What is laparoscopy with open exploration of abdominal trigger points?

Laparoscopy with Open Exploration of Abdominal Trigger Points

The term "laparoscopy with open exploration of abdominal trigger point" does not represent a recognized or established surgical procedure in the medical literature. This appears to be either a misunderstanding of terminology or a conflation of unrelated concepts—laparoscopic exploration and myofascial trigger points—which are not typically combined in standard surgical practice.

What the Evidence Actually Describes

Explorative Laparoscopy

Explorative laparoscopy is a minimally invasive diagnostic and therapeutic surgical technique used to visualize the abdominal cavity through small incisions using a camera and specialized instruments. 1

Key applications include:

• Diagnostic purposes: Visualizing intra-abdominal pathology, assessing peritoneal contamination, and identifying sources of infection or bleeding 1
• Therapeutic interventions: Performing definitive procedures such as suturing defects, wedge resections, and segmental resections depending on surgeon skill 1
• Trauma evaluation: Assessing penetrating abdominal injuries in hemodynamically stable patients, reducing unnecessary laparotomies 2, 3
• Emergency settings: Managing iatrogenic colonoscopic perforations with significantly lower morbidity (18.2%) compared to open laparotomy (53.5%) 1

Open Laparoscopy (Hasson Technique)

Open laparoscopy refers to a specific entry technique where a small incision is made under direct visualization to introduce the trocar, avoiding blind insertion. 4

This technique:

• Prevents visceral and vascular injuries from blind trocar insertion 4
• Is particularly useful in patients with previous abdominal surgery to avoid adhesions 5
• Should be performed in a previously unoperated field when prior surgery exists 5

Conversion to Open Exploration

Laparoscopy may be converted to open laparotomy when necessary based on intraoperative findings, patient stability, or technical limitations. 1

Indications for conversion include:

• Inability to complete the procedure laparoscopically 1
• Large defects or extensive peritoneal contamination 1
• Hemodynamic instability 1
• Highly inflammatory or neoplastic conditions 1

Clinical Context and Advantages

Laparoscopic exploration offers superior outcomes compared to open surgery in appropriate patients, with reduced postoperative complications (RR 0.31), shorter hospital stays (mean difference -5.35 days), and lower wound infection rates. 1

The World Society of Emergency Surgery recommends:

• Explorative laparoscopy should be considered the preferred first-line surgical approach when feasible 1
• Surgeon experience and skills are key limiting factors 1
• Complete abdominal cavity exploration and appropriate management of pathology are mandatory regardless of approach 1

Important Caveats

"Abdominal trigger points" typically refer to myofascial pain points in the abdominal wall musculature, which are managed conservatively with injections or physical therapy—not surgical exploration. There is no established role for laparoscopic or open surgical exploration specifically targeting trigger points in standard practice.

If the question refers to exploring abdominal pain of unclear etiology, diagnostic laparoscopy remains the appropriate terminology and approach, allowing visualization of intra-abdominal structures to identify pathology. 1