Validation of peritoneal adhesion index as a standardized classification to universalize peritoneal adhesions definition

Abstract

Peritoneal adhesion index (PAI) is a score based on appearance and distribution of peritoneal adhesions. The study aims to assess the validity of PAI in order to standardize the definition of peritoneal adhesions. The study includes an expert survey to assess the feasibility of the score and a prospective observational and multicenter trial to assess its validity. 96% of surgeons of the survey consider PAI a useful tool. From January 2013 to March 2015, 205 patients were enrolled to undergo a surgical intervention for bowel obstruction caused by peritoneal adhesions in 21 centers. PAI was significantly higher in the population with previous surgery (P=0.043) and in patients who underwent two previous surgical interventions, if compared to those with only one previous intervention (P=0.012). Length of surgery was significantly longer in patients with higher PAI (P<0.001). Patients with a higher PAI showed a clinically higher risk for early bowel re-obstruction and for early re-intervention. The AUC of the ROC curve for early re-occlusion is 0.8. PAI can be considered a feasible and useful score.

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

“…1 ) [ 35 ]. This score is the only score that has been validated to be prognostic for convalescence after surgery for ASBO and the risk of injuries during adhesiolysis [ 36 ]. A limitation to all these adhesion scores is that they are only applicable to operative cases because they require operative assessment.…”

Small Bowel Obstruction After Neonatal Repair of Congenital Diaphragmatic Hernia—Incidence and Risk-Factors Identified in a Large Longitudinal Cohort-Study

“…Coccolini et al suggested a regimented classification system for adhesions - the peritoneal adhesion index (PAI) - in an effort to standardize their definition and subsequent analysis ( 38 ). A survey on its feasibility showed a high acceptance among surgeons ( 39 ). In a prospective observational study of postoperative ASBO, Sisodia et al found that PAI is a sensitive and effective tool for the quantitative assessment of intraabdominal adhesions ( 40 ).…”

Adhesive Small Bowel Obstruction in the Minimally Invasive Era

“…The incidence of ASBO is 2-3% in the first years after surgery in all patients who undergo abdominal or pelvic surgery [1]. The risk of ASBO depends on the anatomical location of surgery and the extent of surgery and peritoneal injury [1][2][3][4][5][6][7][8][9][10]. ASBO risk varies from 0.5% in abdominal wall surgery, 1.2% after upper gastrointestinal tract surgery to 3.2% in lower gastro-intestinal tract surgery and 4.2% in pediatric surgery [1].…”

“…It has been suggested from a few studies that the decreased adhesion formation after minimally invasive surgery associates with a lower incidence of ASBO. This decrease seems limited compared to open surgery as concluded from one systematic review and one trial reported by our group [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Differences in definitions of ASBO used, types of procedures, outcome parameters and length of follow-up in the studies, preclude a firm conclusion on the beneficial effect of minimally invasive surgery on development of ASBO.…”

“…The degree of density and vascularization is traditionally classified using the Zühlke classification (Table 1) [3]. A more comprehensive and clinically relevant classification including projected locations of adhesions is the Peritoneal Adhesion Index (PAI) (Figure 1) [4,5].…”