Six of the Best, General 24

Abstract

Aims: Patients in whom extensive investigations have failed to identify the cause of abdominal pain present a challenge to surgeons. We present our initial experience of using laparoscopy under local anaesthetic and sedation in the diagnosis of chronic abdominal pain. Methods: Nine patients with chronic abdominal pain and multiple normal investigations underwent laparoscopy under local anaesthetic and sedation. By touching and grasping intra-abdominal viscera and peritoneum, an attempt was made to reproduce the patient's pain. Results: Two patients were found to have pain arising from the gall bladder and subsequently underwent laparoscopic cholecystectomy with resolution of their symptoms. A third patient had a clinical presentation of chronic acalculous cholecystitis and a normal laparoscopy. She decided to undergo laparoscopic cholecystectomy, which cured her pain. Another patient had pain arising from the appendix, which resolved after an appendicectomy. Another patient had pelvic adhesions and after adhesiolysis is pain free. One patient declined surgery for adhesions, which produced chronic pain and another patient had adhesions secondary to an appendicectomy but did not cause any pain at the time of her laparoscopy. Another patient awaits a repeat laparoscopic adhesiolysis. One patient had a normal laparoscopy and a gastroenterologist has made a diagnosis of irritable bowel syndrome. Conclusion: Laparoscopy can be carried out in the awake patient, who is then usually able to differentiate the type of pain experienced during conscious pain mapping. Long-term effectiveness and diagnostic accuracy has not yet been established.