Adhesion Related Disorder International Human Rights Team IHRT: What adhesions feel like ~ analogies

Adhesion Related Disorder International Human Rights Team IHRT: What adhesions feel like ~ analogies

“MY JOURNEY WITH ADVANCED ENDOSCOPIC SURGERY” - Harry Reich

Dr. Harry Reich Honored……

ISGE August 2015 Africa

http://nairobi2015.isge.org/wp-content/uploads/2015/04/ISGE-African-Conference.pdf

CLOSING CEREMONY

Visa Oshwal Auditorium

19.00 pm

“MY JOURNEY WITH ADVANCED ENDOSCOPIC SURGERY” - Harry Reich

HONORARY MEMBERSHIP AWARD OF ISGE TO HARRY REICH

Fighting On -- A Portrait of Two Chronic Pain Survivors

Opioid Use in Chronic Pain: International Adhesions Society (IAS) Resear...

HYSTEROSCOPIC CUTTING OF SEVERE INTRA UTERINE ADHESIONS

Adhesions - Causes, Symptoms, Treatments & More…

Laparoscopic Lysis of Abdominal Adhesions

Adhesions, CAPPS, Pelvic & Bladder Pain

World J Gastroenterol. 2014 May 7;20(17):4917-25. doi: 10.3748/wjg.v20.i17.4917.

Peritoneal adhesions after laparoscopic gastrointestinal surgery.

Mais V1.

Author information

Abstract

Although laparoscopy has the potential to reduce peritoneal trauma and post-operative peritoneal adhesion formation, only one randomized controlled trial and a few comparative retrospective clinical studies have addressed this issue. Laparoscopy reduces de novo adhesionformation but has no efficacy in reducing adhesion reformation after adhesiolysis. Moreover, several studies have suggested that the reduction of de novo post-operative adhesions does not seem to have a significant clinical impact. Experimental data in animal models have suggested that CO₂ pneumoperitoneum can cause acute peritoneal inflammation during laparoscopy depending on the insufflation pressure and the surgery duration. Broad peritoneal cavity protection by the insufflation of a low-temperature humidified gas mixture of CO₂, N₂O and O₂ seems to represent the best approach for reducing peritoneal inflammation due to pneumoperitoneum. However, these experimental data have not had a significant impact on the modification of laparoscopic instrumentation. In contrast, surgeons should train themselves to perform laparoscopy quickly, and they should complete their learning curves before testing chemical anti-adhesive agents and anti-adhesion barriers. Chemical anti-adhesive agents have the potential to exert broad peritoneal cavity protection against adhesion formation, but when these agents are used alone, the concentrations needed to prevent adhesions are too high and could cause major post-operative side effects. Anti-adhesion barriers have been used mainly in open surgery, but some clinical data from laparoscopic surgeries are already available. Sprays, gels, and fluid barriers are easier to apply in laparoscopic surgery than solid barriers. Results have been encouraging with solid barriers, spray barriers, andgel barriers, but they have been ambiguous with fluid barriers. Moreover, when barriers have been used alone, the maximum protection againstadhesion formation has been no greater than 60%. A recent small, randomized clinical trial suggested that the combination of broad peritoneal cavity protection with local application of a barrier could be almost 100% effective in preventing post-operative adhesion formation. Future studies should confirm the efficacy of this global strategy in preventing adhesion formation after laparoscopy by focusing on clinical end points, such as reduced incidences of bowel obstruction and abdominal pain and increased fertility.

KEYWORDS:

Abdomen; Animal models; Anti-adhesion; Clinical studies; Gastrointestinal surgery; Inflammation; Laparoscopic resection of gastrointestinal; Laparoscopy; Learning curve; Peritoneal adhesions

PMID:

 

24803803

 

[PubMed - in process] 

PMCID:

 

PMC4009523

 

Free PMC Article

http://www.ncbi.nlm.nih.gov/pubmed/24803803

Surgery can both cause and treat abdominal adhesions

DEAR DOCTOR K: I had abdominal surgery last year. Soon after, I started experiencing severe pain and swelling in my abdomen. It turns out I have abdominal adhesions. I’d never heard of them. What are they, and how are they treated?

DEAR READER: Abdominal adhesions are bands of fibrous scar tissue. They can cause organs that are normally not connected to stick to one another or to the wall of the abdomen.

Abdominal adhesions most commonly develop after abdominal surgery. Less often, adhesions form in people who develop an infection or other type of inflammation in the abdomen.

In most patients, adhesions do not cause any symptoms. In a small number of people, however, they do. Some people appear to inherit genes that make them more likely to form adhesions. Some are just unlucky: Adhesions form in a location that makes them more likely to pinch and block the intestines.

In any event, the fibrous bands of scar tissue can block the intestines either completely or partially. This blockage is called a bowel obstruction. It can cause cramping abdominal pain. Sometimes an area of intestine alternates between being blocked, then unblocked. As a result, symptoms come and go.

More significant intestinal obstruction can cause:

• severe, cramping abdominal pain;

• nausea and vomiting;

• swelling of the abdomen;

• inability to pass gas and absent or infrequent bowel movements;

• signs of dehydration. These include dry skin, dry mouth and tongue, severe thirst, infrequent urination, fast heart rate and low blood pressure.

Rarely, a portion of the bowel twists tightly around a band of adhesions. This cuts off the normal blood supply to the twisted bowel, causing “strangulation.” That section of bowel begins to die. When this emergency happens, immediate abdominal surgery is required to remove the adhesions and restore blood flow to the bowel.

During surgery, a surgeon removes as much as possible of the scar tissue causing the blockage. In performing the surgery, the surgeon often spots other adhesions besides the ones causing the blockage. The patient is already under anesthesia and the abdomen has been opened. Therefore, other adhesions also are removed to prevent them from causing trouble in the future. (I’ve put an illustration of surgery to remove adhesions on my website, AskDoctorK.com.)

So surgery is both a cause of, and a treatment for, abdominal adhesions. When surgery is done to remove an intestinal obstruction caused by adhesions, the surgery can cause adhesions to form again and create a new obstruction. Laparoscopic surgery, in which several small incisions are made instead of one large incision, can reduce the risk of abdominal adhesions.

So the surgeon’s decision on whether to perform surgery can be a complicated one. When adhesions are causing strangulation, however, it’s not complicated: Surgery is not only necessary, but often lifesaving.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

http://www.thecalifornian.com/story/life/2015/01/24/surgery-can-cause-treat-abdominal-adhesions/21905461/