Re: Has it ever turned out NOT to be adhesions?

From: Katie (katie_scarlett67@hotmail.com)
Wed Mar 4 08:49:28 2009


Mark, you are one of the most industrious people I have encountered so far on this board and I truly appreciate all of your efforts and input.

Thanks, Katie

At Wed, 4 Mar 2009, Mark in Seattle wrote: >
>At Tue, 3 Mar 2009, Linda wrote:
>>
>>Does anyone know the statistics of successful adhesion surgeries by any of the doctor(s) performing them? If not, where could one locate these figures?
>
>--
>Mark in Seattle writes:
>
>Except for the SCAR studies, successes are anecdotally reported first by
>patients, and second by doctors. This is why the new fMRI technique is
>so important. Finally, we can now measure success right away, without
>waiting 5 or 10 years for the patient to report what's been happening.
>
>An article in The World Journal of Surgery in March 2006, reported that
>“the success rate of laparoscopic lysis of adhesions remains between 46%
>and 87%” That's a huge range, isn't it? I think answer varies so much
>because of the above reasons, and also because the question depends on a
>number of surgical factors. I strain to understand them.
>
>Citation:
>Szomstein S, Menzo EL, Simpfendorfer C, Zundel N, Rosenthal RJ.
>Bariatric Institute, Section of Minimally Invasive Surgery, Cleveland
>Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, Florida, 33331,
>USA, szomsts@ccf.org. 2006 Mar 13; Laparoscopic Lysis of Adhesions,
>World J Surg.
>
>I saw another article that reported similar success rates, (assuming I'm
>reading it correctly:
>
>http://7thspace.com/headlines/302194/feasibility_of_laparoscopy_for_small_bowel_obstruction.html
>
>The Surgical and Clinical Adhesions Research (SCAR) steering group in
>the United Kingdom also reports success rates. The numbers they provide
>are confusing to me. This is a cop out, but I don't feel well enough to
>try to boil down the information I have in front of me, (it would take a
>steady 2 hours of intense reading) so I'll merely just refer you to
>their work. Even if I tried to get up to speed with everything in the
>article, I don't have the credentials to present it to you. It's quite
>dense language.
>
>The SCAR group is probably the most prestigious and credentialed group
>of researchers. The lead author in these studies is usually A.M. Lower
>or H. Ellis. There have been at least 3 major reports from the SCAR
>group. The latest one that is in my stack of papers is this one:
>
>A.M. Lower, R.jJ. S. Hawthorn, D. Clark, J.H. Boyd, A.R. Finlayson,
>A.D. Knight, and A.M. Crowe, (2004) Adhesion-related readmissions
>following gynaecological laparoscopy or laparotomy in Scotland: an
>epiemiological study of 24046 patients, Human Reproduction Vol. 19, No.
>1 pp. 1877-1885
>
>There are other earlier reports from the SCAR group. The SCAR group is
>generally credited, especially Ellis, for raising awareness of the
>problem among doctors.
>
>Individual surgeons are free to report their own experience and they do
>so. Of these self-reporters, I've seen figures ranging from 75 to 85
>percent success rates. Here's one of them:
>
>http://www.centerforendo.com/articles/adhesionsupdate.htm
>
>Ideally, a surgeon worth his/her salt should provide you with
>information about risks of success and failure. Surgeons are supposed
>to obtain what is called in legal terms, "informed consent" from their
>patients prior to operating. I do not feel qualified to provide you
>with correct information so that you can make "informed consent." But I
>do know enough to ask pointed questions. In fact, I tell everyone I
>know who is going to have surgery to ask the surgeon to please explain
>the risk of adhesions and to please describe what, if any, techniques
>he/she will be using to try to prevent them from occurring. And then to
>listen carefully. Perhaps he/she can explain why your surgery has a 87
>percent chance of success, while someone else would have a 46 percent.
>
>You've asked a very difficult question, and I don't think I've answered
>it like you want me to. I'm sorry. But I thought I'd give it my best
>try. Perhaps someone else can take this information and come back to us
>with a better response. If there is a simple answer, I don't know what
>it is. But I've done my best to give it to you. Maybe I'm just too
>tired to give a confident answer. But really, I think it's just a very
>complicated question. It's just hard to say. And I'm really, really
>tired right now. I just spent 2 hours poking around in my files and on
>the net, and I'm going to stop and call this good. I did my best.
>
>Yours,
>
>Mark in Seattle
>


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