Dr. Wiseman's Chats......Preventing Post-Surgical Adhesions

From: Helen Dynda (olddad66@runestone.net)
Sun Feb 25 09:44:00 2001

There is alot of information in Dr. Wiseman's Chats!! For example: I have excerpted the following information from Dr. Wiseman's June 23, 1998 Chat on Preventing Post-Surgical Adhesions:

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[] Fibrin sealant and adhesion reduction:

Drbradley "Dr.Wiseman... any comments on fibrin sealant and adhesion reduction?"

Drwiseman "Dr B: Fibrin glue - I noticed from the transcript of your chat last week that you mentioned this. I don't know of anyone who has published a descent RCT on the subject. The animal data looks quite promising and my feeling is that is should certainly help as far as hemostatsis is concerned and will also help facilitate the action of INTERCEED."

Drbradley "I have used it on occasion when I have anticipated a large peritoneal defect in the pelvic after laparoscopic surgery."

Drwiseman "Dr B: Are you using cryo or one of the commercial formulations? I think results will vary greatly on the formulation (e.g. +/- aprotinin). Also, I think it's very important to make sure the glue has set (e.g. wait 2-5 minutes before replacing organs)."

Drbradley "I use cryoprecipitate from the patient, with bovine fibrin. It sets up in 1-3 minutes depending on the mixture. I watch until the "sealant" is totally set up. IMHO, "fibrin GLUE" is a misnomer as it is simply a clot without red cells."

Drwiseman "Peritoneal tissue does regenerate, but if you have had EXTENSIVE dissection it will take a long time with a great risk of adhesion formation."

Drwiseman "DrB: "A clot without red cells" is a good description of what you have. I don't think that too many GYNs have used fibrin "glue" because they make the equation fibrin = adhesions. But the way you are using it can only serve to promote meticulous hemostasis and help to reduce adhesions. I would be interested if you think it reduces adhesions on its own or do you use something else such as INTERCEED. If so, do you think the INTERCEED works better when you have used the cryo?"

Drbradley "That is the precise reason that early (7 day) re-laparoscopy is so important (IMHO): one can knock down whatever adhesions have formed allowing normal reperitonealization to occur."

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[] Dr. Harry Reich

Drbradley "I recently referred a severe adhesion patient in NY to Harry Reich. MD, perhaps the most talented laparoscopic surgeon in the world!! 5 hours of surgery, she is at last pain free!!"

Maryhalm "I've heard great things about Dr. Reich."

Drbradley "Don't assume that your oncologist, however talented, is an adhesion expert!"

Dr.bradley Sadly, egos sometimes preclude good judgement!!"

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[] Special irrigation solutions, NSAIDs, steroids:

Drbradley "I use INTERCEED when ever I can, but as you so well know, adhesions can still occur. All the special irrigation solutions, NSAID. steroids are just voodoo"

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[] Dr. Harry Reich and Dr. Camran Nezhat

Drbradley "Dr.Wiseman, the list suggestion could be very helpful to patients. Unfortunately there is only one Harry Reich, Camran Nezhat etc.Patients sometimes assume that anybody packing up a laparoscope qualifies for this unique company> Not So!!"

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[] Dr. Robert Albee:

Maryhalm "Gotta mention the doc who did my last surgery, Dr. Robert Albee. He's great at what he does."

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[] Hypnosis

Drbradley "Hypnosis is an excellent tool for the suppression of pain."

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[] Dr. Harry Reich and Dr. Camran Nezhat:

Drwiseman "DrB you are right, there is only one Harry Reich and Camran Nezhat et al. what I usually do is have patients let me know where they live and then I try to match them with someone I know in the area"

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[] Re: Dr. Wiseman's Chat Transcripts -- To read more information from Dr. Wiseman's Chats...Click: Chat Transcripts ( left side of this webpage ) ~ ~ ~ ~

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