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Okabe H, Masuda T, Tomita M, Ono A, Kuroda D, Kuroki H, Nitta H, Hibi T, Baba H, Sugita H. Diagnostic accuracy of preoperative adhesion mapping by ultrasonography for laparoscopic surgery in patients with past abdominal surgery with special reference to loose adhesion. Asian J Endosc Surg 2024; 17:e13332. [PMID: 38922724 DOI: 10.1111/ases.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/27/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Endoscopic surgery is widely accepted for both elective and emergent abdominal surgery. This study was performed to assess the accuracy of preoperative adhesion mapping by abdominal ultrasonography (US). METHODS Intra-abdominal intestinal adhesions on the abdominal wall in 50 patients with a history of abdominal surgery were prospectively assessed by the visceral slide test with US before laparoscopic surgery from 2019 to 2022. Adhesion was assessed in six separate abdominal zones during US. Actual adhesion on the abdominal wall was confirmed during laparoscopic surgery. RESULTS The sliding distances in upper right, upper central, upper left, lower right, lower central, and lower left zones in patients with versus without intestinal adhesion were 4.4 versus 1.4 cm (P = .004), 3.4 versus 2.5 cm, 4.3 versus 1.3 cm (P = .011), 3.1 versus 1.5 cm (P = .0014), 3.3 versus 1.1 cm (P = .013), and 3.4 versus 0.8 cm (P = .0061), respectively. Receiver operating characteristic analysis revealed the optimal value of sliding distance as 2.5 cm and the area under the curve as 0.86. The specificity of US assessment of adhesion was lower in the central zone than in lateral zones. Loose adhesion mostly seen around the scar was attributed to either filmy tissue or omental adhesion, leading to visceral sliding during US. CONCLUSION This study revealed the reason for insufficient accuracy of preoperative US assessment of intestinal adhesion around the scar area because of loose adhesion. The upper lateral area might be optimal for first port insertion.
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Affiliation(s)
- Hirohisa Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshiro Masuda
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Masahiro Tomita
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Asuka Ono
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Daisuke Kuroda
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Hideyuki Kuroki
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Hidetoshi Nitta
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroki Sugita
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto, Japan
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Ozturk UK, Keles E, Akış S, Alınca CM, Acar S, Ozyurek SE, Api M. Evaluation of the Preoperative Slide Test in the Prediction of Intra-Abdominal Adhesions: A Single-Center, Double-Blinded, Prospective Observational Study. Surg Innov 2023; 30:557-563. [PMID: 37518021 DOI: 10.1177/15533506231186071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND To evaluate the efficacy of the preoperative ultrasonographic sliding sign in predicting intra-abdominal adhesions. METHODS This was a single-center, double-blinded, prospective observational study undertaken from March and September 2021 on 110 patients with a history of previous abdominal surgery. All patients who were scheduled for laparoscopy underwent slide test in 5 zones of abdomen: right lower quadrant, left lower quadrant, previous operation site, vesicouterine pouch, and rectovaginal pouch. Adhesions were assessed by the same gynecologic surgeon using ultrasonography before the surgery and by gynecological surgeons during surgery, and by a third gynecologic surgeon to compare the preoperative slide test findings and laparoscopic findings after the surgery. RESULTS Seventy-three (66.4%) patients underwent laparoscopic surgery, and 37 (33.6%) patients underwent laparotomy. The mean age of patients was 46.9 ± 1.0 years. Sensitivity, specificity, and positive and negative predictive values of preoperative ultrasonography in predicting adhesions were 89.5%, 91.7%, 97.5%, and 71.0%, respectively. The accuracy of the slide test was calculated as 90.0%. It was found that as the total number of cesarean sections increased the estimates of vesicouterine adhesions and actual adhesions increased (P = .008). Also, the prediction of intra-abdominal adhesions and actual adhesions significantly increased as the total number of surgical operations increased (P = .002). CONCLUSIONS Intra-abdominal adhesions can be detected with the slide test, which is a non-invasive and well-tolerated procedure. Slide test can guide the physician before the elective operation in patients with previous abdominal surgery and may assist in counseling patients.
