EARLY LAPAROSCOPY IN THE MANAGEMENT OF ACUTE NONSPECIFIC ABDOMINAL PAIN

Background: Emergency admissions make up a large proportion of the overall general surgical workload. The mean 
hospital stay for patients admitted with non-specific abdominal pain (NSAP) ranges between 4.1 and 6 days using the 
traditional ‘wait and see’ management. Incorporation of laparoscopy may improve the management of emergency admissions and also have important cost benefits, by reducing hospital stay and readmission rates. A delay in surgical intervention while further investigations are performed may increase morbidity and prolong hospital stay. 
Aim: The aim of this study was to assess the usefulness of early laparoscopy in the management of acute NSAP 
Patients & Methods: This study was done on 43 patients (4M & 39F) who had been admitted with acute abdominal pain of less than 7 days duration and, after examination and baseline investigations had been performed, the diagnosis remained uncertain. Patients had early laparoscopy within 18 hours (median 9 hours, range 2-39 hours) to establish the diagnosis. If the identified pathology was suitable to be treated by laparoscopy, this was done. Otherwise, abdominal incision was placed as seen appropriate by laparoscopy findings. If no pathology was found, the procedure was terminated and the diagnosis of NSAP was made. Postoperative hospital stay, laparoscopy related complication and hospital re-admission were recorded. 
Results: Nine patients (20.9%) were found to have acute appendicitis on laparoscopy. Seven (16%) had laparoscopic 
appendectomy the remaining two (4%) had open appendectomy. Twelve patients (27.9%) were found to have gynaecological pathology. One patient (2%) had caecal carcinoma that was treated by right hemicolectomy. One patient (2%) had localised perforation of caecal diverticulitis. He was treated by limited right hemicolectomy. One patient (2%) had Crohn’s disease that was treated conservatively. Nineteen patients (44.2%) had normal laparoscopy and they had been diagnosed as ‘NSAP. 
No patient had negative laparotomy. Median postoperative stay in patients who were diagnosed to have NSAP after 
laparoscopy was 2 days (range 1-5 days). One patient (2%) had superficial wound infection in the site of umbilical port. One patient (2%) required readmission within 2 days of discharge due to exacerbation of the pain. No further investigations were done. The patient was discharged home after observation for 24 hours. 
Conclusion: Early laparoscopy is valuable in the management of acute NSAP. It provides a significantly high diagnostic 
accuracy, permits early patient discharge and minimise the incidence of unnecessary appendectomy & laparotomy. 
Laparoscopy is particularly useful in the management of acute NSAP in young women of child-bearing age.