Re: Steps to reduce adhesion formation......posted by Sherry Marie

From: Anne Hayashi (mhaya0902@aol.com)
Wed Jul 5 19:17:53 2000


At Wed, 5 Jul 2000, Helen Dynda wrote: >
>[ NOTE: Sherry has provided some very important information here - and the " cyber-mischief " is a big distraction; so hopefully this time her message will fit into the Message Box. ]
>
>From: Sherry Marie (SMGNWV@aol.com)
>
>Wed, 5 Jul 2000 13:04:51 -0500
>Sherry Marie, I can only make a personal response to this

question. I underwent a (3) part laparoscopy after four previous surgeries. No barriers were used. During the first surgery, the adhesions from the abdominal wall to the bladder and intestines were severe. The adhesions were taken down, and normal anatomy was restored. The idea was to go in for a second look one week later, and wash out the adhedilin tissue while it was in a rubber band state. Every original adhesion had returned,100% and 20% more denovo adhesions had returned. These rubber band like adhesions were washed out with something like a water pick (gently), and it was decided to go in a third time the next week. The third look revealed that all the adhesions had returned and there were 50% more denovo adhesions. These were all attachments to the abdominal wall. The "spray out" procedure was tried one more time, and I am now glued down with severe pulling pain, like many of you. I write this only because intervening surgically before the adhesions thickened did not work in my case. Perhaps there are others out there who have had success with this type of procedure. I, like Marla, am guessing that multiple surgeries may make ischemia a real problem due to decreased vascularity. I have often wondered if acupuncture immediately after the surgery would help by increasing vascularity? Anne H.

Achieve meticulous hemostasis: Inadequate hemostatsis and the resultant fibrin deposition promote adhesion formation. Maintain vascularity: Limiting ischemia supports fibrinolysis. Moisten tissues: Frequent irrigation and the use of moist sponges prevent desiccation of tissue. Ringer's lactate or other irrigating solutions also eliminate any residual talc, lint, or blood clots, which may provide a nidus for a foreign body reaction, inflammation, and adhesion formation. Avoid dry sponges and minimize tissue handling: Manipulating tissue increases the possibility of vascular and tissue damage. When direct manipulation of the peritoneum is necessary, use either atraumatic instruments or fingers. In addition, cutting and coagulating should be kept to a minumum to reduce the possibility of trauma and maintain vascularity. Use fine, nonreactive sutures: To minimize foreign body reactions, use the smallest size of suture composed of synthetic material. Avoid peritoneal grafts: Grafting incre >ases the risk of peritoneal trauma while decreasing vascularity. Minimize foreign bodies: Foreign bodies may damage the peritoneal surface, lead to inflammation, and ultimately result in adhesion formation. Minimally invasive surgery results in much less tissue irritation than conventional open techniques, with the result of a much faster recuperation for the patient, as well as a lesser likelihood of further adhesion formation. But what happens when I put off surgery until something shuts down? The adhesions are too dense and therefore the laparoscopy is difficult to use. Laparotomy again, thus the adhesion cycle. Due to the inevitability of adhesion formation, should the surgeon concentrate their efforts on intervening at varying points in the pathway of adhesion formation? Sherry Marie


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