Abstract
Background/aim The purpose of this study was to evaluate the efficacy of trans-abdominal ultrasonography (USG), a noninvasive diagnostic tool, in predicting the presence of intraabdominal adhesions, especially near the trocar entry area, to provide safe surgical access to the abdomen.Materials and methods Fifty-nine women with a previous history of open abdominal surgery (group A) and a group of 91 women with no previous history of surgery (group B) underwent dynamic ultrasound evaluation of the abdominal fields before laparoscopic operations. The anterior abdominal wall was divided into six quadrants: right upper, right lower, left upper, left lower, suprapubic, and umbilical. Adhesions were evaluated by surgeons during the operation and by radiologists using USG prior to the operation. Visceral organ movements greater than 1 cm was defined as normal visceral slide (positive test), with less than 1 cm of movement defined as abnormal visceral slide (negative test). Sliding test measures movements of omental echogenicity or a stable echogenic focus that corresponds to intestine peritoneal echogenicity that underlies abdominal wall during exaggerated inspiration and expiration. Adhesions observed during surgery were evaluated on a four-point scale, with 0 indicating no adhesions present, 1 indicating the presence of a thin, filmy avascular adhesion, 2 indicating the presence of a dense and vascular adhesion, and 3 indicating adhesions that connect surrounding organs with the overlying peritoneal surfaces. The McNemar test was used to compare the results of USG and laparoscopy for each measure. Results We found that preoperative USG was successful in identifying adhesions [sensitivity, 96.39% (95% CI 89.8–99.2); specificity, 97.43%]Conclusion Preoperative ultrasound examination of the abdominal wall may enhance the safety of abdominal entry during laparoscopic operations.
Highlights
Intraabdominal (IA) organs move freely against the abdominal wall during respiration
We found that preoperative USG was successful in identifying adhesions [sensitivity, 96.39%; specificity, 97.43%]
Preoperative ultrasound examination of the abdominal wall may enhance the safety of abdominal entry during laparoscopic operations
Summary
Intraabdominal (IA) organs move freely against the abdominal wall during respiration. This phenomenon is known as visceral sliding. Previous abdominal surgery and peritonitis often cause IA adhesions, which prevents or reduces visceral sliding [1]. Sigel et al reported that a reduction in visceral sliding shown by transabdominal USG can be a reliable marker of abdominal adhesions [2]. The absence of visceral sliding is associated with adhesion of organs to the abdominal wall [3]. Previous studies have shown that adherence between the abdominal wall and visceral organs occurs in 25–50% of patients undergoing surgery [4,5,6]. IA adhesions may be of the thin, filmy, or dense type [7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
