Re: Adhesions

From: Shali (
Tue Jul 3 19:12:19 2007

>I do have a question for anyone out there...Does surgery on adhesions
>(alone) help? I've been trying to find out as much as I can on it, but
>its an elusive subject. If so, how long did it help?

Heidi - As far as surgery on adhesions alone helping, IT DEPENDS. Regardless of what anyone tells you, because their opinions are subjective, IT DEPENDS. So to give you an objective opinion which would be more accurate, I have known people who go up to 30+ years without problems; I have known people who go thru more than one surgery a year.

As far as how long does it help, there is no set time.

>Another question, too...I'm in a smaller community. How do I find a
>doctor for 'Pain Management?' Is it a specialty of practice or what?

Im in a small town too. Look in the yellow pages under Physicians & Surgeons - Pain Management


Role of Fibrin in the Development of Surgical Adhesions Jacob Rajfer, MD Department of Urology, University of California at Los Angeles, Los Angeles, CA

One of the major problems with intra-abdominal surgical procedures, including pelvic surgery, is the development of adhesions within the intra-abdominal space postoperatively. This is usually not a clinical issue unless another intra-abdominal surgical procedure is to be performed at a later date or pain from the adhesions or a bowel obstruction develops. These intra-abdominal adhesions are the bane of every surgeon's existence because they make a subsequent surgical procedure much more difficult, more labor intensive, and more prone to an intra-abdominal injury. Just imagine if all intra-abdominal surgical procedures could be made adhesion free!

Adhesions are fibrotic connections between two tissue planes-in the case of intra-abdominal adhesions, between two organs or an organ and the abdominal wall. The mechanisms by which fibrosis develops are beginning to be deciphered at the biochemical level. Most evidence points to the involvement of the fibrinolytic system in this process, and converging data from a variety of disciplines seem to suggest that a defective fibrinolytic system is intimately involved in or is actually responsible for the development of tissue fibrosis, including intra-abdominal adhesions. Surgery per se can lead to a local inflammatory response, which in turn may lead to the local deposition of fibrin. Fibrin happens to be an extremely pro-fibrotic compound, and its continued presence (or a failure to remove the fibrin) seems to induce fibrosis.1,2 Therefore, it may be hypothesized that the development of surgical adhesions or tissue fibrosis in general may be due to the failure of the fibrinolytic system to degrade the fibrin.

A Role for the Fibrinolytic System in Postsurgical Adhesion Formation Hellebrekers BWJ, Emeis JJ, Kooistra T, et al. Fert and Ster. 2005;83:122-129

In a group of 50 female patients undergoing pelvic laparoscopy for either an infertility evaluation or treatment of endometriosis, the presence or absence of adhesions was noted either at the first laparoscopy or at a second laparoscopy, when indicated. Measurements were made of soluble fibrin, PAI-1 (plasminogen activator inhibitor), tPA (tissue plasminogen activator), plasmin-antiplasmin complexes, and fibrin degradation products in the peritoneal fluid. Patients with adhesions had significantly higher concentrations of PAI-1, tPA, and plasminogen than those without adhesions. In patients who developed adhesions between an initial and subsequent laparoscopy, there was biochemical evidence of a defective fibrinolytic system in the peritoneal fluid. These observations suggest that the plasmin-fibrinogen system is operative in the development of adhesions and that it may be possible to prevent these abdominal adhesions by the use of fibrinolytic enhancers or inhibitors of PAI-1. The development of such a therapeutic regimen would be a major advancement in surgery, as the use of this regimen at the time of surgery would potentially lead to a decrease in surgical adhesions and their resulting clinical sequelae.

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