Preventing Post-Surgical Adhesions...

From: Helen Dynda (
Wed Jul 24 12:46:59 2002

X> Preventing Post-Surgical Adhesions...Chat discussion between David Wiseman, PhD and J. Glenn Bradley, MD (from June 23, 1998) .... [ I have updated some of this information.]

6-23-1998.....Dr. Wiseman: " Regarding INTERGEL: First of all, it has only just been released in Europe and may not be available here for another 18-24 months."

7-24-2002...MY UPDATE: INTERGEL, a gel adhesion barrier, was approved by the FDA on November 16, 2001 - to prevent adhesions from forming after surgical procedures. INTERGEL is the very first adhesion barrier that can be applied at the conclusion of laparoscopic procedures!!

7-24-2002..."If you plan to have surgery, be sure to discuss both the risks and prevention of adhesions with your surgeon!!! When I had a laparotomy in 1970, I was NOT told that adhesions are a risk of surgery!! It took me 27 years to learn that adhesions were the REAL CAUSE of the pain I had suffered with!! I was not a hypochondriac!! My pain was "NOT all in my head"!! I was not suffering from psychoneurosis; nor were the symptoms of my pain psychosomatic!! BUT I had been told that over and over!! I had seen many doctors over those 27 years!! As a result of my doctor-shopping experiences, I will always carry the unpleasant memory of what I experienced when I tried to explain my symptoms: One doctor laughed at me!! Another doctor - the head of the Gastroenterology Department of a famous medical center - in a rageful voice yelled that I was wasting their time!! Several times I was told that I needed to seek help at a mental clinic!! Sorry, I got carried away; but it sure felt good to express some of the anger that unresolved chronic pain has caused and causes!!"

6-23-1998.....Dr. Wiseman (continued): "Second of all, on the limited data that I have seen clinically (I know the animal data very well because my group did most of it when I worked at Ethicon), given the limited clinical data to date it looks as though adhesions will not be prevented 100%. What INTERGEL seems to do - and I stress this is based on limited clinical data available - is work about the same as INTERCEED and Seprafilm, except that it can be used laparoscopically and it can coat many areas at once."

6-23-1998.....Dr.Wiseman: "No, I don't think it (INTERGEL) will be the cure-all, and to be fair to Ethicon, I don't think they are saying it is. Will there ever be one? I hope so, but it is not yet on the horizon."

7-24-2002...MY UPDATE: Confluent Surgical's SprayGel is showing great promise; but SprayGel clinical trials are just beginning in the United States - and may take as long as 1-2 years before the clinical trials will have been completed. Only then will the FDA be ready to evaluate the results of the clinical trials. SprayGel was approved in November 2001 for use in surgical procedures in Europe. I am aware of the names and locations of three surgeons in Germany, who are accepting people, who suffer from adhesion related disorder (ARD).

6-23-1998.....Dr. Bradley: "That is the precise reason that early (7 day) re-laparoscopy is so important - one can knock down whatever adhesions have formed allowing normal re-peritonealization to occur."

7-24-2002...MY UPDATE: A second-look laparoscopic (SLL) is an important follow-up procedure after (about 7 days) an adhesiolysis; because it is well known that adhesions begin to form as early as three (3) hours after any surgical procedure - and continue to form up until about seven (7) days. Unfortunately, there are very few surgeons in the United State, who perform SLL procedures!! Why? One reason is that the cost of a second surgical procedure is very costly!! Dr. Tom Lyons is conducting SprayGel clinical trials at Atlanta, Georgia; and a follow-up SLL procedures will be done seven days later to evaluate the effectiveness of SprayGel adhesion barrier. Clinical trials are considered to be experimental procedures; so it is highly unlikely that medical insurance (of any kind) will pay for the initial surgical procedures. However, for those who have been accepted and have had the initial surgery, Confluent Surgical will be paying the cost for all second look laparoscopic procedures (SLL) The three surgeons in Germany do include second-look laparoscopic (SLL) procedures for the same reason - to evaluate the effectiveness of SprayGel and to lyse any adhesions that may have formed. Adhesions are very easily lysed within the 7 day period of time.

6-23-1998.....Dr. Wiseman: " Dr. Bradley raises a good point. An early (7day) laparoscopy after an initial procedure may allow the Dr. to get the adhesions while they are still filmy. S/he should use an adhesion barrier. Also see someone who knows adhesions."

7-24-2002...UPDATE: The most important part of an adhesiolysis procedure IS the surgeon!! There are very few surgeons in the United States, who are willing to do adhesiolysis procedures; because surgeries for adhesions are not only very time-consuming but surgeons are very poorly reimbursed (by insurance, etc.)!!!! (I've seen the video of a surgery that took 10 hours!!) Adhesiolysis procedures are very risky surgeries!! Massive adhesions - that have attached body organs together - make it very difficult for the surgeon to visualize the operating field; and therefore, there is always the risk that the bowel or bladder could inadvertantly be nicked or perforated, etc. Your best chance for a successful adhesiolysis is to seek a surgeon, who cares so much about adhesion-sufferers, that he/she has taken the initiative to acquire the advanced microsurgical training and techniques that are so necessary in the performance of very difficult adhesion procedures. You will also want a surgeon, who has had a lot of experience and is very skilled in using these techniques. Practice makes perfect!!

6-23-1998....Dr. Wiseman: "Adhesions do form quickly; but they mature with time. What happens is that the adhesion may get more fibrous with time. Also organs may twist around an adhesion many years after surgery and cause a problem that was not there until then. This may happen 50+ years later."

6-23-1998.....Dr. Bradley: "I recently referred a severe adhesion patient to NY to Harry Reich, MD, who is perhaps the most talented laparoscopic surgeon in the world!! 5 hours of surgery - she is at last pain free!!"

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