1.) Describe Mary Pomroy's condition:
Starting with a vagotomy in 1980 the pain problem increased extremely after Mary had bowel surgery in 1990. The pain was mainly in the upper abdomen - but it was also located in the middle and right lower abdomen.
2.) Review Mary's previous surgical history. How many previous surgeries did Mary undergo to try to treat and reduce the adhesions?
Overall, Mary had nearly 20 surgeries. Three of those surgeries were for acute, severe bowel obstructions.
3.) Describe the outcomes of her surgeries to date:
There were more and more adhesions after every surgery. At the endpoint there were adhesions all over to the abdominal wall - especially from the small and large bowel and from the stomach to the diaphragm. We've known Mary Pomroy since July 2000. She was in very bad condition. Mary could not lay flat in bed and she could not raise her arms - due to the severe adhesions. We have tried several times to do endoscopic adhesiolysis with second look procedures. We have used adhesion prevention - like Intergel and steroids; and have reached only a reduction of the adhesions. This has led to a significant improvement of her quality of life. But, the remaining problems were the adhesions - especially in the upper abdomen.
4.) Procedure: Date of surgery
The first surgery was performed on April 11. We lysed all of the adhesions to the anterior abdominal wall and to the diaphragm. After this extensive adhesiolysis we used an adhesion barrier to cover all the serosal defects. The goal was to minimize the extent of serosal damage by using atraumatic surgery. Then, we tried using an adhesion barrier to cover the defects - to reach a further reduction in the adhesion recurrence rate. This should lead to further improvement in her quality of life.
5.) Describe the surgery. What was the goal? Identify and describe the SprayGel adhesion barrier product used in the procedure. Include reasons why you have chosen to use SprayGel to reduce adhesions. This adhesion barrier has several advantages over the currently used adhesion barriers: It can applied directly to the defect area - even the anterior abdominal wall. It stays there. The components are non toxic; and no tissue reaction is known.
6.) Expectations with the Adhesion Barrier
We are currently under the way to investigate the efficacy of this adhesion barrier for different indications such as endometriosis and myomectomies.
7.) Describe how the surgery went.
Due to carefull surgery we have reached a complete adhesiolysis without inducing too much serosal damage. After that, we covered the complete anterior abdominal wall, the transversal colon and the stomach with an adhesion barrier to reduce the recurrence rate.
8.) Follow-Up: SLL
The second look laparoscopy was performed on April 19. Here, we could see a complete adhesion free anterior abdominal wall.
9.) What were the findings upon the second look laparoscopy - on areas where this adhesion barrier was applied? What type of outcome does this represent thus far? Did it meet or exceed expectations?
After several attempts to reduce the adhesions, this was a big step forward and exceeded our expectations! There is no further risk for the development of severe adhesions - unless there's another traumatic surgery.
10.) How is Mary feeling? What can she expect; and how will this surgery impact her lifestyle?
This will improve the quality of her life and reduce the adhesion related pain to a minimum. Only the bowel to bowel adhesions can induce problems in the future.
Dr. Korell, thanks again for your time!