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Adhesions again, surgery or not is the question Adhesions again, surgery or not is the question

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  #1  
Unread 09-22-2003, 11:06 AM
Adhesions again, surgery or not is the question

I had a TAh 3 1/2 years ago for endo. Since then I've had 2 lapraoscopies and 1 lapraotomy for reoccuring endo and severe adhesions. I had my last lap in August where he found adhesions all over my bowel and bladder. I have since been put on Femara for the Endo and will find out next week whether I will have another lapraotomy. It really is my only option. At least that is the way it looks right not. Just wondering if anyone else has been where I am now and what did they do?
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  #2  
Unread 09-22-2003, 12:25 PM
Adhesions again, surgery or not is the question

what is femara?? what is it supposed to do? do you still have ovaries? (sorry for all the questions!)

I have had recurring adhesions, and I had endo prior to my hyst....they have only found minimal amounts since but I believe there is more in there somewhere that just hasn't been located.

I did have two laparoscopies where they cut and released adhesions but did not put in any barrier afterwards.....my pain always returned (mine were on my sigmoid colon and somewhere else can't think of it offhand for some reason).

Finally I ended up seeing a general surgeon who operated in an open setting, cut the adhesions (but did not remove them I never understand that) and put in some Intergel afterwards.......since then the pain from those adhesions and the pain I had in the right end of my incision has not returned .....unless I lift something heavy in which case my incision does act up.....but nothing like before that surgery...prior to that I felt like I was walking around with a knife stuck in my groin all the time and having a bowel movement just about had me passing out from the pain!

so it would seem that it was a success (so far) for me, it's been a year this week......having said that there are some questions where Intergel is concerned now, apparently it's been pulled off the market...whether that was the magic bullet or them just having better access in an open setting or the general surgeon's expertise, I guess I"ll never know....

..dealing with the endo on top of that I don't know what to suggest all I can do is tell you my experience....I know every surgery takes abit more out of me, but given the relief I've gotten, in my case it was worth it....best of luck, let us know what you decide and think hard before proceeding.....it's a matter of can you live with how you are now...and what your doc suggests! 's!!!
  #3  
Unread 09-22-2003, 01:56 PM
Adhesions again, surgery or not is the question

I have had problems with endo too. It can be a tough thing to beat.

I was recently told that my left ovary may need to come out... not because it is a problem in itself but because it is potentially feeding more endo. THere is a much lower chance of the endo coming back if you no longer have ovaries even if you take HRT... however, it can still return even with or without the HRT but the chances are less.

It seems that something for you to consider is the risk of further surgery over and over again for endo/adhesions vs having the ovaries out and those affects BUT possibly having no further endo or much less. It is a hard choice and one I may have to address in the near future.

That said, I have had a little trouble with adhesions but my surgeon always used Interceed. It seemed to have worked well for the most part at avoiding more adhesions.

Sararh
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  #4  
Unread 09-23-2003, 03:36 PM
(((( Meliss99))))

Two websites to check out are adhesions.org, and bombobeach.com . There is alot of information and support on those sites for adhesions. I had a laparoscopy in April of this year to release adhesions, and I am scheduled for another one in November, this time using Interceed. I am hopeful that I will gain some progress over this pain. But only time will tell, and Sarah's post gives me some hopel... More surgery, especially laparotomy brings on a higher risk of adhesion development. But sometimes we are faced with that decision and you have to do what you feel is best for you... Just do some homework, so you know fully what will be happening and the risks...

Good Luck
  #5  
Unread 09-24-2003, 10:49 PM
Adhesions again, surgery or not is the question

((melis99)),
I'm soo sorry to hear you are struggling w/ continuing pain & problems despite numerous surgical attempts at *fixing the problem*
Since my Hyst in Jan 03, I have suffered, an often, severe pain (s) mine is also from extensive Scar Tissue. I underwent an RSO/Lap, at 12 weeks post-op, to remove & DX a large mass that appeared on my Ovary during an U/S that was performed for worsening pain. The mass turned out to be Scar Tissue adherring my Ovary to my vaginal cuff. Unfortunately, the pain only worsened:-( About 6 weeks later, I was admitted thru the ER for emergency surgery to remove Adhesions that were strangulating my Bowels in 2 places I was also dx's w/ a Malrotation. I wound up in the hospital for 2 weeks due to my igestive system refusing to start working. It was one complication after another & only resulted in more pain. Refusing to accept a life of pain, I sought out opinions of several Specialists & Surgeons, all who agreed * no more surgery unless it was life threatening. The Scarring & damage left from previo surgeries had left me in a much higher risk group for further complications, more pain & more damage. I was referred to a Pain Dr, one that I still see. Although I still have pain, it's not the first & foremost on my mind 24/7:-)

Adhesions & surgery to remove them can sometimes become a viciou cycle of pain=surgery=more pain=more surgery & on & on. I have learned thru my yrs of pain & struggles that by educatig myself on my DX, symptoms, viable treatment options ect.....That I am able to make more educated, well researched decisions . Afterall is is our bodies & only we must live w/ the outcomes.
Even w/all of odays advancements in technlogy, they are yet to create an Prevention peoduct that carries any high succss rate. A well versed, very skilled surgeon is a must. Learn all you can then take that info to mind & heart...only you can decide what is best for you...

