Page 11 - Journal of World Association of Laparoscopic Surgeons

ORIGINAL ARTICLE
Role of Diagnostic Laparoscopy in Chronic Abdominal Pain

with Uncertain Diagnosis: A 1-year Cross-sectional Study

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Anil P Bellad , Amar A Murgod
AbstrAct
Aim: Diagnosis of chronic abdominal pain is a significant clinical challenge. Laparoscopy, a minimally invasive technique, could potentially be
diagnostic as well as therapeutic in patients with chronic undiagnosed abdominal pain. This study was aimed to evaluate the role of laparoscopy
as an investigative modality in the diagnosis and management of patients with chronic abdominal pain.
Materials and methods: Demographics, clinical data, and medical and surgical history of the patients (55 patients) with chronic abdominal
pain were noted. Details of pain such as, severity of pain based on visual analog scale (VAS) score, duration of pain, site of pain, and nature of
pain were recorded. Routine along with radiological investigations were also performed. After preoperative investigations, the patients were
subjected to diagnostic laparoscopy, either by open or closed technique under general anesthesia. Postoperative assessment of pain was done
using VAS score.
Results: Most of the patients (65.45%) had a duration of pain between 8 weeks and 12 weeks and mean duration of pain was 10.80 ± 2.78 weeks.
Fever was present in 41.82% of the patients. A history of lower segment cesarean section was observed in 5.45% patients. The most common
surgical procedure performed was adhesiolysis (30.91%) followed by appendectomy (29.09%). Postoperative pain relief was statistically

significant (p < 0.001).
Conclusion: Laparoscopy offers an effective diagnostic modality and excellent pain relief in the management of patients with chronic abdominal
pain. Furthermore, adhesions and inflamed appendix are important causes of chronic abdominal pain. However, studies with a large sample
size are required to validate the findings.
Clinical significance: Laparoscopy is an investigative modality in the diagnosis and management of patients with chronic abdominal pain.
Keywords: Adhesiolysis, Appendectomy, Chronic abdominal pain, Diagnostic laparoscopy.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1362

IntroductIon 1,2 Department of General Surgery, KLE University, Dr Prabhakar Kore
Chronic abdominal pain is an intermittent or continuous pain Hospital and Medical Research Centre, Belagavi, Karnataka, India
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persisting for more than 12 weeks. It is the most common Corresponding Author: Amar A Murgod, Department of General
clinical presentation that affects the patients both physically and Surgery, KLE University, Dr Prabhakar Kore Hospital and Medical
psychologically. In India, it is the 4th frequent chronic pain syn- Research Centre, Belagavi, Karnataka, India, Phone: +91 9036337275,
e-mail: amarmurgod18@gmail.com
drome in the general population that represents about 13% of all
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surgical admissions. Numerous etiologies ranging from organic How to cite this article: Bellad AP, Murgod AA. Role of Diagnostic
to functional cause chronic abdominal pain. The most common Laparoscopy in Chronic Abdominal Pain with Uncertain Diagnosis:
A 1-year Cross-sectional Study. World J Lap Surg 2019;12(1):9–14.
organic disorders include intestinal adhesions, biliary causes, and

appendicular causes, while functional disorders include irritable Source of support: Nil

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bowel disease, functional dyspepsia, and various motility disorders. Conflict of interest: None
In spite of strong diagnostic workups, 40% of the patients with
chronic abdominal pain did not have specific diagnosis at the
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end. Many patients remain undiagnosed even after excluding
the common disorders by meticulous investigations, and pose a diagnostic yield, its applicability and therapeutic management in
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significant diagnostic challenge to the physician. both elective and emergency setups, reduced hospital stay, low
Biochemical, serological, and imaging techniques such as morbidity, and expenditure) have made this treatment modality
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ultrasound sonography (USG), computed tomography (CT), most popular.
and magnetic resonance imaging (MRI) only provide indirect Although diagnostic laparoscopy is becoming acceptable in
evidence of underlying disorder; therefore, many of the cases surgical practice, its role in ascertaining the diagnosis of nonspecific
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remain inconclusive. Thus, it is a major challenge for the surgeon abdominal pain needs to be validated by an evidence base. Studies

to diagnose accurately and decide an appropriate treatment that establish the definite role of diagnostic laparoscopy in patients
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modality. The advent of diagnostic laparoscopy added a new with chronic abdominal pain are limited. Hence, considering
tool in the diagnosis and treatment of chronic abdominal pain. the burden of chronic abdominal pain and the advantages offered
It is a minimally invasive procedure and plays a significant role in by laparoscopy, the present study was undertaken to identify the
the present era to diagnose chronic undiagnosed abdominal pain. etiology of chronic abdominal pain. It was also aimed to assess the
It allows the direct visualization of the peritoneal cavity without the outcome in terms of pain relief in such patients on follow-up, after
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need of open exploratory laparotomy. Many factors (including high elective diagnostic laparoscopy.
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
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