OC16.04: Prediction of POD obliteration using the real time dynamic sliding sign: prospective multi‐centre study of 200 cases undergoing laparoscopy

To evaluate the real time dynamic sliding sign in the prediction of POD obliteration in women undergoing laparoscopy for suspected endometriosis. A multi-centre prospective observational study with 200 women. All women underwent a transvaginal ultrasonographic evaluation of the pelvis at a tertiary referral gynecological sonology unit using the real time dynamic “sliding sign” technique prior to laparoscopy to determine the status of the POD. On TVS, if the bowel wall glided smoothly over the retro-cervix and posterior uterine fundus, then the “sliding sign” was deemed positive and the POD was recorded as not obliterated. If the bowel wall did not glide smoothly over the retro-cervix or posterior uterine fundus, then the “sliding sign” was deemed negative and the POD was recorded as obliterated. The sonographic description of the POD was then compared with gold standard laparoscopy. The prediction of POD obliteration using the “sliding sign” was also evaluated in the first 100 women and the performance of the test was compared to the second 100 women. Bowel DIE at laparoscopy was 24% compared to 28% using TVS. 79% of bowel DIE at laparoscopy was associated with POD obliteration compared to 81% of bowel DIE at TVS. 51/200 (26%) had POD obliteration at laparoscopy. Overall the accuracy and sensitivity for predicting POD obliteration in our unit was 96% and 90.2% respectively.For the first 100 cases, the accuracy and sensitivity was 94% and 83.9%, compared to 98% and 100% for the second 100 cases. Our performance has improved when it comes to prediction of POD obliteration. This is likely related to greater experience in performing and interpreting the real-time dynamic “sliding sign”.