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Affiliation(s)
- Ugur K Ozturk
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Esra Keles
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Kartal Dr Lutfi Kırdar City Hospital, Istanbul, Turkey
| | - Serkan Akış
- Department of Gynecologic Oncology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Cihat M Alınca
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Sami Acar
- Department of General Surgery, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Sefik E Ozyurek
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Murat Api
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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van den Beukel BAW, de Wilde B, Joosten F, van Goor H, Venderink W, Huisman HJ, Ten Broek RPG. Quantifiable Measures of Abdominal Wall Motion for Quality Assessment of Cine-MRI Slices in Detection of Abdominal Adhesions. J Imaging 2023; 9:jimaging9050092. [PMID: 37233312 DOI: 10.3390/jimaging9050092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Abdominal adhesions present a diagnostic challenge, and classic imaging modalities can miss their presence. Cine-MRI, which records visceral sliding during patient-controlled breathing, has proven useful in detecting and mapping adhesions. However, patient movements can affect the accuracy of these images, despite there being no standardized algorithm for defining sufficiently high-quality images. This study aims to develop a biomarker for patient movements and determine which patient-related factors influence movement during cine-MRI. Included patients underwent cine-MRI to detect adhesions for chronic abdominal complaints, data were collected from electronic patient files and radiologic reports. Ninety slices of cine-MRI were assessed for quality, using a five-point scale to quantify amplitude, frequency, and slope, from which an image-processing algorithm was developed. The biomarkers closely correlated with qualitative assessments, with an amplitude of 6.5 mm used to distinguish between sufficient and insufficient-quality slices. In multivariable analysis, the amplitude of movement was influenced by age, sex, length, and the presence of a stoma. Unfortunately, no factor was changeable. Strategies for mitigating their impact may be challenging. This study highlights the utility of the developed biomarker in evaluating image quality and providing useful feedback for clinicians. Future studies could improve diagnostic quality by implementing automated quality criteria during cine-MRI.
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Affiliation(s)
| | - Bram de Wilde
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Frank Joosten
- Department of Radiology and Nuclear Medicine, Hospital Rijnstate Arnhem, 6815 AD Arnhem, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Wulphert Venderink
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Henkjan J Huisman
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Richard P G Ten Broek
- Department of Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Vernamonti JP, Lotakis DM, Hartman H, Dougherty D, Jarboe MD. Ultrasound assessment of abdominal adhesions in neonates: data over dogma for re-operative timing. Pediatr Surg Int 2023; 39:143. [PMID: 36856872 DOI: 10.1007/s00383-023-05430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Neonatal abdominal reoperation is difficult and can be complicated by abdominal adhesions. Identifying patients who could safely undergo early reoperation would save TPN and central line days, decrease associated infection and liver injury, and NICU and hospital length of stay. We sought to determine if ultrasound (US) could accurately assess the location and severity of adhesions in neonates as an objective dynamic marker capable of informing reoperation timing. METHODS After IRB approval, we conducted a prospective observational study including neonates undergoing abdominal operations. Patients received surgeon-performed US approximately every 2 weeks until reoperation or discharge. Adhesions were assessed in five zones: right upper quadrant (RUQ), right lower quadrant (RLQ), left upper quadrant (LUQ), left lower quadrant (LLQ) and peri-incision (INC). RESULTS Over a 6-month study period, 16 neonates were enrolled. Median gestational age was 34 weeks at birth and median weight 2.2 kg. 6 underwent reoperation within initial NICU admission. At time of operation US correctly identified the absence or presence and severity of adhesions in: RUQ (3/3); RLQ (6/6); LUQ (4/5); LLQ (6/6); and INC (5/5). CONCLUSION US can identify location and severity of post-operative adhesions in neonates, potentially identifying patients who can safely undergo reoperation earlier than predetermined wait periods. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jack P Vernamonti
- Section of Pediatric Surgery, University of Michigan, 1540 E. Hospital Drive, Floor 4 Reception B, Ann Arbor, MI, 48109, USA. .,Department of Surgery, Maine Medical Center, 22 Bramhall St, Portland, ME, USA.
