>----- Original Message -----
From: "Katie" <katie_scarlett67@hotmail.com>
To: "Multiple recipients of list ADHESIONS" <adhesions@mail.obgyn.net>
Sent: Wednesday, March 04, 2009 8:20 AM
Subject: Re: Has it ever turned out NOT to be adhesions?
> Mark, you are one of the most industrious people I have encountered so
> far
> on this board and I truly appreciate all of your efforts and input.
>
> Thanks,
> Katie
>
> At Wed, 4 Mar 2009, Mark in Seattle wrote:
>>
>>At Tue, 3 Mar 2009, Linda wrote:
>>>
>>>Does anyone know the statistics of successful adhesion surgeries by any
>>>of the doctor(s) performing them? If not, where could one locate these
>>>figures?
>>
>>--
>>Mark in Seattle writes:
>>
>>Except for the SCAR studies, successes are anecdotally reported first by
>>patients, and second by doctors. This is why the new fMRI technique is
>>so important. Finally, we can now measure success right away, without
>>waiting 5 or 10 years for the patient to report what's been happening.
>>
>>An article in The World Journal of Surgery in March 2006, reported that
>>"the success rate of laparoscopic lysis of adhesions remains between 46%
>>and 87%" That's a huge range, isn't it? I think answer varies so much
>>because of the above reasons, and also because the question depends on a
>>number of surgical factors. I strain to understand them.
>>
>>Citation:
>>Szomstein S, Menzo EL, Simpfendorfer C, Zundel N, Rosenthal RJ.
>>Bariatric Institute, Section of Minimally Invasive Surgery, Cleveland
>>Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, Florida, 33331,
>>USA, szomsts@ccf.org. 2006 Mar 13; Laparoscopic Lysis of Adhesions,
>>World J Surg.
>>
>>I saw another article that reported similar success rates, (assuming I'm
>>reading it correctly:
>>
>>http://7thspace.com/headlines/302194/feasibility_of_laparoscopy_for_small_bowel_obstruction.html
>>
>>The Surgical and Clinical Adhesions Research (SCAR) steering group in
>>the United Kingdom also reports success rates. The numbers they provide
>>are confusing to me. This is a cop out, but I don't feel well enough to
>>try to boil down the information I have in front of me, (it would take a
>>steady 2 hours of intense reading) so I'll merely just refer you to
>>their work. Even if I tried to get up to speed with everything in the
>>article, I don't have the credentials to present it to you. It's quite
>>dense language.
>>
>>The SCAR group is probably the most prestigious and credentialed group
>>of researchers. The lead author in these studies is usually A.M. Lower
>>or H. Ellis. There have been at least 3 major reports from the SCAR
>>group. The latest one that is in my stack of papers is this one:
>>
>>A.M. Lower, R.jJ. S. Hawthorn, D. Clark, J.H. Boyd, A.R. Finlayson,
>>A.D. Knight, and A.M. Crowe, (2004) Adhesion-related readmissions
>>following gynaecological laparoscopy or laparotomy in Scotland: an
>>epiemiological study of 24046 patients, Human Reproduction Vol. 19, No.
>>1 pp. 1877-1885
>>
>>There are other earlier reports from the SCAR group. The SCAR group is
>>generally credited, especially Ellis, for raising awareness of the
>>problem among doctors.
>>
>>Individual surgeons are free to report their own experience and they do
>>so. Of these self-reporters, I've seen figures ranging from 75 to 85
>>percent success rates. Here's one of them:
>>
>>http://www.centerforendo.com/articles/adhesionsupdate.htm
>>
>>Ideally, a surgeon worth his/her salt should provide you with
>>information about risks of success and failure. Surgeons are supposed
>>to obtain what is called in legal terms, "informed consent" from their
>>patients prior to operating. I do not feel qualified to provide you
>>with correct information so that you can make "informed consent." But I
>>do know enough to ask pointed questions. In fact, I tell everyone I
>>know who is going to have surgery to ask the surgeon to please explain
>>the risk of adhesions and to please describe what, if any, techniques
>>he/she will be using to try to prevent them from occurring. And then to
>>listen carefully. Perhaps he/she can explain why your surgery has a 87
>>percent chance of success, while someone else would have a 46 percent.
>>
>>You've asked a very difficult question, and I don't think I've answered
>>it like you want me to. I'm sorry. But I thought I'd give it my best
>>try. Perhaps someone else can take this information and come back to us
>>with a better response. If there is a simple answer, I don't know what
>>it is. But I've done my best to give it to you. Maybe I'm just too
>>tired to give a confident answer. But really, I think it's just a very
>>complicated question. It's just hard to say. And I'm really, really
>>tired right now. I just spent 2 hours poking around in my files and on
>>the net, and I'm going to stop and call this good. I did my best.
>>
>>Yours,
>>
>>Mark in Seattle
>>
>
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