Presence Of Intra-abdominal Adhesions Research Articles

The use of ultrasound sliding sign for prediction of adhesions in women undergoing repeated caesarean section

We carried out this study to validate the use of ultrasound sliding sign to predict intraperitoneal adhesions in women undergoing repeated caesarean section (CS). A cross-section study was performed in women with at least one CS scheduled for an elective CS. We used the sliding sign of the uterus against the anterior abdominal wall to assess intraperitoneal adhesions, positive sliding sign if uterus moved freely and a negative sliding sign if limited mobility. The obstetrician was blind to the ultrasound results, asked to report if adhesions were absent or present during CS to validate accuracy of the sliding sign. We examined 120 women, negative sliding was reported in 54 patients, positive sliding in 66 women. The presence of intra-abdominal adhesions was confirmed in 44/54 cases assigned to the high-risk group, while the prediction of low risk for adhesions confirmed in 66/66 patients with a sensitivity of 100%, specificity of 86.84%. Sliding sign is an effective method to detect intra-abdominal adhesions in women with a history of repeated caesarean delivery. Impact statement What is already known on this subject? There has been a dramatic increase in the caesarean section (CS) rate worldwide; repeated CSs may be associated with intraperitoneal adhesions that result in difficulty during the procedure and may be related to bowel or bladder injuries and neonatal morbidities. What do the results of this study add? The sliding sign by ultrasound has a sensitivity of 100%, specificity of 86.84%, a positive predictive value of 81.5, a negative predictive value of 100, and accuracy of 91.67, considering it rapid, easy and reliable method for prediction of intraperitoneal adhesions. What are the implications of these findings for clinical practice and/or future research? The use of sliding sign by ultrasound in cases with repeated CSs offers a good predictor tool for presence of intraperitoneal adhesions and subsequently avoid severe sequels during surgery and good preparation.

A Retrospective Study of 881 Lateral Transabdominal Laparoscopic Adrenalectomies Performed Between 1997 and 2017 at a Single Center in Poland to Determine Factors Associated with Surgery Time.

BackgroundLaparoscopic adrenalectomy is acknowledged as a standard procedure in adrenal lesions management. This retrospective study of lateral transabdominal laparoscopic adrenalectomy performed between 1997 and 2017 in a single center in Poland aimed to determine the factors associated with surgery time.Material/MethodsThis retrospective study involved 881 patients. The factors identified as potentially affecting surgery time were age, sex, side of the lesion, histopathological type, hormonal activity, size of the lesion, history of previous abdominal operations, presence of intra-abdominal adhesions, and obesity. The following statistical tests were conducted: t test, Mann-Whitney U test, Kruskal-Wallis H test, Pearson correlation test, and multivariate regression modeling.ResultsThe mean surgery time for all operations was 139 min (55–320 min). We observed statistically significant differences for surgery time in the following groups: sex, side of the lesion, presence of intra-abdominal adhesions, obesity, histopathological type, and hormonal activity (P<0.05). The multivariate regression model showed factors affecting surgery time were: sex, side of the lesion, size of the lesion, obesity, histopathological type (nodular hyperplasia and adenoma), and hormonal activity (non-functioning and aldosterone-secreting tumors) (P<0.05). There was no correlation between surgery time and patient age and tumor size (P<0.05). Mean tumor size was 42 mm (6–130 mm).ConclusionsThe 20-year experience of laparoscopic adrenalectomy performed at a single center showed that surgery duration was significantly longer in male patients, obese patients, left-sided adrenal tumors, tumors >6 cm in diameter, patients with a diagnosis of pheochromocytoma, and when intra-abdominal adhesions were present.

Evaluation of In Vivo Adhesion Properties of New Generation Polyglactin, Oxidized Regenerated Cellulose and Chitosan-Based Meshes for Hernia Surgery.

