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

Objective: To validate the technique of PUGSI in high risk patients for adhesions during laparoscopy.Design: Prospective study on PUGSI to predict obliterated subumbilical adhesions.Setting: El-Shatby Maternity Hospital, Alexandria University.Patients: Sixty women with risk factors for intraabdominal adhesions.Interventions: Preoperative examination with PUGSI.Results: The 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%.Conclusion: PUGSI 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