Role of elective laparoscopic appendicectomy in chronic right lower quadrant pain: a prospective & interventional study
Keywords:
Recurrent/chronic, Laparoscopic, Appendectomy, AppendicitisAbstract
Background:Chronic pain occurring in the Right Lower Quadrant (RLQ) region is a common clinical entity and has many differential diagnoses. Chronic/Recurrent appendicitis is an important cause. We evaluate here whether undiagnosed chronic RLQ pain can be relieved after elective laparoscopic appendectomy.
Methods:30 patients, 5-65 years of age, with undiagnosed chronic RLQ pain underwent laparoscopic appendectomy between 2012 and 2014. Inclusion criteria was pain of more than 3 months’ duration. Exclusion criteria was patients who had previously been treated conservatively for appendicitis or appendicular lump, previous abdominal surgery, diagnosed cases of specific urological, gynecological or gastrointestinal diseases. Patients were followed up for 6 months and their pain was graded in the following manner - grade 1 (pain worse than before), grade 2 (pain decreased, but not completely gone) and grade 3 (completely pain free). The histopathology of the appendices was also compared with the grades of pain.
Results:Out of 30 patients, 26 were completely pain free at the end of 6 months. 4 patients had a pain grading of 2. Most of the patients had appendicular adhesions. There was 1 patient who had disseminated abdominal tuberculosis. Other intra-operative findings were ascites, free fluid in cul-de-sac, mesenteric lymphadenopathy and intussusception. There was no significant co-relation between pain relief and histopathology of the appendix.
Conclusions:Laparoscopy is an invaluable tool in diagnosing other conditions existing concurrently. There is no correlation between the relief of chronic right lower quadrant pain and histopathology of the appendix. Chronic right lower quadrant pain is relieved by performing laparoscopic appendicectomy.
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References
De Kok HJ. Laparoscopic appendicectomy: a new opportunity for curing appendicopathy. J Surg Laparosc Endosc. 1992;2(4):297-302.
Mattei P, Sola JE, Yeo CJ. Chronic and recurrent appendicitis are uncommon entities often misdiagnosed. J Am Coll Surg. 1994;178:385-9.
Falk S, Schutze U, Guth H, Stutte HJ. Chronic recurrent appendicitis. A clinicopathological study of 47 cases. Eur J Padiatr Surg. 1991;1:277-81.
Michael Zinner Jr, Stanley Ashley. Laboratory and histopathological evaluation of chronic pain. In: Michael Zinner Jr, Stanley Ashley, eds. Maingot’s Textbook of Abdominal Surgery. 12th ed. New York: McGraw-Hill Professional; 2012: 640.
Roumen RM, Groenendijk RP, Sloots CE. Randomized clinical trial evaluating elective laparoscopic appendicectomy for chronic right lower quadrant pain. Br J Surg. 2008;95:169-75.
Teli B, Ravishankar N, Harish S, Vinayak CS. Role of elective laparoscopic appendicectomy for chronic right lower quadrant pain. Indian J Surg. 2013 Oct;75(5):352-5.
Charles C, van Rossem, Kaij Treskes. Laparoscopic appendicectomy for chronic right lower quadrant pain. Int J Colorectal Dis. 2014;29:1199-202.
Safaei M, Moeinei L, Rasti M. Recurrent abdominal pain and chronic appendicitis. J Res Med Sci. 2004;1:11-4.
Kolts RL, Nelson RS, Park R. Exploratory laparoscopy for recurrent right lower quadrant pain in a pediatric population. Pediatr Surg Int. 2006;22:247-9.
Karim Shalan Al-Araji. Recurrent “Chronic” appendicitis. Is it a myth? Is appendicectomy indicated? Med J Babylon. 2006;3(1-2):51-5.
