Risk Factors For Adhesions Research Articles

A Relook into Visceral Slide Test as a Preoperative Screening Modality to Detect Abdominal Wall Adhesions: A Prospective Observational Cohort Study

Background: Ultrasound has become an invaluable tool in our daily practice. Its role in screening for adhesions has been tested since the 1990s. Objective: This study aims to determine the role of the visceral slide test as a screening method to predict abdominal wall adhesions in women undergoing gynecological surgery. Methods: We conducted a prospective observational cohort study from August 2017 to July 2019 in women undergoing elective abdominopelvic surgery for a gynecological indication. Preoperatively, a visceral slide test was performed in 5 specified zones on the abdomen and the test results were clinically correlated with the presence, severity, and extent of adhesions intra-operatively. Results: Results were reported as mean, standard deviation, range of values or number and percent. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy (including 95% confidence interval for all) of visceral slide test were calculated to determine intra- abdominal adhesions . We also found a correlation between the number of negative slide tests and PAI scores using Spearman’s correlation test. Of the 339 women who completed the study, 41.2% had a previous history of abdominopelvic surgery. In this study, the visceral slide test was found to have a sensitivity of 70.87% (95%CI 62.15-78.59), specificity of 86.32% (95% CI 80.95-90.64), Positive Predictive Value (PPV) of 75.63% (95% CI 68.49-81.59), negative predictive value (NPV) of 83.18%(95% CI 78.95-86.70) and diagnostic accuracy of 80.53%(95% CI 75.91-84.61)with p-value less than 0.001. The number of negative slide tests positively correlated with the Peritoneal Adhesion Index score (r = 0.662, p < 0.001) and also with increasing operative time and intraoperative blood loss. Accuracy and positive predictive value of the test were significantly higher in patients with a history of abdominal surgeries, endometriosis and PID. Conclusion: Visceral slide test is an easy, rapid, non-invasive and reliable screening test to predict abdominal adhesions in women undergoing gynecological surgery. The presence of risk factors for adhesions increases the accuracy of the test.

Incidence of intestinal obstruction due to post-surgical adhesions in the Central Military Hospital. Associated risk factors

Introduction: Intestinal obstruction (IO) due to postoperative adhesions is an important cause of hospital admissions worldwide, with signifi cant morbidity and mortality that represent great costs for health systems worldwide. Objective: To estimate the incidence of intestinal obstruction due to postoperative adhesions and to identify risk factors in patients admitted to the General Surgery Service of the Central Military Hospital (CMH). Material and methods: The database of admitted patients to the CMH was revised from January 2009 to December 2013. Of the 14,769 surgeries performed, 393 patients presented intestinal obstruction. The demographic characteristics, type and number of previous surgeries and other risk factors for adhesions were identifi ed. Each patient was classified as IO by adhesions (IOA) or as IO associated with another pathology (IOP). Results: The overall incidence of post-surgical IO was 2.7%; 236 cases (1.6%) were secondary to surgical adhesions and the rest (1.1%) were associated with other pathology. Morbidity occurred in 8.5% of the IOA patients versus 13.5% of the IOP group (p = 0.118). Mortality was 6.4 versus 12.1%, respectively (p < 0.05). Laparotomy (34%), cholecystectomy (22%) and appendectomy (19%) were the surgeries most frequently associated with obstruction. Surgical treatment was done in 20% of the patients of the IOA group, versus 43% in the IOP group (p = 0.001). Risk factors associated to IOA were: female patients, number of previous abdominal surgeries and past admissions for intestinal obstruction. Conclusions: Intestinal obstruction syndrome due to post-surgical adhesions was the most common cause of IO from 2009 to 2013 in the Central Military Hospital. The incidence of this post-surgical adhesion syndrome is similar to that reported in world literature. Therapeutic decision oriented toward an initial conservative treatment should be correct. There were fewer hospitalization days and less mortality in the adhesion group treated without surgery.

Abdominal and pelvic adhesions: Possible role of leiomyomas and skin scar anomaly in profiling high risk patients

Background and aims: Adhesions can cause important morbidity including abdominal and pelvic pain, intestinal obstructions, and infertility. When adhesions are formed, there is no efficient method, nowadays, to resolve them, thus the reduction of their prevalence relies on the prevention. Profiling high risk patients for abdominal and pelvic adhesions (APA) is an important step to this prevention. The risk factors of adhesions in our institution, the association between APA, leiomyomas and skin scar anomaly (SSA) were investigated. Methods: A cross-sectional study was conducted from March 1st to June 30th 2013 including patients who underwent laparotomy or laparoscopy. Patients’ characteristics, presence of a SSA and leiomyomas, as related to adhesions, were analyzed. Student’s t, Pearson’s Khi-square, Fisher’s Exact, Mann-Whitney tests and logistic regression were used. P values cant. Results: The frequency of adhesions was 41.74%. Patients had a mean age of 32.69 ± 8.94 years. Those with a previous abdominal surgery (PAS), SSA and leiomyomas had respectively 12 times [OR: 11.98, CI95 (4.63 - 30.97)], 3 times [OR: 2.79, CI95 (1.16 - 6.71) and 2.5 times [(OR: 2.49, CI95 (1.07 - 5.78)] more adhesions. In logistic regression, a PAS and leiomyomas remained associated significantly to adhesions with p = 0.000 and p = 0.037 respectively. Conclusion: In peritoneal adhesions, leiomyomas and SSA are other factors that may allow a cautious selection of high risk patients who must benefit from particular attention during surgery. Further well designed studies are necessary to investigate the accurate clinical relation among those three conditions.

