International Adhesions Society





Chat About Adhesions

The following chat transcript courtesy of now


Prior Chat Transcripts Conference Coverage
From American Association of Gynecological Laparoscopists
Orlando, Florida, November 2000

" Adhesions" Editorial Advisors, Larry Demco, MD and David M. Wiseman, Phd, M.R.Pharm.S

Dr. Larry Demco: “Good morning again, this is Dr. Demco reporting from the 29th Congress of the AAGL. This morning I’d like to interview Dr. David Wiseman who is the Chair and Founder of the International Adhesion Society. Dr. Wiseman, adhesions are a serious problem not only for doctors but for patients, could you give us some idea of the scope of the problem?”

Dr. David Wiseman: “The scope is enormous and it’s under-appreciated. Almost everyone having surgery will form adhesions and a number of studies have been done to that effect showing that up to 95% or even 100% of patients having some type of surgery will form adhesions. The question is how many of those patients will have problems due to adhesions? There are varying numbers on that depending on the type of surgery that is performed. A recent paper published in the LANCET about a year ago shows that the number of hospital re-admissions for adhesion related complications rivals that for the number of procedures formed either for cardiac bypass, appendectomy, or hip replacement. Everyone has heard of the cardiac bypass operation or a hip replacement or an appendectomy but very few people know what an adhesion is. So that gives you an extent of the problems and those are the severe ones that occur relatively in a short time, within five years. The numbers are probably much greater if you take the time out and adhesions can occur at any time. We know of cases where people who report problems due to adhesions seventy years later after having an appendectomy when they were a young child.”

Dr. Larry Demco: “It’s a funny situation, this variance in the presentation has led to a lot of the problems of even the doctors viewing their idea about adhesions. I know general surgeons mainly associate adhesions with bowel obstruction. From in your Society in review of your patients, what symptoms do the patients most often present with when they do have adhesions?”

Dr. David Wiseman: “First of all, the majority of people that we come into contact with are people that have already had several operations for adhesions so it’s well established what their problems are and their problems are, first of all, bowel obstruction, either partial or full obstruction, and/or some kind of abdominal pain. Now it’s important to understand that not all pain is caused by adhesions and not all adhesions cause pain but probably a bowel obstruction type of syndrome is most common and then pain. There is another group of patients in the infertility world that will report infertility most probably without those kinds of complications but if the infertility is due perhaps to adhesions, say endometriosis related, then those patients may end up after several operations in the bowel obstruction chronic pelvic pain category.”

Dr. Larry Demco: “I’ve done some work with adhesions myself and we’re actually mapping which adhesions hurt and which ones do not. It’s quite interesting to see that from our research we’ve seen that the bowel is not much different from your arm. If you break an arm, any little movement while you’re getting it to the hospital causes severe pain in the arm. If you don’t even treat the arm but put it in a cast, the pain in your arm will disappear. We found that when looking at mapping adhesions in the abdomen that similar procedures are done if the structure is movable and attaches itself to the peritoneum, it’s very painful. Something that’s fixed is a problem that seems to be corrected and those are not the source of the pain. So it’s interesting and a lot of work has to be done in this. In what research capacity that you’ve seen looks most promising for your prospective?”

Dr. David Wiseman: “Unfortunately, the research isn’t that extensive and it’s limited to the kinds of things that you’re talking about. In terms of establishing the causes of the pain and obstruction, it’s very limited. It has begun recently with the advent of the conscious pain mapping type procedures that you’re describing but really we don’t know very much about this at all. There are some other promising avenues that are related to it that suggest there may be pain nerve fibers that grow within the adhesions. We know that they’re there but we don’t know if they’re hooked up and if they’re functioning. So the whole problem as to why adhesions cause problems or whether the adhesion that’s there is really causing the pain or if there’s something within that - a hidden endometriosis, for example, or a scar that’s entrapping a nerve deep down in the tissue, we really don’t understand any of that. The majority of the work is being done by medical device and pharmaceutical companies that are trying to prevent adhesions but they’re really not addressing the fundamental issues such as the one that you’ve described.”

Dr. Larry Demco: “Let’s move on to the prevention of adhesions. Can you give us a short summary on what’s available for that?”

Dr. David Wiseman: “Certainly, really in the United States there are two products available; one is INTERCEED made by Johnson & Johnson ETHICON, the other one is Seprafilm made by Genzyme. In Europe there’s a product called ADEPT made by ML Laboratories. There’s a product called INTERGEL, which is ETHICON, which is in Europe and other countries, and there are a number of companies that are developing products, which look quite promising, some of which were presented here. I presented two products - one from Europe, IMEDEX, and one from the 3M Company and then there was another presentation by a company called CONFLUENT which also has a very promising product. These are incremental or perhaps quantum advances in what we know about how to prevent adhesions but we’re still a long way off.”

Dr. Larry Demco: “It seems that the adhesion story seems to be two-fold and looks like there’s a lot of research that has to be done on both the cause of the pain of adhesions and further research to see how we could prevent them. I’d like to thank you very much, and I would like to support your society in any way that I can.”

Dr. David Wiseman: “Thank you very much.” Please remember to contact our web site for more details:


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