OBJECTIVE: To determine whether the office visceral slide test is an effective screening test for predicting obliterating periumbilical adhesions compared with two ultrasound tests performed in the operating room.
METHODS: Women undergoing benign laparoscopic gynecologic surgery between July 2012 and August 2013 were invited to participate. All participants had an office-based ultrasound test at their preoperative visit (the office visceral slide test), two operating room ultrasound tests (the preoperative examination with visceral slide and the periumbilical ultrasound-guided saline infusion test), and then their scheduled laparoscopic procedure. We measured the ability of the three screening tests to detect obliterating periumbilical adhesions.
RESULTS: Eighty-two women completed the study; 12 women were excluded because they had no history of surgery and 70 women with a history of abdominal and pelvic surgery were analyzed in the study group. The study group (n=70) had a median of two (range, 1–6) previous abdominal surgeries. The median number of previous laparotomies was 0 (range, 0–5). The median number of previous laparoscopies was 1 (range, 0–6). At laparoscopy, 6 of 70 women (8.6%) had periumbilical adhesions diagnosed; 18 of 70 women (25.7%) had any adhesions located in the abdomen or pelvis. The office visceral slide test had a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100%, negative predictive value of 98.5% and diagnostic accuracy of 98.6%.
CONCLUSION: The office visceral slide test is a simple and reliable test for detecting obliterating periumbilical adhesions in the outpatient setting.
LEVEL OF EVIDENCE: II
The office visceral slide test is an accurate test for preoperatively detecting periumbilical adhesions; it is comparable with two ultrasound tests performed in the operating room.
Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, Georgia; the Department of Obstetrics and Gynecology, Northshore-Long Island Jewish Health Systems, Manhasset, New York; and the Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
Corresponding author: Ceana H. Nezhat, MD, FACOG, FACS, Adjunct Clinical Professor of Gynecology and Obstetrics, Stanford University School of Medicine, Fellowship Director, Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, 5555 Peachtree Dunwoody Road, Suite 276, Atlanta, GA 30342; e-mail: firstname.lastname@example.org.
Pilot data were presented at the American Society for Reproductive Medicine Annual Meeting 2013, October 12–17, 2013, Boston, Massachusetts. Oral presentation was presented at the 42nd American Association of Gynecologic Laparoscopists Global Congress on Minimally Invasive Gynecology, November 10–14, 2013, Washington, DC.
Financial Disclosure The authors did not report any potential conflicts of interest.