Yasemin GÜNDÜZ, Alper KARACAN, Hilal Uslu YUVACI, Nermin AKDEMİR, Ünal ERKOKRMAZ, Arif Serhan CEVRİOĞLU, Abdurrahim KESKİN

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

diagnostic tool, in predicting the presence of intraabdominal adhesions, especially near the trocar entry area, to provide safe surgicalaccess to the abdomen.Materials and methods: Fifty-nine women with a previous history of open abdominal surgery (group A) and a group of 91 womenwith no previous history of surgery (group B) underwent dynamic ultrasound evaluation of the abdominal fields before laparoscopicoperations. The anterior abdominal wall was divided into six quadrants: right upper, right lower, left upper, left lower, suprapubic, andumbilical. Adhesions were evaluated by surgeons during the operation and by radiologists using USG prior to the operation. Visceral organmovements greater than 1 cm was defined as normal visceral slide (positive test), with less than 1 cm of movement defined as abnormalvisceral slide (negative test). Sliding test measures movements of omental echogenicity or a stable echogenic focus that corresponds tointestine peritoneal echogenicity that underlies abdominal wall during exaggerated inspiration and expiration. Adhesions observed duringsurgery were evaluated on a four-point scale, with 0 indicating no adhesions present, 1 indicating the presence of a thin, filmy avascularadhesion, 2 indicating the presence of a dense and vascular adhesion, and 3 indicating adhesions that connect surrounding organs with theoverlying 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 laparoscopicoperations.

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1. Zinther NB, Zeuten A, Marinovskij E, Haislund M, Friis- Andersen H. Detection of abdominal wall adhesions using visceral slide. Surgical Endoscopy 2010; 24(12): 3161-3166. doi: 10.1007/s00464-010-1110-2
2. Sigel B, Golub RM, Loiacono LA, Parsons RE, Kodama I et al. Technique of ultrasonic detection and mapping of abdominal wall adhesions. Surgical Endoscopy 1991; 5(4): 161-165.
3. Tu FF, Lamvu GM, Hartmann KE, Steege JF. Preoperative ultrasound to predict infraumbilical adhesions: a study of diagnostic accuracy. American Journal of Obstetrics and Gynecology 2005; 192(1): 74-79.
4. Brill AI, Nezhat F, Nezhat CH, Nezhat C. The incidence of adhesions after prior laparotomy: a laparoscopic appraisal. Obstetrics and Gynecology 1995; 85(2): 269-72.5.
5. Okabayashi K, Ashrafian H, Zacharakis E, Hasegawa H, Kitagawa Y et al. Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity. Surgery Today 2014; 44(3): 405-420. doi: 10.1007/s00595-013- 0591-8.6
6. Levrant SG, Bieber EJ, Barnes RB. Anterior abdominal wall adhesions after laparotomy or laparoscopy. The Journal of the American Association of Gynecologic Laparoscopists 1997; 4(3): 353-356.
7. Operative Laparoscopy Study Group: Postoperative adhesion development after operative laparoscopy: evaluation at early second-look procedures. Fertility and Sterility 1991; 55: 700- 704.
8. vanGoor H. Consequences and complications of peritoneal adhesions. Colorectal Disease 2007; 9Suppl 2: 25-34.
9. van den Beukel BA, de Ree R, van Leuven S, Bakkum EA, Strik C et al. Surgical treatment of adhesion-related chronic abdominal and pelvic pain after gynaecological and general surgery: a systematic review and meta-analysis. Human Reproduction Update 2017; 23(3): 276-288. doi: 10.1093/ humupd/dmx004
10. Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS et al. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet 1999; 353(9163): 1476-1480.
11. Hindocha A, Beere L, Dias S, Watson A, Ahmad G. Adhesion prevention agents for gynaecological surgery: an overview of Cochrane reviews. The Cochrane Database of Systematic Reviews 2015; 1: CD011254. doi: 10.1002/14651858. CD011254.pub2
12. Ahmad G, Baker J, Finnerty J, Phillips K, Watson A. Laparoscopic entry techniques. The Cochrane Database of Systematic Reviews 2019; 1: CD006583. doi: 10.1002/14651858. CD006583.pub5
13. van der Voort M, Heijnsdijk EA, Gouma DJ. Bowel injury as a complication of laparoscopy. The British Journal of Surgery 2004; 91: 1253-1258.
14. Bhoyrul S, Vierra MA, Nezhat CR, Krummel TM, Way LW. Trocar injuries in laparoscopic surgery. Journal of the American College of Surgeons 2001; 192(6): 677-683.
15. Marin G, Bergamo S, Miola E, Caldironi MW, Dagnini G. Prelaparoscopic echography used to detect abdominal adhesions. Endoscopy 1987; 19(4): 147-149.
16. Dehghani Firoozabadi MM, Alibakhshi A, Alaeen H, Zand S, Nazemian R et al. Evaluation of the diagnostic potential of trans abdominal ultrasonography in detecting intra-abdominal adhesions: A double-blinded cohort study. Annals of Medicine and Surgery 2018; 36: 79-82. doi: 10.1016/j.amsu.2018.09.013
17. Randall D, Joosten F, ten Broek RP, Gillott R, Bardhan KD et al. A novel diagnostic aid for intra-abdominal adhesion detection in cine-MR imaging: Pilot study and initial diagnostic impressions. The British Journal of Radiology 2017: 20170158. doi: 10.1259/bjr.20170158
18. Gerner-Rasmussen J, Donatsky AM, Bjerrum F. The role of non-invasive imaging techniques in detecting intra-abdominal adhesions: a systematic review. Langenbeck’s Archives of Surgery 2019; 404(6): 653-661. doi: 10.1007/s00423-018-1732-8
19. Ghonge NP, Ghonge SD. Computed tomography and magnetic resonance imaging in the evaluation of pelvic peritoneal adhesions: What radiologists need to know? Indian Journal of Radiology and Imaging 2014; 24(2): 149-155. doi: 10.4103/0971-3026.134400
20. Nezhat CH, Dun EC, Katz A, Wieser FA. Office visceral slide test compared with two perioperative tests for predicting periumbilical adhesions. Obstetrics and Gynecology 2014; 123(5): 1049-1056. doi: 10.1097/AOG.0000000000000239
21. Kolecki RV, Golub RM, Sigel B, Machi J, Kitamura H et al. Accuracy of viscera slide detection of abdominal wall adhesions by ultrasound. Surgical Endoscopy 1994; 8(8): 871-874.