Use of keyhole surgery in pain abdomen

Completed

• Conditions: SURGICAL ACUTE ABDOMEN

• Registration Number: CTRI/2018/06/014457
• Lead Sponsor: MAHARAJA AGRASEN HOSPITAL

Brief Summary

Acute abdomen continues to be the commonest complaint for emergency surgical admission and demands a large portion of the general surgeons workload. Patients selected for this study were admitted with surgical causes of acute abdomen. Based on clinical history and examination, relevant investigations of patients with acute abdomen were done. A detailed proforma was used to collect this information. After initial assessment and informed written consent, they were subjected to laparoscopy. All patients were informed about the risk and benefit of procedure and also about the probability of laparotomy if need arose. The preoperative diagnosis was compared with laparoscopic diagnosis to evaluate accuracy of diagnostic laparoscopy. Wherever possible, therapeutic procedure was undertaken. If the therapeutic procedure required conversion to open procedure (laparotomy) the same was done. The patients were managed in Intensive Care Unit or surgical wards. The patients were followed postoperatively till 6 months.The patient were thus divided into three groups after undergoing diagnostic laparoscopy. The patients undergoing therapeutic laparoscopy, those who had laparoscopic assisted procedure done and those patients on whom laparoscopy was converted to laparotomy. The parameters compared were operating time, hospital stay and complication.

Diagnostic laparoscopy was found to be more accurate than preoperative diagnosis. Laparoscopy was found to decrease the time of procedure and duration of hospital stay. By exact diagnosis, diagnostic laparoscopy prevents non- therapeutic laparotomy. Laparoscopic assisted procedures also serve as a bridge between laparoscopy and laparotomy as it reduces operating time and their is faster postoperative recovery. Laparoscopy is an helpful tool for the diagnosis and treatment of surgical abdominal emergencies in patients especially in right lower abdominal pain, small bowel pathology and gallbladder and liver pathologies. The usage of laparoscopy is further widened by its application in the case of abdominal trauma.



Laparoscopy was found to be of great diagnostic value and a therapeutic procedure was feasible in significant number of patients. Moreover, observation on laparoscopy changed the further course of management in several cases.

Detailed Description

Not available

Study Timeline

• Study Start: 2014-01-03
• Study Completion: 2015-08-31
• Last Update Posted: 2018-06-06

Recruitment & Eligibility

• Status: Completed
• Sex: All
• Target Recruitment: 50

Inclusion Criteria

• Acute abdominal pain of recent onset.
• Patients whose age is 14 years and above.
• Patients giving consent for surgical procedure.

Exclusion Criteria

• Uncontrolled coagulopathy.
• Haemodynamically unstable patients.
• Patients presenting with chronic abdominal pain.
• Patients having undergone multiple previous abdominal procedures.
• Patients refusing the minimal access technique (diagnostic laparoscopy) for diagnosis.
• Other causes which exclude laparoscopy in acute abdomen.
• (e.g. multiple stab wounds) 7.
• Patients undergoing elective procedures.

Study & Design

• Study Type: Observational
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
The pre- operative diagnosis was compared with laparoscopic diagnosis to evaluate accuracy of diagnostic laparoscopy. With the use of diagnostic laparoscopy a diagnosis could be reached in 49 (98%) cases. It confirmed the diagnosis in 35 (70%) patients.In 14 patients (28%) laparoscopy changed the diagnosis.	The Laparoscopic/ post operative diagnosis was compared with pre- operative diagnosis after each procedure.
50 patients with surgical acute abdomen were selected for this study.	The Laparoscopic/ post operative diagnosis was compared with pre- operative diagnosis after each procedure.

Secondary Outcome Measures

Name	Time	Method
In our series 28 (56%) laparoscopic appendectomy were performed.	Therapeutic laparoscopy was done in 37 (74%) cases. Lap assisted procedure were done in 4 (8%) cases. 8 (16%) cases required conversion to open procedure. Hence, the conversion rate was 16%. The main causes for conversion were due to extensive adhesions, distended bowel.

Trial Locations

Locations (1)

MAHARAJA AGRASEN HOSPITAL; 🇮🇳 West, DELHI, India

MAHARAJA AGRASEN HOSPITAL

🇮🇳West, DELHI, India

DR MAYANK NARANI

Principal investigator

9811887880

mayank_narani@yahoo.co.in