PUGSI risk assessment before laparoscopy скачать в хорошем качестве

PUGSI risk assessment before laparoscopy

The technique I utilize prior to abdominal entry in patients at risk for abdominal wall adhesion is known as PUGSI (Peroperative periumbilical ulturasound-guided Salin infusion). It is a modification of a method described by Frank Tu and John Steege utilizing visceral slide to identify adhesions. In their study prevalence of infraumbilical bowel adhesions was 12%. A visceral slide threshold more than 1 cm to predict adhesions had sensitivity = 86%, specificity = 91%, positive predictive value = 55%, and negative predictive value = 98% (Am J Obstet Gynecol. 2005 Jan;192(1):74-9.). In our study of 171 patients the prevalence of obliterating umbilical adhesions in the risk group was 3.6% (112 patients). The visceral slide test had an accuracy of 96.4%, a sensitivity of 50%, and a specificity of 98.1%, with a negative predictive value of 98.1% and a positive predictive value of 50%. The PUGSI test was able to detect all cases of obliterating subumbilical adhesions, demonstrating sensitivity and specificity of 100% (Fertil Steril. 2009 Jun;91(6):2714-9). Steps Involved in PUGSI: 1. Perform visceral slide 2. Infraumbilical injection of 6-10 cc of sterile saline on spinal needle under direct U/S guidance 3. Formation of fluid pocket and non-dispersion suggest subumbilical adhesions Since the publication of above paper I have used this technique in over 1000 cases with risk factors for adhesion, with no cases of bowel injury to report