Validation of peritoneal adhesion index as a standardized classification to universalize peritoneal adhesions definition

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Paola Fugazzola
Federico Coccolini *
Gabriela E. Nita
Giulia Montori
Davide Corbella
Abdulrasheed R.K. Adesunkanmi
Alessandro Aluffi
Gianluca Baiocchi
Walter Biffl
Fausto Catena
Andrea Celotti
Nicolas Cheynel
Michele Colledan
Yunfeng Cui
Salomone Di Saverio
Mario Paulo Jr. Faro
Karateke Faruk
Gustavo Pereira Fraga
Igor Gerych
Carlos Augusto Gomes
Gianluca Guercioni
Arda Isik
Vladimir Khokha
Yoram Kluger
Victor Kong
Ari Leppaniemi
Roberto Manfredi
Damien Massalou
Eugeene Moore
Noel Naidoo
Bruno Monteiro Tavares Pereira
Dario Piazzalunga
Michele Pisano
Elia Poiasina
Eugenio Poletti de Chaurand
Patrick Rat
Boris Sakakushev
Massimo Sartelli
Boonying Siribumrungwong
Leonardo Solaini
Matteo Tomasoni
Nereo Vettoretto
Kuo-Ching Yuan
Luca Ansaloni
(*) Corresponding Author:
Federico Coccolini |


Peritoneal adhesion index (PAI) is a score based on appearance and distribution of peritoneal adhesions. The study aims to assess the validity of PAI in order to standardize the definition of peritoneal adhesions. The study includes an expert survey to assess the feasibility of the score and a prospective observational and multicenter trial to assess its validity. 96% of surgeons of the survey consider PAI a useful tool. From January 2013 to March 2015, 205 patients were enrolled to undergo a surgical intervention for bowel obstruction caused by peritoneal adhesions in 21 centers. PAI was significantly higher in the population with previous surgery (P=0.043) and in patients who underwent two previous surgical interventions, if compared to those with only one previous intervention (P=0.012). Length of surgery was significantly longer in patients with higher PAI (P<0.001). Patients with a higher PAI showed a clinically higher risk for early bowel re-obstruction and for early re-intervention. The AUC of the ROC curve for early re-occlusion is 0.8. PAI can be considered a feasible and useful score.

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