  Quote:
The only way to treat adhesions is to remove or separate them surgically. This procedure is called adhesiolysis. Studies have shown that patients with pelvic pain and severe adhesions can experience a marked reduction in symptoms after adhesiolysis.

Meticulous surgical technique:

Careful surgical technique can help minimize trauma, minimize the interference with the blood supply, prevent the introduction of foreign bodies, minimize bleeding, lessen the incidence of raw surfaces and decrease the incidence of infection - all of which help reduce adhesion formation.

Although adhesions often form after gynecologic surgery, they are not inevitable. And, even if adhesions do form, they usually don’t cause pain or other problems.

Although there is no way to eliminate the risk of adhesions completely, there are steps your surgeon can take to reduce the likelihood of adhesion formation. The most effective methods of adhesion prevention involve meticulous surgical technique and the use of a physical barrier to separate tissue surfaces while they heal.

Surgeons have developed minimally invasive techniques such as the laparoscopy, that are designed to minimize trauma, blood loss, infection, and the introduction of foreign bodies, all of which can lead to inflammation and adhesion formation. Good surgical technique involves minimizing tissue handling, using delicate instruments, and keeping the tissues moist when they are exposed to the air.

While good surgical technique is important, it is often not sufficient to prevent adhesions. There are also other preventive steps that can be taken: http://www.ethiconinc.com/womens_hea...oduct/faq.html
  Quote:
"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 laparoscopy 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.
http://medseek.com/glennbradley/newsdetail.cfm?ref=264
www.Adhesions.com
http://www.dyspareunia.org/html/pelv...revention_.htm
http://www.dyspareunia.org/html/pelvic_adhesions.htm

Adhesion Prevention Home Page:
http://www.adhesions.com/welcome_main.html

Proven Adhesion Prevention:
http://www.genzymebiosurgery.com/opa...vel=2&opage=66

http://www.ethiconinc.com/womens_hea...oduct/faq.html
[/quote]


Welcome to SPRAYGEL :: Adhesion Barrier: http://www.confluentsurgical.com/spraygel/usa_home.htmA Meta-analysis of Interceed Barrier Safety/Efficacy:
http://www.adhesions.com/clinical_studies.html

Interceed:
http://www.ethiconinc.com/womens_hea...interceed.html
Contemporary Adhesion Prevention:
http://www.centerforendo.com/news/ad.../adhesions.htm

GYNECARE INTERGEL® Adhesion Prevention Solution:
http://www.fda.gov/cdrh/pdf/p990015.html

Seprafilm surgical intestinal adhesion prevention: http://www.gbcrs.org/seprafi.html

CO2 laser, Harmonic Scalpel, Electrosurgery, LAP Surgery:ADHESIOLYSIS:
http://www.endogyn.com/en/endogyn-en.htm

ANTI-Adhesion treatment for Gynecologic surgery:
http://www.fda.gov/bbs/topics/ANSWER.../ANS01117.html

Gynecare Intergel:
http://www.ethiconinc.com/womens_hea.../intergel.html

http://www.drdaiter.com/hyst_ecto/hyst3.html

2nd look Lap:
http://www.reproductivecenter.com/m...aparoscopy.html

ABDOMINAL ADHESIONS:
[i]by John N. Withers MD [/]
When small scars result from nature healing the nicks and scrapes of our skin, we rarely complain about the resulting scar tissue. However this same healing process inside the abdomen, following an operation, can result in adhesions (internal scars) which can have troublesome side effects.

Many people know about or have experienced "adhesions in the belly" but what are they? Why do they occur?

