From the Journals

Diagnostic laparoscopy pinpoints postop abdominal pain in bariatric patients


Key clinical point: Diagnostic laparoscopy successfully identified the cause of post–bariatric surgery abdominal pain in about half of patients.

Major finding: In the study group, 57% of patients had a positive diagnostic laparoscopy results identifying the source of their chronic abdominal pain.

Data source: Retrospective review of post–bariatric surgery patients who underwent diagnostic laparoscopy (DL) during 2003-2015.

Disclosures: The investigators had no relevant financial disclosures to report.



The etiology of chronic pain after bariatric surgery can be difficult to pinpoint, but diagnostic laparoscopy can detect causes in about half of patients, findings from a small study have shown.

In an investigation conducted by Mohammed Alsulaimy, MD, a surgeon at the Bariatric and Metabolic Institute at the Cleveland Clinic, and his colleagues, 35 patients underwent diagnostic laparoscopy (DL) to identify the causes of their chronic abdominal pain after bariatric surgery. Patients included in the study had a history of abdominal pain lasting longer than 30 days after their bariatric procedure, a negative CT scan of their abdomen and pelvis, a gallstone-negative abdominal ultrasound, and an upper GI endoscopy with no abnormalities. Researchers collected patient data including age, gender, body, weight, and body mass index, type of previous bariatric procedure, and time between surgery and onset of pain.

These patients presented with abdominal pain a median of 26 months after surgery, although nine patients began to have abdominal pain within the first year (Obes Surg. 2017 Aug;27[8]:1924-8).

The results of DL were either positive (presence detected of pathology or injury) or negative (no disease or injury detected).

Twenty patients (57%) had positive findings on DL including the presence of adhesions, chronic cholecystitis, mesenteric defect, internal hernia, and necrotic omentum, and of this group, 43% had treatment that led to improvement of pain symptoms. Only 1 of the 15 patients with negative DL findings had eventual improvement of their pain symptoms. Most patients with negative DL findings had persistent abdominal pain, possibly because of nonorganic causes and were referred to the chronic pain management service, the investigators wrote.

“About 40% of patients who undergo DL and 70% of patients with positive findings on DL experience significant symptom improvement,” the investigators said. “This study highlights the importance of offering DL as both a diagnostic and therapeutic tool in post–bariatric surgery patients with chronic abdominal of unknown etiology.”

The investigators had no relevant financial disclosures to report.

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