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Joppin V, Bendahan D, Ahmadi AAE, Masson C, Bege T. Biomechanics of the abdominal wall before and after ventral hernia repair using dynamic MRI. Hernia 2025; 29:185. [PMID: 40411602 DOI: 10.1007/s10029-025-03337-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Accepted: 04/06/2025] [Indexed: 05/26/2025]
Abstract
PURPOSE This study aims to investigate the use of dynamic MRI to assess abdominal wall biomechanics before and after hernia surgery, considering that such evaluations can enhance our understanding of physiopathology and contribute to reducing recurrence rates. METHODS Patients were assessed using dynamic MRI in axial and sagittal planes while performing exercises (breathing, coughing, Valsalva) before and after their abdominal hernia surgery with mesh placement. Rectus and lateral muscles, linea alba, viscera area, defect dimensions and hernia sac were contoured with semiautomatic process to quantify the abdominal wall biomechanical temporal modifications. RESULTS This study enrolled 11 patients. During coughing, the axial area of the hernia sac increased by 128.4 ± 199.2%. The sac increased similarly in axial and sagittal planes during Valsalva. Post-surgical evaluations showed a 26% reduction in inter-recti distance and a lengthening of all muscles (p ≤ 0.05). The post-operative rectus abdominis thickness change was negatively correlated with defect width during breathing (p ≤ 0.05). The largest change in linea alba displacement was observed in the surgical site (p = 0.07). Post-operatively, lateral muscles had a larger inward displacement during Valsalva (p ≤ 0.05). Rectus abdominis had a larger outward displacement during breathing (p = 0.09), reduced with the mesh size (p ≤ 0.05). A large inter-individual variability was observed. CONCLUSION Using a semi-automatic methodology, an in-depth analysis of the biomechanics of the abdominal wall was conducted, highlighting the importance of a patient-specific assessment. A broader study and consideration of recurrence would subsequently complete this methodological work.
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Affiliation(s)
- Victoria Joppin
- Laboratoire de Biomécanique Appliquée, Faculté des Sciences Médicales et Paramédicales, Univ Gustave Eiffel, Aix-Marseille Univ, LBA , F-13016, Marseille, France.
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France.
| | | | - Ahmed Ali El Ahmadi
- Laboratoire de Biomécanique Appliquée, Faculté des Sciences Médicales et Paramédicales, Univ Gustave Eiffel, Aix-Marseille Univ, LBA , F-13016, Marseille, France
- Department of Radiology, North Hospital, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Catherine Masson
- Laboratoire de Biomécanique Appliquée, Faculté des Sciences Médicales et Paramédicales, Univ Gustave Eiffel, Aix-Marseille Univ, LBA , F-13016, Marseille, France
| | - Thierry Bege
- Laboratoire de Biomécanique Appliquée, Faculté des Sciences Médicales et Paramédicales, Univ Gustave Eiffel, Aix-Marseille Univ, LBA , F-13016, Marseille, France
- Department of General Surgery, Aix-Marseille Univ, North Hospital, APHM, Marseille, France
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Toneman MK, Marianne Faas PP, Christian Antoine Marie Gielen MJ, Carotti V, Adriana van Oirschot AE, Maria Mangnus JP, Wintjens A, Mihl C, Huige J, Grosser B, Blussé van Oud-Alblas M, Willem van Dongen K, Bouvy ND, van Goor H, Keszthelyi D, Grabsch HI, Gerardus Ten Broek RP. Morphological features and molecular mechanisms in peritoneal adhesions from patients with chronic abdominal postoperative pain. EBioMedicine 2025; 116:105746. [PMID: 40412079 DOI: 10.1016/j.ebiom.2025.105746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 03/26/2025] [Accepted: 04/23/2025] [Indexed: 05/27/2025] Open
Abstract
