Visceral Slide Research Articles

Diagnostic accuracy of preoperative adhesion mapping by ultrasonography for laparoscopic surgery in patients with past abdominal surgery with special reference to loose adhesion.

Endoscopic surgery is widely accepted for both elective and emergent abdominal surgery. This study was performed to assess the accuracy of preoperative adhesion mapping by abdominal ultrasonography (US). Intra-abdominal intestinal adhesions on the abdominal wall in 50 patients with a history of abdominal surgery were prospectively assessed by the visceral slide test with US before laparoscopic surgery from 2019 to 2022. Adhesion was assessed in six separate abdominal zones during US. Actual adhesion on the abdominal wall was confirmed during laparoscopic surgery. The sliding distances in upper right, upper central, upper left, lower right, lower central, and lower left zones in patients with versus without intestinal adhesion were 4.4 versus 1.4 cm (P = .004), 3.4 versus 2.5 cm, 4.3 versus 1.3 cm (P = .011), 3.1 versus 1.5 cm (P = .0014), 3.3 versus 1.1 cm (P = .013), and 3.4 versus 0.8 cm (P = .0061), respectively. Receiver operating characteristic analysis revealed the optimal value of sliding distance as 2.5 cm and the area under the curve as 0.86. The specificity of US assessment of adhesion was lower in the central zone than in lateral zones. Loose adhesion mostly seen around the scar was attributed to either filmy tissue or omental adhesion, leading to visceral sliding during US. This study revealed the reason for insufficient accuracy of preoperative US assessment of intestinal adhesion around the scar area because of loose adhesion. The upper lateral area might be optimal for first port insertion.

Ultrasonographic diagnosis of adhesions, quantification of uterine wall and managerial perspectives of uterine torsion in buffaloes.

The present study aimed to diagnose uterine adhesion using ultrasonography to decide the treatment approach for better survival of buffaloes suffering from uterine torsion. The peculiar visceral slide against the other abdominal organs induced by breathing was considered an absence of uterine adhesion, while the total absence of visceral slide was considered the presence of uterine adhesions on ultrasonographic examination. The 59 Mehsana buffaloes suffering from uterine torsion were divided into two groups based on the presence (Group I; n=27) or absence (group II; n=32) of adhesions. The mean pixel values (MPV) and thickness of uterine wall were also quantified in both the groups. In group I, severe type adhesions (n=16/27) were directly subjected to caesarean section (CS), while fibrinous adhesions (n=11/27) were subject to rolling by Sharma's modified Schaffer's method, and if rolling failed were further, subjected to CS and adhesions were confirm during CS. In Group II, 28 buffaloes were subjected to rolling by Sharma's modified Schaffer's method and 4 buffaloes were directly subjected to CS because of longer duration of illness (≥3 days), higher degree (≥180°) and previous field handling. The incidence of adhesions was 45.76 per cent (27/59) in buffaloes with uterine torsion. The degenerative changes such as oedematous (hyperoedema-hypoechoic with anechoic trabeculae) or thin (homogenous hypoechoic), sloughing of serosa and wall separation were observed in the uterine wall. The significantly thinner uterine wall (p=.017) and higher MPV (p=.001) were evident in group I than in group II. The weak negative non-significant correlation between uterine wall thickness and MPV was observed in group I (r=-.250, p=.147) and group II (r=-.235, p=.089). The dam survival rate was 48.15 per cent (13/27) in group I and 81.25% (26/32) in group II. There was a significant (p=.04) association between the treatment approach and dam survival. Ultrasonography has synergistic diagnostic value for uterine adhesions by evaluating uterine surfaces beyond the reach of obstetricians during a manual clinical examination. Thereby, avoiding futile efforts to relieve uterine torsion by rolling might help to improve dam survival by planning a better obstetrical manoeuvre to salvage buffaloes suffering from uterine torsion.

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.

