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Adhesion Alternative Relief Methods? Adhesion Alternative Relief Methods?

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  #1  
Unread 04-09-2003, 09:44 PM
Adhesion Alternative Relief Methods?

I know we have lots of info on our site referencing adhesions and alternative solutions.

My question to the ladies here on the road is what alternative have you used that have been successful or somewhat successful etc?

I have been researching Soft Tissue Management and made an appt with a Chiro in our area certified in Active Release Techniques. I have never been to a Chiropractor before so I was curious as to others opinions on the effectiveness or concerns they might have.

Also, has anyone had any success with other types of Physical Therapy, Acpuncture,etc. Any info would be great to add to my list of options and other's experiences.

Hugs to all,
lenee
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  #2  
Unread 04-09-2003, 10:52 PM
Adhesion Alternative Relief Methods?

Hmm, (((Darlene))), I will be following this thread to see what info you come up with. The DR who did my recent surgery did not want to use any adhesion barriers. He told me that I might initially feel small amounts of pulling inside as I heal and scar tissue 'tries' to form, but that I should keep moving around and gradually it should go away. So, I'm interested to hear what you find out about physical methods of reducing adhesions.
s,
-Linda
  #3  
Unread 04-10-2003, 02:37 AM
Adhesion Alternative Relief Methods?

I'll be following this one with interest too!

Good question Lenee, thanks for posting it. I have had chiro for back pain in tha past and was impressed with results, had not thought of it for adhesions.

I posted about this to someone else recently so you may have seen it, so sorry if I am repeating - my Mum has a fabulous (& gorgeous ) osteopath,

this is what she emailed me -

"Saw the lovely Hans this morning so that he could loosen my neck a little. In general wide ranging discussion of medical matters the subject of your ops and pains came up, Stephanie. He said you should find yourself a good osteopath who is trained in cranial and visceral osteopathy because they can help a great deal. For the benefit of anyone else as ignorant as me, visceral means relating to the organs. He finds it very distressing that so many people suffer great pain from scar tissue and adhesions and he treats several people with good results."

Have not gone that route yet myself as I think maybe its early and I need a bit more healing time - maybe not?

To be honest I am not too sure the difference between osteo and chiro - something else to search the web for LOL.

Surferbabe you just made me feel a lot better by saying what yr doc said about feeling pains - mine told me nothing at all - seemed to expect me to feel fine when he took stitches out at 5 days. I DO feel a lot of pulling (5 weeks tomorrow from lap for oopherectomy/adhesions) and hope they are what yr doc said.

Good luck to both, see you back in this thread later

Steph xxx
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  #4  
Unread 04-10-2003, 07:18 AM
Adhesion Alternative Relief Methods?

((((Darlene)))),
I've tried various methods to help w/ zero success..there are some newer techniques available Any of which I personally would at least attemp b/c of them being non-invasive. Here is some info I have that might be of help to each of you

  Quote:
apply firmer frictions to reduce adhesions:
http://www.sportsinjuryclinic.net/cy...ts_massage.php

Massage Therapy:

http://www.back2health4you.com/mt.html

http://www.powerup.com.au/~centaur/alison/massage.htm

http://www.margossalon.com/cynthia/faq.htm

  Quote:
Techniques are used to decrease adhesions by avoiding damage to the blood vessel, drying, use of sutures, crushing with instruments, drying and infection._ These techniques can include laparoscopy that uses air to move tissue, fluid solutions to keep tissues wet and antibiotics to avoid infection.Specialized material is often used at surgery to keep the tissue edges apart._ Permanent patches such as Gor-Tex® can be used when the two areas do not need to touch._ An example of this is the area between the ovary and lateral sidewall._ However, this will not work between the tube and ovary because that would stop egg transport._ In this area, a material such as Interceed® can be used in a temporary fashion._ Interceed® dissolves over time but slows adhesions while it is still present._ Fluid solutions are also used which contain various components to help decrease the chance of adhesions._ All of these have some data to support them but none have uniform support by testing.Laparoscopy (belly-button surgery) is used to decrease the chance of getting new adhesions when compared to laparotomy (open surgery)._ However, both of these have about the same chance of having of old adhesions._Lasers at laparoscopy were originally felt to add to this to a greater extent but the major advantage of lasers was that they were used at laparoscopy._ Equipment other than lasers have the same effect.
http://www.danmartinmd.com/adhesions.htm
http://www.wordplay.org/endometriosi...dhesions.shtml