| | - Dimitra M Lotakis
- Section of Pediatric Surgery, University of Michigan, 1540 E. Hospital Drive, Floor 4 Reception B, Ann Arbor, MI, 48109, USA
| | - Heather Hartman
- Section of Pediatric Surgery, University of Michigan, 1540 E. Hospital Drive, Floor 4 Reception B, Ann Arbor, MI, 48109, USA
| | - Danielle Dougherty
- Section of Pediatric Surgery, University of Michigan, 1540 E. Hospital Drive, Floor 4 Reception B, Ann Arbor, MI, 48109, USA
| | - Marcus D Jarboe
- Section of Pediatric Surgery, University of Michigan, 1540 E. Hospital Drive, Floor 4 Reception B, Ann Arbor, MI, 48109, USA
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Limperg T, Chaves K, Jesse N, Zhao Z, Yunker A. Ultrasound Visceral Slide Assessment to Evaluate for Intra-abdominal Adhesions in Patients Undergoing Abdominal Surgery - A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2021; 28:1993-2003.e10. [PMID: 34252609 DOI: 10.1016/j.jmig.2021.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Abdominal entry at the time of laparoscopy is a critical step with a risk of injury to underlying viscera owing to bowel adhesions. Ultrasound can be used as a preoperative tool to assess the slide of viscera underneath the abdominal wall to detect adhesion-free areas. The objective of this systematic review and meta-analysis was to determine the diagnostic accuracy of preoperative visceral slide assessment with ultrasound to detect intra-abdominal adhesions, compared with the gold standard of intraoperative findings. DATA SOURCES Using Cochrane, Medline PubMed, Embase, and Google Scholar electronic databases, 3737 articles were screened in April 2020 using a query that included variations of "adhesions" and "ultrasound." Reference lists of relevant articles were searched for further articles. METHODS OF STUDY SELECTION Prospective and cross-sectional studies in English that included patients at risk for intra-abdominal adhesions who underwent preoperative ultrasound visceral slide assessment and subsequent intraoperative assessment of adhesions were selected. Two reviewers independently selected 25 articles, extracted data, and assessed bias using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. TABULATION, INTEGRATION, AND RESULTS Twenty-five articles reported on 1609 patients and 5812 assessed abdominal areas, with considerable heterogeneity of described abdominal areas and degrees of adhesions. Meta-analysis was performed for 21 studies. The periumbilical area was assessed specifically for bowel adhesions in 890 patients in 12 studies, with a 12.0% bowel adhesion rate. Ultrasound assessment for periumbilical bowel adhesions had a combined sensitivity of 95.9% (95% confidence interval, 82.7%-99.1%), specificity of 93.1% (85.1%-96.9%), positive predictive value of 60.4% (44.2%-74.7%), and negative predictive value of 99.2% (97.9%-99.7%) with low heterogeneity (I2 = 16%). CONCLUSION Visceral slide assessment with ultrasound has a high negative predictive value for the absence of periumbilical bowel adhesions in patients at risk for adhesions and can function as a useful tool to detect adhesion-free areas to allow for safe laparoscopic entry.
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Affiliation(s)
- Tobias Limperg
- Department of Obstetrics & Gynecology (Drs. Limperg, Chaves, Jesse, and Yunker), Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Katherine Chaves
- Department of Obstetrics & Gynecology (Drs. Limperg, Chaves, Jesse, and Yunker), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicholas Jesse
- Department of Obstetrics & Gynecology (Drs. Limperg, Chaves, Jesse, and Yunker), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zhiguo Zhao
- Department of Biostatistics (Mr. Zhao), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amanda Yunker
- Department of Obstetrics & Gynecology (Drs. Limperg, Chaves, Jesse, and Yunker), Vanderbilt University Medical Center, Nashville, Tennessee
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Recknagel JD, Goodman LR. Clinical Perspective Concerning Abdominal Entry Techniques. J Minim Invasive Gynecol 2020; 28:467-474. [PMID: 32712324 DOI: 10.1016/j.jmig.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Entry into the abdomen during operative laparoscopy is a source of some controversy regarding the safest and most useful method. The objective of this review is to describe, compare, and contrast the most popular entry techniques. DATA SOURCES Data were collected from the historical starting point until present day from English language journal articles and book chapters. METHODS OF STUDY SELECTION Descriptive accounts dating back to the start of laparoscopy in the 1970s and spanning to present day well-designed randomized controlled trials and Cochrane reviews were compiled to evaluate the evidence for the effectiveness and safety of abdominal entry techniques. TABULATION, INTEGRATION, AND RESULTS The most common sites of entry are the umbilicus and the left upper quadrant. Between the Veress needle, direct trocar insertion, and open entry there is no high-quality evidence to suggest that any of these offers a universal safety advantage. The Veress needle is still the most used among gynecologists and facilitates primary trocar placement. Direct trocar entry under laparoscopic visualization may be underused, is faster, and may result in fewer failed entries. Open (Hasson) entry can be more technically challenging, but may be best for patients with suspected intra-abdominal adhesions. CONCLUSION Surgeon comfort is critical in choosing the entry site, method, and equipment. Surgeon familiarity with entry-failure troubleshooting, possible complications, and management is essential because major entry complications are rare in modern laparoscopy but critical because the essential steps of recognition and management can be lifesaving.
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Affiliation(s)
- Johnathon D Recknagel
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina Hospitals, Chapel Hill, North Carolina (all authors)
| | - Linnea R Goodman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina Hospitals, Chapel Hill, North Carolina (all authors).