BACKGROUND Chronic abdominal pain affects 10-20% of all patients following abdominal surgery, with adhesions as a predominant cause. However, the biological mechanisms underlying adhesion-related pain are not fully elucidated. This study aimed to establish the morphological and molecular phenotype of adhesions in patients with and without chronic postoperative abdominal pain. METHODS In this case-control study, biopsies of adhesions were obtained from patients with chronic postoperative abdominal pain (related to adhesions on cineMRI) and controls without pain, from two tertiary care and one secondary care hospital. Quantitative histological analysis of haematoxylin and eosin-stained sections was performed, while immunohistochemical (IHC) markers for nerve tissue (S100, calretinin and synaptophysin) were quantified through image analysis. RNA expression of genes (TRPV1, BDNF, TAC1, TACR1, NGF) was measured using real time quantitative polymerase chain reaction (RT-qPCR). Controls were matched to cases by sex, age, and prior surgery, accepting small variations due to patient availability. An independent two-sided t-test was used to detect differences in IHC and RT-qPCR analysis between groups. FINDINGS Adhesions from 31 patients with pain were compared to those from 31 patients without pain, consisting of 48% connective tissue and 41% adipose tissue. Immunohistochemical analysis revealed increased nerve tissue in patients with pain (S100: median 597 ppm (range 92.2-3223.2 ppm) vs 151 ppm (range 15.2-1683.8 ppm) p < 0.001; calretinin: median 463 ppm (range 72.7-2996.5 ppm) vs 275 ppm (range 35.3-3194.8 ppm) p = 0.040). NGF showed a higher mRNA expression in adhesions from patients with pain compared to controls (p = 0.012). INTERPRETATION This study suggests a distinct morphological and molecular phenotype of adhesions in patients experiencing adhesion-related pain, providing insights into underlying mechanisms. FUNDING Veni grant from The Dutch Governmental Organisation for Health Research and Development (ZonMw grant number 91619035).
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Affiliation(s)
| | | | - Maurits Johan Christian Antoine Marie Gielen
- Surgery Department, Maastricht University Medical Centre+, Maastricht, the Netherlands; GROW-School for Oncology and Reproduction, Maastricht University, 6229 ER, Maastricht, the Netherlands
| | | | | | | | - Anne Wintjens
- Surgery Department, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Casper Mihl
- Radiology Department, Maastricht University Medical Centre+, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Universiteitssingel 50, PO Box 616, 6200 MD, Maastricht, the Netherlands
| | - Josephine Huige
- Radiology Department, Rijnstate Hospital, Arnhem, the Netherlands
| | - Bianca Grosser
- Pathology Department, Medical Faculty Augsburg, University of Augsburg, Augsburg, Germany
| | | | | | - Nicole Dorine Bouvy
- Surgery Department, Maastricht University Medical Centre+, Maastricht, the Netherlands; Surgery Department, Leiden University Medical Centre, Leiden, the Netherlands
| | - Harry van Goor
- Surgery Department, Radboudumc, Nijmegen, the Netherlands
| | - Daniel Keszthelyi
- Gastroenterology-hepatology Department, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Heike Irmgard Grabsch
- GROW-School for Oncology and Reproduction, Maastricht University, 6229 ER, Maastricht, the Netherlands; Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's University, University of Leeds, Leeds, UK
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Carmichael S, Wiseman D, Foster D, Appel E, Cardenas J, Zindel J, Maggard-Gibbons M, Ten Broek RP, De Wilde RL, Bauer S, Mutsaers S, Russell T, Huy TC, Donahue T, Koltun W, Rinkevich Y, Ko CY. Proceedings of the American College of Surgeons Surgical Adhesions Improvement Project Summit. J Am Coll Surg 2025; 240:812-819. [PMID: 40013692 DOI: 10.1097/xcs.0000000000001358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2025]
Affiliation(s)
- Samuel Carmichael
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC (Carmichael)
| | - David Wiseman
- From the International Adhesions Society, Dallas, TX (Wiseman)
| | | | - Eric Appel
- Materials Science and Engineering, Stanford University, Stanford, CA (Appel)
| | - Jessica Cardenas
- Department of Surgery, University of Colorado, Aurora, CO (Cardenas)
| | - Joel Zindel
- Department of Biomedical Research, University of Bern, Bern, Switzerland (Zindel)
| | - Melinda Maggard-Gibbons
- Department of Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA (Maggard-Gibbons)
