Document Detail


Ultrasound detection of the "sliding viscera" sign promotes safer laparoscopy.
MedLine Citation:
PMID:  19573821     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: To estimate the feasibility of preoperative ultrasound evaluation of the umbilical region in patients undergoing laparoscopy with a previous history of abdominal surgery. DESIGN: Prospective study (Canadian Task Force Classification II-1). SETTING: Department of Obstetrics and Gynecology Fatebenefratelli Isola Tiberina Hospital. PATIENTS: Twenty-five women with a previous history of open abdominal surgery (group A) and a group of 22 women with no previous history of surgery (group B) underwent dynamic ultrasound evaluation of the umbilical field. INTERVENTION: Ultrasound Slide-By test. RESULTS: Patients were asked to take a deep inspiratory breath, which accentuated respiratory excursion. The movement of the intraabdominal contents in a vertical fashion in relation to the abdominal wall, referred to as the "viscera slide," between the bowel and peritoneum was evaluated. Abdominal wall tissue thickness, Uracus to peritoneum thickness (UTP, mm) were also evaluated. Non parametric Mann-Whitney testing was used. No major demographic differences between the 2 study groups was noted. The abdominal wall tissue thickness was not significantly different between the 2 groups. The UTP was shorter in A group than in B group (1.5 +/- 0.3 mm vs 3.5 +/- 0.9 mm, p = .002). Absence of the "sliding viscera" sign was observed in 16 patients in group A and in 1 patient in group B. Patients with an absence of the sliding viscera sign were found to have subumbilical fibrous adhesions during laparoscopy. CONCLUSIONS: Evaluation of trocar insertion sites may be difficult and remains a challenge for peritoneal endosurgical access. We have shown that absence of the "sliding viscera" sign is more likely to be linked to subumbilical adhesions and represents a quick method for preoperative assessment. The UTP may also be a useful measurement, which requires further validation.
Authors:
Giovanni Larciprete; Edoardo Valli; Paolo Meloni; Ioannis Malandrenis; Maria Elisabetta Romanini; Sheba Jarvis; Federica Rossi; Giulia Barbati; Elio Cirese
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of minimally invasive gynecology     Volume:  16     ISSN:  1553-4650     ISO Abbreviation:  -     Publication Date:    2009 Jul-Aug
Date Detail:
Created Date:  2009-07-03     Completed Date:  2009-10-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101235322     Medline TA:  J Minim Invasive Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  445-9     Citation Subset:  IM    
Affiliation:
Department of Obstetrics and Gynecology, Fatebenefratelli Isola Tiberina Hospital, Rome, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adult
Case-Control Studies
Feasibility Studies
Female
Gynecologic Surgical Procedures / contraindications*
Humans
Laparoscopy / contraindications*
Preoperative Care / methods*
Tissue Adhesions / ultrasonography*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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