The visceral slide test for the prediction of abdominal wall adhesions: a prospective cohort study

INTRODUCTION: An accurate prediction of abdominal wall adhesions would be extremely beneficial to help preventing injuries during the initial abdominal entry. Our aim was to evaluate the accuracy of the visceral slide test in predicting abdominal wall adhesions before surgery.

METHODS: One hundred fifty-five patients who underwent benign gynecologic surgery were prospectively enrolled. Seventy patients (45%) had previous baseline risk factors including abdominal surgeries, episodes of pelvic inflammatory disease [PID] or peritonitis. Eighty-five patients (55%) had no risk for intraabdominal adhesions. On the day of surgery, patients underwent the visceral slide test in five zones of the abdomen using ultrasonography, and a prediction of adhesions was made for each zone. Ultrasound findings were then compared with intraoperative visualization.
RESULTS: A total of 112 laparotomies and 43 laparoscopies were performed. The use of the visceral slide test for the prediction of adhesions showed an overall accuracy of 86.5%, a sensitivity of 78.6%, a specificity of 88.2, a positive predictive value of 59.5%, and a negative predictive value of 94.9%.
DISCUSSION AND CONCLUSION: Our study suggests that the visceral slide test is an easy, non-invasive, and reliable method for predicting abdominal wall adhesions in women undergoing benign gynecologic surgery.