Muscle Energy Technique:
http://www.geocities.com/satmassage/whatido.htm

Active Release Techniques:
http://www.getbacktohealth.com/about_the_clinic.html

Extended Muscle Stimulation:
http://users.moscow.com/araymer/therapies.html

Contemporary Adhesion Prevention:

  Quote:
.Many people have re-examined what we know about peritoneal repair. Several studies have shown conclusively that microsurgical techniques alone cannot prevent adhesion formation. In six studies from 1982 to 1987, from 55 to 100% of patients had pelvic adhesions at second-look surgery.

In addition to causing pain, adhesions are expensive. Costs include subsequent surgeries to free adhesions, doctor visits, pain medication and millions of dollars in lost work time.

A fairly recent approach to adhesion formation has been the use of a physical barrier, such as Interceed. In order to understand this approach, it is first necessary to understand how the peritoneum heals.

In 1919, it was shown that peritoneum heals differently from skin. If you scrape your knee, healing occurs from the outside edges. Gradually, the raw spot in the center becomes smaller as the skin regenerates. In the peritoneum, islands of regenerated peritoneum occur over the entire surface at once. This means that large peritoneal wounds heal as quickly as small ones.

How long does it take?
Most investigators agree that regeneration is complete within three to eight days.

COLOR=purple]Inflammation[/color]
Inflammation is an integral part of post-surgical repair. A major challenge in identifying drugs and physical barriers is the requirement that they do not further inflame an already inflamed area.

How Adhesions Are Formed:

Typically, adhesions begin with a fibrin matrix that occurs during coagulation._ Over the next few days (in the rat model) a variety of cellular elements become encased in fibrin matrix, which are gradually replaced by vascular granulation tissue containing macrophages, fibroblasts and giant cells._ By four days post-injury, most of the fibrin is gone and more fibroblasts and collagen are present. Through days five through ten, fibroblasts align within the adhesion. At two weeks, the relatively few cells present are predominantly fibroblasts. At one to two months, the collagen fibrils organize into discrete bundles.

Eventually, the adhesion matures into a fibrous band, often holding small calcifications. Extensive adhesions often contain blood vessels.

Historical Approaches to Adhesion Prevention
Most studies that looked at using corticosteroid drugs to help prevent adhesions reported little success. The pharmacologic properties of corticosteriods (they are anti-inflammatories) suggests they would be helpful in adhesion prevention. Why is this not the case? One possibility is that peritoneal surgery simply overwhelms the therapeutic benefits of the dose. If a higher dose is used, the effects on other organs (immunosuppression and delayed wound healing) outweighs any positive benefit.

NSAIDs:

Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of drugs that ease the post-surgical inflammatory response. Some studies have shown a marked reduction in adhesion formation in animal models when the drug was given peri-operatively. Another study showed that two doses of Ibuprofen post-operatively did not help, but a five-dose barrage did. When the NSAIDs were administered intraperitoneally, adhesions reduction resulted.

Areas devascularized by surgery are hypoxic, thus permitting fibrin persistence and adhesion formation. Devascularized sites are prime adhesion candidates. However, these sites are not readily available to drugs given systemically. Perhaps another method of drug delivery would help.


Dextran:

Dextran is a water-soluble glucose polymer originally used as a plasma expander. The weight most often considered in adhesion studies is a 32% solution of dextran 70 suspended in glucose. Hyskon is the best known brand name. Hyskon is slowly absorbed in five to seven days. Hyskon draws fluid equal to 2-1/2 to 3 times the original volume into the pelvis.

