Original Article

Efficacy of Diagnostic and Therapeutic Laparoscopy in Chronic

Abdominal Pain - A Hospital Based Prospective Study
Ram Nagina Sinha
Associate Professor, Department of General Surgery, Lord Buddha Koshi Medical College & Hospital, Saharsa, Bihar

ABSTRACT
Background: Patients with chronic abdominal pain can undergo numerous diagnostic tests with little change in
their pain. This study was under taken to assess the efficacy of performing diagnostic and therapeutic
laparoscopy in patients with chronic abdominal pain for longer than 12 weeks. Methods: All patients
undergoing laparoscopy for chronic abdominal pain were included in the study for a period of 1 year from July
2015 to June 2016. The patient’s demographic data, length of time with pain, diagnostic studies, intraoperative
findings, interventions and follow-up were determined. Results: A total of 50 patients with an average age of
35.75 years underwent diagnostic laparoscopy for the evaluation and treatment of chronic abdominal pain. The
average length of time with pain was 32.96 weeks (range 12-96). 4 cases required conversion to an open
procedure and no complications occurred. Findings included abdominal Koch's in 18, appendicitis in 16,
cholecystitis in 2, cirrhosis in 2; ovarian cyst in 2, bilateral fimbrial cyst in 2 and 8 patients had no obvious
pathology. 82.6% of patients had pain relief at the time of follow up. Conclusions: Laparoscopy has a
diagnostic and therapeutic role in patients with chronic pain abdomen.

Key words: Chronic Abdominal Pain, Diagnostic Laparoscopy, Abdominal Koch’s, Abdominal, Tuberculosis

INTRODUCTION

Unending stomach agony can be symptomatic test. These
troublesome patients are oftentimes observed by a wide
range of doctors and are heap of test without distinguishing
the etiology of torment. Surgical counsel regularly happens
late after different modalities have neglected to give
determination of their symptomatology. Endless stomach
torment is a critical clinical issue that regularly prompts to
rehashed laparotomies. The introduction of laparoscopic
surgery and recent in laparoscopy have been increasingly
recognised as a procedure that offers precise visual
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DOI:
10.21276/iabcr.2016.2.4.10
Received:09.10.16| Revised:24.10.16| Accepted:30.10.16
Corresponding Author
Dr. Ram Nagina Sinha
Associate Professor, Department of General Surgery, Lord
Buddha Koshi Medical College & Hospital, Saharsa, Bihar
Copyright: © the author(s) and publisher. IABCR is an official publication of
Ibn Sina Academy of Medieval Medicine & Sciences, registered in 2001
under Indian Trusts Act, 1882. This is an open access article distributed under
the terms of the Creative Commons Attribution Non-commercial License,
which permits unrestricted non-commercial use, distribution, and
reproduction in any medium, provided the original work is properly cited.
assessment of intra-abdominal condition for diagnosis and
prompt intervention. Laparoscopy has a noteworthy
symptomatic and restorative part in patient with unending
stomach torment. In the event of analytic instability,
laparoscopy may keep away from superfluous
laparotomies, give precise determination and arrangements
surgical treatment. The primary capacity of laparoscopic
assessment is to recognize the nearness or nonappearance
of intra-stomach natural sore.
Laparoscopy is the only method of visualising the
pathological anatomy of abdominal cavity in clinical
practice.
Laparoscopy permits specialists to see and treat numerous
stomach changes that couldn't be analyzed something else.
Consequently, symptomatic laparoscopy ought to be
considered for patients experiencing ceaseless stomach
torment, as it is negligibly intrusive, protected, useful and
successful analytic methodology and can be performed
quickly, securely with insignificant continuation.
METHODS
This study was conducted in the Department of General
Surgery, Lord Buddha Koshi Medical College & Hospital,
Saharsa, Bihar. This study included 50 patients presenting
with history of abdominal pain for 3 or more months who

