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

Abstract

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.