Animal studies were split. Some found that using Hyskon reduced the number and severity of adhesions. Other studies did not show positive results.

In people, Hyskon studies were also mixed. Some found that patients treated with Hyskon had fewer and less severe adhesions than patients treated with saline (Ringer's lactate). Other studies found no differences between treatments.

Hyskon carries with it side effects that include temporary weight gain, vulvar edema, leg edema, pleural effusion, and coagulopathy. Rarely, a patient may be allergic to it.


Barrier Agents:

Barrier agents include mechanical barriers and viscous solutions. Many different mechanical barriers have been tried, but they are generally inadequate because they interfere with the blood supply or produce_ foreign body reaction. However, there are some exceptions.

Ideally, a barrier agent for adhesion prevention should be non-reactive, maintain itself during the critical stages of peritoneum regeneration, and then be absorbed by the body. Oxidized regenerated cellulose (Surgicel and Interceed) appear to satisfy these criteria. In addition, they do not support bacterial growth.

The first surgical studies were done with Surgicel. A few days after placement with sutures, Surgicel changes to a gelatinous mass and is absorbed. Some animal studies were very promising, but others were not. Surgicel was altered by its manufacturer with some positive studies then resulting.


Interceed:

Interceed is a newer product of the same type. It was designed to last longer in the pelvis than Surgicel. In addition, it didn't require sutures, if the pelvis were kept very dry. Animal studies yielded mixed results.

Early clinical studies were very positive, and Interceed was approved by the FDA in 1989 as the first product specifically indicated for reduction of postsurgical adhesions. Many studies since then have shown that the proper use of Interceed is useful in reducing formation of adhesions after surgery.

Gore-Tex:

Gore-Tex has also been tested for adhesion prevention. Unlike Interceed and Surgicel, Gore-Tex is not absorbed by the body and must be anchored in place. It is used in heart surgery. However, its use in gynecological procedures is far from certain. A comparison study of Interceed and Gore-Tex showed that both reduced adhesions, although Interceed performed better.


Peritoneal Closure:

Studies have shown that it is not necessary to suture the peritoneum to help it heal after surgery. Indeed, two studies showed that using stitches made the adhesions worse. Therefore, it is better to leave the peritoneum unsutured after surgery. It will heal satisfactorily on its own.


Crystalloid Solution:

The most common method used to try to prevent adhesion formation after surgery is to use a crystalloid solution. The best known are Ringer's and plain saline. However, several studies have shown that these solutions do not help prevent adhesion formation. The most common amount of solution used is 200mL. This is absorbed by the body in about six hours. Peritoneal repair takes many more hours. Adding more solution isn't the answer, either. Five thousand mL of solution takes about five days to absorb. However, such a large amount may reduce the body's ability to fight infection.


Laparoscopy:

Although many clinicians assume that laparoscopic surgery will reduce post-operative adhesion formation, the data is not compelling. However, de novo adhesion formation was substantially reduced by laparoscopic surgery.


Further Developments:

Much progress has been made. Use of barrier methods, however, is limited to surgical situations where the area in question can be completely covered. In addition, Gore-Tex needs to be anchored, and Interceed requires hemostasis and removal of excess peritoneal fluid.

The development of new aids to prevent postsurgical adhesion formation is encumbered by the way the peritoneum heals, access to the peritoneal cavity, limitations of animal models, and the complexities of interperitoneal circulation and transperitoneal transport.


Important Questions Remain:
  • Why do some patients form adhesions after trauma while others do not?

    What are the differences between adhesion reformation and de novo adhesions?

    What are the different potential for adhesion formation due to general surgery, endometriosis, cancer, infection and ovulation?

A direct cause-and-effect relationship between adhesions prevention and outcome measures is difficult to establish. Screening of potential tools is time consuming and expensive. For a company to invest in this therapeutic area only to find a disparity between preclinical animal results and clinical trials is disappointing and costly. Soon, regulatory agencies must set guidelines of "effectiveness" and delineate clinical settings for definitive evaluation of usefulness.

