> ----- Original Message -----
From: M.Korell <M.Korell@t-online.de>
To: <email@example.com> Sent: Tuesday, May 30, 2000 5:39 AM
Subject: Re: adhesions
Dear Beverly Doucette,
I understand your questions and I will try to answer:
I work in the field of adhesions since now 20 years both - experimental and clinically. Enclosed you find some abstracts and publications regarding my work in adhesions. If you need any further informations or papers - please let me know.
Regarding the adhesiolysis we try to induce peritoneal defects as less as possible. Intensive rinsing and clot evacuation is standard during the whole procedure. We prefer the endoscopic approach because it leads to less recurrences. But, sometimes the adhesions are so severe that one must do a laparotomy first. Here, an early second look laparoscopy can be helpful in further reducing the adhesions.
Specially the Intergel seems to increase the chance for adhesion-free healing. As you see in the abstract we have experience and controls in myomectomy patients with good results. I have seen many patients with severe intraabdominal adhesions in the last years with a long follow up. If one can reach an adhesion-free abdominal cavity the chance for no pain is good.
Depending on the extent of adhesions there is a risk of recurrence, which leads to pain again - typically 6 weeks up to some months after a pain-free interval. Otherwise the patients have no problems for years. While the induction of adhesions by peritoneal defects is understood, the pathomechanism of pain is not so clear. I suppose that especially the fixation of bowel to the abdominal wall can cause pain. The adhesions from bowel to bowel seems to be less severe. The typical adhesions from the omentum to the peritoneum causes normally no problem.
To decide whether a patient may profit from an adhesiolysis, we need the medical records of the previous interventions and a description of type and location of the pain. After that we can discuss the individual case with the patient whether there is a chance for an improvement.
The costs for surgery in Germany depends on the length of the hospital stay (every day about 750 DM)...and the type of surgery and special medical treatment (about 2-3000 DM).
There is at the moment no special waiting list. We have dates about 6 weeks in advance.
I hope I could help with my answer. If there are any further questions don`t hesitate to contact me again.
Matthias Korell, M.D.
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Bernie and Beverly Doucette schrieb:
Dear Dr. Korell,
If an American patient sent their current medical records - including their diagnostic evaluations - along with their most current operative reports and pathology/cytology reports, would you be able to determine if this patient would qualify for an adhesiolysis procedure from you in Germany?
Can any or all pre-operative workups be done prior to coming to Germany? Examples: Blood draw, EKG, Chest X-ray, urinalysis. If these things were done let's say within five to seven days prior to a scheduled adhesiolysis procedure, can they be completed here?
Do you have any statistics, in writing, as to the longest length of time an Adhesion Related Disease patient, who underwent your adhesiolysis, remained pain free? Have you tracked the second look surgeries in any form of a report? Do you have your adhesiolysis procedure in writing?
You did not mention whether you used " clot " evacuation during your procedure, do you do that? What is your theory on adhesion formation, as to the etiology of them? Are you of the opinion that adhesions, which are attached to the peritoneum, are the problematic ( painfull ) adhesions?
Dr. Korell, I assist many people throughout the world who suffer with ARD ( Adhesion Related Disease ) in finding surgical intervention for their adhesions. It is very important that I find out as much as I can about a particular surgeon, who appears to be skilled in dealing with adhesions as they are few and far between throughout the world! I am sure you can agree with that and that you also understand that it is of the utmost importance that when I make a referral to a surgeon, I must have facts and statistics available for them. When I do make a referral I must feel comfortable that I am referring them to the highest quality of medical care available to them today! How long of a waiting list does your office have at this time for an adhesiolysis procedure?
I appreciate very much your taking the time to discuss these issues and I look forward to hearing from you again soon.
In friendship Bev