we can write and fax it or send it in the mail- what we want? why the latest barrier hasn't been approved (sprayshield and spraygel)yet why we have to have a bowel obstruction to remove adhesions? why has to be a life and death situation to be taken seriously and be place with the first surgeon probably with a little experience. O magazine 300 WEST 57 street NY,NY 10019 very brief , am in pain and i hardly come to the computer- not able to sit for long thanks
________________________________ From: Mark in Seattle <mark7@skynetbb.com>=0ATo: Multiple recipients of list ADHE= sit for long thanks
________________________________ From: SIONS <adhesions@mail.obgyn.net> Sent: Wednesday, March 4, 2009 3:26:29 AM Subject: Re: Has it ever turned out NOT to be adhesions?
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.
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