;20(2):75–78. DOI: 10.4103/1117-6806.137301.
after adhesiolysis. So our study well correlated with Arya et al. study. 12. Perri SG, Altillia F, Pietrangeli F, et al. Laproscopy in abdominal
Compared to series of Mehta et al. out of 21 patients, 4 who emergencies. Indications and limitations. Chir Ital 2002;54(2):165–178.
underwent laparotomy, conversion rate was 19%. In another series, 13. Kerman US, Reddy KR. Diagnostic laparoscopy; an update. Endoscopy
Al-Akeely had 6% conversion rate. 2002;34(2):146–153. DOI: 10.1055/s-2002-19847.
In our series out of 62 patients, 12 who underwent laparotomy, 14. Ahmad MM, Dar HM, Waseem M, et al. Role of laparoscopy in
conversion rate is 19.4%. With the growing availability of trained nonspecific abdominal pain. Saudi Surg J 2014;2(3):71–74. DOI:
10.4103/2320-3846.147021.
and experienced laparoscopic surgeons along with improved 15. Mehta S, Juneja I, Udani D. Role of diagnostic laparoscopy in
management of acute abdomen. Int J Surg 2009;20(1).
Table 8: Comparison of therapeutic efficiency of 16. Al-Akeely MH. The impact of elective diagnostic laparoscopy in
laparoscopy in various studies chronic abdominal disorders. Saudi J Gastroenterol 2006;12(1):27–30.
DOI: 10.4103/1319-3767.27741.
Study Therapeutic efficiency (%) 17. El-Labban GM, Hokkam EN. The efficacy of laparoscopy in the
Raymond et al. 20 >70 diagnosis and management of chronic abdominal pain. J Minim
Paajanen et al. 3 >70 Access Surg 2010;6(4):95–99. DOI: 10.4103/0972-9941.72594.
Present study 85.48 18. Mustafa Ates, Sedat Sevil, Mahmut Bulbul. Routine use of laparoscopy
in patients with clinically doubtful diagnosis of appendicitis.

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