1.) Describe Mary's condition --- Starting with a vagotomy in 1980 the pain problem increased extremely after bowel surgery in 1990. The pain was mainly in the upper abdomen but also in the middle and right lower abdomen.
2.) Review previous surgical history (x - number of previous surgeries to try to treat and reduce adhesions). --- Overall there were nearly 20 surgeries with threetimes acute severe bowel obstruction.
3.) Describe the outcomes of the surgeries to date --- There were more and more adhesions after every surgery. The endpoint were adhesions all over to the abdominal wall specially from the small and large bowel and from the stomach to the diaphragm. We know Mary Pomroy since 7/00. She was in a very bad condition. She could not lay flat in bed and she could not raise her arms due to the severe adhesions. We have tried several time to do endoscopic adhesiolysis with second look procedures. We have used adhesion prevention like Intergel and steroids and have reached only a reduction of the adhesions. This has led to a significant improvement of the life quality. But, the remaining problems were the adhesions specially in the upper abdomen.
4.) Date of surgery -- The first surgery was performed on April 11. We have lysed all adhesions to the anterior abdominal wall and to the diaphragm. After this extensive adhesiolysis we have used 5 kits of SprayGel to cover all the serosal defects. The goal was to minimize the extent of serosal damage by using atraumatic surgery. Then we have tried SprayGel for covering the defects to reach a further reduction of the adhesion recurrence rate. This should lead to a further improvement of the life quality.
5.) Describe surgery - what was the goal? Identify and describe adhesion barrier product (a novel product called SprayGel - include reasons why you have chosen to use SprayGel to reduce adhesions) used in the procedure --- The new SprayGel has several advantages over the currently used adhesion barriers: 1.) It can applied directly to the defect area (even the anterior abdominal wall). 2.) SpraGel stays in place. 3.) The components of SprayGel (PEG) are non toxic and no tissue reaction is known.
6.) Expectations with SprayGel Adhesion Barrier --- We are currently under the way to investigate the efficacy of SprayGel in different indications like adhesions, endometriosis and myomectomies.
7.) Describe how the surgery went --- Due to carefull surgery we have reached a complete adhesiolysis without inducing too much serosal damage. After that we have covered the complete anterior abdominal wall and the transversal colon and the stomach with SprayGel to reduce the recurrence rate.
8.) Follow-Up: SLL --- The second look laparoscopy was performed on April 19. Here we could see a complete adhesion free anterior abdominal wall.
9.) Findings upon the second look laparoscopy (describe what that is) on areas where SprayGel was applied. What type of outcome does this represent thus far? Did it meet or exceed expectations? --- After several attempts to reduce the adhesions this was a big step forward and exceed our expectations. There is no risk for the development of severe adhesions - unless another traumatic surgery.
10.) How is Mary feeling, what can she expect and how will this surgery impact her lifestyle? --- This will improve the life quality and reduce the adhesion related pain to a minimum. Only the bowel to bowel adhesions can induce problems in the future.