General Obstetrics and Gynecology: GynecologyPreoperative ultrasound to predict infraumbilical adhesions: A study of diagnostic accuracy
Section snippets
Material and methods
We measured visceral slide preoperatively in a series of 60 women with risk factors for intra-abdominal adhesions. Participants were approached between January 1, 2003 and June 13, 2003 for consent to participate in the study while in the UNC Hospitals Women's and Children's Hospital preoperative waiting area on the morning of their procedure. Ninety-five percent of women approached gave consent, as shown by the participant flow diagram in Figure 1. Authorization for the study was obtained from
Results
We evaluated a total of 60 women at a mean age of 43.9 years old (SD 13.9). In 43% of the subjects, the BMI was ≥30 kg/m2. The self-reported racial identification of the participants was 62% white, 20% black, and 11% other. Of the 55 women (92%) who were scheduled for a laparoscopic procedure, 43% had an open trocar entry, 32% had a Veress needle infraumbilical entry, and 17% had left upper quadrant entry. Three of these procedures (5%) were subsequently converted to open surgery for the
Comment
No method currently is in use for rapid, inexpensive, and noninvasive identification of infraumbilical bowel adhesions before laparoscopy. In the women we studied, who had historic risk factors for bowel adhesions, identifying these problems before surgery has appeal. Existing entry methods, such as entering the left upper quadrant or performing a small laparotomy, do not directly address the issue of adequately identifying those with adhesions, and require additional tissue dissection.
Acknowledgments
The authors wish to acknowledge Drs David Grimes and Denniz Zolnoun for substantial assistance in the design and execution of this study.
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Cited by (41)
Ultrasound Visceral Slide Assessment to Evaluate for Intra-abdominal Adhesions in Patients Undergoing Abdominal Surgery – A Systematic Review and Meta-analysis
2021, Journal of Minimally Invasive GynecologyCitation Excerpt :Tu et al [33] reported on 3 different cut offs for slide (<0.8 cm, <1 cm, <1.5 cm). The lower limit of 1 cm for normal slide was used for the purposes of this review as it is consistent with other studies and had excellent NPV without affecting the PPV [33]. Two studies used different cutoffs based on either the abdominal area (upper/mid abdomen: <1.5 cm, lower abdomen: <1 cm [16]) or the technique of induced movement used (<2 cm for spontaneous breathing and/or <1 cm for manual compression [34]).
Evaluation of the diagnostic potential of trans abdominal ultrasonography in detecting intra-abdominal adhesions: A double-blinded cohort study
2018, Annals of Medicine and SurgeryCitation Excerpt :Abdominal adhesion is estimated in 20–50% of patients with history of abdominal operation. Although adhesions can occur between all intra-abdominal organs and damaged serosal membranes, it most occurs between omentum and scar sites [3,5,6]. Abdominal adhesion can cause abdominal pain, intestinal complications, infertility and it increases the risk of damages to internal organs, urinary system, vessels, omentum, leading to more bleeding, hematoma, infection, fistula formation, length of hospitalization and risk of reoperation [1,2,6].
Transabdominal ultrasound: Can it be used to detect and quantify adhesions/reported pain, following Caesarean section?
2018, Journal of Bodywork and Movement TherapiesCitation Excerpt :VS indicates 98% specificity in detecting peritoneal adhesions (Kolecki et al., 1994) and 96% accuracy, 50% sensitivity and 98% specificity in detecting peri-umbilical adhesions (Nezhat et al., 2009; Tan et al., 2003). In detecting infra-umbilical peritoneal adhesions a VS of <1 cm was shown to have 86% sensitivity and 91% specificity (Tu et al., 2005). For the purposes of this study VS was measured between two landmarks; the PS (a hyperechoic outline of cortical bone) and the border of the posterior wall of the uterus using the calliper function.
Post-cesarean parietal scar characteristics are predictive of pelvic adhesions. A prospective cohort study
2015, Journal de Gynecologie Obstetrique et Biologie de la ReproductionPotential risk of port-site adhesions in patients after laparoscopic myomectomy using radially expanding trocars
2015, International Journal of Gynecology and Obstetrics
Supported in part by NRSA grant 1 T32 HD40672-01 from the National Institute of Child Health and Human Development.
Reprints not available from the authors.