IntroductionComposite meshes coated with anti-adhesive barriers have been developed by taking advantage of the robustness of polypropylene meshes for use in hernia repair. We aimed to evaluate the effects of composite meshes containing polyglactin, polycaprolactone, oxidized regenerated cellulose and chitosan on the adhesion formation.MethodsForty-two Sprague Dawley male rats were divided into six groups of seven rats according to the content of the meshes used. A defect was created on the right abdominal wall of the rats and an oval composite mesh of 2 cm in diameter was placed over the defect and fixed. The rats were sacrificed under anesthesia on the 7th postoperative day. Macroscopic and histopathological examination was performed and the incorporation of the mesh with the abdominal wall and the presence of intraabdominal adhesions were evaluated.ResultsWhen the macroscopic findings of the rats were evaluated, there was a statistically significant difference between the rat groups in terms of the distribution of peritoneal adhesion scores (p<0.05). There was no statistically significant difference between the rat groups in terms of the distribution of inflammation, fibrosis and macrophage levels (p>0.05).ConclusionIt was evaluated that the development of intraabdominal adhesion and the strength of adhesion decreased when biocompatible adhesion barriers with anti-adhesive properties such as oxidized regenerated cellulose and chitosan were used in the structure of composite meshes used in hernia repair. Hemostatic and antibacterial properties of these substances are promising to create the ideal mesh.

947: Are skin scar characteristics associated with intra-abdominal adhesions at repeat cesarean delivery?

The current study aims to evaluate the association between skin scar characteristics and intra- abdominal adhesions at repeat cesarean delivery (CD). The current study was a prospective cross-sectional study carried out in a tertiary Maternity hospital between November 2016 and March 2018. Three hundred women with at least one prior CD and scheduled for repeat elective CD were included. Preoperative evaluation of the skin scar characteristics was performed including scar appearance (flat-depressed-elevated), scar pigmentation (hyper-pigmented or non-pigmented), scar length and width. During repeat CS, intra-abdominal adhesions were evaluated and classified according to the Nair's scoring system. The primary outcome was the rate of pelvic adhesions among study participants and its association with the different scar characteristics. Regarding presence of intra-abdominal adhesions, no difference between women with flat scar versus non-flat scars regarding presence of adhesions (p=0.148). However, dense adhesions were significantly present in women with non-flat scar (71.7%) versus (46.1%) in the other group (p=0.001). no difference between women with hyper- pigmented versus non-pigmented scars regarding presence of adhesions (p=0.448). Correlation analysis shows that Nair's score was positive moderately CS scar length (r=0.575, p=0.032), however not correlated with CS scar width (r= 0.137, p=0.082). Using logistic regression analysis scar length, scar width and scar pigmentation were not related to adhesions formation. Only the non-flat scars were significant predictor to the occurrence of intra-abdominal adhesions (p<0.001) There is an association between CS scar appearance and formation of intra-abdominal adhesions, particularly for elevated and depressed scars

Hand-Assisted Laparoscopic Surgery: A Versatile Tool for Colorectal Surgeons.

PurposeHand-assisted laparoscopic surgery (HALS) is a minimally invasive surgical technique with the combined benefits of laparoscopic surgery while allowing the use of the surgeon's hand for better tactile control. Obesity has been associated with higher conversion rates with multiport laparoscopic surgery, but not with HALS. This study aimed to examine the versatility of HALS in various clinical contexts.MethodsAll HALSs performed at 2 major tertiary centers in Sydney were prospectively collected for retrospective analysis. Variables including age, sex, body mass index (BMI), previous surgeries, pathologies including size and T-stage, and the number of conversions to a midline laparotomy were examined.ResultsA total of 121 HALS colorectal resections were analyzed. The median age of the patients was 62 years, with 63.6% being women. Seven patients required conversion to a midline laparotomy. Of the 121 patients, 50.2% were overweight or obese, and 52.9% had undergone previous abdominal/pelvic operations. However, neither obesity nor abdominal adhesions from previous operations were an indication for conversion to an open laparotomy in any of the 7 converted patients. The presence of intra-abdominal adhesions did not impact the operative time. HALS allowed access to the entire colon and rectum and allowed resection of the bladder, uterus, and ureter, when these organs were involved.ConclusionHALS is a versatile, minimally invasive technique, which is independent of the patient's BMI, for performing a colorectal resection.