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Kim YI, Lee M, Kim SI, Seol A, Lee EJ, Kim HS, Song YS. A Randomized Controlled Trial of Thermo-Sensitive Sol-Gel Anti-Adhesion Agent after Gynecologic Surgery. J Clin Med 2020; 9:E2261. [PMID: 32708699 PMCID: PMC7408806 DOI: 10.3390/jcm9072261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 11/17/2022] Open
Abstract
Postoperative abdominal adhesions can lead to several adverse consequences such as pelvic pain, bowel obstruction, and infertility. We aimed to explore the anti-adhesion efficacy and safety of a thermo-sensitive sol-gel agent in patients who receive abdominopelvic surgery for benign gynecologic disease. This study was a randomized, controlled, single-blind clinical trial of women undergoing benign gynecologic surgery between January 2017 and December 2017. The patients were randomly assigned to three groups with a 1:1:1 ratio: experimental group (received the thermo-sensitive sol-gel agent), control group (untreated), and comparator group (received 4% icodextrin). Patients were followed for 4 weeks postoperatively, and efficacy was evaluated by performing the visceral slide test to identify adhesion formation. In total, 183 patients were enrolled in the study, and 178 (97.3%) completed the trial. The incidence rate of abdominal adhesion formation was significantly lower in the experimental group than in the control group (7.9% vs. 21.1%, p = 0.040); however, it was similar between the experimental and comparator groups (7.9% vs. 13.8%. p = 0.299). At 4 weeks, no differences in adhesion-related symptoms were observed between the experimental and control groups. Adverse events were mostly mild and did not differ significantly among the three groups (p = 0.375). In conclusion, use of a thermo-sensitive sol-gel agent was safe and effective to prevent abdominal adhesions after benign gynecologic surgeries.
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Affiliation(s)
- Young Im Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul 03080, Korea;
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea or (M.L.); (S.I.K.); (A.S.); (E.J.L.); (H.S.K.)
| | - Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea or (M.L.); (S.I.K.); (A.S.); (E.J.L.); (H.S.K.)
| | - Aeran Seol
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea or (M.L.); (S.I.K.); (A.S.); (E.J.L.); (H.S.K.)
| | - Eun Ji Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea or (M.L.); (S.I.K.); (A.S.); (E.J.L.); (H.S.K.)
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea or (M.L.); (S.I.K.); (A.S.); (E.J.L.); (H.S.K.)
| | - Yong Sang Song
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul 03080, Korea or (M.L.); (S.I.K.); (A.S.); (E.J.L.); (H.S.K.)
- Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea
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Levy AT, Yurkanin MA, Plante LA. Fetal head entrapment within the lower uterine segment. CASE REPORTS IN PERINATAL MEDICINE 2019. [DOI: 10.1515/crpm-2019-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Fetal head entrapment by a uterine scar or adhesion is a rare obstetric complication. We present a case of a uterine constriction diagnosed in pregnancy that resulted in confinement of the fetal head to the lower uterine segment. The developing fetus ultimately suffered growth restriction of the head and was delivered after the mother experienced preterm premature rupture of membranes (PROM). Severe adhesions of the lower uterine segment were confirmed during the patient’s classical cesarean section.
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Affiliation(s)
- Ariel T. Levy
- Department of Obstetrics and Gynecology , Hahnemann University Hospital , 245 N. 15 Street MS 495 , Philadelphia, PA 19192 , USA , Tel.: 484-574-6037
| | - Melissa A. Yurkanin
- Department of Obstetrics and Gynecology , Hahnemann University Hospital , Philadelphia, PA , USA
| | - Lauren A. Plante
- Department of Obstetrics and Gynecology , Hahnemann University Hospital , Philadelphia, PA , USA
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Penzias A, Bendikson K, Falcone T, Gitlin S, Gracia C, Hansen K, Hill M, Hurd W, Jindal S, Kalra S, Mersereau J, Odem R, Racowsky C, Rebar R, Reindollar R, Rosen M, Sandlow J, Schlegel P, Steiner A, Stovall D, Tanrikut C. Postoperative adhesions in gynecologic surgery: a committee opinion. Fertil Steril 2019; 112:458-463. [DOI: 10.1016/j.fertnstert.2019.06.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
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Prevention and management of bowel injury during gynecologic laparoscopy: an update. Curr Opin Obstet Gynecol 2019; 31:245-250. [PMID: 31045654 DOI: 10.1097/gco.0000000000000552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current article aims to briefly review recent literature on bowel injury in gynecologic surgery with a focus on minimally invasive techniques, strategies for prevention, and management of injury. RECENT FINDINGS Recent reviews describe a low incidence of bowel injury that is likely affected by low rates of reporting and inconsistent definitions. The major risk factor for bowel injury is adhesive disease, and assessment and prevention techniques for the presence of adhesive disease are evolving. When bowel injury occurs, prompt diagnosis and intraoperative repair yields more favorable outcomes than delayed diagnosis. Repair can be performed by a gynecologic surgeon, with or without the help of a consultant depending on the extent of the injury and surgeon comfort. SUMMARY Bowel injury is a potentially catastrophic complication in gynecologic surgery, but its rarity presents a challenge in research. A high index of suspicion and meticulous surgical technique are the cornerstones of managing a bowel injury.
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