Evaluation of intra-abdominal adhesion formation after laparoscopic ventral hernia repair with composite mesh using abdominal ultrasound: a prospective observational study

Background: Laparoscopic ventral hernia repair has revolutionized treatment of ventral hernia by offering shorter recovery time, decreased pain, reduced wound complications and lower recurrence rates as compared to conventional open hernia repair. But intra-abdominal mesh placement is associated with a high risk of complications including adhesions, bowel obstruction and fistula formation. Many different types of meshes with adhesion barriers have been developed to overcome these problems. This prospective observational study evaluated the outcomes of laparoscopic repair of ventral hernias in terms of Intra-abdominal adhesion formation with composite mesh using ultrasound.Methods: The study was conducted from August 2017 to February 2019. All patients underwent standard laparoscopic ventral hernias repair using composite mesh secured with tackers. Omentum was interposed between the mesh and underlying bowel. At a mean follow-up of one year, all patients were subjected to ultrasound examination using visceral slide technique to detect Intra-abdominal adhesions.Results: Our study included 50 patients with a mean age of 43 years (range 26-59 years) and mean body mass index of 29.07±2.35 kg/m2 (range, 24-33 kg/m2). Mean fascial defect size of hernia was 13.4±3.77 cm2 (range12-16 cm2). There were no mesh-related complications and recurrence during the follow-up period of 1 year.Conclusions: Laparoscopic ventral hernia repair using composite mesh seems to be a promising technique for treating ventral hernias. However, longer follow-up periods are needed to confirm effectiveness and safety of the composite mesh.

Ultrasound Visceral Slide Assessment to Detect Adhesions in Patients Undergoing Abdominal Surgery – a Systematic Review and Meta-Analysis

Study Objective To determine the diagnostic accuracy of preoperative visceral slide assessment with ultrasound to detect intra-abdominal adhesions, compared to the gold standard of intraoperative findings. Design Systematic review and meta-analysis, prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO). Setting Abdominal entry at time of laparoscopy is a critical step with risk of injury to underlying viscera due to bowel adhesions. Ultrasound can be used as a preoperative tool to assess slide of viscera underneath the abdominal wall in order to detect adhesion-free areas. Patients or Participants Prospective and cross-sectional studies in English that included patients at risk for adhesions, undergoing ultrasound visceral slide assessment followed by abdominal surgery. Interventions N/A Measurements and Main Results 3737 articles were screened through electronic searches of Cochrane, MEDLINE, EMBASE, and Google Scholar databases. Reference lists of relevant articles were searched for further articles. Two reviewers independently selected articles, extracted data, and assessed bias using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Primary authors were contacted for additional relevant data. Twenty-five articles reported on 1620 patients and 6166 assessed abdominal areas, with considerable heterogeneity of described abdominal areas and degrees of adhesions. Only 5 studies were performed blinded and 21 had high risk of selection bias. The periumbilical area was assessed for bowel adhesions in 869 patients in 11 studies, with 12.2% reported to have adhesions. Ultrasound assessment for periumbilical bowel adhesions had a combined sensitivity of 93.5% (95% confidence interval, 87.0-97.3), specificity of 91.7% (89.6-93.6), positive predictive value of 61.4% (55.5-66.9), and negative predictive value of 99.0% (98.0-99.5). Conclusion Visceral slide assessment with ultrasound has a high negative predictive value for absence of bowel adhesions in patients at risk for adhesions and should be considered as a useful tool to detect adhesion-free areas to assist with safe laparoscopic entry.

A Randomized Controlled Trial of Thermo-Sensitive Sol-Gel Anti-Adhesion Agent after Gynecologic Surgery.

Postoperative abdominal adhesions can lead to several adverse consequences such as pelvic pain, bowel obstruction, and infertility. We aimed to explore the anti-adhesion efficacy and safety of a thermo-sensitive sol–gel agent in patients who receive abdominopelvic surgery for benign gynecologic disease. This study was a randomized, controlled, single-blind clinical trial of women undergoing benign gynecologic surgery between January 2017 and December 2017. The patients were randomly assigned to three groups with a 1:1:1 ratio: experimental group (received the thermo-sensitive sol–gel agent), control group (untreated), and comparator group (received 4% icodextrin). Patients were followed for 4 weeks postoperatively, and efficacy was evaluated by performing the visceral slide test to identify adhesion formation. In total, 183 patients were enrolled in the study, and 178 (97.3%) completed the trial. The incidence rate of abdominal adhesion formation was significantly lower in the experimental group than in the control group (7.9% vs. 21.1%, p = 0.040); however, it was similar between the experimental and comparator groups (7.9% vs. 13.8%. p = 0.299). At 4 weeks, no differences in adhesion-related symptoms were observed between the experimental and control groups. Adverse events were mostly mild and did not differ significantly among the three groups (p = 0.375). In conclusion, use of a thermo-sensitive sol–gel agent was safe and effective to prevent abdominal adhesions after benign gynecologic surgeries.