Intra-Abdominal Adhesions Make the Interpretation of Magnetic Resonance Enterography in Crohn's Disease More Difficult

Aims: The present study compares preoperative magnetic resonance enterography (MRE) accuracy in diagnosing stenoses, abscesses and fistulas to intraoperative findings in Crohn's disease patients, and determines whether discordance between these methods alter surgical plans. Methods: Our study included 55 consecutive patients scheduled for elective surgery due to Crohn's disease in a single institution between January 2011 and May 2015, whose surgical findings were also compared to preoperative MREs. Data were retrospectively analyzed. Results: Among these 55 patients, we found 80 stenoses, 5 abscesses and 18 fistulas during surgery. The MRE sensitivity, specificity and accuracy, respectively, reached 100, 77.8 and 96.4% for stenoses; 80.0, 90.0 and 89.1% for abscesses; and 77.8, 83.8 and 81.8% for fistulas. The operative plan was modified for 7 patients (12.7%) due to erroneous MRE diagnoses. No patient needed conversion or an unplanned stoma placement due to an incorrect diagnosis using MRE. The MRE diagnosis did not agree with the surgical findings for 36 lesions, 16 of which resulted from adhesions that explained the incorrect MRE diagnoses. Conclusions: Hence, while MRE is a useful diagnostic tool preoperatively in Crohn's disease patients, the presence of intra-abdominal adhesions may cause erroneous diagnosis through MRE.

Incidence of Intra-Abdominal Adhesions in a Continuous Series of 1000 Laparoscopic Procedures

Intra-abdominal adhesions occurring after intraperitoneal surgery are responsible for a substantial proportion of cases of intestinal obstruction (74%), chronic pelvic pain (20%–50%), and female infertility (15%–20%). They increase the risk of bowel injuries during subsequent surgery. This prospective monocentric study investigated the incidence of intra-abdominal adhesions and their relationship to previous abdominal surgery for a continuous series of 1000 gynecologic laparoscopic procedures. The study was conducted between 2006 and 2007 at a university hospital in France. Data on individual patient history were obtained on the number of prior abdominal surgeries, the indications for surgery, abdominal cavity access, and type of incision. The primary study outcome was the presence of intra-abdominal adhesions. Over 60% (637/1000) of the laparoscopic procedures were performed in patients with a history of 1 or more abdominal surgery; 35% of these cases (350/1000) had only 1 prior abdominal surgery. The presence of intraoperative adhesions were noted in 21.1% (211/1000) of the cases; 28% (59/211) of these involved bowel loops. There was a significant increase in the rate of intestinal adhesions with increasing number of prior abdominal surgeries (1 [6.29%], 2 [8.29%], 3 [16.9%], and >3 [74%]; P < 0.001). The rate of intestinal adhesions was significantly higher among patients with a history of midline incision compared with the other incisions (P < 0.012). These findings indicate that evaluation of the risk of adhesion formation requires extensive preoperative knowledge of prior surgery. Adhesion formation does not appear to be influenced by the prior indication for surgery.

Deep Infiltrating Endometriosis is Frequent in All Stages of Endometriosis and the Depth of Infiltration Influences Surgical Parameters Proportionally

