الفهرس 
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Abstract
Chronic abdominal pain is a common disorder and remains a difficult challenge to medical practitioners . Although patients with this type of pain may have undergone numerous diagnostic workups, including surgery, their pain remains a challenge to all known diagnostic and treatment methods. More than 40% of the patients presenting with chronic abdominal pain had no specific etiological diagnosis at the end of their diagnostic workup.
Chronic abdominal pain is associated with poor quality of life and significant levels of depressive symptoms. Much is known about the prevalence, societal burden, and suffering associated with chronic abdominal pain. Many common organic and functional diseases can cause it. The most common organic conditions include intestinal adhesions, biliary causes, and appendicular causes, while functional conditions include irritable bowel disease, functional dyspepsia, and various motility disorders.
In spite of clinical, laboratory, and radiological investigations, when the cause of abdominal pain remains obscure, the surgeon has only one choice left i.e., exploratory laparotomy. Most surgeons feel that exploratory laparotomy is a more complete examination and carries little morbidity and mortality.
Minimal access surgery or minimally invasive surgery has grown widely. Laparoscopy is most effective technique for bridging gap between clinical evaluation and major surgical exploration. Advantage in terms of safety, reduced morbidity and mortality, decreased postoperative pain and short hospital stay makes it a valuable diagnostic tool.
In case of diagnostic uncertainty, laparoscopy avoids unnecessary laparotomy and provides accurate diagnosis to planned surgical treatment. Due to improvement in instrumentation and greater experience with therapeutic laparoscopy, the procedure is no longer limited to visualization. Operative intervention can be provided at the same instance and formation of adhesions which is an important cause of chronic abdominal pain is less compared to laparotomy.
The aim of the present study was to determine the diagnostic efficacy of laparoscopy in the management of ill-defined recurrent vague abdominal pain.
This was an interventional one arm study, was conducted in the Department of surgery at Beni-Suef University on 30 cases with nonspecific vague recurrent abdominal pain where other clinical symptoms and investigations were not be conclusive, willing for diagnostic laparoscopy, over a period of six months from June 2022 till December 2022. Cases were subjected to: Detailed History taking, clinical and physical examination, abdominal radiograph and abdominal ultrasound, Diagnostic laparoscopy under general anesthesia, Postoperative evaluation, and follow-up.
The main results of the study revealed that:
The current study included 30 patients, their age ranged between 18 – 57 years with mean value of 32.367 ± 10.172. 73.3% were females and 26.7% were males. Their BMI ranged between 24 – 40 with mean value of 30.767 ± 4.183.
In 56.7% of cases pain was dull aching followed by colicky pain in 36.7% then cutting pain and stinging pain in 3.3% for each.
In 43.3% of cases pain was located at the right iliac fossa followed by pelvic pain in 36.7% then left iliac fossa pain and diffuse abdominal pain in 10% for each.
The most frequent symptom other than pain was anorexia in 56.7% of patients followed by nausea in 46.7%, then constipation in 33.3% then menstrual cramps in 23.3%, vomiting in 26.7%, fever and dysuria in 20% for each, diarrhea and dyspareunia in 6.7% for each then weight loss, vaginal discharge, menstrual irregularities and hip joint pain in 3.3% for each.
Regarding the ultrasound findings, free fluid and echogenic fat was detected in 33.3% of cases for each followed by gynecological findings in 23.3% then inflamed appendix in 20%, enlarged mesenteric lymph nodes in 13.3% then distended bowel loops in 10%. No abnormal finding was detected in 15.7%.
Regarding the laparoscopic findings, enlarged/inflamed appendix in 36.7%, adhesion was detected in 30% of cases followed by fluid collection, thickened omental fat and ovarian cyst in 23.3% for each then Endometriosis in 10%, Meckel’s diverticulitis and hemorrhagic cyst in 6.7% for each and lastly fibrous bands, ruptured ovarian cyst and gangrenous gall bladder in 3.3% for each.
Regarding the final diagnosis, chronic appendicitis and gynecological problems in 36.7% of cases for each, followed by PID in 10%, Meckel’s diverticulitis in 6.7% and lastly fibrous bands, gall bladder perforation and gangrenous gall bladder in 3.3% for each.
Treatment strategies include appendectomy in 36.7% followed by cystectomy in 26.7%, dhesolysis with proper antibiotics in 13.3%, biopsy in 10% then resection of diverticulum with repair of intestine and cholecystectomy in 6.7% for each.
Among our performed laparoscopic surgeries; 10% were converted to labarotomy.
Regarding therapeutic efficacy of laparoscopy, most of cases 80% reported pain resolution after laparoscopy while the remaining 20% reported pain persistence.
Based on results we recommend for further studies on these patients and longer period of follow up to emphasize our conclusion.