A Relook into Visceral Slide Test as a Preoperative Screening Modality to Detect Abdominal Wall Adhesions- A Prospective Observational Cohort Study

Background: 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 percentage. 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.

Preoperative ultrasonography in the evaluation of abdominal wall adhesions

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.

Role of ultrasound in reducing complication during primary trocar insertion in laparoscopic surgery: prospective observational study

Background: Patients presenting to Gynecology OPD at LLRM Medical College, Meerut, UP, India for benign laparoscopic surgery from June 2016 to May 2017 were included in the study. A total of 130 women completed the study of which 30 had history of previous abdominal surgery and 100 had no history of previous abdominal surgery. The ability of the visceral slide test to detect periumbilical adhesions was compared with laparoscopic detection of adhesions.Methods: Patients fulfilling inclusion and exclusion criteria and preanaesthetic clearance were subjected to office based Visceral Slide test using high frequency ultrasound probe (7.5 MHz) in the sagittal plane at the level of umbilicus. Distance between the skin and posterior rectus sheath was measured. Diagnostic accuracy of visceral slide test and mean time taken to perform the test was noted.Results: On laparoscopy 4 women had periumbilical adhesions while 24 women in the total sample had adhesions elsewhere in the abdominal cavity. The visceral slide test had a sensitivity of 75%, specificity of 98%, positive predictive value of 75% and negative predictive value of 99%. The diagnostic accuracy of the test is 97%. The median time to perform the examination was 1.69 minutes.Conclusions: The visceral slide technique was convenient and rapid to perform, and reliably identified adhesions in the periumbilical area.

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.