Steps to reduce adhesion formation......posted by Sherry Marie

From: Helen Dynda (olddad66@runestone.net)
Wed Jul 5 13:17:56 2000


[ NOTE: Sherry has provided some very important information here - and the " cyber-mischief " is a big distraction; so hopefully this time her message will fit into the Message Box. ]

From: Sherry Marie (SMGNWV@aol.com)

Wed, 5 Jul 2000 13:04:51 -0500

Achieve meticulous hemostasis: Inadequate hemostatsis and the resultant fibrin deposition promote adhesion formation. Maintain vascularity: Limiting ischemia supports fibrinolysis. Moisten tissues: Frequent irrigation and the use of moist sponges prevent desiccation of tissue. Ringer's lactate or other irrigating solutions also eliminate any residual talc, lint, or blood clots, which may provide a nidus for a foreign body reaction, inflammation, and adhesion formation. Avoid dry sponges and minimize tissue handling: Manipulating tissue increases the possibility of vascular and tissue damage. When direct manipulation of the peritoneum is necessary, use either atraumatic instruments or fingers. In addition, cutting and coagulating should be kept to a minumum to reduce the possibility of trauma and maintain vascularity. Use fine, nonreactive sutures: To minimize foreign body reactions, use the smallest size of suture composed of synthetic material. Avoid peritoneal grafts: Grafting increases the risk of peritoneal trauma while decreasing vascularity. Minimize foreign bodies: Foreign bodies may damage the peritoneal surface, lead to inflammation, and ultimately result in adhesion formation. Minimally invasive surgery results in much less tissue irritation than conventional open techniques, with the result of a much faster recuperation for the patient, as well as a lesser likelihood of further adhesion formation. But what happens when I put off surgery until something shuts down? The adhesions are too dense and therefore the laparoscopy is difficult to use. Laparotomy again, thus the adhesion cycle. Due to the inevitability of adhesion formation, should the surgeon concentrate their efforts on intervening at varying points in the pathway of adhesion formation? Sherry Marie


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