The ultrasonic localization of abdominal wall adhesions

Abstract

Laparoscopic candidates with abdominal scars may have adhesions that result in visceral injury during trocar insertion. The purpose of this study was to evaluate the use of preoperative ultrasound mapping of abdominal wall adhesions, to provide safe initial laparoscopic access, and to guide the placement of subsequent trocars, facilitating adhesolysis when necessary. Thirty consecutive patients with previous abdominal surgery who were scheduled for laparoscopy underwent a preoperative ultrasonic examination of the abdominal wall using a 7-MHz linear ultrasound probe. Spontaneous viscera slide was measured during longitudinal scanning (normal = 2-5 cm) and induced viscera slide was evaluated during longitudinal and transverse scanning (normal = 1 cm or more) over the existing abdominal scar, the peri-umbilical region, and the remaining abdominal quadrants. Sixteen (53%) of 30 patients had adhesions under their scar and only four patients (25%) had umbilical adhesions. The 12 patients without umbilical adhesions all had successful closed cannulation while open cannulation at alternate sites was successful in the four individuals with umbilical adhesions. Blind umbilical needle cannulation was successfully done in all of the remaining 14 patients (47%) without visceral injury, including three patients (21%) with upper abdominal scars who were adhesion-free elsewhere. No adhesions were encountered that had not been preoperatively predicted by ultrasound. We conclude that examination of the abdominal wall with spontaneous and induced viscera slide, using ultrasound scanning, can reliably detect intraabdominal adhesions. The examination is best done on a highly selective basis by the operating surgeon to guide the location for initial trocar insertion

Cine magnetic resonance imaging vs high-resolution ultrasonography for detection of adhesions after laparoscopic and open incisional hernia repair: a matched pair pilot analysis

“…Surgeons must consider the presence and distribution of abdominal wall adhesions, especially before relaparoscopy or relaparotomy, because of the potential for bowel or other visceral injury at the site of entry [4,6,18]. This pilot study showed noninvasive cine MR imaging to be highly superior to high-resolution US in terms of detecting long-term intraabdominal adhesions and correlations with patientsÕ complaints.…”

Laparoscopic management of acute small bowel obstruction

“…Franklin et al [6] have routinely used this technique without complications. Caprini et al have used ultrasound mapping of the adhesions as a way of avoiding the complications of Veress needle puncture [4]. Most authors recommend mandatory open insertion of the initial trocar [2,8,9,15] as a means of preventing small bowel injury.…”

Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery

“…Preoperative planning using ultrasonography also may be useful in these cases. Ultrasonography is designed to show spontaneous or manual compression-induced visceral slide in an effort to map the geography of dense intraperitoneal adhesions [2,7]. For blind initial access to the abdominal cavity, consideration also may be given to the use of novel instrumentation including blunt-tipped, optical, and electrosurgical trocars [9,12,15,16], although none of these techniques have the same demonstrated safety in the avoidance of vascular or visceral injuries as the open cannulation procedure.…”