What kinds of troubles do they cause? Adhesions are essentially scar formations within the abdomen and are nature's way of controlling infections, foreign bodies or intestinal injuries. Mother Nature had been at this job for hundreds of thousands of years before physicians came on the scene, and it was only those cave men (and cave women) who were able to form adhesions who survived and passed this natural ability on to their children.Adhesions develop following any operation in the abdomen. Surgeries, such as those on the appendix, stomach, intestine or uterus, will produce adhesions as the body heals inside. Surgeons try to be very gentle with the inside organs as well as washing the blood, bile and other materials from the cavity, yet adhesions still form. Other than surgery there are assorted causes of adhesion formation. Some adhesions, such as those formed by perforated ulcers, appendicitis and infections in women's fallopian tubes, can be reduced through early recognition and treatment. If adhesions are a natural healing process, why worry about them? Abdominal adhesions are like banjo strings stretching between the intestines or from the front of the abdomen to the back. The intestine can wrap itself around the adhesion blocking that portion of the bowel and preventing the food from passing through. This condition is called "intestinal obstruction." The obstructed portion of bowel will become larger and larger until a perforation or rupture of the bowel occurs with resultant infection, shock and death. What are the symptoms of intestinal obstruction? The patient will experience nausea, then abdominal pain, and finally vomiting. The vomiting may occur in waves, being quiet for a while and then recurring like a storm. Everyone has experienced intestinal flu with these identical symptoms, but that does not indicate intestinal obstruction. However, if you have had abdominal surgery and the intense cramping and vomiting persists for more than an hour, then it is possible that an intestinal obstruction has developed. You should see your physician immediately. Nature has been marvelous in protecting the human body with its healing processes but, perhaps the next time the body is designed, a little more time could be spent on preventing intestinal adhesions.
_</BLOCKQUOTE></BLOCKQUOTE>
http://www.laplatamedicalsociety.com...bdomadhes.html

ADVANCES IN LAPAROSCOPIC SURGERY LAPAROSCOPIC LYSIS OF ADHESIONS

Postoperative adhesions are the primary cause of occlusion of the small bowel. We evaluated the feasibility and the immediate postoperative resultsof laparoscopic procedures for acute adhesions on the small bowel. BetweenSeptember 1992 and March 1995, we performed laparoscopic procedures in 35patients with acute occlusion of the small bowel. The preoperative work-up highly suggestive of adhesion. There were 17 males and 18 females, mean age 48.2 years. In 30 patients, the operation confirmed the preoperative diagnosis of occlusion by adhesions. Lysis was performed entirely via the laparoscopic route in 21 of the 30 patients (70%). Immediate postoperative complications were 3 bowel lesions. Intestinal mobility was re-established in 1.8 days after operation and the mean duration of hospitalization was 5days for patients with laparoscopic procedure alone compared with 3.4 daysfor intestinal mobility and 10.4 days hospitalization for the 9 patients who were converted to laparotomy. An eventration of the trocar orifice occurred late in one patient and ischaemic stenosis of the bowel required laparotomy in another. There were no deaths. Laparoscopic treatment of adhesion occlusions is a feasible operation. Morbidity is low in experienced hands.The immediate benefit is rapid intestinal mobility and shorter hospital stay. ===========================================================

Benoist S, De Watteville JC, Gayral F[Role of celioscopy in acute obstructions of the small intestine
Service de Chirurgie Generale et Digestive, CHU de Bicetre, LeKremlin-Bicetre.
Gastroenterol Clin Biol 1996;20(4):357-61

SUMMARY:OBJECTIVES--The aim of this study was to evaluate the possibilities oflaparoscopy in the diagnosis and treatment of acute small bowel obstruction.METHODS--Thirty five patients, with less than three abdominal incisions, whohad undergone initial laparoscopy for acute small bowel obstruction, werereviewed. The small bowel was mobilized to determine the cause and site ofobstruction. RESULTS--In 31 cases, small bowel obstruction was caused by asingle or numerous obstructing bands. Among 31 cases of adhesions,laparoscopic treatment of intestinal obstruction was possible in 16 cases(51.6%). In 15 cases, laparoscopy had to be completed by laparotomy:numerous adhesions could not be divided in 12 cases; intestinal ischemiawhich required resection was present in 3 cases. There was no hospitalmortality and postoperative complications occurred in 19% of cases

CONCLUSIONS--Laparoscopic treatment ofacute small bowel obstruction is difficult and was possible in only half ofthe cases. The first port should be inserted by open technique to avoid therisk of perforation of distented small bowel. When laparoscopy showsnumerous adhesions, laparoscopic treatment should not be pursued, andlaparotomy should be recommended to avoid the risk of visceral perforation.


SUMMARY:This trial set out to test the hypothesis that there is no difference in the incidence of intra-abdominal adhesions after a stereotyped intraperitoneal injury created via laparoscopy or laparotomy. Twenty New Zealand Whiterabbits had a 2 x 2 cm area of peritoneum stripped off their caecum andadjacent parietal peritoneum, either by laparotomy or laparoscopy. Outcome was assessed by the incidence of adhesions to the test site and the wound.There was no difference in the rate of adhesions at the test site in the two groups. The rate of adhesions to the wound was different in the two groups(70% laparotomy, 0% laparoscopy; P = 0.003). In a rabbit model, comparing laparoscopy and laparotomy in a strictly controlled operative environment, a stereotyped intraperitoneal injury results in similar rates of postoperativeadhesions. Laparoscopy is, however, associated with a much lower incidence of wound adhesion. The potential for postoperative adhesions is real after laparoscopic surgery.===========================================================================
www.foxhall.com/adhesions.htm

[/quote]

Good Luck w/ everything I hope you are able to find some answers & relief soon....(((((((hugs)))))))))
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