Preoperative ultrasonography in the evaluation of abdominal wall adhesions

Authors

  • Neha Rani Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
  • Shalini Rajaram Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
  • Sarita Chaube Department of Obstetrics and Gynecology, SGT Medical College and Hospital, SGT University, Gurugram, Haryana, India
  • Vineeta Rathi Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20204802

Keywords:

Abdominal wall, Adhesions, Ultrasonography, Abdominal scar, Visceral slide

Abstract

Background: To detect and document preoperatively the presence of bowel and omental adhesions in the periumbilical region and along the previous abdominal scar using visceral slide scale by ultrasonography, and to compare the ultrasonic findings with intraoperative laparotomy or laparoscopy.

Methods: It was a cross-sectional observational study conducted between for 18 months at Guru Teg Bahadur Hospital, Delhi. Patients who had previously undergone abdominal surgery and were subsequently admitted for either laparotomy or laparoscopy (N=100) were selected. All patients underwent ultrasonography for visceral slide evaluation both along the scar and in a radius of 4 cm around the umbilicus. Later, peroperative findings were compared with ultrasonic findings.

Results: Mean visceral slide without and with adhesions was 2.39 (±1.21) versus 1.74 (±1.26) cm, correlation being significant (p=0.017) along the scar. While, the mean slide along the scar without and with adhesions in periumbilical region was 2.33 (±1.24) versus 1.07 (±1.07) cm, (p=0.007) on un-paired t-test showing sensitivity=51.6%, specificity=81.15%, positive predictive value=55.2%, and negative predictive value=78.9%. Patients with bowel adhesions (N=3) had restricted visceral slide both in periumblical region and along the scar (1.07 and 0.5 cm respectively).

Conclusions: Preoperative ultrasonography using visceral slide is a valuable technique in the detection of abdominal wall adhesions. A slide of ≤1 cm in the periumbilical region strongly suggests bowel adhesions.

 

Author Biography

Neha Rani, Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

Assistant Professor in the department of Obstetrics and gynaecology 

References

Nehzat C, Berker B. Laparoscopic adhesiolysis and adhesion prevention. Nehzat C, Nehzat F (eds.) In: Nezhat’s Operative Gynecologic Laparoscopy and Hysteroscopy. 3rd ed. Cambridge. Cambridge University Press. 2008;304-15.

Brill AI, Nezhat F, Nezhat CH, Nezhat C. The incidence of adhesions after prior laparotomy: A laparoscopic appraisal. Obstet Gynecol. 1995;85:269-72.

Krebs HB. Intestinal injury in gynaecologic surgery: A ten-year experience. Am J Obstet Gynecol. 1986;155:509-14.

Zinther NB, Zeuten A, Marinovskij E, Haislund M. Detection of abdominal wall adhesions using visceral slide. Surg Endosc. 2010;24:1361-6.

Caprini JA, Arcelus JA, Swanson J, Coats R, Hoffman K, Brosnan JJ, et al. The ultrasonic localisation of abdominal wall adhesions. Surg Endosc. 1995;9:283-5.

The Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society of Reproductive Surgeons. Pathogenesis, consequences, and control of peritoneal adhesions in gynaecologic surgery. Fertil Steril. 2008;90(3):144-9.

Levrant SG, Bieber EJ, Barnes RB. Anterior Abdominal Wall Adhesions after Laparotomy or Laparoscopy. J Am Assoc Gynecol Laparosc. 1997;4(3):353-6.

Dhama V, Dhama V, Chaudhary R, Singh S, Aafrin S. Role of ultrasound in reducing complication during primary trocar insertion in laparoscopic surgery: prospective observational study. Int J Reprod Contracept Obstet Gynecol. 2018;7(7):2747-52.

Rafii A, Camatte S, Lelièvre L, Daraï E, Lécuru F. Previous abdominal surgery and closed entry for gynaecological laparoscopy: a prospective study. BJOG. 2005;112:100-2.

Audebert AJM, Gomel V. Role of microlaparoscopy in the diagnosis of peritoneal and visceral adhesions and in the prevention of bowel injury associated with blind trocar insertion. Fertil Steril. 2000;73(3):631-5.

Sigel B, Golub RM, Loiacono LA, Parsons RE, Kodama I, Machi J, et al. Technique of ultrasonic detection and mapping of abdominal wall adhesions. Surg Endosc. 1991;5:161-5.

Kolecki RV, Golub RM, Sigel B, Machi J, Kitamura H, Hosokawa T, et al. Accuracy of viscera slide detection of abdominal wall adhesions by ultrasound. Surg Endosc. 1994;8:871-4.

Borzellino G, Manzoni GD, Ricci F. Detection of abdominal adhesions in laparoscopic surgery. Surg Laparosc Endosc. 1998;273-6.

Aubé C, Pessaux P, Tuech JJ, du Plessis R, Becker P, Caron C, et al. Detection of peritoneal adhesions using ultrasound examination for the evaluation of an innovative intraperitoneal mesh. Surg Endosc. 2004;18:131-5.

Kothari SN, Fundell LJ, Lambert PJ, Mathiason MA. Use of transabdominal ultrasound to identify intraabdominal adhesions prior to laparoscopy: a prospective blinded study. Am J Surg. 2006;192:843-7.

Larciprete G, Valli E, Meloni P, Malandrenis I. Ultrasound detection of the “sliding viscera” sign promotes safer laparoscopy. J Minim Invasive Gynecol. 2009;16(4):445-9.

Nezhat CH, Dun EC, Katz A, Wieser FA. Office Visceral Slide Test compared with two Perioperative Tests for predicting periumbilical adhesions. Obstetr Gynecol. 2014;123(5):1049-56.

Firoozabadia M, Alibakhshia A, Alaeenb H, Zand S, Nazemian R, Rahmani M. Evaluation of the diagnostic potential of transabdominal ultrasonography in detecting intra-abdominal adhesions: A double-blinded cohort study. Ann Med Surg. 2018;36(7):79-82.

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Published

2020-10-27

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Original Research Articles