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 Sinha RM.: Laparoscopy in Chronic Abdominal Pain

were admitted in surgical wards between July 2015 to June abdominal adhesion. Out of which, 6 patients had
2016. Detailed history was recorded from patients and abdominal tuberculosis, 4 patients had appendicitis, B/L
thorough clinical examination was performed. The findings fimbrial cyst in 2, cirrhosis in 2 and 2 patients had
were recorded in the proforma. acalculus cholecystitis.
The recorded data included demographics, length of time; it
had been presented, location of pain, patient’s abdominal Treatment
examination and diagnostic studies performed. From the below Table 3 it is evident that most common
Intraoperative findings and operative interventions findings were abdominal tuberculosis (36%) which was
undertaken were also identified. found in 18 cases. All patients proven with omental biopsy,
HB%, TC, DC, ESR, Urine microscopy was the basic then treated with CAT 1 anti-tubercular drugs.
investigations done for all patients. RBS, BUN, and S. The second common cause was appendicitis which was
creatinine, chest X-ray, ECG and stool for ova, cyst and found in 16 (32%) cases. At laparoscopy, no abdominal and
occult blood were done when indicated. Commonly pelvic abnormality was noted except that appendix
performed imaging studies included plain abdominal appeared abnormal.
radiographs, ultrasounds studies. Barium studies, upper These abnormalities some were thickened and adherent to
gastrointestinal and lower gastrointestinal endoscopy were adjacent structure. Some curved and felt rigid. HPE s/o
done when indicated. The surgical methods employed were chronic appendicitis.
as per etiology. A written informed consent was taken from Two patient had B/L fimbrial cyst, laparoscopy was
all the payments before starting the study. converted to open. Fimbrial cyst excision with right
Patients with history of abdominal pain for 3 months or oophorectomy done.
more, are included in our study. Also, Patients with Two patient had ovarian cyst, laparoscopy aspiration done.
previous history of abdominal operation are included. Two patient had cirrhosis of liver, managed conservatively.
Two patient had thickened gall bladder wall, laparoscopic
RESULTS cholecystectomy done.
This prospective study was conducted on 50 cases of In eight patients, no abnormality was found and kept on
chronic abdominal pain showed peak incidence in 3rd observation.
decade. The mean age of presentation was 34.64 (Table 1). In 42 patients with chronic abdominal pain pathological
findings on laparoscopy were present, giving a diagnostic
Table 1: Age distribution of patients with chronic abdominal accuracy of 84%.
pain. In 8 patients (16%) no abnormal findings were present.
Age group
No. of cases Male Female (%)
(years)
Table 3: Findings at laparoscopy and treatment adopted.
15-30 20 8 12 40
31-45 18 8 10 36 Operative findings Treatment No. of cases %
46-50 08 4 4 16 Tuberculosis Cat 1 ATT 18 36
51-65 04 3 1 08 Appendicitis Appendectomy 16 32
>65 00 00 Fimbrial cyst B/L cyst excision 02 4
Total 50 23 27 100 Cirrhosis of liver Symptomatic 02 4
Ovarian cyst Aspiration 02 4
Acalculus cholecystitis Cholecystectomy 02 4
This study of 50 cases of chronic abdominal pain showed Normal study Observation 08 16
peak incidence in female (54%) (Table 1).
The peak incidence of duration of pain was between 12 to Follow up
Patients were followed up at regular intervals of one month.
30 weeks. The average duration of pain was 32.96 weeks
Four patients were lost from follow up. Subjective
(Table 2). The present study showed most of the patients assessment of pain was done by asking patients, what
presented with lower abdominal pain (52%), diffuse occurred to their pain, resolution or no change in pain. Our
abdominal pain (40%) and eight percent with upper study had limitation of shorter follow up ranging from 3-9
abdominal pain (Table 2). months.