| | | | - Rudy Leon De Wilde
- University Hospital for Gynecology Pius Hospital, Oldenburg, Germany (De Wilde)
| | - Steven Bauer
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (Bauer)
| | - Steven Mutsaers
- School of Biomedical Sciences, University of Western Australia, Perth, Australia (Mutsaers)
| | - Tara Russell
- David Geffen School of Medicine, UCLA, Los Angeles, CA (Russell)
| | - Tess C Huy
- Department of Surgery, UCLA, Los Angeles, CA (Huy, Donahue, Ko)
| | - Timothy Donahue
- Department of Surgery, UCLA, Los Angeles, CA (Huy, Donahue, Ko)
| | - Walter Koltun
- Department of Surgery, Penn State Health, Hershey, PA (Koltun)
| | - Yuval Rinkevich
- Chinese Institutes for Medical Research (CIMR), Beijing, China (Rinkevich)
| | - Clifford Y Ko
- Department of Surgery, UCLA, Los Angeles, CA (Huy, Donahue, Ko)
- American College of Surgeons, Chicago, IL (Ko)
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Nishino H, Nishimura T, Miyashita S, Tada M, Fujimoto Y, Fujimoto J, Iijima H, Hatano E. Preoperative diagnosis of adhesion severity between the abdominal wall and intestinal tract with novel abdominal ultrasound methodology to enhance surgical safety. Surgery 2024; 176:469-476. [PMID: 38811324 DOI: 10.1016/j.surg.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/26/2024] [Accepted: 04/13/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Adhesions between the abdominal wall and intestinal tract from previous surgeries can complicate reoperations; however, predicting the extent of adhesions preoperatively is difficult. This study aimed to develop a straightforward approach for predicting adhesion severity using a novel abdominal ultrasound technique that quantifies the displacement of motion vectors of two organs to enhance surgical safety. The efficacy of this methodology was assessed experimentally and clinically. METHODS Using Aplio500T, a system we developed, we measured the displacement of the upper peritoneum and intestinal tract as a vector difference and computed the motion difference ratio. Twenty-five rats were randomized into surgery and nonsurgery groups. The motion difference ratio was assessed 7 days after laparotomy to classify adhesions. In a clinical trial, 51 patients undergoing hepatobiliary pancreatic surgery were evaluated for the motion difference ratio within 3 days preoperatively. Intraoperatively, adhesion severity was rated and compared with the motion difference ratio. A receiver operating characteristic curve was used to appraise the diagnostic value of the motion difference ratio. RESULTS In the animal experiment, the adhesion group exhibited a significantly higher motion difference ratio than the no-adhesion group (0.006 ± 0.141 vs 0.435 ± 0.220, P < .001). In the clinical trial, the no-adhesion or no-laparotomy group had a motion difference ratio of 0.128 ± 0.074; mild-adhesion group, 0.143 ± 0.170; moderate-adhesion group, 0.326 ± 0.153; and high-adhesion group, 0.427 ± 0.152. The motion difference ratio receiver operating characteristic curve to diagnose the adhesion level (≥moderate) was 0.938, indicating its high diagnostic value (cut-off 0.204). CONCLUSION This methodology may preoperatively predict moderate-to-high adhesions.
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Affiliation(s)
- Hiroto Nishino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Nishimura
- Department of Gastroenterology, Hyogo Medical University, Nishinomiya, Japan
| | - Seikan Miyashita
- Department of Hepato-Biliary-Pancreatic Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Masaharu Tada
- Department of Hepato-Biliary-Pancreatic Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Yasuhiro Fujimoto
- Department of Hepato-Biliary-Pancreatic Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Jiro Fujimoto
- Department of Hepato-Biliary-Pancreatic Surgery, Hyogo Medical University, Nishinomiya, Japan; Osaka Heavy Ion Therapy Center, Osaka International Cancer Treatment Foundation, Osaka, Japan
| | - Hiroko Iijima
- Department of Gastroenterology, Hyogo Medical University, Nishinomiya, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Hyogo Medical University, Nishinomiya, Japan.
