The office visceral slide test for preoperative prediction of periumbilical adhesions

Abstract

More than half of all laparoscopic complications occur during entry. Thus, reliable detection of obliterating adhesions, defined as thick tissue containing viscera, could assist with preoperative surgical planning. The study objective was to determine if the Office Visceral Slide is an effective diagnostic test for predicting obliterating periumbilical adhesions. A prospective, comparison of the Office Visceral Slide with the previously validated Preoperative Exam with Visceral Slide, Preoperative Periumbilical Ultrasound-Guided Saline Infusion (PUGSI), and laparoscopy. The Office Visceral Slide Test was performed using 7-MHz abdominal ultrasound probe placed at the umbilicus. The patients took an exaggerated inspiration/expiration and the presence or absence of the visceral slide, the longitudinal distance the viscera traveled as visualized on ultrasound, was noted. A normal visceral slide is movement of the viscera greater than 1 cm. Forty-five consecutive patients with prior surgical history and scheduled to undergo laparoscopic surgery were included. Mean age was 44.4 years (SD=12.4), range 21-76. The patients had a median of 2 previous abdominal surgeries (1.4), range 1-6. Median number of prior laparotomies was 0 (1.2), range 0-5. Median number of prior laparoscopies was 2 (1.3), range 0-5. The Office Visceral Slide Test had a sensitivity=80%, specificity=100%, positive predictive value (PPV)=100%, and negative predictive value (NPV)=97.6%. The Preoperative Exam with Visceral Slide had a sensitivity=80%, specificity=95%, PPV=66.7%, and NPV=97.4%. The PUGSI had a sensitivity=60%, specificity=97.5%, PPV=75%, and NPV=95.1%. The Office Visceral Slide Test is a simple and reliable diagnostic for detecting obliterating periumbilical adhesions in an outpatient setting. The accuracy of the test is comparable to the Preoperative Exam with Visceral Slide and PUGSI. This test could be an important tool to assess surgical difficulty before entering the operating room.