At Sat, 12 Feb 2000, Helen Dynda wrote:
> >These are some websites which could be helpful as you compare laparotomy surgery with laparoscopy surgery: > >1.) * Contemporary Adhesion Prevention -- Both quotations (below) are from this article: > >http://www.centerforendo.com/news/adhesions/adhesions.htm > >LAPAROSCOPY > >"Although many clinicians assume that laparoscopic surgery will reduce post-operative adhesion formation, the data is not compelling. However, de novo (new) 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." [Note: Adhesion barriers have been approved by the FDA only for open-abdominal (laparotomy) surgery.] > >"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." > > 2.) * Lap Advantages > >http://clos.net/lap_vs_open.htm > >3. * How are Adhesions Treated? > >http://www.drcook.com/adca17.html > > 4.) * Reduction of Postoperative Adhesions (Scar) > >http://www.drdaiter.com/hyst_ecto/hyst3.html > >5.) * Frequently Asked Questions > >http://www.womenssurgerygroup.com/frequently_asked_questions.htm > >6.) * Laparoscopy - excellent > >http://www.womenssurgerygroup.com/LAPAROSC.HTM > >7.) * All of these quotes are from Dr. Wiseman's June 23, 1998 chat: > >http://www.obgyn.net/women/features/Wiseman_chat_062398.htm > >(a.)* Dr. Wiseman: "Re: INTERGEL, First of all, it has only just been released in Europe and may not be available here for another 18-24 months. Second of all, on the limited data that I have seen clinically (I know the animal data very well because my group did most of it when I worked at Ethicon), given the limited clinical data to date it looks as though adhesions will not be prevented 100%. What INTERGEL seems to do, and I stress this is based on limited clinical data available, is work about the same as INTERCEED and Seprafilm, except that it can be used laparoscopically and it can coat many areas at once." > >(b.) * Dr.Wiseman: ".....No, I don't think it (INTERGEL) will be the cure all, and to be fair to Ethicon, I don't think they are saying it is. Will there ever be one? I hope so, but it is not yet on the horizon.?" > >(c) * Dr. B: "That is the precise reason that early (7 day) re-laparoscopy is so important: one can knock down whatever adhesions have formed allowing normal re-peritonealization to occur." > >(d.) * Dr. Wiseman: "Dr. B. raises a good point. An early (7day) laparoscopy after an initial procedure may allow the Dr. to get the adhesions while they are still filmy. S/he should use an adhesion barrier. Also see someone who knows adhesions." > >(e.) * Dr. Wiseman: "Adhesions do form quickly, but they mature with time. What happens is that the adhesion may get more fibrous with time. Also organs may twist around an adhesion many years after surgery and cause a problem that was not there until then. This may happen 50+ years later." > >(f.) * Dr. B: "I recently referred a severe adhesion patient to NY to Harry Reich, MD, perhaps the most talented laparoscopic surgeon in the world!! 5 hours of surgery, she is at last pain free!!"