To date, no treatment has proven uniformly effective in preventing postoperative adhesions formation. Surgical techniques that preserve good blood flow as well as the use of mechanical barriers, provide clinical benefits to the patient today.

Dr. diZerega's article is thorough and objective. His expertise in this area is evidenced by his huge list of publications. I am very impressed by his work. And, as he makes clear, pelvic adhesions can cause terrible problems.I'll spend the rest of this space explaining what I do here at the Center for Endometriosis Care to minimize adhesion formation.In my opinion, the single most important thing I do to lessen the chance for adhesion formation is our thorough, painstakingly meticulous approach to the surgery. That approach includes the following items:

I aim for complete hemostasis. This means I accept absolutely no bleeding or oozing from any surface area.
I handle all tissues with atraumatic instruments so there is no crushing of tissues.
Because all abnormal tissue is excised instead of_ laser ablated, fulguration or cautery, I minimize the amount of devitalized tissue left behind. This greatly reduces adhesion formation.
Bleeding vessels that cannot be controlled with the laser are bipolar cauterized intermittently to minimize heat accumulation.
If an ovarian capsule that has been opened to remove endometriosis does not naturally fall into an opposed position, I suture it closed to lessen the exposed raw surface.
I do float the pelvic tissues with saline at the end of the procedure.
When I think it will be advantageous, I use Interceed on the uterus or ovary.
I acknowledge Dr. diZerega's report that a published study that proves laser dissection creates fewer adhesions has not yet been seen. However, it has been my experience that laser dissection can cause less tissue trauma and less heat-related injury, if it is used according to the principles outlined above. Any technique is only as good or bad as the surgeon using it, which helps explain the wide disparity of results at the hands of different surgeons who use similar techniques.At the Center for Endometriosis Care, the majority of our problems with adhesions have come from our stage III and IV patients. We routinely remove all adhesions we see when we operate on a patient. Because endometriosis can hide beneath adhesions, it is vital to completely excise the scar tissue to be certain no endometriosis is left behind.

Occasionally, I will perform a second surgery on a patient I have operated on before. Should those cases reveal adhesions, it is usually a straightforward process to cut through them with the laser and remove the source of pain. If all the endometriosis was removed at the first surgery, the resulting adhesions were formed post-operatively. Without deep dissection or endometriosis to cause re-formation, I feel the chance for de novo adhesions is minimal. This lets us safely cut through them, restoring the anatomy to normal and relieving any ongoing pain._
http://www.centerforendo.com/news/ad.../adhesions.htm
http://www.angelfire.com/on/endometriosis/lapscope.html

What treatments are available:

  Quote:
They are barriers that protect tissue.

What is there function?
_
Hopefully to prevent Adhesions reforming.

How successful are they?
_
It is unlikely that any one product will prevent Adhesions in all situations.
_
When will they be available?
_
They are available at the moment, but are still limited for a variety of reasons.
_
Why are they still limited?
_
They have not been rigorously tested on patients with severe Adhesions.

What can be done to aid Adhesion prevention?

A great deal of effort has been dedicated to reduce Adhesion formation. A number of steps can be taken to minimize the risk of Adhesions, including good surgical technique.Techniques to prevent or reduce Adhesion formation these include - Gental use of tissue handling - Use of delicate instruments/microsurgical techniques - Constant irrigation - Meticulous hemostasis - Removal of all foreign materials - Suturing without significant tension - Mecanical barriers to separate raw surfaces.

Surgeons are developing microsurgical techniques that minamize trauma, ischemia, foreign bodies, hemorrhage, raw surfaces and infection to help reduce Adhesion formation.