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5
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Ozturk UK, Keles E, Akış S, Alınca CM, Acar S, Ozyurek SE, Api M. Evaluation of the Preoperative Slide Test in the Prediction of Intra-Abdominal Adhesions: A Single-Center, Double-Blinded, Prospective Observational Study. Surg Innov 2023; 30:557-563. [PMID: 37518021 DOI: 10.1177/15533506231186071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
BACKGROUND To evaluate the efficacy of the preoperative ultrasonographic sliding sign in predicting intra-abdominal adhesions. METHODS This was a single-center, double-blinded, prospective observational study undertaken from March and September 2021 on 110 patients with a history of previous abdominal surgery. All patients who were scheduled for laparoscopy underwent slide test in 5 zones of abdomen: right lower quadrant, left lower quadrant, previous operation site, vesicouterine pouch, and rectovaginal pouch. Adhesions were assessed by the same gynecologic surgeon using ultrasonography before the surgery and by gynecological surgeons during surgery, and by a third gynecologic surgeon to compare the preoperative slide test findings and laparoscopic findings after the surgery. RESULTS Seventy-three (66.4%) patients underwent laparoscopic surgery, and 37 (33.6%) patients underwent laparotomy. The mean age of patients was 46.9 ± 1.0 years. Sensitivity, specificity, and positive and negative predictive values of preoperative ultrasonography in predicting adhesions were 89.5%, 91.7%, 97.5%, and 71.0%, respectively. The accuracy of the slide test was calculated as 90.0%. It was found that as the total number of cesarean sections increased the estimates of vesicouterine adhesions and actual adhesions increased (P = .008). Also, the prediction of intra-abdominal adhesions and actual adhesions significantly increased as the total number of surgical operations increased (P = .002). CONCLUSIONS Intra-abdominal adhesions can be detected with the slide test, which is a non-invasive and well-tolerated procedure. Slide test can guide the physician before the elective operation in patients with previous abdominal surgery and may assist in counseling patients.
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Affiliation(s)
- Ugur K Ozturk
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Esra Keles
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Kartal Dr Lutfi Kırdar City Hospital, Istanbul, Turkey
| | - Serkan Akış
- Department of Gynecologic Oncology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Cihat M Alınca
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Sami Acar
- Department of General Surgery, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Sefik E Ozyurek
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
| | - Murat Api
- Department of Gynecologic Oncology, University of Health Sciences Turkey, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Istanbul, Turkey
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6
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van den Beukel BAW, de Wilde B, Joosten F, van Goor H, Venderink W, Huisman HJ, Ten Broek RPG. Quantifiable Measures of Abdominal Wall Motion for Quality Assessment of Cine-MRI Slices in Detection of Abdominal Adhesions. J Imaging 2023; 9:jimaging9050092. [PMID: 37233312 DOI: 10.3390/jimaging9050092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Abdominal adhesions present a diagnostic challenge, and classic imaging modalities can miss their presence. Cine-MRI, which records visceral sliding during patient-controlled breathing, has proven useful in detecting and mapping adhesions. However, patient movements can affect the accuracy of these images, despite there being no standardized algorithm for defining sufficiently high-quality images. This study aims to develop a biomarker for patient movements and determine which patient-related factors influence movement during cine-MRI. Included patients underwent cine-MRI to detect adhesions for chronic abdominal complaints, data were collected from electronic patient files and radiologic reports. Ninety slices of cine-MRI were assessed for quality, using a five-point scale to quantify amplitude, frequency, and slope, from which an image-processing algorithm was developed. The biomarkers closely correlated with qualitative assessments, with an amplitude of 6.5 mm used to distinguish between sufficient and insufficient-quality slices. In multivariable analysis, the amplitude of movement was influenced by age, sex, length, and the presence of a stoma. Unfortunately, no factor was changeable. Strategies for mitigating their impact may be challenging. This study highlights the utility of the developed biomarker in evaluating image quality and providing useful feedback for clinicians. Future studies could improve diagnostic quality by implementing automated quality criteria during cine-MRI.
