Role of Early Laparoscopy in Diagnosis of Acute Abdominal Pain
Journal Title: International Journal of Contemporary Medical Research - Year 2017, Vol 4, Issue 7
Abstract
Introduction: Emergency admissions due to acute non specific abdominal pain, make up large proportion of overall general surgical workload. Hospitalization followed by active clinical observation, has been the most widely used method earlier, but entails risk of complications to patients eg peritonitis, infertility etc and unnecessary laparotomy. Incorporation of laparoscopy has improved management of emergency admissions, besides providing cost benefits. The study was undertaken to evaluate role of early laparoscopy in management of acute non-specific abdominal pain and to compare early laparoscopy with clinical observation in cases of acute abdominal pain. Material and Methods: The study was performed in 50 patients admitted with acute non specific abdominal pain with normal baseline investigations. Patients were randomly divided for early laparoscopy (Group I) and clinical observation (Group II). Early laparoscopy was done within 18 hours to establish diagnosis and simultaneous intervention was done, if possible. The clinical observation group was managed with serial investigations, empirical treatment and interventions. Postoperative hospital stay, laparoscopy related complication, hospital re-admission, final diagnosis achieved and response rate were recorded. Results: The mean age of presentation was 30.5±12.9 years, with M:F ratio of 1:2.1. 62% patients were young adults (20- 40 years). The most common presenting symptom were pain, nausea, vomiting. The laparoscopic findings were appendicitis (32%), bands and adhesions (20%) and gynaecological pathology (24%). Group I had less mean radiation exposure (p<0.01), less VAS score on days 1,3,5,7 (p<0.01), less mean injectable antibiotic requirement (p<0.01), injectable analgesic (p<0.01) requirement with less NBM status (p<0.01) and decreased hospital stay (p<0.01). Recurrence rate and readmissions were more in Group II at 3 months (48%), 6 months (16%) and 12 months (8%). Final diagnosis was achieved in 92% cases. Conclusion: Early laparoscopy is valuable in management of acute non specific abdominal pain. It provides significantly high diagnostic accuracy, permits early patient discharge and minimizes the incidence of unnecessary laparotomy.
Authors and Affiliations
Anand Thawait, Sankalp Dwivedi, Manisha Bhatt, Karan Bakhshish, Amit Mittal
Keywords
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