adhesion wash during surgery

Did any one have the adhesion wash used during surgery to prevent adhesions? I had temperatures right after surgery (TAH) in the evening and now at 4 weeks post -op am having them again. The doctor said it might be a reaction to the wash. I have never seen a post about this being used on anyone though my doctors say it is not uncommon. I have had problems with adhesions from previous surgeries to deal with endo problems in the past but this is the first time this was ever used on me.

Aslyn, I'm going to bump your post up so others will be sure to see it. I don't have any knowledge of adhesion wash during surgery, but hopefully someone that's heard of it or had it will be along soon.
Take care!

Aslyn,

I had an adhesion wash during my surgery. But I haven't had any problems with fevers. I wish I could help more. Did you ask your doctor about the fevers.


God Bless,
Steph

Yes, I have talked to them, that was the determining factor about what was causing the fevers. But it took some four weeks and me bringing up the possiblity of the wash being the problem. Guess my concern is I was released even with the knowledge I was having these fevers at 2 weeks and was told that I didn't need to be seen until my yearly visit. When I call in it is just more of a waiting game. I feel there is a lack of concern. I do not get anything more than "rest and call us if you need us." I have and just feel very uncomfortable about the whole ordeal because I don't want it to go into some bigger problem when it should have been checked out from the beginning. Sorry to vent my frustrations. If it were not for this site, I do not know what I would have done because I would have been so unprepared and still so during recovery. Just figuredsomeone of the 1,000 + on teh site might have "been there, done that." I might just be that rare bird. thanks for you reply.

Hi aslyn so sorry you're still having some trouble. Do you know if the material used in the wash was called Intergel? Here is a link to information about it:

http://www.jnj.com/news/jnj_news/200...?textOnly=true

If it was Intergel, the info says that it stays in the body for a while after surgery. There are a couple of ladies over on the Road Less Traveled board who have had surgery using Intergel; if you do a search here on Intergel it will pull up their posts.

I'm concerned that you are not getting good response when you call your DR to ask about the fevers. How high is your temperature going? If it's over 101.5 degrees I would definitely make sure you get seen, even if it means going to an ER if your DRs don't seem concerned. Low grade fever, though, can be a response to inflammation and the body's efforts at healing.

Hang in there, sweetie I hope you're doing better soon!

-Linda

Here is some info I have on Post surgical Adhesion reduction:

Reduction of Post Surgical Adhesions:

	Quote:
The prevention of adhesion (scar) formation should be a primary goal of all fertility surgery. Efforts can (and should) be undertaken to reduce postoperative adhesion formation partially by using principles collectively referred to as "microsurgical techniques." When the infertility surgeon recreates a pelvic organ, opens a previously blocked fallopian tube, removes abnormal structures from within the uterine cavity, ablates endometriosis, or lyses existing pelvic adhesions the restoration of normal anatomy and function often depends on minimizing scar tissue secondary to the surgery. very gentle tissue handling (pulling, rubbing and poking the delicate reproductive tissues can result in trauma and adhesion formation), meticulous control of bleeding = hemostasis (whole blood within the pelvis is highly irritating to the peritoneal lining and the inflammation that results can lead to adhesion formation), use of magnification if necessary (for establishing proper tissue planes during dissection and for determining the degree of reapproximation accomplished when tissues are placed together) careful avoidance of infection (administration of antibiotics to prevent reactivation of a dormant infection within say the fallopian tubes, sterile technique in handling the operating instruments) maintaining tissue moisture (irrigation is generally better than sponging, preventing desiccation or drying is important since either leads to adhesion formation) minimal effective coagulation of bleeding sites (over cauterizing results in ischemia and this may enhance adhesion formation) reducing foreign material that is placed intraoperatively (use of small caliber suture material reduces overall bulk, rinsing sterile gloves or similar objects placed intraabdominally removes talc) reducing lateral thermal damage of tissue (lasers, especially ultrapulse and superpulse CO2 lasers, allow application of very high power densities to tissues to accomplish ablation by vaporization with little lateral thermal damage. This is theoretically of great significance) In theory (although not proven in the existing literature) laparoscopy has an advantage over laparotomy in terms of adhesion formation. With laparoscopy, small abdominal incisions are made and ports maintain access while occluding the holes when no instruments are actively being used. When compared to laparotomy, this should result in less infection (since the sites are not open for the duration of the case), less tissue drying (especially for longer duration cases when drying can be tremendous for open laparotomies), and less tissue trauma secondary to rubbing or moving intraabdominal structures with surgical gloves. Additionally, the laparoscope is able to be placed immediately adjacent to the operative site to enhance visualization of structures that are buried in the pelvis and the laparoscope can magnify tissues slightly. The magnification achieved with the laparoscope is proportional to the distance of the lens from the tissue viewed, such that at a distance of 1 cm from tissue the laparoscope typically magnifies the tissue about 6 fold, at 2 cm about 4 fold, at 3 cm about 2 fold, at 4 cm there is no magnification and at distances greater than 4 cm there is a reduction in size of the viewed tissue. Adjuvants are materials that can be used to help prevent adhesion formation. The two primary classes of adjuvants include mechanical barriers and surgical adjuvants. Mechanical barriers include Gore-Tex surgical membranes (that must be sewn into position), Interceed TC-7 (a material placed over raw surfaces), and 32% Dextran 70 (a highly concentrated sugar like solution made up of high molecular weight glucose polymers that draws in water to act as a mechanical barrier between structures). Of these barriers, Interceed seems to be the most commonly used. Literature from several clinical reports support a role for Interceed in adhesion prevention. 32% Dextran 70 (Hyskon) has been popular in the past and is still in use in some centers. Mechanical separation of raw surfaces is associated with the water drawn into the concentrated solution (hydroflotation) and a siliconizing effect (the solution is slick). When 200 cc of 32% Dextran is placed intraperitioneally there is usually some ascites for up to a week, and patients occasionally complain of fluid leaking from the incision sites, labial swelling, bloating and weight gain. Surgical adjuvants include antiinflammatory drugs, anticoagulants, prophylactic antibiotics, calcium channel blockers and plasminogen activators. The antiinflammatory drugs include corticosteroids (intended to decrease vascular permeability and enhance lysosomal stabilization, each of which should limit adhesion formation), antihistamines (intended to decrease vascular permeability and decrease fibroblast proliferation, each of which should limit adhesion formation), and nonsteroidal antiinflammatory agents like motrin (reduces prostaglandin formation to limit adhesion formation). None of these agents has been shown to be beneficial in terms of adhesion formation in large clinical trials but they are often used by physicians whose personal experience with the medications has been favorable. I do not use these agents at this time. Anticoagulants include low dose heparin (about 1-5 units/mL) within irrigation solutions. High doses of heparin should not be used because there is an increased chance of hemorrhagic surgical complications. Low dose heparin has not been shown to be of benefit in terms of adhesion formation in clinical trials. Antibiotics may reduce the incidence of infection when given prophylactically. The goal is to achieve adequate doses at the tissue sites during the surgery. Vibramycin is often used for tubal surgery since it effectively treats Chlamydia. Many of the higher generation cephalosporins also work well for gynecological pelvic surgery. I typically use cefotetan or mefoxin (depending on availability). Calcium channel blockers have been used in hamsters with good results, but human studies are lacking. In theory, these agents decrease tissue ischemia, limit prostaglandins, reduce platelet aggregation, and limit vasoconstriction. The use of these agents is awaiting appropriate human trials. http://www.drdaiter.com/hyst_ecto/hyst3.html

Pelvic manipulation:
http://www.whonamedit.com/syndlist.cfm/51

http://www.pelvicpain.org/pdf/Gyneco~1.pdf

http://www.obgyn.net/english/pubs/fe..._adhesions.ppt

http://www.annexclinic.com/vm.html

Hope this helps Good Luck w/ your recovery..pls let us know how your doing...(((hugs)))

Do adhesions form after vaginal hysterectomies (TVH's) or only after abdominal surgery?

I am curious if anyone else had surgicel used in them. I am almost two years post op and have never heard in here of another person the doc used surgicel on but that is what they put in me to prevent adhesions

((SHARONBATT)),
Unfortunately, yes, Adhesions can form w/ a TVH Even tho you have no exterior scar, there was the same amount of cutting & stitching done internally