Does applied ultrasound prior to laparoscopy predict the existence of intra-abdominal adhesions?

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.

Assessment of the diagnostic efficacy of abdominal ultrasonography and cine magnetic resonance imaging in detecting abdominal adhesions: A double-blind research study

PurposeThis cohort aimed to determine the efficacy and safety of abdominal ulrasonography and cine-MRI by a double-blind study in the diagnosis of intraabdominal organs and abdominal wall adhesions in patients with previous abdominal operations. MethodsBetween 2017 and 2019, 108 consecutive patients were prospectively included in the study. Visceral slide and induced visceral slide were measured during AU and cine-MRI. An abdominal map consisting of nine segments was created to document the location and extent of the adhesion. The degree and severity of the adhesions detected by the radiologist preoperatively and detected in surgery as the gold standard was recorded in the same abdominal zones. AU, c-MRI and intraoperative findings were correlated. ResultsThe mean age was 53.0 ± 10.3 years, body mass index was 30.4 ± 3.4, male (52.8 %) and female (47.2 %). According to the total nine zones, the sensitivity of AU was 91.4 %, specificity was 100 %, positive predictive value was 90.7 %, negative predictive value was 100 % and diagnostic accuracy was 87.9 %. Considering the total zones, the sensitivity of c-MRI was 90.8 %, specificity was 100 %, PPV was 90.7 %, NPV was 100 % and diagnostic accuracy was 91.7 %. A comparison of AU and c-MRI showed no significant difference in the detection of adhesions to the abdominal wall; however, c-MRI was superior in detecting intraabdominal organs adhesion. ConclusionWe have demonstrated that AU and c-MRI are accurate for diagnosing adhesions in patients undergoing repeated surgery and may have a place on planning elective laparoscopic or open surgery to avoid bowel injury.

The visceral slide test for the prediction of abdominal wall adhesions: a prospective cohort study

The visceral slide test for the prediction of abdominal wall adhesions: a prospective cohort study

Evaluation of the diagnostic potential of trans abdominal ultrasonography in detecting intra-abdominal adhesions: A double-blinded cohort study.

BackgroundIntra-abdominal adhesion is one of the most important complications of abdominopelvic surgery. It increases morbidity and mortality for patients. Although laparoscopy is the gold standard of adhesion diagnosis, it can cause visceral damage during the operation. Therefore, surgeons prefer to use non-invasive methods for planning the operation. We designed this study to evaluate transabdominal ultrasonography ( TAU) accuracy for diagnosing Intra-abdominal AdhesionsMaterial & methodsThis double-blinded cohort study was conducted on 47 patients with previous laparotomy who undergo another surgery. Spontaneous visceral slide (SVS) and induced visceral slide (IVS) were measured during TAU.ResultsThe mean age and BMI of 47 patients were 43.21±10.3 and 27.545±5.76. The majority of the patients were female (76%). Mean SVS and IVS in patients with intra-abdominal adhesion were 8.73±1.60 and 44.84±11.60. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of TAU in intra-abdominal diagnosis were 83.33%, 51.72%, 51.72%, 83.33%, 63.83%.ConclusionsAlthough TAU is an appropriate method for detecting the intra-abdominal adhesion, it isn't good enough for diagnosing free adhesion area. We recommended further researches with greater sample size and other non-invasive techniques.

Transabdominal ultrasound: Can it be used to detect and quantify adhesions/reported pain, following Caesarean section?

