Viduthalai Venthan, T (2020) The Efficacy of Laparoscopy in the Diagnosis and Management of Chronic Abdominal Pain. Masters thesis, Chengalpattu Medical College and Hospital, Chengalpattu.
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Abstract
BACKGROUND: Patients with chronic abdominal pain are amongst the most difficult to manage. Potentially it can be unrewarding for both the patient and the treating physician. It can affect a patient both physically and mentally. Chronic abdominal pain is associated with poor quality of life. Most patients in this group would have already undergone many diagnostic procedures. No results can be reached in > 40% patients even after complete evaluation with imaging studies. These searches for pathology often include such procedures as upper and lower gastrointestinal endoscopies, computerized tomography and screening for undetected carcinoma. When the limits of reasonable noninvasive testing are reached in an individual patient’s illness, which is likely to occur without the extensive testing practiced today, the surgeon is often consulted. A high chance of a non-therapeutic abdominal exploration naturally results. Clearly diagnostic laparoscopy is an important intermediate option between refusing to explore a patient’s abdomen and performing laparotomy. Diagnostic laparoscopy can be done under direct vision with simple equipment as it does not require a video camera or the electronic gadgetry associated with laparoscopic surgery. With advances in optics, laparoscopy allows perfect visual examination of the peritoneal cavity and further makes possible, histological diagnosis of target biopsy under vision. Laparoscopy is as much a surgical procedure as an exploratory laparotomy, often just as informative, and to the trained surgeon affords a better view of the entire peritoneal cavity than the usual exploratory laparotomy. To achieve a high rate of positive diagnosis from laparoscopy requires much more than correct technique, it requires thorough background of surgery, sound clinical acumen as also knowledge and awareness of abdominal pathology In many cases it prevents unnecessary negative laparotomy. The early recovery and return to daily activities are a source of gratification for the operating surgeon. AIM AND OBJECTIVES: 1. To study the efficacy of diagnostic laparoscopy in identifying the etiology of undiagnosed chronic abdominal pain. 2. To establish that laparoscopy can also be offered as effective therapeutic option for patients with chronic abdominal pain. 3. To evaluate causes for chronic abdominal pain using laparoscopy in order of increasing frequency. MATERIALS AND METHODS: Source of data: Study is a CROSS SECTIONAL type which includes all patients admitted in CHENGALPATTU MEDICAL COLLEGE for management of Chronic abdominal pain. Definition of a study subject: Patients subjected to this study were taken form surgical unit of Chengalpattu Medical College and Hospital, Chengalpattu over a period of one year. From March 2018 to February 2019. This study was conducted in the surgical wards of Chengalpattu Medical College, Chengalpattu. The study group consisted of 30 patients admitted to the surgical wards of Chengalpattu medical college hospital with pain abdomen for 3 months duration or more between March 2018 to February 2019.A detailed history was taken from each of the patient as per the proforma designed before the commencement of the study. The clinical examination findings were also recorded in the proforma The results were then tabulated. The recorded data included particulars of the patient, duration of illness, site of abdominal pain, other associated symptoms such as vomiting or fever or white discharge per vagina, past history of surgical explorations, co morbid conditions, investigations. Subsequently the intra operative findings, therapeutic/ diagnostic intervention done, correlation of the intra operative findings with the histopathology report, complications during the intra and post operative period and the relief from the pain were recorded and analysed. As a part of the work up of a patient the following investigations were done routinely: • Hemoglobin estimation, • Bleeding time, • Clotting time, • Random blood sugar, • Total leucocyte count and differential count, • Serum electrolytes, • Blood urea, • Serum creatinine, • Urine for albumin, sugar and microscopic examination, • Electrocardiogram, • Ultrasonogram abdomen and • Chest X Ray. The other investigations listed below were done as and when indicated Blood: Erythrocyte Sedimentation Rate, Fasting blood sugar and post prandial blood sugar. Imaging: Erect X Ray abdomen, Barium studies, Esophago gastro duodenoscopy, Colonoscopy, Computerised tomograph of the abdomen, Written informed consent was taken prior to all the procedures. Inclusion criteria: All cases of undiagnosed (by conventional methods and investigations such as detailed history, clinical examination, blood counts, urine examination, USG abdomen, Plain x ray abdomen) chronic abdominal pain > 3 months duration of both sex. All cases of undiagnosed chronic abdominal pain in patients >14 years of age. Cases of clinically diagnosed chronic abdominal pain of >3 months duration not responding to the treatment given. Exclusion criteria: All cases of undiagnosed chronic abdominal pain <3months duration of both sex. All cases of undiagnosed chronic abdominal pain in patients <14years of age. The following investigations will be done after taking written informed consent- 1. Routine Investigations for General Surgical Procedure Blood Investigation and Urine Investigations: Hb%, TC , DC, Peripheral smear, ESR, Renal function tests, Liver function tests, Lipid profile, FBS/PPBS, HIV, HBsAg, Urine for albumin, sugars, ketone bodies, microscopy, BT CT. Other investigations: X-ray of the chest, proctoscopy in chronic cases. CONCLUSION: The above study is to evaluate THE EFFICACY OF LAPROSCOPY IN THE DIAGNOSIS AND MANAGEMENT OF CHRONIC ABDOMINAL PAIN in Chengalpattu Medical College Hospital during the period March 2018 to February 2019.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711265 |
| Uncontrolled Keywords: | Efficacy, Laparoscopy, Diagnosis, Management, Chronic Abdominal Pain. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 10 Feb 2021 17:43 |
| Last Modified: | 10 Feb 2021 17:43 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14011 |
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