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Prior Chat Transcripts
OBGYN.net Conference Coverage
From American Association of Gynecological Laparoscopists
Orlando, Florida, November 2000
" Adhesions"
OBGYN.net Editorial Advisors, Larry Demco, MD and David M. Wiseman, Phd, M.R.Pharm.S
Dr. Larry Demco: “Good morning again, this
is Dr. Demco reporting from the 29th Congress of
the AAGL. This morning I’d like to interview
Dr. David Wiseman who is the Chair and Founder of
the International Adhesion Society. Dr. Wiseman,
adhesions are a serious problem not only for doctors
but for patients, could you give us some idea of
the scope of the problem?”
Dr. David Wiseman: “The scope is enormous and
it’s under-appreciated. Almost everyone having
surgery will form adhesions and a number of studies
have been done to that effect showing that up to 95%
or even 100% of patients having some type of surgery
will form adhesions. The question is how many of those
patients will have problems due to adhesions? There
are varying numbers on that depending on the type of
surgery that is performed. A recent paper published
in the LANCET about a year ago shows that the number
of hospital re-admissions for adhesion related complications
rivals that for the number of procedures formed either
for cardiac bypass, appendectomy, or hip replacement.
Everyone has heard of the cardiac bypass operation
or a hip replacement or an appendectomy but very few
people know what an adhesion is. So that gives you
an extent of the problems and those are the severe
ones that occur relatively in a short time, within
five years. The numbers are probably much greater if
you take the time out and adhesions can occur at any
time. We know of cases where people who report problems
due to adhesions seventy years later after having an
appendectomy when they were a young child.”
Dr. Larry Demco: “It’s a funny situation,
this variance in the presentation has led to a lot
of the problems of even the doctors viewing their idea
about adhesions. I know general surgeons mainly associate
adhesions with bowel obstruction. From in your Society
in review of your patients, what symptoms do the patients
most often present with when they do have adhesions?”
Dr. David Wiseman: “First of all, the majority
of people that we come into contact with are people
that have already had several operations for adhesions
so it’s well established what their problems
are and their problems are, first of all, bowel obstruction,
either partial or full obstruction, and/or some kind
of abdominal pain. Now it’s important to understand
that not all pain is caused by adhesions and not all
adhesions cause pain but probably a bowel obstruction
type of syndrome is most common and then pain. There
is another group of patients in the infertility world
that will report infertility most probably without
those kinds of complications but if the infertility
is due perhaps to adhesions, say endometriosis related,
then those patients may end up after several operations
in the bowel obstruction chronic pelvic pain category.”
Dr. Larry Demco: “I’ve done some work
with adhesions myself and we’re actually mapping
which adhesions hurt and which ones do not. It’s
quite interesting to see that from our research we’ve
seen that the bowel is not much different from your
arm. If you break an arm, any little movement while
you’re getting it to the hospital causes severe
pain in the arm. If you don’t even treat the
arm but put it in a cast, the pain in your arm will
disappear. We found that when looking at mapping adhesions
in the abdomen that similar procedures are done if
the structure is movable and attaches itself to the
peritoneum, it’s very painful. Something that’s
fixed is a problem that seems to be corrected and those
are not the source of the pain. So it’s interesting
and a lot of work has to be done in this. In what research
capacity that you’ve seen looks most promising
for your prospective?”
Dr. David Wiseman: “Unfortunately, the research
isn’t that extensive and it’s limited to
the kinds of things that you’re talking about.
In terms of establishing the causes of the pain and
obstruction, it’s very limited. It has begun
recently with the advent of the conscious pain mapping
type procedures that you’re describing but really
we don’t know very much about this at all. There
are some other promising avenues that are related to
it that suggest there may be pain nerve fibers that
grow within the adhesions. We know that they’re
there but we don’t know if they’re hooked
up and if they’re functioning. So the whole problem
as to why adhesions cause problems or whether the adhesion
that’s there is really causing the pain or if
there’s something within that - a hidden endometriosis,
for example, or a scar that’s entrapping a nerve
deep down in the tissue, we really don’t understand
any of that. The majority of the work is being done
by medical device and pharmaceutical companies that
are trying to prevent adhesions but they’re really
not addressing the fundamental issues such as the one
that you’ve described.”
Dr. Larry Demco: “Let’s move on to the
prevention of adhesions. Can you give us a short summary
on what’s available for that?”
Dr. David Wiseman: “Certainly, really in the
United States there are two products available; one
is INTERCEED made by Johnson & Johnson ETHICON,
the other one is Seprafilm made by Genzyme. In Europe
there’s a product called ADEPT made by ML Laboratories.
There’s a product called INTERGEL, which is ETHICON,
which is in Europe and other countries, and there are
a number of companies that are developing products,
which look quite promising, some of which were presented
here. I presented two products - one from Europe, IMEDEX,
and one from the 3M Company and then there was another
presentation by a company called CONFLUENT which also
has a very promising product. These are incremental
or perhaps quantum advances in what we know about how
to prevent adhesions but we’re still a long way
off.”
Dr. Larry Demco: “It seems that the adhesion
story seems to be two-fold and looks like there’s
a lot of research that has to be done on both the cause
of the pain of adhesions and further research to see
how we could prevent them. I’d like to thank
you very much, and I would like to support your society
in any way that I can.”
Dr. David Wiseman: “Thank you very much.” Please
remember to contact our web site for more details:
www.adhesions.org
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