Introduction: Patients with chronic abdominal pain can undergo numerous diagnostic tests with little change in their pain. This study was undertaken to assess the utility of performing diagnostic and therapeutic laparoscopy in patients with chronic abdominal pain of greater than 12 weeks.
Methods: All patients undergoing laparoscopy by the primary author were prospectively entered into a database for a three-year period between July 1, 1997 and June 30, 2000. The patients' demographic data, length of time of pain, number of diagnostic studies performed prior to surgery, intraoperative findings, interventions, pathology, and long-term follow-up were determined.
Resutls: A total of 70 patients(5% out of a total of 1308 laparoscopic procedures performed) underwent diagnostic laparoscopy only for the evaluation and treatment of chronic abdominal pain. There were 61 women and 9 men with an average age of 42 years. The average length of time with pain was 74 weeks(range 12-260) and the average number of studies performed prior to surgical referral was 3.3. Fifty-three(76%)patients had their procedures performed as true outpatients with the remainder admitted for observation status. The average length of operative time was 70 minutes, no cases required conversion to an open procedure and no complications occurred. Findings included adhesions in 39, a hernia in 13, adhesions from the appendix to adjacent structures in 6, apppendiceal pathology in 5, endometriosis in 3 and gallbladder pathology in 2. Ten patients had no obvious pathology. At the time of their postoperative visit, 90% reported ther pain to be gone or improved. After an average follow-up of 74 weeks, 30% noted recurrence of their symptoms therefore 70% had long-term pain relief. All patients with recurrence of pain had it in the first 6 months. No patients experienced any long-term complications and all reported satisfaction with their procedure.
Conclusion: Laparoscopy has a significant diagnostic and therapeutic role in patients with chronic pain. Therapeutic laparoscopy studies have to follow patients at least 6 months. With aggressive indicated therapeutic laparoscopy including adhesiolysis, appendectomy, cholecystectomy or hernia repairs, 70% of patients can have an improvement in their pain.