Trauma -
Trauma is frequently a major contributor to the formation of Adhesions. It has been shown that Adhesions that form after surgery are a result of the body's normal healing process. Adhesions frequently develop during the first three to five days after surgery.Ischemia - Ischemia During surgery, blood flow often must be disrupted by cutting, coagulation or tying of sutures. This disruption can result in ischemia, or lack of blood supply. This can also lead to inflammation and cause Adhesions formation.Foreign bodies - Foreign bodies can also cause an inflammatory reaction in the body. A foreign body can be suture material, lint from sponges, or talc from surgical gloves. Local cells respond to the foreign body by releasing factors that incite an inflammatory reaction which may result in Adhesion formation.

Hemorrhage -
hemorrhage brings blood products into the operating field. The raw surfaces from the operation plus the blood from tissues can enhance the formation of Adhesions. Infection - Infection from a variety of sources, endometriosis or pelvic inflammatory disease can cause inflammation, which can result in Adhesion formation.
Chemical Methods
Various drugs have been evaluated in an effort to reduce the post-operative incidence of Adhesions. To date, no well-controlled study has documented the efficacy of these drugs. Barrier Methods - The use of a barrier between raw tissue surfaces appears to be one of the most promising methods of Adhesion prevention. Barriers mechanically separate the surgical surfaces and keep those surfaces apart. The ideal barrier method for Adhesion prevention should be safe and proven effective - easy to use in both laparascopic procedures and laparotomy - absorbibal - non inflamitory - should not require sutures - does not potentiate infection - should not interfere with wound healing.Adhesion Barriers
For over 100 years, surgeons have tried to use drugs and other materials to prevent Adhesions from occurring or recurring with little success. Such materials have included animal membranes, gold foils, mineral oil, silk, rubber and Teflon sheets and even the amniotic membranes (membranes which surround an unborn baby). These materials are placed at or near the site of surgery, rather like a wound dressing. Other exotic treatments have included ingesting iron filings and then moving a magnet around on the abdomen to keep the bowel moving and prevent it from sticking. When the tissue has healed, there is no longer a danger of forming Adhesions. Recently, scientists have been successful in developing effective absorbable Adhesion barriers that protect tissue and dissolve when they are no longer needed. To date, the only products specifically approved by Food and Drug Administration for use in humans are Interceed barrier made by Johnson & Johnson, Seprafilm made by Genzyme Corporation. Interceed barrier has been shown to be efficacious in gynaecological surgery and Seprafilm in certain types of gynaecological and general surgery. However, the use of Interceed and Seprafilm is still limited for a variety of reasons. They do not prevent Adhesions every time. Furthermore, neither product has been rigorously tested on patients with severe recurrent Adhesions.Another product produced is Preclude made by W L Gore, is made of Gore-Tex a version of Teflon. It has not been specifically approved to reduce Adhesions although some doctors use it for this purpose. It does not dissolve in the body and many doctors like to perform a subsequent surgery to remove it. Today many surgeons still instil large volumes of crystalloid, or salt (saline) solutions into the abdomen in the belief that these alone will reduce Adhesions. This premise is not supported by clinical data.Other products are currently undergoing clinical testing such as Adcon P (Gliatech). Repel and Resolve (Life Medical Sciences) and Intergel (formerly Lubricoat) (Life Core Biomedical). These products should be available in the year 2000.It is important to note that whatever product is used, it must be combined with good surgical technique in which the surgeon handles tissues as delicately as possible, attempting to avoid further trauma (damage) to them. Powder free gloves should be worn at all times. (No longer used)It is unlikely that any one product will completely prevent Adhesions in all situations. There thus remains a need for an improved product that works in a variety of surgical situations and works on a greater no of patients. The value of an absorbable Adhesion barrierThe value of an absorbable Adhesion barrier, Interceed, in the prevention of Adhesions Reformation following microsurgical adhesiolysis.
Department of Obstetrics and Gynaecology, Jessop Hospital for Women, Sheffield, UK.Objective: To determine whether Interceed, an absorbable Adhesion barrier, confers any additional benefit over conventional microsurgery, including the use of an adjuvant (hydrocortisone), in the prevention of Adhesion reformation after pelvic microsurgery. Design: A prospective, randomised, controlled study. Setting: Jessop Hospital for Women, Sheffield, UK. Subjects: Twenty-eight women who underwent pelvic microsurgery for infertility or for chronic pelvic pain and who had bilateral pelvic Adhesions and deperitonealised areas following adhesiolysis. Interventions: Following microsurgical adhesiolysis, one side of the pelvis was randomised to have its deperitonealised areas covered with Interceed, whereas the contra lateral side served as the control. A second look laparoscopy was carried out 3 to 14 weeks after microsurgery to evaluate Adhesion reformation. Main outcome measure: The amount of Adhesion reformation at second look laparoscopy compared with the amount of deperitonealised area exposed following microsurgical adhesiolysis. Results: The use of Interceed resulted in a significant reduction of Adhesion reformation over and above that achieved by conventional microsurgical techniques with hydrocortisone as an adjuvant. Conclusion: Interceed, an absorbable Adhesion barrier, is of value in the prevention of adhesion reformation and may be used in conjunction with hydrocortisone instilled intraperitoneally at the conclusion of microsurgery.