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Affiliation(s)
| | - Bram de Wilde
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Frank Joosten
- Department of Radiology and Nuclear Medicine, Hospital Rijnstate Arnhem, 6815 AD Arnhem, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Wulphert Venderink
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Henkjan J Huisman
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Richard P G Ten Broek
- Department of Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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7
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de Wilde B, Joosten F, Venderink W, Davidse MEJ, Geurts J, Kruijt H, Vermeulen A, Martens B, Schyns MVP, Huige JCBM, de Boer MC, Tonino BAR, Zandvoort HJA, Lammert K, Parviainen H, Vuorinen AM, Syväranta S, Vogels RRM, Prins W, Coppola A, Bossa N, ten Broek RPG, Huisman H. Inter- and Intra-Observer Variability and the Effect of Experience in Cine-MRI for Adhesion Detection. J Imaging 2023; 9:jimaging9030055. [PMID: 36976106 PMCID: PMC10054690 DOI: 10.3390/jimaging9030055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Cine-MRI for adhesion detection is a promising novel modality that can help the large group of patients developing pain after abdominal surgery. Few studies into its diagnostic accuracy are available, and none address observer variability. This retrospective study explores the inter- and intra-observer variability, diagnostic accuracy, and the effect of experience. A total of 15 observers with a variety of experience reviewed 61 sagittal cine-MRI slices, placing box annotations with a confidence score at locations suspect for adhesions. Five observers reviewed the slices again one year later. Inter- and intra-observer variability are quantified using Fleiss’ (inter) and Cohen’s (intra) κ and percentage agreement. Diagnostic accuracy is quantified with receiver operating characteristic (ROC) analysis based on a consensus standard. Inter-observer Fleiss’ κ values range from 0.04 to 0.34, showing poor to fair agreement. High general and cine-MRI experience led to significantly (p < 0.001) better agreement among observers. The intra-observer results show Cohen’s κ values between 0.37 and 0.53 for all observers, except one with a low κ of −0.11. Group AUC scores lie between 0.66 and 0.72, with individual observers reaching 0.78. This study confirms that cine-MRI can diagnose adhesions, with respect to a radiologist consensus panel and shows that experience improves reading cine-MRI. Observers without specific experience adapt to this modality quickly after a short online tutorial. Observer agreement is fair at best and area under the receiver operating characteristic curve (AUC) scores leave room for improvement. Consistently interpreting this novel modality needs further research, for instance, by developing reporting guidelines or artificial intelligence-based methods.
