A two-center study of laparoscopic appendectomy for chronic abdominal pain

Chronic right lower quadrant (RLQ) abdominal pain in pediatric patients with a negative workup poses a diagnostic and therapeutic challenge. The role of laparoscopic appendectomy (LA) in this cohort remains controversial.

Patients ≤ 18 years old who underwent LA for chronic RLQ pain between 2010 and 2021 were reviewed across two academic centers. Clinical data, operative findings, and histopathological results were compared between those with resolved and persistent pain following appendectomy.

123 patients underwent LA for chronic RLQ pain. Patients were categorized based on resolution (n = 78) or persistence (n = 45) of their pain following LA. Neither median symptom duration (9.3 [IQR: 2.7-18.7] vs. 6.4 [2.9-18.6] months, p=0.75), presenting symptoms, nor incidence of prior abdominal surgery (14.1% vs. 17.8%, p = 0.58) differed between groups. There was a high incidence of psychiatric diagnoses in both groups (21.8% vs. 24.4%, p = 0.74). Histopathologic findings did not differ between responders and non-responders. Concomitant surgeries were performed in 14.1% of responders (6 planned cholecystectomies, 6 incidental pathologies) and 20.0% of non-responders (4 planned cholecystectomies, 7 incidental).

LA provided sustained pain relief for a large subset of pediatric patients with chronic RLQ pain, even though no objective findings could distinguish responders from non-responders. These findings underscore the need for additional research to optimize diagnostic and treatment strategies for these difficult patients.