Detection of abdominal adhesions in laparoscopic surgery. A controlled study of 130 cases

The risk of visceral injury during laparoscopy occurs mainly during the creation of the pneumoperitoneum and the insertion of the first trocar and is substantially greater in patients with a previous history of laparotomic surgery or peritonitis, owing to the possible presence of abdominal wall adhesions. In this study we assessed the results of preoperative ultrasonography of the parietal wall for the diagnosis of peritoneal adhesions, through the detection of two signs unrelated to one another, for the purpose of minimizing the number of false-negative results. Ultrasonography of the parietal wall was performed preoperatively in 130 patients who had previously undergone laparotomy. The ultrasound results were transcribed in the form of a map of the abdominal wall and checked during laparoscopy. The overall diagnostic accuracy was 88.5%, the specificity was 31.8%, and the sensitivity was 100%. The hazardous laparoscopic maneuvers were performed in adhesion-free areas in all cases, and there were no cases of complications due to visceral injury.