Table 2: Duration and Location of pain before laparoscopy. Outcome

Duration (weeks) Nos. of cases Percentage (%) Out of 46 cases who came for regular follow up, 38 patient
12-30 18 76 had resolution of pain (82.6%), 8 patients (17.4%) had no
30-50 02 04
50-70 02 04 change in pain.
70-90 02 04 Eighteen patients were treated with anti-tubercular drugs
90-110 06 12
Location of Pain
following confirmation by histopathological report.
Location No. of cases Percentage (%) Fourteen had resolution of pain (88.9%) and in another 4
Upper abdomen 04 8 patients (11.1%) there was no change (Table 8).
Lower abdomen 26 52
Diffuse abdomen 20 40 N=16 patients underwent appendectomy, in n=2 patients
laparoscopy converted to open appendectomy; n=2 patients
Only 16 patients (32%) with chronic abdominal pain had was lost from follow-up. Twelve (85.7%) patients had
previous history of abdominal operation. All of them are complete resolution of pain and pain persisted in only two
with history of tubectomy, none of them had intra- patients. (14.3%).
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 Sinha RM.: Laparoscopy in Chronic Abdominal Pain
DISCUSSION
Incessant stomach agony is a typical issue, managed by an
assortment of restorative masters. Indeed, even after a broad
work up in a few patients, no obsessive condition is found by
non-obtrusive examination and the agony is frequently
ascribed to unconfirmed finding.
Diagnostic laparoscopy makes it possible for the surgeon to
visualize surface anatomy of intra-abdominal organs with
greater details better than any other imaging modality.
Laparoscopy may be useful to establish a histological
diagnosis of intra-abdominal tuberculosis. Deep
parenchymal organs, process of the retroperitoneal space,
and the inner surface of the hollow organs cannot always be
noticed using laparoscopy. Another limitation of laparoscopy
is that it does not allow the surgeon to palpate organs. Before
laparoscopy is performed in chronic abdominal pain, pre-
operative imaging studies must be undertaken. As in our
material, most of the patients have been studied by
endoscopies and ultrasound before laparoscopy. The
subjective benefit of laparoscopy for both the operating
surgeons and for the patients is the definitive answers that no
serious pathology is found intra abdominally. Therefore, the
placebo effect of laparoscopy may explain at least partly the
patient`s pain relief.
In our study, 50 patients were admitted in surgical wards
with chronic abdominal pain.
In our study 42 (84%) patient had pathological findings
identified at the time of laparoscopy. Karl Miller et al[1]
reported that laparoscopy provided diagnoses in 89.8% of
patients. These results compare favorably with our series.
In our study, 42 (84%) patients had a definitive therapeutic
procedure performed. In our study, most common findings
were abdominal tuberculosis. In study by Prafull Arya and
Gaur[2] most common findings was intestinal and peritoneal
tuberculosis. This correlates with our study. Second
common cause was appendicitis. Our study again correlates
with Prafull Arya and Gaur.[2]
Abdominal tuberculosis is a common disease in India, as
was seen in present study. Laparoscopy has a great deal to
offer an early diagnosis of abdominal tuberculosis and
treatment.[2]
Krishnan P et al.,[3] reported that in patients suspected to
have abdominal tuberculosis without evidence of extra
abdominal disease, early laparoscopy may be useful to
establish a histological diagnosis with acceptably low
morbidity (8%). Rai S and Thomas M,[4] reported
abdominal tuberculosis in 46 (92%) patients of the 50
patients in whom laparoscopy was performed.
In our study, common finding in abdominal tuberculosis
are peritoneal or visceral tubercles, varying from 2 mm to 1
cm. Ascites and small bowel adhesions also seen. For the
tubercular peritonitis laparoscopy is of special practical
benefit in under privileged area where high end
investigations are not available.
Our study reported improvement or resolution of symptoms
in patients with abdominal tuberculosis in 88.9%.
In a study by Fayez et al.,[5] records of chronic abdominal
pain undergoing appendectomy were reviewed 92% of
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patients appendices had abnormal histological findings and
the 95% of patients had resolution of pain. Raymond et
al.,[6] reported improvement of pain in 74% of patients with
chronic right lower abdominal pain.
In our study 85.7% patient who underwent appendectomy
for chronic abdominal pain had resolution of pain.
In our study 8 (16%) patients did not have any pathological
findings on laparoscopy. Six of these patients had
resolution of pain after procedure which suggestive of
placebo effect.
In our study 82.6% of patients had pain relief. Raymond et
al.[6] also reported the same fact that more than 70%
patients had long term pain relief. Our study also in
accordance with Pajnen et al.,[7] who reported that
laparoscopy alleviates the symptoms in more than 70% of
patients. This correlate well with our study and it should be
considered if other diagnostic tests are negative.
CONCLUSION
Interminable stomach agony of obscure starting point
speaks to a huge issue in surgical patients. At times, even
battery of examination does not uncover the reason for
agony. Because of change in instrumentation and more
noteworthy involvement in the laparoscopy, the technique
no longer restricted to perception.
This study showed that laparoscopy is an effective
approach in the management of patients with chronic
abdominal pain.
Abdominal tuberculosis is common disease in India.
Laparoscopy has a great deal to offer in early diagnosis of
abdominal tuberculosis. Treatment with anti-tubercular
drugs provided pain relief.
Advantages of diagnostic laparoscopy are that it is safe,
efficacious and therapeutic procedure can be performed at
same time.
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4. Rai S, Thomas WM. The importance of laparoscopy in diagnosis
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How to cite this article: Sinha RM. Efficacy of Diagnostic and
Therapeutic Laparoscopy in Chronic Abdominal Pain - A
1.Hospital Based Prospective Study. Int Arch BioMed Clin Res.
2016;2(3):46-48.DOI: 10.21276/iabcr.2016.2.4.10
Source of Support: Nil, Conflict of Interest: None
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