((DJYBH)),
I underwent 2 additional surgeries after my TAH in Jan 2000, both for complications from Adhesions. Unfortunately due to the manner in which they where performed, Adhesion prevention was not discussed, so none was used..
At the time of that surgery both my Ovaries were retained but due to the worsening amount of right-sided pain my Gyn did an U/S which revealed a large mass on my right Ovary, along with mulitple blood-filled cysts, it was very enlarged as well. Due to the unknown origin of the mass( it wasnt there 12 weeks prior at the time of my Hyst) he scheduled an RS0/lap to remove the Ovary, which he thot was the source of my pain, & to remove the mass. It turned out to be Adhesions that were adherring it to my vaginal cuff. 8 weeks later I ended up in the ER b/c of the pain, I was also experiencing vomiting & nausea. I had 2 total bowel obstructions that required emergency surgery & a 2 week hospital stay from complications that occured afterwards. My Surgeon stated that I was a mess inside, all my organs were adherred to each other..she had to cut thru all the overlying Adhesions to access the obstructions. I also had a condition known as a malrotation. I was left in greater pain...
I'm left w/ Chronic Pelvic & Abdominal pain due to extensive Adhesions & Nerve Damage. I wish during the last surgery they would've took it upon themselves to use a prevention product but I think b/c of the rush to get me to the OR as soon as problem was found, it just wasnt thot of.

I frequent the forum here The Road Less Traveled, there are several ((Sisters)) there suffering from Adhesions & some of the complications they can cause..many of them have had surgery for Adhesions which some of the different Prevention products were used..here is some more info on Adhesions that will hopefully help in understanding them better...


PELVIC ADHESIONS:

