ROLE OF LAPAROSCOPY IN MANAGEMENT OF UNEXPLAINED CHRONIC ABDOMINAL PAIN

Objective: Patients with chronic abdominal pain (CAP) can undergo numerous diagnostic tests with failure to detect 
any structural or biochemical abnormality. This study was undertaken to assess the diagnostic and therapeutic role of 
laparoscopy in patients with unexplained chronic abdominal pain (UCAP). 
Patients And Methods: Diagnostic laparoscopy was performed for 56 patients with UCAP not diagnosed by usual clinical examination and investigations. Their mean age was 27.8 years. In 36 patients (64.3%) the diagnostic procedures was extended to operative laparoscopy. 
Results: UCAP represent 22.6% of the patients complaining of CAP and it is common in females (71.3%) than in males. The most frequent laparoscopic findings detected were abdominal adhesions (26.8%), endometriosis (14.2%), chronic appendicitis (12.5%), pelvic varicosities (8.9%), internal ring for clinically undiagnosed indirect inguinal hernia (5.4%), uterine myoma (3.6%) and abdomino-pelvic tuberculosis (1.8%). In 21.4% of patients with UCAP, laparoscopy did not reveal any pathologic findings in the abdomen. Laparoscopic operative interventions were in the form of adhesiolysis in 26.8%, ablation or drainage and cauterization of endometriotic tissue in 12.5%, laparoscopic appendectomy in 12.5%, laparoscopic transabdominal preperitoneal hernioplasty in 5.4% and salpingostomy for chronic tubal ectopic in 3.6%. Other lines of treatment were given for 9 patients (16.1%) with pathologic findings. Follow up for 6 months revealed, pain relief in 53.5%, pain reduction in 26.7% and persistent pain in 19.8%. 
Conclusions: Diagnostic laparoscopy in UCAP is a significant procedure, which increase our understanding of many 
underlying abdominal disorders. However, it should be undertaken only after complete diagnostic evaluation has been carried out. It permits the effective surgical treatment of many conditions encountered at time of diagnostic laparoscopy.