BackgroundCaesarean section is common in the UK with post–procedural adhesions causing life-long clinical symptoms and impacting future pregnancies. This study's aim was to explore associations between these surgical adhesions, via transabdominal ultrasound findings, and perceived symptoms. MethodFemales demonstrating 1–3 transverse, lower-segment Caesareans were included. Visceral slide transabdominal ultrasound elicited positive adhesions (<1 cm movement) and negative adhesions (>1 cm movement). Scar tissue quality was assessed by the Patient and Observer Scar Assessment Scale (POSAS) and Numerical rating scales (NRS) described pain symptoms. The relationship between adhesions was explored using Fisher's exact test and multiple regression analysis. ResultsTwenty-two subjects (mean-age 35) were recruited; twenty participants (91%) had undergone 1 Caesarean, one each of the remainder had undergone 2 and 3 Caesareans respectively. Increased Visceral slide (>1 cm) was seen as predictive of increased scar pain (R2 = 0.76 (95% CI 0.12–0.28), P < 0.001). ConclusionCaesarean adhesion scans showed significant associations with pain symptomology. Comprehensive adhesion assessment needs to be developed to improve long term outcomes of adhesions. Transabdominal Ultrasound can be considered a useful, quick and non-deleterious alternative diagnostic tool to Laparoscopy, therefore preventing further adhesion formation.

The Utility of Sonographic Assessment in Selecting Patients for Percutaneous Insertion of Peritoneal Dialysis Catheter.

Percutaneous insertion of peritoneal dialysis (PD) catheters by nephrologists is a safe and effective alternative to open surgical techniques. These patients are usually carefully selected due to anatomical considerations and medical comorbidities, with the current literature suggesting exclusion of patients with prior abdominal surgery. We conducted a retrospective cohort study of pre-dialysis patients who attended a preprocedural clinic in a tertiary center over 6 years. Procedural complications and catheter survival were assessed. Chi-squared test and Kaplan-Meier survival analysis were undertaken. Inpatient assessments were excluded. A total of 217 patients were assessed, of whom 171 (78.8%) were accepted for percutaneous PD catheter insertion by a nephrologist. The key exclusion criteria were: (1) the clinical presence of abdominal hernia (p < 0.001), (2) ultrasound findings of skin to peritoneum depth of > 5.5 cm (p < 0.001) and (3) ultrasound findings of impaired visceral slide test (p < 0.001). Prior abdominal surgery was not a default exclusion criterion (p = 0.1), as 63 patients (37%) with prior abdominal surgery, average of 1.3 prior surgeries per patient, were assessed as appropriate for the percutaneous procedure. There was no difference in the procedural complication rate and catheter survival between patients with and without prior abdominal surgery. A comprehensive preprocedural assessment utilizing ultrasound permits an objective selection of patients for percutaneous insertion of PD catheters by nephrologists. This allowed for successful and safe percutaneous insertion of PD catheters in patients who may have otherwise been excluded, e.g., prior abdominal surgery, patients with large bilateral polycystic kidneys, and central obesity.

Prediction of intra-abdominal adhesions using the visceral slide test: A prospective observational study

ObjectiveThe goal of this study was to determine whether the visceral slide test is an effective screening method for the prediction of intra-abdominal adhesions. Study designA prospective, observational study was conducted assessing a cohort of women undergoing benign gynaecologic surgery between April 2015 and June 2015. At the patient’s preoperative visit, they underwent the ultrasound-based visceral slide test in five zones of the abdomen. The ultrasound assessments were validated against direct visualization during surgery. The effectiveness of the slide test as a screening technique was examined by recording the presence, extent, and severity of adhesions observed intraoperatively; this was scored using a modified version of the American Fertility Society (mAFS) system. ResultsIn total, 144 women completed the study, 33 (22.9%) of whom had previously undergone intra-abdominal surgery. The median time to perform the visceral slide test was 2min, and using our methodology, 48 patients (33.3%) were diagnosed with adhesions. We found that the visceral slide test had a sensitivity of 97.2%, specificity of 68.6%, positive predictive value of 90.6%, negative predictive value of 88.9%, and diagnostic accuracy of 90.3%. Further, the number of negative visceral slide tests was positively correlated with the mAFS scores. ConclusionOur data suggest that the visceral slide test is a simple, fast, reliable assay for detecting intra-abdominal adhesions in patients undergoing gynaecologic surgery.

A Novel Diagnostic Aid for Detection of Intra-Abdominal Adhesions to the Anterior Abdominal Wall Using Dynamic Magnetic Resonance Imaging.