	Quote:
Pelvic adhesions cause many problems for millions of women. From obstructed tubes associated with infertility, to pelvic tenderness, and painful intercourse, to chronic pelvic pain. Curiously, adhesions can be very extensive, yet relatively silent. They may remain silent indefinitely, or long after the causative event, become symptomatic. The causes of adhesions are multiple but basically the tissue irritation that produces the adhesive process arises from an inflammatory event, or from trauma (i.e. post surgical). Examples of an inflammatory event would be a tubal infection from a sexually transmitted disease (e.g. Gonorrhea), a post surgery infection, or appendicitis. Chronic "irritation" of the pelvic tissues from a common disease process such as endometriosis, may also incite adhesions. A very significant proportion of symptomatic pelvic adhesive disease arises from previous necessary pelvic surgery (removal of an ovarian cyst would be a good example). What are "pelvic adhesions" anyway? In the process of trying to repair injured tissue, a series of normal healing events may cause some structures in the pelvis to become unintentionally "stuck" to another tissue or structure. In a normal healthy pelvis (or the whole abdominal cavity for that matter) this large space is lined with a tissue called peritoneum, which also covers the outside of organs located in the abdomen and pelvis. In a non-injured or irritated state, the peritoneum can be likened to slippery cellophane wrap the organs and structures lying immediately adjacent to each other just slip off each other and do not become bonded together. Given a tissue injury, the healing process initiates a sequence of events that can result in a certain tissue becoming "stuck" to its neighbor, and when this happens certain undesirable results occur. The ovary for example is a very sensitive structure, much like the testis. If as a consequence of an ovarian cystectomy, (the removal of the cyst from the ovary) the ovary becomes "attached' to the pelvic sidewall, or the top of the vagina, the patient may experience persistent pelvic pain and/or painful intercourse. The diagnosis is suspected by a history of ovarian surgery, and subsequent persistent pain or tenderness unrelated to her menstrual cycle. After a large abdominal incision (e.g. a hysterectomy for large fibroids) the bowel or an associated fatty structure called the omentum may become adherent to the abdominal wall. Adhesions begin to develop within hours of surgery. If by chance it is a loop of bowel, the patient may experience intermittent bouts of crampy pain, perhaps associated with some nausea, bloating, or even vomiting. The intestinal symptoms are related to some degree of bowel obstruction that inhibits the passage of the bowel contents or gas through the partially obstructed area. When the obstruction is severe then the patient will be very ill with nausea, distention and vomiting, and may not be passing any gas rectally. X-ray studies may confirm the severe obstruction, and treatment may require decompression of the bowel by means of a tube passed through the stomach to the intestine, or even exploratory surgery. More often in my experience, the symptoms are troublesome and annoying, and the obstruction is not severe enough to make any of the X-ray tests informative. Often the patient will be sent to the gastroenterologist, and endoscopoic evaluation of both the upper and lower bowel will be performed. Frequently, the diagnosis is "irritable bowel syndrome". It should be remembered that intra-abdominal and pelvic adhesions rarely if ever show up on X-ray or ultrasound. Unfortunately, every time an abdominal incision is performed, the risk is present for recurrent Adhesion problems. The good news is however that most patients will not develop serious post-operative adhesions causing further problems. Those unfortunate to do so may ultimately undergo repeated surgeries, always hoping that "this will do it!!" Does everybody develop adhesions? No they do not, but it is not understood why one person develops very extensive adhesions, and the next individual none at all. The nature of the traumatic tissue event, the duration of the inflammatory insult, the nature of the preceding surgery, the operative technique of the surgeon, and the unknown healing characteristics of a given individual all interplay in the final outcome. **What can be done to minimize pelvic adhesions from forming? Early treatment of an infectious process if identified, utilization of safe sex practices to minimize the transmission of sexually transmitted disease, meticulous surgical technique to minimize unnecessary tissue trauma, and perhaps using barrier products where appropriate. The latter may be helpful in reducing the extent or severity of the postoperative Adhesion development. What to do if symptomatic adhesions develop, what are the patients options? The first option in any situation is don't do anything. Pain is a relative experience, and the degree of severity will vary from individual to individual. Minor, or even moderately severe discomfort can often be lived with, or controlled by medication, acupuncture, or medical hypnosis. Not infrequently pelvic pain is not helped by conventional treatment such as hormones, pain medicine, or even surgery. In those circumstances, non-conventional treatment with acupuncture or hypnosis can sometimes be very helpful. Given significant symptomatic pelvic adhesions being suspected from the history and physical exam, a thorough workup is indicated, which may include special x-ray studies and ultrasound. Ultimately, laproscopy may be utilized to allow visual inspection of the intra-abdominal organs. What to do surgically depends on the findings. If an ovary is bound down with adhesions from previous surgery, the extent of the adhesive process may indicate a simple cutting of the adhesions or if necessary, removal of the ovary. If the patient has completed her fertility requirements, and if the pelvic adhesive process is very extensive, a complete hysterectomy with removal of both tubes and ovaries may be indicated. Obviously, the patient and her gynecologist need to have had a very comprehensive and detailed discussion about what might be encountered, and what options might be exercised. What about abdominal wall adhesions resulting from prior abdominal surgery? These can usually be taken down laproscopically, thus minimizing tissue injury, as opposed to a conventional large incision. Multiple tiny incisions may be necessary in order for the surgeon to see well, and from different angles the area of dense adhesions. Nonetheless, several tiny 1/2 inch incisions are far less uncomfortable than a conventional laparotomy incision. If the adhesions are extensive, and the patient has undergone previous Adhesion surgery that failed, I have taken an unorthodox approach to such individuals. Because adhesions begin to form almost immediately, along with the healing process involving the raw anterior abdominal wall, I have in special situations recommended a repeat laproscopy in one week. At this point, the "new" adhesions are flimsy, soft, do not contain a blood supply, and can be swept away with minimal tissue injury, compared to a conventional adhesiolysis (freeing the adhesions surgically) of old adhesions that are dense, very adherent, and bloody. This is performed in an outpatient setting, and usually takes but a few minutes, compared to the time involved dealing with extensive, dense old adhesions. It is important that patients inquire about their surgeon's experience with extensive adhesions, because what might be viewed as "not possible laproscopically" by one gynecologist, may be very familiar territory for another. Because bowel may be intimately involved with the adhesive process the patient has to be aware that the worst case scenario may require bowel surgery, and a conventional laparotomy incision. Pelvic adhesions can be a serious detrimental quality of life issue. Some patients are total pelvic cripples because of this problem. Once formed, they do not disappear with time. If you are suffering from some of the medical complaints outlined earlier, do consider a consultation with an experienced laproscopic gynecologist and hopefully your adhesive problems can be solved. "An adhesion is an abnormal fibrous band between adjacent parts or structures of the body. Within the abdominal cavity, adhesions commonly occur between loops of intestine or between the intestine and pelvic organs and the area of the appendix or the gallbladder. They may form following abdominal surgery such as an appendectomy, hysterectomy, and removal of the gallbladder or of a bowel tumor. They also may occur in response to an infection such as appendicitis or inflamed gallbladder that did not lead to surgery. "Most adhesions do not cause symptoms unless they entrap a section of the intestine. Such a complication may obstruct the normal flow of intestinal contents (bowel obstruction) or even impair blood supply to the bowel. Then the symptoms may include cramping abdominal pain, vomiting, inability to pass gas rectally, and bloating. Although intestinal obstruction due to an adhesion may resolve with conservative treatment, if the obstruction does not resolve, or if there is damage to the bowel wall, surgical removal of the involved segment may be required." http://www.alternativemedicine.com/

A DELICATE TOUCH REQUIRED FOR ABDOMINAL SURGERY:

DEAN EDELL, M.D.

