Re: Adhesions after perforated appendectomy - Adapt, Interceed

From: Mark in Seattle (mark7@skynetbb.com)
Fri Apr 10 19:00:31 2009


>The literature vary, but most say that there is an 70% chance of
>improvement.
>
>SO...What say you all? Do the surgery or wait?
>
>Has anyone tried Adapt or Interceed in their surgery.
>
>PS - What with IHrt.blogspace and why is that website going after that
>german doc?
>

You're asking the right question. I think you have a very good grasp of the information available, so it's hard to help you further. But I'll try.

My feeling is that that the new adhesion barrier agents work better than we know. The risk of post-operative infection is something to consider. Barrier agents have been accused of increasing such risks, which makes sense because anything that interrupts the flow of bodily fluids is likely to slow down the immune system. But my instinct tells me that the risk is exaggerated. The successes are quiet while the failures are sensational. But that's just my feeling. Others will tell you that they have had many unsuccessful surgeries and are reluctant to try again. There is no consensus on this forum, which tells me that the success rates are not above 90 percent. The World Journal of Surgery wrote an article back in March of 2006 saying the success rate is somewhere between 46 and 87 percent. Your figure of 70 percent sounds familiar. Another article in The Lancet written April 2006 says that adhesiolysis surgery was no better than a placebo. (This article was later disputed April 2008 in the American Journal of Obstetrics and Gynecology).

No one has written a good meta-analysis, so nobody really knows for sure. We've only had hospital codes (computer identification) for adhesion barriers since 2002. And it's hard to wait 10 years or more for a patient to come back and report success or failure. It's even harder for doctors to accept mere anecdotal reports as "gospel." They'd rather have a test.

So you can see that the truth is really obscured. So for the time being, doctors in the media are being really tight-lipped about the whole thing.

The bloggers you mention are really hard to understand, aren't they? It's hard to glean any useful information there, I think. I don't go there anymore.

I humbly offer this opinion. I'm not a doctor and I have no right to give you advice about having surgery. That's too great a responsibility. But you asked for it. I'll send you more detailed, less opinionated information in a direct email. It's long and boring, but you seem to be up to the task of reading it.

Yours,

--
Mark in Seattle

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