Laparoscopy for the management of acute lower abdominal pain in women of childbearing age.
BACKGROUND
Acute lower abdominal pain is common and making a diagnosis is particularly challenging in premenopausal woman as ovulation and menstruation symptoms overlap with the symptoms of appendicitis and pelvic infection. A management strategy involving early laparoscopy could potentially provide a more accurate diagnosis, earlier treatment and reduced risk of complications.


OBJECTIVE
To evaluate the effectiveness and harms of laparoscopy for the management of acute lower abdominal pain in women of childbearing age.


METHODS
The  Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, LILACS and CINHAL were searched (to April 2010).


METHODS
Randomised controlled trials (RCTs) that included women of childbearing age who presented with acute lower abdominal pain, nonspecific lower abdominal pain or suspected appendicitis were included.


METHODS
Data from studies that met the inclusion criteria were independently extracted by two authors and the risk of bias assessed.


RESULTS
Laparoscopy was compared with open appendicectomy in eight RCTs. Laparoscopy was associated with an increased rate of specific diagnoses (7 RCTs, 561 participants; OR 4.10, 95% CI 2.50 to 6.71; I(2) 18%) but there was no evidence of reduced rate for any adverse event (8 RCTs, 623 participants; OR 0.46, 95% CI 0.19 to 1.10; I(2) 0%).Laparoscopic diagnosis versus a 'wait and see' strategy was investigated in four RCTs. There was a significant difference favouring laparoscopy in the rate of specific diagnoses (4 RCTs, 395 participants; OR 6.07, 95% CI 1.85 to 29.88; I(2) 79%) but there was no evidence of a difference in the rates of adverse events (OR 0.87, 95% CI 0.45 to 1.67; I(2) 0%).


CONCLUSIONS
The advantages of laparoscopy in women with nonspecific abdominal pain and suspected appendicitis include a higher rate of specific diagnoses being made and a lower rate of removal of normal appendices compared to open appendicectomy only. Hospital stays were shorter. There was no evidence of an increase in adverse events with any of the strategies.
Universidad Nacional de Colombia, Calle 119a # 18-14 (502), Bogota, Colombia.
Hernando G
HG
Gaitán
Ludovic
L
Reveiz
Cindy
C
Farquhar
D015746:Abdominal Pain / Q000209:etiology*; D000208:Acute Disease; D000328:Adult; D001062:Appendectomy / Q000379:methods / Q000706:statistics & numerical data; D001064:Appendicitis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy; D017699:Pelvic Pain / Q000209:etiology; D017697:Premenopause; D016032:Randomized Controlled Trials as Topic; D057832:Watchful Waiting; D055815:Young Adult