Re: Adhesions
From: Shali (shalix@rraz.net)
Tue Jul 3 19:12:19 2007
>I do have a question for anyone out there...Does surgery on adhesions
>(alone) help? I've been trying to find out as much as I can on it, but
>its an elusive subject. If so, how long did it help?
Heidi - As far as surgery on adhesions alone helping, IT DEPENDS.
Regardless of what anyone tells you, because their opinions are
subjective, IT DEPENDS. So to give you an objective opinion which would
be more accurate, I have known people who go up to 30+ years without
problems; I have known people who go thru more than one surgery a year.
As far as how long does it help, there is no set time.
>Another question, too...I'm in a smaller community. How do I find a
>doctor for 'Pain Management?' Is it a specialty of practice or what?
Im in a small town too. Look in the yellow pages under Physicians &
Surgeons - Pain Management
--
Shali
Role of Fibrin in the Development of Surgical Adhesions
Jacob Rajfer, MD
Department of Urology, University of California at Los Angeles, Los
Angeles, CA
One of the major problems with intra-abdominal surgical procedures,
including pelvic surgery, is the development of adhesions within the
intra-abdominal space postoperatively. This is usually not a clinical
issue unless another intra-abdominal surgical procedure is to be
performed at a later date or pain from the adhesions or a bowel
obstruction develops. These intra-abdominal adhesions are the bane of
every surgeon's existence because they make a subsequent surgical
procedure much more difficult, more labor intensive, and more prone to
an intra-abdominal injury. Just imagine if all intra-abdominal surgical
procedures could be made adhesion free!
Adhesions are fibrotic connections between two tissue planes-in the case
of intra-abdominal adhesions, between two organs or an organ and the
abdominal wall. The mechanisms by which fibrosis develops are beginning
to be deciphered at the biochemical level. Most evidence points to the
involvement of the fibrinolytic system in this process, and converging
data from a variety of disciplines seem to suggest that a defective
fibrinolytic system is intimately involved in or is actually responsible
for the development of tissue fibrosis, including intra-abdominal
adhesions. Surgery per se can lead to a local inflammatory response,
which in turn may lead to the local deposition of fibrin. Fibrin
happens to be an extremely pro-fibrotic compound, and its continued
presence (or a failure to remove the fibrin) seems to induce
fibrosis.1,2 Therefore, it may be hypothesized that the development of
surgical adhesions or tissue fibrosis in general may be due to the
failure of the fibrinolytic system to degrade the fibrin.
A Role for the Fibrinolytic System in Postsurgical Adhesion Formation
Hellebrekers BWJ, Emeis JJ, Kooistra T, et al.
Fert and Ster. 2005;83:122-129
In a group of 50 female patients undergoing pelvic laparoscopy for
either an infertility evaluation or treatment of endometriosis, the
presence or absence of adhesions was noted either at the first
laparoscopy or at a second laparoscopy, when indicated. Measurements
were made of soluble fibrin, PAI-1 (plasminogen activator inhibitor),
tPA (tissue plasminogen activator), plasmin-antiplasmin complexes, and
fibrin degradation products in the peritoneal fluid. Patients with
adhesions had significantly higher concentrations of PAI-1, tPA, and
plasminogen than those without adhesions. In patients who developed
adhesions between an initial and subsequent laparoscopy, there was
biochemical evidence of a defective fibrinolytic system in the
peritoneal fluid. These observations suggest that the
plasmin-fibrinogen system is operative in the development of adhesions
and that it may be possible to prevent these abdominal adhesions by the
use of fibrinolytic enhancers or inhibitors of PAI-1. The development
of such a therapeutic regimen would be a major advancement in surgery,
as the use of this regimen at the time of surgery would potentially lead
to a decrease in surgical adhesions and their resulting clinical
sequelae.
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