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Affiliation(s)
- Bram de Wilde
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Correspondence:
| | - Frank Joosten
- Department of Radiology, Rijnstate Hospital, 6883 AD Arnhem, The Netherlands
| | - Wulphert Venderink
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Mirjam E. J. Davidse
- Faculty of Science and Technology, University of Twente, 7522 NB Enschede, The Netherlands
| | - Juliëtte Geurts
- Faculty of Science and Technology, University of Twente, 7522 NB Enschede, The Netherlands
| | - Hanneke Kruijt
- Faculty of Science and Technology, University of Twente, 7522 NB Enschede, The Netherlands
| | - Afke Vermeulen
- Faculty of Science and Technology, University of Twente, 7522 NB Enschede, The Netherlands
| | - Bibi Martens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| | - Maxime V. P. Schyns
- Department of Radiology, Rijnstate Hospital, 6883 AD Arnhem, The Netherlands
| | | | - Myrte C. de Boer
- Department of Radiology, Rijnstate Hospital, 6883 AD Arnhem, The Netherlands
| | - Bart A. R. Tonino
- Department of Radiology, Rijnstate Hospital, 6883 AD Arnhem, The Netherlands
| | | | - Kirsti Lammert
- Radiology, HUS Diagnostic Center, Helsinki University Hospital, 00014 Helsinki, Finland
| | - Helka Parviainen
- Radiology, HUS Diagnostic Center, Helsinki University Hospital, 00014 Helsinki, Finland
| | - Aino-Maija Vuorinen
- Radiology, HUS Diagnostic Center, Helsinki University Hospital, 00014 Helsinki, Finland
| | - Suvi Syväranta
- Radiology, HUS Diagnostic Center, Helsinki University Hospital, 00014 Helsinki, Finland
| | - Ruben R. M. Vogels
- Department of Radiology, Medical Spectrum Twente, 7512 KZ Enschede, The Netherlands
| | - Wiesje Prins
- Department of Radiology, Rijnstate Hospital, 6883 AD Arnhem, The Netherlands
| | - Andrea Coppola
- Department of Diagnostic and Interventional Radiology, ASST dei Sette Laghi, 21100 Varese, Italy
| | - Nancy Bossa
- Department of Radiology, Centro Radiologico Dr Gomez Pereda, 50004 Zaragoza, Spain
| | | | - Henkjan Huisman
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Suzuki N, Wakaki Y, Watanabe K, Kumasaka Y, Suzuki R. Difficulty in predicting intra-abdominal adhesion before cesarean section: A case report. Clin Case Rep 2022; 10:e05643. [PMID: 35356188 PMCID: PMC8958188 DOI: 10.1002/ccr3.5643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/11/2022] [Accepted: 03/09/2022] [Indexed: 12/14/2022] Open
Abstract
Severe adhesions between the bladder and uterus necessitated an atypical incision in the cesarean section of a woman with endometriosis. This could not be predicted with pre-surgery MRI. No methods in the literature are able to predict adhesions with true certainty; it is therefore still difficult to diagnose intra-abdominal adhesions.
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Affiliation(s)
- Nanao Suzuki
- Department of Obstetrics and GynecologyOhara General HospitalFukushimaJapan
| | - Yu Wakaki
- Department of Obstetrics and GynecologyOhara General HospitalFukushimaJapan
| | - Kaori Watanabe
- Department of Obstetrics and GynecologyOhara General HospitalFukushimaJapan
| | | | - Rika Suzuki
- Department of Obstetrics and GynecologyOhara General HospitalFukushimaJapan
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9
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Jourdan A, Le Troter A, Daude P, Rapacchi S, Masson C, Bège T, Bendahan D. Semiautomatic quantification of abdominal wall muscles deformations based on dynamic MRI image registration. NMR IN BIOMEDICINE 2021; 34:e4470. [PMID: 33525062 DOI: 10.1002/nbm.4470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/14/2020] [Indexed: 06/12/2023]
Abstract
Quantitative analysis of abdominal organs motion and deformation is crucial to better understand biomechanical alterations undermining respiratory, digestive or perineal pathophysiology. In particular, biomechanical characterization of the antero-lateral abdominal wall is central in the diagnosis of abdominal muscle deficiency. Here, we present a dedicated semiautomatic dynamic MRI postprocessing method enabling the quantification of spatial and temporal deformations of the antero-lateral abdominal wall muscles. Ten healthy participants were imaged during a controlled breathing session at the L3-L4 disc level using real-time dynamic MRI at 3 T. A coarse feature-tracking step allowed the selection of the inhalation cycle of maximum abdominal excursion. Over this image series, the described method combines (1) a supervised 2D+t segmentation procedure of the abdominal wall muscles, (2) the quantification of muscle deformations based on masks registration, and (3) the mapping of deformations within muscle subzones leveraging a dedicated automatic parcellation. The supervised 2D+t segmentation (1) provided an accurate segmentation of the abdominal wall muscles throughout maximum inhalation with a 0.95 ± 0.03 Dice similarity coefficient (DSC) value and a 2.3 ± 0.7 mm Hausdorff distance value while requiring only manual segmentation of 20% of the data. The robustness of the deformation quantification (2) was indicated by high indices of correspondence between the registered source mask and the target mask (0.98 ± 0.01 DSC value and 2.1 ± 1.5 mm Hausdorff distance value). Parcellation (3) enabled the distinction of muscle substructures that are anatomically relevant but could not be distinguished based on image contrast. The present genuine postprocessing method provides a quantitative analytical frame that could be used in further studies for a better understanding of abdominal wall deformations in physiological and pathological situations.