	Quote:
"Sometimes an athlete seems to be able to transcend gravity and the physical world. At these moments, basic hand-eye coordination goes beyond sport and becomes almost an art form. The same can be true of a great surgeon whose hands dance through your wounds with all the grace and rhythm of an artist. "But not all surgeons hands are the same, nor all surgical outcomes. A new report says whenever a doctor opens your abdominal cavity you could be at risk for painful surgical adhesions or scar tissue. "This report says up to 90 percent of women having a hysterectomy will get adhesions. And it's not limited to hysterectomies. Men and women undergoing abdominal surgery - everything from C-sections to appendicitis - can get surgical adhesions. "The report says half of all post-surgical patients with chronic abdominal or pelvic pain suffer from them. Adhesions often look like white webs of scar tissue which can surround and bind organs tightly like rubber bands. They are the most common cause of intestinal obstruction, and in many cases, the pain can be excruciating. "But what causes adhesions? Some have suggested powder from surgical gloves irritates abdominal tissues. Others think perhaps cauterization or the sutures that are used to control bleeding are to blame. "But this report says one of the main culprits is rough tissue handling. That's right. We're talking good hands. If your doctor treats your insides like they're making bread, this can contribute to adhesions. "To prevent them, researchers recommend something that may sound a little bit nebulous to you: 'careful surgical technique.' When it comes to surgery, good hands are gentle hands." END NOTE: The researchers say, post-surgical adhesions are the most common cause of intestinal obstructions, accounting for up to three-fourths of all problems. If you are suffering from chronic abdominal pain you might mention any previous surgery to your doctor. Source: Am J Ob & Gyn 170:1396-03 A study claimed that 95% of abdominal surgery produces internal scars--it's just that the majority are not in places that cause problems and pain. Here's what Dr. Andrew Weil says about it-- Abdominal adhesions are the result of internal scar tissue that can develop after abdominal or pelvic surgery and are a frequent cause of chronic abdominal pain in people who have had such operations. Although adhesions are quite common and are the leading cause of obstruction in the small bowel, we still don't know how to prevent or treat them. You might try abdominal manipulation, done by an osteopathic physician or a chiropractor who has experience in this area. Guided imagery may also be helpful. If you're having problems with constipation because of adhesions, you should probably take the bowel regulator Triphala, an Ayurvedic remedy that is available in capsules at health food stores. This combination of three fruits is a much better bowel regulator than laxatives. Follow the dosage recommendations on the label. No one can predict which patients will develop adhesions, or which types of surgery are most likely to cause them, but a recent study from Scotland found that nearly six percent of hospital readmissions could be blamed on them. They also found that nearly 35 percent of all the patients who had abdominal or pelvic surgery were readmitted -- on an average of twice in a 10-year period -- because of adhesions. Another study found the link between adhesions and bowel obstruction a bigger problem than previously believed: Of the 18,912 Medicare patients who had some type of abdominal surgery at the Ochsner Clinic in New Orleans, about 46 percent developed obstructions requiring treatment, which usually led to more surgery. Scientific studies have shown that you're less likely to develop adhesions following laparoscopic surgery, which requires only a very small incision and uses a tiny "scope" for doctors to see what they're doing. However, even this type of operation doesn't eliminate the risk. To make matters worse, problems related to internal scarring can develop years after an otherwise successful surgery. If you do get another adhesion, you will need more surgery -- and unfortunately, any kind of abdominal surgery increases your risk of developing more troublesome scarring. So you can find yourself caught in a vicious circle of requiring surgery to eliminate adhesions but risking more adhesions with each additional procedure. If you're lucky it's not a lot of adhesion and it's not around something important--then it causes no pain. Apparently the more skilled your surgeon, the less they handle things, the less inflammation (rest rest rest) the better off you are. Other than that, they don't know a lot. So, the lap I think has like a 50/50 chance of working from what I've read. But if there's a lot of pain, those might sound like good odds. trish tah/bso 7/12/99, cancer of the stroma http://www.hystersisters.com/vb2/sho...threadid=24207 http://wsg.myriad-development.com/t...esioncauses.asp

Good Luck to both of you....
((hugs))

Hi there,

I had surgery on 3/24/03 and had extensive adhesions removed. My DR. used DYNAGEL if I spelled that right. She said it has the consistency of "motor oil" and helped to keep everthing free floating while healing.
As I am only less than two months post-op and getting ready for more surgery only time will tell with me. I have had no troublesome reactions to it though.
Sorry I couldn't be more help.

Blessings,
Sherri