http://www.adhesions.org.uk/barriers.html
Adhesions, the Silent Growths:
  Quote:
One of the complications of multiple surgeries for endometriosis is the formation of scar bands or adhesions. These are not endometrial growths, but scar tissue due to the removal of old endometrial growths during surgery. Adhesions can also form around incision sites inside the abdomen. The "bands" can often bind pelvic organs, block tubes preventing pregnancy and can also block or "suffocate" the bowel causing a bowel obstruction.Adhesions in and of themselves are also painful, so it is very difficult for a woman who has had multiple surgeries for endometriosis to determine if her ain is from recurrent endometriosis or adhesions. This is problematic as treatment for adhesions are surgical, thus, risking the formation of further scar bands. if this sounds like a viscous cycle you're right. Adhesions can form within hours after surgery.I had seven laparoscopies and a total hysterectomy with removal of my tubes and ovaries. Six months after my hysterectomy I awoke with a severe stomach ache. The pain was about three to five inches above my navel and it felt like someone was trying to tie a knot inside of me. After an abdominal series of X-rays, it was confirmed that I had a bowel obstruction due to an adhesional blockage. Essentially, scar bands had wrapped themselves around my small bowel creating a blockage. I was told that after a trial of decompression treatment, if no better, I would need major abdominal surgery. After four days of decompression via a nasal gastric tube (a tube that is inserted through your nose into your stomach) I was deemed no better and rushed to the OR. This laparotomy was extensive. The incision was from my public line all the way up, 3 inches above my navel. Ouch. The surgeon had to clip the scar bands that were suffocating my bowel causing the blockage. I was lucky. I needed no colostomy and no resection. In some cases, a temporary colostomy may be needed after resection of the bowel to let the bowel heal properly. A resection is where the surgeon actually removes a part of the bowel and then reattaches the healthy segments.I was devastated. I knew that this surgery had left behind even more adhesions. It was not any one's fault, just a possible side effect of surgery. When the surgeon opened me up they found massive adhesions all over my bowel and right abdominal wall. Part of my bowel had slid down to where my uterus once was. I was told there was no way they could safely remove any further adhesions, and that they did excise endometriosis on my abdominal wall, using Surgiceed afterwards. Surgiceed, and other barrier methods work to form a wall or barrier between the surgical area and the scar tissue. The intent is to help create less friction and cohesion. Thus, fewer adhesions.The most common sites for adhesions are the pelvic organs, most often adhering to the bowels, uterus, tubes and ovaries. They can also form over endometrial implants themselves. Having adhesions on or around the bowel can mimic several other intestinal disorders. It is imperative that you seek medical help immediately if you have any of the following:

Sharp, stabbing or strangulating pain in the center of your abdomen.
Projectile vomiting that appears green ( from your gall bladder ) or brown, accompanied by a foul stench.
Absence of gas; a bloated feeling with the above symptoms. Any of these symptoms should be checked out by a physician to rule out intestinal obstruction.