Background Deep infiltrating endometriosis (DIE) in contrast to superficial endometriosis is known to cause intense pain-related symptoms depending on the anatomic region and depth of infiltration. Despite the known impact of DIE, clinical comparison to superficial endometriosis is difficult to accomplish because no DIE classification is used regularly and the rASRM score does not consider DIE adequately. Methods We regularly use the ENZIAN classification to group DIE additionally to the rASRM score. The surgical treatment of patients without prior known endometriosis from January 2006 to December 2008 was evaluated in relation to the classification systems used. Results The study population included 100 patients and all were scored according to the rASRM score. Forty-two percent (42/100) presented with DIE and were additionally classified to the ENZIAN score. In all rASRM stages of endometriosis, a high rate of over 33% DIE was found with a maximum of 80% in stage 4 patients. Patient characteristics did not differ between patients with superficial EM and DIE. Laparoscopy was the main surgical approach regardless of the type of endometriosis. The presence of intra-abdominal adhesions, duration of excisional surgery and hospital stay correlated with the depth of infiltration according to the ENZIAN. Conclusions This is the first study to reveal that the presence of DIE is an unexpectedly frequent finding in all rASRM stages. Though patient characteristics do not differ between DIE and superficial EM, the surgical parameters for adequate excisional surgery are significantly different and proportionally influenced by the depth of infiltration.

Systematic guide to complex cases from adhesive disease

Intestinal adhesions are inevitable after abdominal surgery. The presence of intra-abdominal adhesions can create very complex situations which require careful preoperative planning, meticulous intra-operative technique and detailed postoperative management. This manuscript will review the management of these complex cases of adhesions.

Splenic Injury: A Rare Complication of Endoscopic Retrograde Cholangiopancreatography

Splenic injury is an extremely rare complication after endoscopic retrograde cholangiopancreatography (ERCP); to our knowledge, only seven such cases have previously been reported in the literature. Though the mechanism of splenic injury after ERCP is unclear, "bowing" of the endoscope in the "long position" with torsion on the greater curvature of the stomach may lead to splenic vascular or capsular avulsion. Other contributing factors potentially include excessive manipulation of the duodenoscope (particularly with difficulty cannulating the ampulla of Vater or common bile duct), excessive manipulation of the patient during the procedure, or the presence of intra-abdominal adhesions. As ERCP is being employed more frequently for the diagnosis and treatment of pancreatico-biliary disease, clinicians must be aware of this rare but potentially lethal complication to allow for early accurate diagnosis and therapy.

Mouse laparoscopy

To develop a technique for performing laparoscopy in the mouse. Controlled animal study (Canadian Task Force classification II-1). University research laboratory. Twenty-eight CD-1 pregnant mice. Eight mice underwent anesthesia only and 20 had anesthesia plus laparoscopy at 5.5 and at 10.5 days' gestation (implantation occurs on day 4.5 and delivery on days 19-20). Four mice in the laparoscopy group died early in the series, three due to hemorrhage and one due to anesthetic overdose. Among survivors, there were no differences between operated and control groups in number of pups delivered at term (8.7 +/- 5.1 and 8.9 +/- 3.8, respectively), frequency of pregnancy failure (18.8% and 12.5%), and presence of intraabdominal adhesions on autopsy after delivery (12. 5% and 12.5%). Intraabdominal contents could be manipulated to visualize both uterine horns in their entirety. The number of gestations could be counted accurately as early as 1 day after implantation. Given the fact that laparoscopy is not accompanied by the immunosuppression characteristic of laparotomy, this technique could prove useful for investigations requiring intraabdominal manipulations in mice when preservation of immune function is critical. The technique can be performed safely and repeatedly after an initial learning period. (J Am Assoc Gynecol Laparosc 6(2):173-177, 1999)

Comparison of CO2- and N2O-Induced Discomfort During Peritoneoscopy Under Local Anesthesia

The most comfortable gas for peritoneoscopy has been the subject of debate. We subjected 46 patients to double-blind comparison of carbon dioxide and nitrous oxide during initial pneumoperitoneum. The discomfort from local anesthesia was similar in both patient groups. The patient's and the physician's assessment of discomfort during gas insufflation showed that carbon dioxide was more uncomfortable as perceived by the patient (p = 0.02), the physician (p = 0.0006), and objectively assessed by degree of abdominal splinting (p = 0.006). The presence of intraabdominal adhesions had no relationship to discomfort. We conclude that nitrous oxide is more comfortable for institution of pneumoperitoneum during peritoneoscopy under local anesthesia.