Role of Diagnostic Laparoscopy in NonSpecific Abdominal Pain (NSAP)

Abstract

Introduction: Non-Specific Abdominal Pain (NSAP) is defined as pain in abdomen with uncertain diagnosis after physical examination and baseline investigations which include routine hematological and imaging tests. The traditional three step approach to abdominal pain of non-specific nature including history and clinical examination, various investigations and therapeutic intervention is tedious and lengthy. Patients are hospitalized, subjected to a battery of costly investigations and often end-up undergoing a laparotomy which may prove unnecessary with no therapeutic benefit. Laparoscopy has become an emerging diagnostic as well as therapeutic tool in management of NSAP. Aim: To evaluate the role of laparoscopy as a diagnostic and therapeutic tool investigating its effectiveness in patients with NSAP and find out the cause for it in Central India as there is scarcity of data in Indian scenario. Materials and Methods: A total of 45 patients were enrolled in this study for a duration of 2 years starting from September 2014 to September 2016. It was a Tertiary Care Hospital based longitudinal study. The mean age of the patients was 32.53±11.7 years with female preponderance. On laparoscopic examination, maximum patients were found to have some appendicular pathology with other common diagnoses being Koch’s abdomen and ovarian cyst. Results: Out of 45 cases, 36 were accurately diagnosed by laparoscopy with sensitivity of 90%, specificity of 80% and accuracy of 88.9%. No definitive cause of pain could be established in 4 patients in laparoscopy or histopathological diagnosis.No laparoscopic pathologies were found in total 8 patients, out of which prophylactic appendectomies were done in 5 patients and histopathologiclly confirmed to be appendicitis in 4 patients. Conclusion: Diagnostic laparoscopy is helpful in confirming a diagnosis made on clinical grounds and radiological evaluation. It is a good tool for diagnosis and therapeutic surgery. For undiagnosed recurrent vague abdominal pain with no specific etiology, diagnostic laparoscopy may be considered as first line operative investigation. By establishing definitive diagnosis, definitive treatment can be initiated early thus reducing patient’s suffering.

Keywords

• appendicitis
• minimally invasive
• ovarian cyst