Adhesions are the way the human body heals and protects
itself following surgical procedures; and I remember
Dr. Wiseman mentioned - on one of his OBGYN.net chats in 1998 - that adhesions
can return years later!! After reading some of the messages on the IAS
MB, I am beginning to think he may be right.
Adhesion-formation begins as soon as 3 hours after surgery!! How do I
know this? I have read that surgeons, who have performed
lengthy adhesiolysis procedures - more than 3 hours to as many as 10
hours - have actually seen the formation of adhesions in places where they had
already lysed (cut) adhesions!!
Surgeons in Germany, Australia and the United Kingdom currently are able
to apply the new SprayGel adhesion barrier (www.confluentsurgical.com/) at
the conclusion of a surgical procedure. Dr. Korell asked me to wait with
my surgery until SprayGel had been approved in Europe (November 2001);
so I chose to wait until January 2002 to have my surgery.
If any adhesions are going to reform after a surgical procedure, they will
form within 7 days after the surgical procedure. On about the 7th day
patients in Germany undergo a second surgical procedure that's known as a
second look laparoscopy (SLL).
The SLL gives the surgeon a chance to evaluate the results of the
initial surgery. If any adhesions have reformed, the surgeon can very
easily "take down" these reformed adhesions, which are like wispy cob
webs on the 7th day following the initial surgery. Then the
surgeon will apply more SprayGel to areas in need of an adhesion barrier.
Both a second look laparoscopy and SprayGel adhesion barrier are
NOT available for use in surgery in the United States -
unless someone wants to volunteer - and meets certain requirements -
to take part in the SprayGel clinical trials.
SprayGel is currently in clinical trials throughout the United
States. These clinical trials began in June 2002. It could take as
many as 2 years before Confluent Surgical will be ready to present the results
of the SprayGel clinical trials to the FDA for their approval.
Gasless laparoscopy - another adhesion-prevention technique - is offered
only at Frankfurt, Germany for surgical patients at Frankfurt. The
carbon dioxide - that is used by surgeons to inflate the abdomen at the
beginning of a surgical procedure - is also known to be a cause
adhesion formation.
Adhesions that remain within the abdominal-pelvic cavity will begin to
mature after the 7th day. As adhesions mature they tend to shrink
(become shortened) and they will toughen. As time goes by - it's only a
matter of time before the patient finds himself or herself having to deal once
again with the chronic pain of adhesions.
More than 11 months have gone by since my surgery in Germany in January
2002; and I continue to be free of pain that's caused by
adhesions!!
I wish I could tell you that I am completely free of pain - but I
can't. I had hoped that Dr. Korell would be able
to resect the painful scar tissue that resulted from the laparotomy I had
in 1970. This scar tissue is located at the lowest point of the
incisional scar that result from the laparotomy I had in 1970; and
is located deep within the sutured tissues.
The day before my January 2002 surgery, Dr. Korell told me what
happens when an incision is made. When the surgeon makes the incision,
he/she has to cut through several layers of tissue. Unfortunately, in the
process of making an incision, nerves are also severed (cut)!!
At the end of the surgical procedure, the surgeon then has to individually
suture each layer of tissue together. As a result of the incision, scar tissue
forms along the severed edge of each layer of tissue - which creates a
barrier that prevents the severed nerves from reconnecting to their former
nerve pathways; and the severed nerves become trapped!! Since the nerves
cannot penetrate the scar tissue, they " mis-fire." I believe entrapped
nerves are the cause of the unrelenting "burning" pain I continue to
have.
Dr. Korell has had some success with freeing up entrapped nerves - via an
abdominal revision procedure. Since I was desperate for relief from
pain, I was willing to try anything that might help - in spite of Dr. Korell's
explanation about scar tissue causing nerves to be trapped. Had I not
been so deperate and filled with hope, I might have used my analytical
brain to realize (that the odds of a successful abdominal revision are
unpredictable) my hope for success and pain relief was also unpredictable.
I knew I was taking a chance when I gave Dr. Korell my permission to
perform an abdominal revision (like a bikini cut) - in addition to my
adhesiolysis procedure. Dr. Korell carefully applied both SprayGel and
Intergel to the area where adhesions had attachd my bowel to the peritoneum in
the RLQ - and to the area where adhesions had attached my omentum to the
abdominal wall.
In spite of Dr. Korell's very careful and skillful surgical expertise, the
abdominal revision was unsuccessful in eliminating the pain I continue to
experience; and the recovery from the abdominal revision has been a very
painful experience!!
I can best describe the pain of entrapped nerves as a burning, knife-like
pain that radiates throughout my lower pelvis and out to both of my
hips. Sitting exacerbates the pain; however, I don't let the
burning pain prevent me from sitting. I rely on a psychological
technique, known as distraction. Distraction helps to prevent the
full impact of pain messages from reaching my brain, the pain center.
Distraction has worked very well for me for most of my life!!
To recapitulate: scar tissue is NOT the same as adhesions!! To
recapitulate: The scar tissue, that I'm referring to, is the scar tissue that
forms within the tissues as a result of the incision made at the time of the
surgery. As the tissues heal, scar tissue forms - creating a barrier that the
severed nerves are unable to penetrate!!. Consequently, the nerves begin to
"misfire" - and that's what causes the pain!! I'm not sure if my description
of inter-tissual scarring is completely acurate; but I think you will get the
picture.
Beverly Doucette was invited by Dr. Harry Reich to attend the International
Society of Gynecologic Endoscopy (ISGE) Congress at Berlin in late April 2002.
During a break Bev found the opportunity to open a discussion about laparotomy
procedures and inter-tissual scarring. In a matter of a few minutes, Bev
attacted about a dozen surgeons, who also entered into the discussion.
Bev used my experience with inter-tissual scarring - that resulted from a
laparotomy in 1970 - as the topic for discussion.
These highly educated and very experienced laparoscopic surgeons had NO
idea that scarring from a laparotomy incision would cause debilitating pain!!
Now they do know - including Dr. Reich. Dr. Reich told Bev that he plans
to write a paper about inter-tissual scarring!!
According to Bev, there isn't anything surgeons can do to "fix"
inter-tissual scarring!! Once nerves have been severed, nothing can be
done surgically to restore the nerves to their former nerve pathways!!
Medical research has not found a way to prevent the human body from forming
adhesions. That is the reality!! Medicine is still in the "Dark
Ages" regarding adhesion-formation and inter-tissual scarring!!
Hopefully, someday soon medical research will discover "the key" that will
provide surgeons with a barrier that actually will help to prevent adhesions.
Maybe SprayGel will be that barrier; but we will never know until
SprayGel clinical trials have been completed. Currently, Confluent
Surgical's SprayGel adhesion barrier continues to show real promise; but
will be the long term results of SprayGel? That's the million/billion
dollar question. I sure hope it is!!!