Introduction. Abdominal adhesions can cause serious morbidity and complicate subsequent operations. Their diagnosis is often one of exclusion due to a lack of a reliable, non-invasive diagnostic technique. Development and testing of a candidate technique are described below. Method. During respiration, smooth visceral sliding motion occurs between the abdominal contents and the walls of the abdominal cavity. We describe a technique involving image segmentation and registration to calculate shear as an analogue for visceral slide based on the tracking of structures throughout the respiratory cycle. The presence of an adhesion is attributed to a resistance to visceral slide resulting in a discernible reduction in shear. The abdominal movement due to respiration is captured in sagittal dynamic MR images. Results. Clinical images were selected for analysis, including a patient with a surgically confirmed adhesion. Discernible reduction in shear was observed at the location of the adhesion while a consistent, gradually changing shear was observed in the healthy volunteers. Conclusion. The technique and its validation show encouraging results for adhesion detection but a larger study is now required to confirm its potential.

PTH-243 Intra-abdominal adhesions: identifying the “sticking point(s)” using novel cine-magnetic resonance image analysis. pilot results

<h3>Introduction</h3> Peritoneal adhesion formation is a common complication of abdominal surgery and is associated with chronic abdominal pain, bowel obstruction, female infertility and reoperation complications. Non-invasive diagnosis has the potential to improve patient management by determining the cause of symptoms. Cine-MR (cMR) has been used for this purpose¹but in our experience has proven labour intensive and with high inter-operator variability. We previously presented a mathematical interpretation of abdominal movement in cMR to infer gross abnormalities.²We have since refined our approach to detect more subtle changes. Here we present the preliminary results of our new technique. <h3>Method</h3> Sagittal cMR images were obtained using a previously defined scanning protocol.²Images from 3 patients were analysed, 2 with abdominal wall adhesions and 1 without. The principle driving the methodology is the expectation that an adhesion’s resistance to visceral slide produces a quantifiable reduction in shear at that location. The method entails image processing of cMR images in which visceral slide is captured over several breathing cycles. Specifically this involves: Defining a line of demarcation between the sliding regions, typically the abdominal contents and the abdominal wall. Independent interrogation of the respective modes of motion in these separate regions using image registration software. Deduction of the relative motion at the boundary between the two regions Extraction of the magnitude of shear and its presentation in a ‘sheargram’. <h3>Results</h3> The images display the accumulated shear over approximately 3 respiratory cycles in patients with and without abdominal wall adhesions. The left image (with adhesions) shows a marked reduction in shear in the lower fifth of the abdominal wall correlating to a surgically verified adhesion. The reliability of these preliminary results is also supported by the more even distribution of shear observed in a patient without anterior abdominal wall adhesions (right image). <h3>Conclusion</h3> Our pilot results demonstrate the potential of this newly developed image analysis technique. In combination with other relevant diagnostic information it facilitates the efficient localisation of adhesions to the abdominal wall. A larger study is in progress to confirm these results. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Lienemann, <i>et al</i>. <i>Radiology</i>2000;<b>217</b>(2):421–5 Fenner, <i>et al</i>. <i>Phys Medica</i>2014;<b>30</b>(4):437–447

Mo2016 Intra-Abdominal Adhesions: Identifying the “Sticking Point(s)” Using Novel Cine-Magnetic Resonance Image Analysis. Pilot Results

Introduction Peritoneal adhesion formation is a common complication of abdominal surgery and is associated with chronic abdominal pain, bowel obstruction, female infertility and reoperation complications. Non-invasive diagnosis has the potential to improve patient management by determining the cause of symptoms. Cine-MR (cMR) has been used for this purpose1but in our experience has proven labour intensive and with high inter-operator variability. We previously presented a mathematical interpretation of abdominal movement in cMR to infer gross abnormalities.2We have since refined our approach to detect more subtle changes. Here we present the preliminary results of our new technique. Method Sagittal cMR images were obtained using a previously defined scanning protocol.2Images from 3 patients were analysed, 2 with abdominal wall adhesions and 1 without. The principle driving the methodology is the expectation that an adhesion’s resistance to visceral slide produces a quantifiable reduction in shear at that location. The method entails image processing of cMR images in which visceral slide is captured over several breathing cycles. Specifically this involves: 1. Defining a line of demarcation between the sliding regions, typically the abdominal contents and the abdominal wall. 2. Independent interrogation of the respective modes of motion in these separate regions using image registration software. 3. Deduction of the relative motion at the boundary between the two regions 4. Extraction of the magnitude of shear and its presentation in a ‘sheargram’. Results The images display the accumulated shear over approximately 3 respiratory cycles in patients with and without abdominal wall adhesions. The left image (with adhesions) shows a marked reduction in shear in the lower fifth of the abdominal wall correlating to a surgically verified adhesion. The reliability of these preliminary results is also supported by the more even distribution of shear observed in a patient without anterior abdominal wall adhesions (right image). Conclusion Our pilot results demonstrate the potential of this newly developed image analysis technique. In combination with other relevant diagnostic information it facilitates the efficient localisation of adhesions to the abdominal wall. A larger study is in progress to confirm these results. Disclosure of interest None Declared. ![Abstract PTH-243 Figure 1][1] Abstract PTH-243 Figure 1

