>----- Original Message -----
From: "Vict." <anonymous@obgyn.net>
To: "Multiple recipients of list ADHESIONS" <adhesions@forum.obgyn.net>
Sent: Sunday, April 23, 2000 6:12 PM
Subject: Adhesions & post- Laparoscopic complications
> Hi,
> I just wanted to put out a word of general caution. There are times
> that lap surgery of any type is appropriate for adhesion lysis. There
> are certain individuals that due to the severity of their adhesions
> should not be subjected to laparoscopic surgery...especially if that
> laprascopist's experience is limited to a typical gyn practice. There
> are lap docs who confine their surgery to scope surgery only. I am NOT
> saying that a gyn could not do the surgery. What I am trying to get
> across is there are cases of severe adhesions that first of all surgery
> will not help...that will actually produce more adhesions. The hard
> evidence I've seen states that: Laparoscopic surgery is associated with
> a lower incidence of wound adhesion. It is not associated with a lower
> incidence of actual internal abdominal adhesions. If you have severe
> dense adhesions you really need to weight the potential risks. There
> are serious complications associated with this type of surgery. Most
> physicians and patients have an attitude that after the surgery is over
> and they are 7 or more days post-op, "hey, no problem". They don't
> relate symptoms that crop up to the surgery. This can be really bad
> news. People have not survived due to this attitude. If you are even
> 14 days post op and you begin feeling a bit ill, have a fever, nausea,
> vague abdominal pain, dehydration, or other symptoms you need to rule
> out the possibility of post op complication. This means it must be
> diagnosed and ruled not to be associated with surgery. There is a
> gentleman who almost died one year after an apendectomy...the area
> walled off and formed an abcess which later burst. Complications can
> include perforated bowel or other organs, infection, bleeding, etc. You
> may have symptoms of a "PID" and the doc will say it was because you are
> not clean or due to sex...etc. That it was caused by bacteria entering
> the vagina and traveling up as far as the tubes...reality is that it can
> be caused from the inside out...it can be caused by surgical
> contamination. Many times the scope will keep fogging up...I know of
> someone who became ill after a microscopic piece of fiber somehow became
> inbedded (?) in the bowel wall and became infected. There are really
> more cases out there than previously believed. The real "Experts" know
> about these cases. They know how many scope surgeries have been
> converted to open procedures...
>
> I just feel that a woman or man, as it affects them too, should be fully
> aprised of their particular case and the benefits vs risks of a
> particular type of surgery along with a realistic discussion of the
> potential complications.
>
> A for instance. The risk of perforated bowel, infection, or bleeding
> from a scope surgery is fairly low. They happen but the risk is fairly
> low...generally speaking. If you have severe, dense, adhesions that
> obliterate (make it so the surgeon cannot identify planes)then you do
> not fall in that generally speaking category. Of course this can be
> dependant upon where the adhesions are located, which ones the surgeons
> attempt to lyse, what type of instruments, cautery devices, or lasers
> they choose to use, and laparoscopic skill...Calling oneself an expert
> is oftentimes subjective. The surgeon may have only two years
> experience, he does 10 tubal ligations with a scope on virgin abdomens
> per week, and a few other scope surgeries...this does not an expert
> make...there are actual levels of competancy...Level one, level two,
> etc. Your idea of an expert may be 8 years or more experience and his
> may be one or two courses and a couple scope surgeries per week. I am
> NOT out to bash doctors...I have doctors too...I am out to hopefully
> educate women...I have huge amounts of info...and "inside" info that
> women and men must be aware of before undergoing lap surgery. I've
> heard all the pros and cons and then some...
>
> Anyway, if you have a complicated belly then the risk goes up for you
> and is directly related to how complicated your belly is. The
> complications are life and death situations that generally are not
> caught at the time of surgery. If you are two weeks post-op you and the
> surgeon may not be looking at the possibility of surgical complications
> thus placing you in jepardy. Also remember that you may or may not have
> temporary relief...For me personally, unless I had a bowel obstruction,
> stricture, etc. then I cannot subject myself to any more. There are
> advantages to open procedures too. It's just hard to judge.
>
> I feel it is ever so important that post-scope patients be given at
> discharge a list of potential symptoms of post-op complications...not
> just the standard or typical post-op instructions but ones that are
> specifically written for that specialized type of surgery. It would
> also be helpful if your doctor discussed with you precisely what he did
> in there...did he have a tough time with anything in particular, was the
> surgery difficult or easy? Did he at any time think he should back out?
>
> I've heard the positive outcomes but I also know of the potential
> complications...
>
> Just be careful...really check it out...I don't want any of you sustaing
> serious damages.
>