Intra-articular adhesions following hip arthroscopy: a risk factor analysis

The purpose of this study was to evaluate possible risk factors for symptomatic adhesions after hip arthroscopy. Data were analysed from hip arthroscopies performed between 2005 and 2009. Only primary hip arthroscopies were included. Data collected included demographics, primary treatment, rehabilitation, revision surgery, and presence of adhesions at revision. One thousand two hundred and sixty-four hips in patients 18 years or older underwent primary hip arthroscopy during the defined period. Eight underwent revision hip arthroscopy by a different surgeon. Patients under 30 years of age were 5.9 times more likely to be in the adhesion group [95 % CI 3.1-11.5]. Patients who underwent microfracture were 3.1 times less likely to have adhesions compared to patients who did not [95 % CI 1.1-8.2]. Patients who did not receive circumduction therapy were 4.1 times more likely to have adhesions compared to those who performed circumduction exercises [95 % CI 1.25-11.0]. Risk factors for adhesions following hip arthroscopy identified were age under 30, modified Harris Hip score under 50, no microfracture performed, and rehabilitation without circumduction.

Risk Factors for Adhesions Following Hip Arthroscopy (SS-39)

Introduction Intra-articular adhesions have been reported both after open and arthroscopic approaches to the hip. However the factors which may lead to an increased rate of adhesions have not been identified. The purpose of this study was to evaluate the possible risk factors for adhesions after hip arthroscopy. Methods Between 2005 and 2009, data from arthroscopic hip surgeries were analyzed. The study included only those primary hip arthroscopies. For all cases, it was determined if hips had been revised due to adhesions. This was determined by patients returning to surgeon or by patient report. Patients were excluded if no contact could be made to determine if a revision had occurred. Data included age, gender, labral treatment, microfracture of chondral surfaces, and rehabilitation protocol. The study was IRB approved. Results Between 2005 and 2009, 1,402 hip in patients over the age of 18 years had primary hip arthroscopy. 1,358 of the 1,402 (96%) were contacted. 65 hips required revision hip arthroscopy (4.8%). 153 of the hips had labral debridement, and 1,196 had labral repair. 6/153 debridements had adhesions and 57/1,196 of the repair had adhesions (p=0.641). There is no difference in the prevalence of adhesions between debridement and repairs. 5% of patients who did not undergo microfracture had adhesions and 3% of hips that did undergo microfracture had adhesions. In November of 2008, the hip rehabilitation program was changed to include hip circumduction. 1,067 hips did not do circumduction, and 291 did do circumduction. 4/291 had adhesions with circumduction, while 61/1,108 had adhesions without circumduction (p=0.001). Patients without circumduction were 4.4 [95 CI 1.6 to 11.6] times more likely to have adhesions. Conclusion Adhesions following hip arthroscopy were reduced with changes to the rehabilitation protocol. Other factors such as demographics and surgical treatment were not associated with risk of adhesions. Intra-articular adhesions have been reported both after open and arthroscopic approaches to the hip. However the factors which may lead to an increased rate of adhesions have not been identified. The purpose of this study was to evaluate the possible risk factors for adhesions after hip arthroscopy. Between 2005 and 2009, data from arthroscopic hip surgeries were analyzed. The study included only those primary hip arthroscopies. For all cases, it was determined if hips had been revised due to adhesions. This was determined by patients returning to surgeon or by patient report. Patients were excluded if no contact could be made to determine if a revision had occurred. Data included age, gender, labral treatment, microfracture of chondral surfaces, and rehabilitation protocol. The study was IRB approved. Between 2005 and 2009, 1,402 hip in patients over the age of 18 years had primary hip arthroscopy. 1,358 of the 1,402 (96%) were contacted. 65 hips required revision hip arthroscopy (4.8%). 153 of the hips had labral debridement, and 1,196 had labral repair. 6/153 debridements had adhesions and 57/1,196 of the repair had adhesions (p=0.641). There is no difference in the prevalence of adhesions between debridement and repairs. 5% of patients who did not undergo microfracture had adhesions and 3% of hips that did undergo microfracture had adhesions. In November of 2008, the hip rehabilitation program was changed to include hip circumduction. 1,067 hips did not do circumduction, and 291 did do circumduction. 4/291 had adhesions with circumduction, while 61/1,108 had adhesions without circumduction (p=0.001). Patients without circumduction were 4.4 [95 CI 1.6 to 11.6] times more likely to have adhesions. Adhesions following hip arthroscopy were reduced with changes to the rehabilitation protocol. Other factors such as demographics and surgical treatment were not associated with risk of adhesions.

Preoperative periumbilical ultrasound-guided saline infusion (PUGSI) as a tool in predicting obliterating subumbilical adhesions in laparoscopy

To report the novel technique of periumbilical ultrasound-guided saline infusion (PUGSI). Prospective study of two noninvasive diagnostic tests to detect obliterating subumbilical adhesions. Tertiary care center. One hundred fifty patients were included in the study. Patients without risk factors for adhesions were used as a control group (n = 38), whereas the study group had risk factors for intra-abdominal adhesions (n = 112). Preoperative examination with the visceral slide and the PUGSI. The presence of obliterating subumbilical adhesions in the high-risk patient and the ability of the PUGSI to detect them preoperatively. There were no obliterating umbilical adhesions in the control group. The prevalence of obliterating umbilical adhesions in the risk group was 3.6%. The visceral slide test had an accuracy of 96.4%, a sensitivity of 50%, and a specificity of 98.1%, with a negative predictive value of 98.1% and a positive predictive value of 50%. The PUGSI test was able to detect all cases of obliterating subumbilical adhesions, demonstrating sensitivity and specificity of 100%. The PUGSI test has excellent negative and positive predictive values and is useful in determining patients who have obliterating subumbilical adhesions. Use of both tests preoperatively appears to be helpful in identifying patients at risk for visceral injury during laparoscopic surgery.