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Affiliation(s)
- Arthur Jourdan
- Aix-Marseille Université, Université Gustave Eiffel, LBA, Marseille, France
| | | | - Pierre Daude
- Aix Marseille Université, CNRS, CRMBM, Marseille, France
| | | | - Catherine Masson
- Aix-Marseille Université, Université Gustave Eiffel, LBA, Marseille, France
| | - Thierry Bège
- Aix-Marseille Université, Université Gustave Eiffel, LBA, Marseille, France
- Department of General Surgery, Aix Marseille Université, North Hospital, APHM, Marseille, France
| | - David Bendahan
- Aix Marseille Université, CNRS, CRMBM, Marseille, France
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10
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Recknagel JD, Goodman LR. Clinical Perspective Concerning Abdominal Entry Techniques. J Minim Invasive Gynecol 2020; 28:467-474. [PMID: 32712324 DOI: 10.1016/j.jmig.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Entry into the abdomen during operative laparoscopy is a source of some controversy regarding the safest and most useful method. The objective of this review is to describe, compare, and contrast the most popular entry techniques. DATA SOURCES Data were collected from the historical starting point until present day from English language journal articles and book chapters. METHODS OF STUDY SELECTION Descriptive accounts dating back to the start of laparoscopy in the 1970s and spanning to present day well-designed randomized controlled trials and Cochrane reviews were compiled to evaluate the evidence for the effectiveness and safety of abdominal entry techniques. TABULATION, INTEGRATION, AND RESULTS The most common sites of entry are the umbilicus and the left upper quadrant. Between the Veress needle, direct trocar insertion, and open entry there is no high-quality evidence to suggest that any of these offers a universal safety advantage. The Veress needle is still the most used among gynecologists and facilitates primary trocar placement. Direct trocar entry under laparoscopic visualization may be underused, is faster, and may result in fewer failed entries. Open (Hasson) entry can be more technically challenging, but may be best for patients with suspected intra-abdominal adhesions. CONCLUSION Surgeon comfort is critical in choosing the entry site, method, and equipment. Surgeon familiarity with entry-failure troubleshooting, possible complications, and management is essential because major entry complications are rare in modern laparoscopy but critical because the essential steps of recognition and management can be lifesaving.
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Affiliation(s)
- Johnathon D Recknagel
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina Hospitals, Chapel Hill, North Carolina (all authors)
| | - Linnea R Goodman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina Hospitals, Chapel Hill, North Carolina (all authors).
