FROM, DR. PRAKASH RATHOD, POST GRADUATE, DEPARTMENT OF SURGERY, KIMS , HUBLI.

TO, THE PRINCIPAL, KIMS, HUBLI.

(THROUGH PROPER CHANNEL)

Respected Sir,

Subject : Submission of Proforma for Registration of Subject for Dissertation.

I am here with submitting my proforma for registration of dissertation titled “STUDY TO EVALUATE THE ROLE OF LAPAROSCOPY IN CHRONIC ABDOMINAL PAIN AT KIMS, HUBLI”. Kindly forward this to RGUHS, Bangalore.

Thanking you,

Yours faithfully

(DR. PRAKASH RATHOD)

Place :

Date :

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, BANGALORE,
KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / nAME OF THE CANDIDATE & ADDRESS / DR. PRAKASH RATHOD PG IN GENERAL SURGERY KARNATAKA INSTITUTE OF MEDICAL SCIENCES, KIMS, HUBLI - 22
2. / nAME OF THE INSTITUTION: / KARNATAKA INSTITUTE OF MEDICAL SCIENCES, HUBLI-580 022.
3. / cOURSE OF STUDY & SUBJECT: / M.S. IN GENERAL SURGERY
4. / DATE OF ADMISSION TO COURSE: / 31ST MAY 2008
5. / tITLE OF THE TOPIC: / “STUDY TO EVALUATE THE ROLE OF LAPAROSCOPY IN CHRONIC ABDOMINAL PAIN”.
6.

7. / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
Chronic abdominal pain of unknown origin represents a significant problem in surgical patients. Patients with chronic abdominal pain present a more difficult diagnostic dilemma. In some cases even battery of investigations does not reveal the causes of pain. Due to improvements in instrumentation and greater experience with therapeutic laparoscopy, the procedure is no longer limited to visualization. The purpose of current study is to determine the efficacy of laparoscopy on patients with CHRONIC ABDOMINAL PAIN. Additionally, a negative laparoscopic examination potentially would avoid the morbidity of unnecessary laparotomy in this group. Hence this study is taken up.
6.2.REVIEW OF LITERATURE :
  1. Hannu Paajanen, Kristiina julkunen and Hedi Waris1. : Prospective study nonrandomisd study of 72 patient (60 women and 12 men) with chronic pain abdomen, Diagnostic laparoscopy was performed. Finding included intrabdominal adhesions in 61, gynecologic disorders in 4, chronic appendicitis in 1 and no abnormalities in 6 patients. In the long term follow up, chronic abdominal pain was totally healed in 33% , diminished in 46% and unchanged in 21% of the patient. A total of 65 patient(90%) reported that the surgery had been beneficial for their intractable pain.
  1. Prafull K. Arya and K.J.B.S Gaur2 :Prospective study of 49 patients who under went Laparoscopy for chronic abdominal pain. Finding included (including Histopathology)abdominal tuberculosis in 14,appendicitis in 13,post operative adhesions in 4 , Jejunal Diverticulitis in 1, genito – urinary tuberculosis in 5, endometriosis in 2, Fibroid uterus in 2, pelvic inflammatory disease in 3 and no organic cause in 5. Present study shows a diagnostic rate of 90% inpatients with lower abdominal pain. Therapeutic laparoscopy has a role in many of these patients.
  1. Onders RP, Mittendorf EA.3Performed diagnostic laparoscopy for the evaluation and treatment of chronic abdominal pain in 70 patients. Findings included adhesions in 39, hernia in13, adhesions from the appendix to adjacent structure in appendiceal pathology in 5, endometriosis in 3 and gallbladder pathology in 2. Ten patients had no obvious pathology. Laparoscopy has a significant diagnostic and therapeutic role in patients with chronic pain. With aggressive indicated therapeutic laparoscopy including adhesiolysis, appendectomy, cholecystectomy, or hernia repairs, more than 70% of patients can have improvement in their pain.
  1. Lavonius M, et a14- Performed exploratory laparoscopy in patients with chronic abdominal pain. Forty-six patients underwent diagnostic laparoscopy for abdominal pain of unknown origin during 1992-1996. An organic disease was found in 68% of the laparoscopies. Adhesions were found in 29 patients, inguinal hernia in 2 patients, and abnormal mesenteric lymph nodes in 1 patient. Adhesiolysis was carried out in 24 patients. Seventy-seven percent of patients who had undergone adhesiolysis considered the result good or beneficial. Sixty percent of all patients reported a beneficial outcome after laparoscopy. This retrospective study suggests that laparoscopy is a safe and useful procedure in the diagnosis and treatment of chronic abdominal pain.
  1. Miller K, Mayer E, Moritz E5- Performed 66 laparoscopictreatments on 59 patients. Laparoscopy provided diagnosis in 53 of 59 patients (89.8%). All 66 attempted laparoscopic procedures were completed successfully, no conversion to laparotomy was necessary, and no postoperative complication occurred. Five out of 59 patients (8.5%) revealed no improvement of pain postoperatively, and 6 out of 56 (10.7%) still suffer from pain at the time of the follow-up. The pain assessment and disability score was statistically significant postoperatively and at the time of the follow-up in relation to the preoperative score.
6.3 OBJECTIVES OF STUDY :
  1. To determine the efficacy of laparoscopy on patients with a history of chronic abdominal pain longer than 3 months, of unknown origin.
MATERIALS AND METHODS
7.1 SOURCE OF DATA :
Patients admitted with chronic abdominal pain of longer than 3 months duration in surgical wards at KIMS, HUBLI.
7.2METHODS OF COLLECTION OF DATA : (Including sampling procedure if any):
The present study is a time bound prospective study conducted during the period from November 2008 to October 2009.
Sample size :
Cases satisfying inclusion criteria admitted in surgical wards at KIMSHOSPITAL HUBLI during time bound period of November 2008 to October 2009.
Definition of study subject :
Patients with chronic abdominal pain for longer than 3 months admitted in surgical wards at KIMS HOSPITAL HUBLI satisfying following inclusion criteria and exclusion criteria.
Inclusion :
Patients with history of chronic abdominal pain for longer than 3 months, if physical examination and conventional diagnostic tests are unrevealing .
Exclusion :
  1. Oncological Patients, Pregnant Women, Women who had recently given birth, Patients with coagulation defects.
  2. Patients with critical illness, patients who are medically unfit for surgery.
7.3DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS ? IF SO DESCRIBE
BRIEFLY
YES,
Surgical interventions will be undertaken after necessary prospective assessment routine for all cases.
  • Routine blood and Urine investigations
  • RBS, blood urea, serum creatinine
  • X – RAY abdomen
  • USG abdomen
  • UPPER GI ENDOSCOPY
7.4HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3 ?
Yes, clearance from ethical committee of kims, hubli has been obtained. Individual consent will be obtained from each patient / guardian apart from general surgical consent.
8 / LIST OF REFERENCES :
1.Hannu Paajanen, Kristiina pulkunen and Heidi Waris.
“Laparoscopy in chemic abdominal pain ”.
J clin gastroentrol , Feb 2005 : 39(1) : 110-114
2.Prafull k. arya and kj.b.s. gaur –
“Laparoscopy , a tool in diagnosis of lower abdominal pain”.
indian j. surg, aug 2004 : 66 (4) : 216 -220.
3.Onders R.P, mittendorf EA – “ Utility of laparoscopy in chronic abdominal pain”.
Surg , Oct 2003 ; 134 (4) : 549 – 52 ; Discussion 552 – 4.
4.Lavonius M, et al – “Laparoscopy for chronic abdominal pain”.
Surg Laparosc Endosc, Jan 1999 ; 9(1) : 42-4
5.Miller K, Mayer E, Moritz E. “The role of laparoscopy in chronic and recurrent abdominal pain”.
Am J Surg., Oct 1996 ; 172 (4) : 353 – 6 ; discussion 356 -7.
9 / SIGNATURE OF THE CANDIDATE:
10 / REMARKS OF THE GUIDE:
11 /

NAME AND DESIGNATION OF

11.1 GUIDE

/

DR. ISHWAR r. HOsMANI

M.S

PROFESSOR,
DEPARTMENT OF SURGERY,
KIMS, HUBLI.
11.2 SIGNATURE:
11.3 HEAD OF THE DEPARTMENT: /

DR. B.S. MADAKATTI

M.S
PROFESSOR & HEAD,
DEPARTMENT OF SURGERY,

KIMS, HUBLI.

11.4 SIGNATURE:
12 / 12.1 REMARKS OF THE CHAIRMAN & PRINCIPAL:
12.2 SIGNATURE: