[Ultrasonography mapping of peritoneal adhesions]

A previous laparotomy is still a contraindication to laparoscopy because of the possible presence of abdominal wall adhesions exposing the patient to the risk of a visceral injury when the pneumoperitoneum is created and/or the first trochar is inserted. We report the results of abdominal wall US exams performed preoperatively for the diagnosis of peritoneal adhesions: we investigated two distinct signs unrelated to one another, to minimize false-negative findings. Ultrasonography was performed on 141 patients subdivided into two groups: 81 patients with no previous abdominal surgery (group A) and 60 patients with a history of abdominal surgery (group B). For diagnostic purposes, the visceral movement sign according to Sigel, modified on the basis of preliminary observations, and the reflection band sign were studied. US data were included in the patient's record and compared with intraoperative findings. Overall diagnostic accuracy was 94% and sensitivity 100% in the two groups. To conclude, the preoperative US mapping of abdominal wall adhesions enabled us to establish adhesion-free areas unquestionably and thus to choose the safest and most suitable sites for risky maneuvers during laparoscopy in the patients with a history of previous abdominal surgery.