Introduction: The success of any operation depends to a great extent on how well the optimal surgical approach is chosen. The purpose of the present study was to propose a method of sonographic projection of an abdominal pathologic site on the anterior abdominal wall which can facilitate the selection of an optimal surgical approach.
Material and methods: The study included 26 patients aged 20 to 65 years operated on in the Clinic of Thoracic and Abdominal Surgery in the Medical University, Plovdiv between January 1996 and December 2001. Using ultrasonography we projected a pathologic site located in the abdomen on the anterior abdominal wall. A strip of adhesive band was placed on the scanning surface of a 3.5 MHz linear transducer to cast an acoustic shadow and thus draw the outlines of the site on to the anterior abdominal wall.
Results: Patients with liver hydatid cysts (primary and recurrent) and with recurrent calculous cholecystitis were predominant (20/26, 76.9%). The surgical approach in the cases of primary liver hydatid cysts was in the right hypochondriac region; after laparotomy it was extended in both directions. In the patients with recurrent liver hydatid cysts (6/26, 23.07%) the incision was made on the projected image, directly over the site; it was less traumatic and associated with less blood loss. In eight patients with chronic calculous cholecystitis (30.7%) the projection was used for minilaparotomy (up to 6 cm); in two patients the projection suggested that we should use the transrectal approach as optimal instead of the subcostal approach. The right subcostal approach was used in one patient with chronic calculous cholecystitis and retroperitoneal cyst instead of median laparotomy. In patients with retroperitoneal tumours and intra-abdominal non-organ echinococcosis the projection had confirmatory character. According to the review of the literature we made, such sonographic projection of pathologic sites on the anterior front wall for the purpose of selecting an optimal surgical approach has been done for the first time.
Conclusions: 1. The sonographic projection of a pathologic site located in the abdomen on the anterior abdominal wall creates a direct visual association between intra-abdominal lesions and superficial structures (body constitution, subcutaneous fat, operative cicatrices). 2. This direct visual association, as well as the information provided about the depth, size and relation to adjacent organs helps the surgeon to choose the most appropriate surgical approach.