If you suffer from ARD, should you have surgery?

From: Helen Dynda (olddad66@runestone.net)
Sat Jul 13 22:18:33 2002

If you suffer from adhesions, should you have surgery? This is a question that you, as an adhesion-sufferer, will be faced with when your chronic pain and other debilitating symptoms become so unbearable that you know that you need to reach out for help of some kind. If you suffer from chronic pain -- and other debilitating symptoms because of adhesions -- what can you do?

Don't allow just any surgeon to do your surgery!! Just because a surgeon is a surgeon, does not mean that he/she has the skill and experience necessary to perform a successful adhesiolysis (surgery for adhesions).

Surgery for adhesions is very risky surgery -- for both the patient and the surgeon!! There ARE surgeons, who specialize in doing adhesiolysis procedures on a regular basis...and NOT just a couple of times a week. Unless you seek a surgeon, who specializes in adhesiolysis procedures, it would be very unwise for you to have just any surgeon to perform your adhesiolysis surgery.

I had an appointment with a colon-rectal surgeon at the Mayo Clinic in January 1997. He told me that he would NOT perform an adhesiolysis for me -- unless I were having a bowel obstruction. A bowel obstruction is an emergency situation!! That is NOT the time to start looking for a surgeon with the skill and experience necessary for performing an adhesiolysis procedure!!

The doctors at the Mayo Clinic advise their patients, who suffer from chronic pain as a result of adhesions, to find a good PAIN MANAGEMENT program at a multidisciplinary pain management center. This does not necessarily mean that Mayo Clinic surgeons believe that adhesions do not cause pain. It means that their surgeons have learned -- through many failed attempts in doing adhesiolysis procedures -- that surgery for adhesions is not only risky for both the the patient and the surgeon; but surgery for adhesions does NOT always have a successful outcome.

At this time surgery is not the best answer for people who have adhesion problems; because at the present time there are NO adhesion barriers that have been proven to be 100% effective in providing protection from the re-formation of adhesions...and/or de nova (new ) adhesions!!

With the right medications many chronic pain people are being helped to successfully manage their pain. Until the FDA has approved one of the gel adhesion barriers, which are currently in clinical trials, pain management may be your best and only alternative.

There are surgeons who have recognized the desperate need there is to help patients, who have severe cases of adhesions. These surgeons have made a commitment to specialize in performing adhesiolysis procedures in an attempt to try to help help these deperate people.

The following list includes some of the things that these very skilled and very experienced laparoscopic surgeons have done to make a difference:

1.) They have a lot of experience in laparoscopic microsurgical techniques -- techniques which are so very necessary in order for them to be able to complete very difficult and time-consuming adhesiolysis procedures. Surgery for adhesions is a very difficult challenge for the surgeon!!

2.) A surgeon, who specializes in adhesiolysis procedures, must have the virtue of PATIENCE; because surgeries of this kind can take many hours to complete!

3.) These surgeons not only learn from each adhesiolysis procedure; but they do whatever is necessary to improve their surgical techniques and skill in each surgery they perform. In other words, they are continually perfecting their surgical technique and skills.

4.) Surgeons, who are specializing in trying their best to help adhesion sufferers, have logged thousands of hours in performing laparoscopic adhesiolysis procedures -- on a daily basis!!! NOT just occasionally!!

The following items will give you information about some of the things to think about before ever considering or agreeing to surgery. Most surgeons WILL NOT suggest or perform an adhesiolysis procedure because: 1.) Surgery for adhesions is very risky for both the patient and the surgeon. There are too many things that can go wrong!! For example: There is always the real possibility of perforating the bowel or causing injury to other abdominal/pelvic organs.

2.) An adhesiolysis procedure is a very time-consuming task for the surgeon. I saw the video of a patient who was in surgery for 10 hours! It was impossible for me to visualize what her intestines looked like; because her adhesions were so severe that it looked as if someone had sprayed and completely covered her intestines with Crazy Glue. I'm not kidding!!

3.) Surgery for adhesions is a very difficult task for the surgeon -- requiring many hours of advanced surgical training and many hours of experience before a surgeon has developed the essential meticulous skills so necessary in the performance of an adhesiolysis.

4.) NONE of the adhesion barriers -- that are currently available -- are 100% effective in preventing the return of adhesions following surgery. For this reason many of the best surgeons have elected NOT to use adhesion barriers.

5.) The patient's body is in charge of the healing which happens following surgery. The formation of adhesions is the natural way in which the body heals itself. That's right!! And researchers have not been able to devise an adhesion device or substance that will prevent the body from forming adhesions.

6.) With repeated surgeries, adhesions will re-form and de novo (new) adhesions may form at a distance from the surgical site. Thus -- instead of getting rid of the adhesions -- it is highly likely that the patient will develop even more adhesion problems -- along with an increase in chronic pain. Surgery for adhesions becomes a Catch-22 situation:

"Surgery begets adhesions. Adhesions beget surgery. More surgery begets more adhesions - and so forth."

7.) Research has not yet been successful in discovering the formula for a gel adhesion barrier which will match or surpass our body's ability to heal itself.

Once a gel adhesion barrier is formulated, tested in clinical trials, and finally approved by the FDA, surgeons will be able to apply this protective gel at the conclusion of both open abdominal (laparotomy) and laparoscopic surgical procedures. This adhesion barrier -- because it will be in a gel form -- will easily flow throughout the abdominal/pelvic cavity to provide a protective coating that will prevent abdominal/pelvic organs from sticking to one another. As a result, this yet-to be-discovered gel barrier will give the patient the best chance to be as adhesion-free as possible. Hopefully, one day soon, this will be a reality; but there are NO predictions as to when.

8.) When a person has had prior surgeries, laparoscopic surgery can be very difficult -- if not impossible -- for the surgeon to perform -- unless the surgeon is very skilled and very experienced.

I actually know a patient, who was told by her surgeon -- who was highly recommended to her -- that he absolutely could NOT access her abdomen laparoscopically!!! This same patient chose to have Dr. Korell (from Germany) perform her adhesiolysis; and Dr. Korell WAS able to access her abdomen laparoscopically!!!!!

9.) Only a surgeon, who does surgery for adhesions on a regular basis, is able to develop the techniques and skills that are necessary in order to help the patient become as adhesion-free as possible. Unfortunately, even these adhesion specialists cannot guarantee that their patient will be adhesion-free following surgery

10.) Too often patients compare their surgeon's ability to perform surgery to that of an automobile mechanic. What do I mean? Their thought process goes something like this: "If a mechanic can fix cars", any surgeon should be able to "fix me." It's not that simple! The surgeons is not in charge of the healing that occurs following surgery!! The human body is in charge of the healing; and it is well known that the body does not heal in the same way for everyone.

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