title: Ultrasound detection of the "sliding viscera" sign promotes safer laparoscopy.
abstract: OBJECTIVE
  To estimate the feasibility of preoperative ultrasound evaluation of the umbilical region in patients undergoing laparoscopy with a previous history of abdominal surgery.
  
  
  METHODS
  Prospective study (Canadian Task Force Classification II-1).
  
  
  METHODS
  Department of Obstetrics and Gynecology Fatebenefratelli Isola Tiberina Hospital.
  
  
  METHODS
  Twenty-five women with a previous history of open abdominal surgery (group A) and a group of 22 women with no previous history of surgery (group B) underwent dynamic ultrasound evaluation of the umbilical field.
  
  
  METHODS
  Ultrasound Slide-By test.
  
  
  RESULTS
  Patients were asked to take a deep inspiratory breath, which accentuated respiratory excursion. The movement of the intraabdominal contents in a vertical fashion in relation to the abdominal wall, referred to as the "viscera slide," between the bowel and peritoneum was evaluated. Abdominal wall tissue thickness, Uracus to peritoneum thickness (UTP, mm) were also evaluated. Non parametric Mann-Whitney testing was used. No major demographic differences between the 2 study groups was noted. The abdominal wall tissue thickness was not significantly different between the 2 groups. The UTP was shorter in A group than in B group (1.5 +/- 0.3 mm vs 3.5 +/- 0.9 mm, p = .002). Absence of the "sliding viscera" sign was observed in 16 patients in group A and in 1 patient in group B. Patients with an absence of the sliding viscera sign were found to have subumbilical fibrous adhesions during laparoscopy.
  
  
  CONCLUSIONS
  Evaluation of trocar insertion sites may be difficult and remains a challenge for peritoneal endosurgical access. We have shown that absence of the "sliding viscera" sign is more likely to be linked to subumbilical adhesions and represents a quick method for preoperative assessment. The UTP may also be a useful measurement, which requires further validation.
authors: Department of Obstetrics and Gynecology, Fatebenefratelli Isola Tiberina Hospital, Rome, Italy.
authors: Giovanni
authors: G
authors: Larciprete
authors: Edoardo
authors: E
authors: Valli
authors: Paolo
authors: P
authors: Meloni
authors: Ioannis
authors: I
authors: Malandrenis
authors: Maria Elisabetta
authors: ME
authors: Romanini
authors: Sheba
authors: S
authors: Jarvis
authors: Federica
authors: F
authors: Rossi
authors: Giulia
authors: G
authors: Barbati
authors: Elio
authors: E
authors: Cirese
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D000075202:Contraindications; D005240:Feasibility Studies; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy; D011300:Preoperative Care / Q000379:methods*; D000267:Tissue Adhesions / Q000000981:diagnostic imaging*; D014463:Ultrasonography