Can general surgeons evaluate visceral slide with transabdominal ultrasound to predict safe sites for primary laparoscopic port placement? A prospective study of sonographically naïve operators at a tertiary center

BackgroundPort placement injuries are a potentially devastating complication of laparoscopic surgery. Ultrasound assessment for visceral slide has the ability to preoperatively determine adhesion-free areas. The utility of this technique has not been studied when performed by surgeons. MethodsSurgeons without expertise in ultrasound were taught the visceral slide technique. Patients with a history of abdominal surgery were then assessed for adhesion-free areas on the abdominal wall. Ultrasound assessments were validated against intraoperative visualization. ResultsNine surgeons using the visceral slide technique assessed 145 patients for the presence of adhesions immediately before surgery. Surgeon who performed ultrasound demonstrated a sensitivity of 69.6%, specificity of 98.7%, and positive predictive value of 99.5% for detection of areas free from critical adhesions. The median time to perform the examination was 2 minutes. ConclusionThe visceral slide technique was easily learned, was rapid to perform, and reliably identified adhesion-free areas of the abdominal wall.

Office Visceral Slide Test Compared With Two Perioperative Tests for Predicting Periumbilical Adhesions

Women undergoing laparoscopic gynecologic surgery are at high risk of injury during trocar insertion, with most injuries occurring at the umbilical port site. The authors developed the visceral slide test to create a noninvasive, reliable method for detecting adhesions in women with a history of abdominal surgery. Visceral slide refers to an ultrasound finding of intra-abdominal viscera sliding in relation to the abdominal wall during inspiration and exhalation. When significant adhesions are predicted, surgeons can guide port selection or choose instead to perform laparotomy. Finding this test is accurate in the office could help guide preoperative counseling. The aim of this study was to compare the accuracy of the office visceral slide test for predicting obliterating periumbilical adhesions. Female patients older than 21 years were enrolled who had planned laparoscopic gynecologic surgery for benign disease. All had a history of abdominal or pelvic surgery. Prior to laparoscopic surgery, participants underwent a visceral slide test in the office as well as 2 previously validated tests used in the operating room. When visualized with ultrasonography, the visceral slide was defined as normal (positive test) with movement of the viscera more than 1 cm and as abnormal (negative test) with movement of the viscera less than 1 cm during exaggerated inspiration and exhalation. Each screening test took approximately 2 minutes or less to perform. The accuracy of the tests for predicting periumbilical adhesions was compared with that of diagnostic laparoscopy, the criterion standard. The study group comprised 70 women who had a median of 2 (range, 1–6) previous abdominal surgeries. Among these women, the median number of previous laparotomies was 0 (range, 0–5), and the median number of previous laparoscopies was 1 (range, 0–6). At laparoscopy, the incidence of obliterating periumbilical adhesions was 8.6% (6/70), and the incidence of any adhesions in the abdomen or pelvis was 25.7% (18/70). The office visceral slide test had a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 98.5%, and diagnostic accuracy of 98.6%. These values were similar to those of the other 2 tests performed in the operating room. These data show that the office-based ultrasound test is an accurate predictor of obliterating periumbilical adhesions and can provide important information to guide incision choice and preoperative counseling.

Office Visceral Slide Test in Predicting Periumbilical Adhesions: A Pilot Study

Half of all laparoscopic complications occur during entry. Thus, reliable detection of obliterating adhesions, defined as thick tissue containing viscera, can 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.

The office visceral slide test for preoperative prediction of periumbilical adhesions

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.