Laparoscopy in chronic abdominal pain: a prospective nonrandomized long-term follow-up study.
OBJECTIVE
Our aim was to assess the long-term efficacy of diagnostic laparoscopy and adhesiolysis on the treatment of intractable chronic abdominal pain.


METHODS
This was a prospective nonrandomized study of 72 patients (60 women and 12 men). One surgeon performed a total of 79 diagnostic laparoscopies including 61 adhesiolysis. The patients' demographic data, operative findings, and long-term postoperative course were carefully recorded. A quality-of-life questionnaire was mailed after the mean follow-up of 3.7 years to find out the late course of any chronic abdominal symptoms after the surgery.


RESULTS
Intra-abdominal adhesions were found in 61 patients (85%) in the laparoscopy, gynecologic disorders in 4, chronic appendicitis in 1, and no abnormality in 6 patients. The abdominal wall pain was a likely reason for pain in 12 patients (17%). The complication rate was minimal, including only four bleedings (one major), one perforation of urinary bladder, and three wound infections. At 1-month control, 38% of the patients were completely free of pain. In the long-term follow-up, chronic abdominal pain was totally healed in 33%, diminished in 46%, and unchanged in 21% of the patients. A total of 65 patients (90%) reported that the surgery had been beneficial for their intractable pain.


CONCLUSIONS
By careful selection, for patients with chronic abdominal pain, laparoscopy alleviates the symptoms in more than 70% of the patients, and it should be considered if other diagnostics tests are negative. A placebo-controlled study is needed, in which the patients are randomized into laparoscopy and conservatively treated groups with a quality-of-life measurement.
Paajanen
Hannu
H
Department of Surgery, Central Hospital of Mikkeli, 50100 Mikkeli, Finland. hannu.paajanen@esshp.fi
Julkunen
Kristiina
K
Waris
Heidi
H
D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D000267:Tissue Adhesions / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D016896:Treatment Outcome