Exploratory laparoscopy for recurrent right lower quadrant pain in a pediatric population

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Diagnostic Medicine

Background:

• Recurrent abdominal pain is common in children, often lacking a clear diagnosis.
• Chronic appendicitis is a controversial diagnosis for persistent right lower quadrant (RLQ) pain.
• Conventional diagnostics frequently fail to identify the etiology of chronic abdominal pain in pediatric patients.

Purpose of the Study:

• To evaluate pediatric patients undergoing laparoscopic exploration for chronic RLQ pain.
• To determine histologic diagnoses, pain etiologies, and factors predicting outcomes.
• To assess the efficacy of laparoscopic appendectomy for undiagnosed chronic RLQ pain.

Main Methods:

• Study included 44 pediatric patients with abdominal pain >1 month, undergoing laparoscopic exploration and appendectomy.
• Excluded patients with identified preoperative pain sources or <2 years follow-up.
• Collected data on intraoperative findings, histology, preoperative tests, mental health, and symptoms; assessed outcomes at 2 years.

Main Results:

• 70.5% of patients experienced partial or complete symptom resolution at 2 years.
• Abnormal appendiceal histology was found in 63.6% of patients; 31.8% had other laparoscopic findings.
• No predictive factors for positive outcomes were identified; 29.5% continued to experience pain.

Conclusions:

• Laparoscopic exploration and appendectomy provided symptom relief for a majority of pediatric patients with chronic RLQ pain.
• Histologic abnormalities were common, but the definitive etiology of pain often remained elusive.
• While beneficial for many, this intervention may not resolve symptoms or provide a definitive diagnosis for all patients.