Detection of abdominal wall adhesions using visceral slide.

Background: Abdominal surgery, peritonitis, and pelvic inflammatory disease often give rise to intra-abdominal adhesions. They may lead to chronic pain, infertility, bowel obstruction, etc. Development in surgical strategies in the last decade has resulted in an increase in laparoscopic procedures and, as a consequence, a steep rise in reported bowel lesions. Accordingly, noninvasive diagnostic tools are desirable to identify adhesions before abdominal surgery. This study was designed to validate transabdominal ultrasonography (TAU) and magnetic resonance imaging (cine MRI) for detection of abdominal wall adhesions.

Methods: Sixty patients scheduled for laparoscopic surgery were prospectively enrolled. They were divided into two groups of 30 each; previous abdominal surgery/peritonitis and no history of abdominal surgery/peritonitis. Before elective surgery, TAU and cine MRI were performed. Visceral slide was measured in nine predefined abdominal segments and compared with intra-operative data on abdominal wall adhesions. Results were obtained in a double-blinded fashion.

Results: Patient characteristics were similar in both groups. Cine MRI showed a sensitivity, specificity, and accuracy of 21.5%, 87.1%, and 72.4%. TAU showed a sensitivity, specificity, and accuracy of 24%, 97.9%, and 81.3%. Comparison of TAU and cine MRI showed no significant difference in the detection of adhesions to the abdominal wall; however, TAU was significantly superior in depicting adhesion-free areas.

Conclusions: This study represents the first comparative study of TAU and cine MRI as noninvasive methods in detecting adhesions to the abdominal wall. Both methods are specific in detecting adhesion-free areas, and may serve as a diagnostic tool for future planning of laparoscopic surgery, elucidation of adhesion-related symptoms, and as a tool in the follow-up after ventral hernia repair with implantation of intraperitoneal mesh.