Periumbilical ultrasonic-guided saline infusion technique (PUGSI): A step for safer laparoscopy in high risk patients for adhesions

ObjectiveTo validate the technique of PUGSI in high risk patients for adhesions during laparoscopy.DesignProspective study on PUGSI to predict obliterated subumbilical adhesions.SettingEl-Shatby Maternity Hospital, Alexandria University.PatientsSixty women with risk factors for intraabdominal adhesions.InterventionsPreoperative examination with PUGSI.ResultsThe prevalence of obliterated subumbilical adhesions was 26.7%. Abnormal PUGSI was detected among 18 patients, of these, 15 patients were diagnosed at the time of laparoscopy to have obliterated subumbilical adhesions (9 patients with omental and 6 patients with bowel adhesions). PUGSI had a diagnostic accuracy of 93.3%, a sensitivity of 93.8%, a specificity of 93.2%, a positive predictive value (PPV) of 83.3% and a negative predictive value (NPV) of 97.6%.ConclusionPUGSI can accurately predict obliterated subumbilical adhesions prior to laparoscopy in patients at high risk of visceral injury. Widespread application of this technique may decrease trocar-related injuries during laparoscopic access.