Does laparoscopy used in open exploration alleviate pain associated with chronic intractable abdominal wall neuralgia?
BACKGROUND
This study aimed to assess the efficacy of diagnostic laparoscopy and open exploration of trigger points (scar revision and neurectomy) in the treatment of intractable chronic abdominal wall pain.


METHODS
This prospective nonrandomized study enrolled 24 patients (21 women) with an average age of 59 +/- 11 years. Abdominal wall pain was diagnosed by excluding other causes of pain and using multiple injections of bupivacain. The patients' demographic data and long-term postoperative course (37 +/- 13 months) were carefully recorded.


RESULTS
Using laparoscopy, intraabdominal adhesions close to trigger points were found and lysed in 15 patients (63%). Next, a subcutaneous nerve resection was performed. After 1 month, 33% of the patients were completely pain free, and 42% reported alleviation of pain. After 3 years, chronic abdominal pain was totally healed in 25%, diminished in 50%, and unchanged or increased in 25% of the patients. A total of 23 patients (96%) reported that surgery was beneficial for their intractable pain.


CONCLUSIONS
Laparoscopy used in open exploration is beneficial for 75% of carefully selected patients with chronic abdominal wall pain.
Paajanen
H
H
Department of General Surgery, Central Hospital of Mikkeli, 50100 Mikkeli, Finland.
D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D034861:Abdominal Wall / Q000294:innervation*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D010147:Pain Measurement; D010148:Intractable Pain / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D010525:Peripheral Nerves / Q000601:surgery*; D011446:Prospective Studies; D013997:Time Factors