So what can be done about adhesions?

There are newer techniques used during surgery to prevent formation, as well as speculation as to why they occur so rapidly. One method is insertion of a degradable substance that gets absorbed by the body within a few weeks post-op. As mentioned above, it acts as a barrier to prevent the scar tissue and surgical site from rubbing together. Prior to surgery discuss adhesions and ways to help prevent them with your physician.

http://www.obgyn.net/women/articles/...comfort009.htm

  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. The microsurgical techniques that should be employed includevery 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. Lo
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.

Plasminogen activators accelerate fibrinolysis to reduce the bulk of fibrin clots. Use of these agents is also awaiting appropriate human clinical 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 is of some help
((((hugs))))
  #5  
Unread 04-10-2003, 09:02 AM
Adhesion Alternative Relief Methods?

WOW, that is some really interesting information!!! Thanks Sheri..

I am going to print that out to take to my Gyn with me tomorrow since I am having the lap the 30th.

Good luck to all in finding relief from the pain!!!

Thanks for posting the topic Lenee. I hope you find someting in the info helpful...

to all
  #6  
Unread 04-10-2003, 09:27 AM
Adhesion Alternative Relief Methods?

Steph... just when I had forgotten about your note about the lovely Hans... sounds like he might just be worth the trip to Spain Think your Mum could hook me up?

Seriously, I also wonder what an osteopath is... let us know if you find out.

Take care!
  #7  
Unread 04-10-2003, 09:34 AM
Adhesion Alternative Relief Methods?

I will be watching this post with interest too. I was curious if, as (((Linda))) suggested, the pulling etc. of adhesions would lessen in time.

I think there is a dear sister (IMLori???) who's husband is a chiro. Maybe she will be along shortly with some info.
  #8  
Unread 04-10-2003, 10:21 AM
Adhesion Alternative Relief Methods?

Thanks as always, dear (((Sheri))), and I'm glad you included the bit about NSAIDS. I have not been on any pain meds since I got home, but my DR has me on a two week course of Vioxx to reduce inflammation and he did suggest that that should help reduce the likelihood of adhesion formation.

-Linda
  #9  
Unread 04-10-2003, 12:28 PM
adhesions, accupressure and golfing

I have been having hip pain (leg length discrepancy) so I started to see a chiropracter. He calls himself a chiropracter, yet does not crack your back. He does an accupressure technique. He was one of the most informed medical professional I have ever talked to about endo and adhesions.

He explained that if you suspect adhesions, you should slowly begin stretching the muscles and the organs and they will release without the pain. The more you continue to stretch the more mobility you will experience. He explained that if you do drastic quick stretches that cause you pain, you will actually increase adhesions. He explained that when you cause pain from too quickly stretching an area that pain receptors will target the area and adhesions will form and scar tissue will get thicker.

Last year I had really bad pain after golfing. Golfing is the kind of sport where you use your abdominal muscles in quick pulling movements. This year I practiced swinging a club in the back yard for several weeks before going out. I golfed 9 holes and have no pain! yea!
  #10  
Unread 04-10-2003, 05:22 PM
Adhesion Alternative Relief Methods?

Wow this is a busy thread! It is awful that so many of us have to be here but how great it is to be able to share the information each of us have.

Michelle - of course you can go visit my Mum and see Han's

I found this re osteopathy compared to other forms of therapy-

Chiropractic originated from osteopathy.

The greatest difference between osteopathy and chiropractic is that the latter concentrates on the axial skeleton or spinal system when treating patients. Osteopathy goes further and treats all the other systems of the body as well.

Physiotherapy

Physiotherapy principally treats patients who need rehabilitation or they treat local problems symptomatically. Osteopathy approaches the patient as a whole.

this site explains more and mentions adhesions.

http://www.billferguson.co.uk/visceral_osteopathy.htm

imalith- your treatment sounds rather like what I have been reading.

Surferbabe - your doc sounds well informed and wise - can you send him to Aus please!

love
Steph xx
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