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KMID : 0978820060090020045
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Journal of the Korean Society of Endoscopic & Laparoscopic Surgeons
2006 Volume.9 No. 2 p.45 ~ p.48
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Ultrasound Can Prevent Visceral Injuries during the Creation of Pneumoperitoneum in Patients with Previous Abdominal Surgery
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Chung Huk-Jun
Park Il-Young
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Abstract
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Purpose: The purpose of this study was to evaluate the usefulness of preoperative ultrasound in providing safe initial access in patients with previous abdominal surgery.
Methods: Between November 2005 and July 2006, surgical patients with previous abdominal surgery underwent preoperative ultrasound. Viscera slide was defined as the movement of abdominal viscera during real-time ultrasonography. Viscera slide was produced spontaneously by respiratory movement or induced by manual compression. Restricted viscera slide was defined as ultrasonically detected movement of viscera of less than 1 cm during both spontaneous and induced viscera slide.
Results: A total of 42 patients underwent preoperative ultrasonic examination to evaluate viscera slide. The type of previous abdominal surgery and the incision site varied. Comparison of adhesions predicted by the viscera slide ultrasound with surgical findings revealed 12 true-positive results, 4 false-positive results, 25 true-negative results, and one false-negative result. Viscera slide ultrasound scan had a demonstrated sensitivity of 92%, a specificity of 86%, a positive predictive value of 75%, a negative predictive value of 96%, and an overall accuracy of 88%. The creation of pneumoperitoneum and the insertion of the first trocar were performed in adhesion-free areas in all cases. There were no complications associated with these procedures.
Conclusion: We conclude that viscera slide ultrasound can detect intra-abdominal adhesions and prevent injuries during the creation of pneumoperitoneum.
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KEYWORD
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Laparoscopic surgery, Adhesion, Ultrasound
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