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Uslu Yuvaci H, Cevrioğlu AS, Gündüz Y, Akdemir N, Karacan A, Erkorkmaz Ü, Keskin A. Does applied ultrasound prior to laparoscopy predict the existence of intra-abdominal adhesions? Turk J Med Sci 2020; 50:304-311. [PMID: 31905491 PMCID: PMC7164757 DOI: 10.3906/sag-1910-61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/01/2020] [Indexed: 01/24/2023] Open
Abstract
Background/aim The purpose of this study was to evaluate the efficacy of trans-abdominal ultrasonography (USG), a noninvasive diagnostic tool, in predicting the presence of intraabdominal adhesions, especially near the trocar entry area, to provide safe surgical access to the abdomen. Materials and methods Fifty-nine women with a previous history of open abdominal surgery (group A) and a group of 91 women with no previous history of surgery (group B) underwent dynamic ultrasound evaluation of the abdominal fields before laparoscopic operations. The anterior abdominal wall was divided into six quadrants: right upper, right lower, left upper, left lower, suprapubic, and umbilical. Adhesions were evaluated by surgeons during the operation and by radiologists using USG prior to the operation. Visceral organ movements greater than 1 cm was defined as normal visceral slide (positive test), with less than 1 cm of movement defined as abnormal visceral slide (negative test). Sliding test measures movements of omental echogenicity or a stable echogenic focus that corresponds to intestine peritoneal echogenicity that underlies abdominal wall during exaggerated inspiration and expiration. Adhesions observed during surgery were evaluated on a four-point scale, with 0 indicating no adhesions present, 1 indicating the presence of a thin, filmy avascular adhesion, 2 indicating the presence of a dense and vascular adhesion, and 3 indicating adhesions that connect surrounding organs with the overlying peritoneal surfaces. The McNemar test was used to compare the results of USG and laparoscopy for each measure. Results We found that preoperative USG was successful in identifying adhesions [sensitivity, 96.39% (95% CI 89.8–99.2); specificity, 97.43%] Conclusion Preoperative ultrasound examination of the abdominal wall may enhance the safety of abdominal entry during laparoscopic operations.
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Affiliation(s)
- Hilal Uslu Yuvaci
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Arif Serhan Cevrioğlu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Yasemin Gündüz
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Nermin Akdemir
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Alper Karacan
- Department of Radiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Ünal Erkorkmaz
- Department of Biostatistics, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Abdurrahim Keskin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
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Dehghani Firoozabadi MM, Alibakhshi A, Alaeen H, Zand S, Nazemian R, Rahmani M. Evaluation of the diagnostic potential of trans abdominal ultrasonography in detecting intra-abdominal adhesions: A double-blinded cohort study. Ann Med Surg (Lond) 2018; 36:79-82. [PMID: 30425829 PMCID: PMC6224334 DOI: 10.1016/j.amsu.2018.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 08/31/2018] [Accepted: 09/15/2018] [Indexed: 12/12/2022] Open
Abstract
Background Intra-abdominal adhesion is one of the most important complications of abdominopelvic surgery. It increases morbidity and mortality for patients. Although laparoscopy is the gold standard of adhesion diagnosis, it can cause visceral damage during the operation. Therefore, surgeons prefer to use non-invasive methods for planning the operation. We designed this study to evaluate transabdominal ultrasonography ( TAU) accuracy for diagnosing Intra-abdominal Adhesions Material & methods This double-blinded cohort study was conducted on 47 patients with previous laparotomy who undergo another surgery. Spontaneous visceral slide (SVS) and induced visceral slide (IVS) were measured during TAU. Results The mean age and BMI of 47 patients were 43.21±10.3 and 27.545±5.76. The majority of the patients were female (76%). Mean SVS and IVS in patients with intra-abdominal adhesion were 8.73±1.60 and 44.84±11.60. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of TAU in intra-abdominal diagnosis were 83.33%, 51.72%, 51.72%, 83.33%, 63.83%. Conclusions Although TAU is an appropriate method for detecting the intra-abdominal adhesion, it isn't good enough for diagnosing free adhesion area. We recommended further researches with greater sample size and other non-invasive techniques. Evaluation of accuracy, sensitivity, specificity, PPV, NPV for adhesion diagnosis. There are not a lot of studies on ultrasonography accuracy before. It’s an only double-blinded cohort study. Our study refers to high sensitivity and NPV for diagnosing the adhesion.
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Affiliation(s)
| | - Abbas Alibakhshi
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoorieh Alaeen
- Students' Research Scientific Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Zand
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Ryan Nazemian
- Institute for Transformative Molecular Medicine, Case Western Reserve University, Cleveland, USA
| | - Maryam Rahmani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Department of Radiology, University of Medical Sciences, Tehran, Iran
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