Dr. C.Y. Liu OBGYN M.D. FACOG, FACS

St. Vincent’s Medical Center in New York and Chattanooga Tennessee. 
http://www.womenssurgerygroup.com

Dr. C.Y. Liu is an internationally recognized leader and pioneer in the subspecialty of gynecological endoscopic surgery (laparoscopic and hysteroscopic) surgery. For the past 15 years, Dr. Liu has devoted his work exclusively to gynecological endoscopic surgery. Recognized internationally is his pioneer work in urogynecological laparoscopic surgery (a specialty dealing with female organ prolapse and urinary and fecal incontinence).He holds the record for performing the most laparoscopic hysterectomy in the world and has extensive professional publications and presentations to his credit. Dr. Liu is one of the most sought-after surgeons for the performance of interactive live surgical demonstration at large international medical meetings both in United States and abroad. He was recognized and awarded by the European Gynecologic Endoscopic Society as one of the most achieved and excellent Gynecologic Endoscopic Surgeon in the world in September 2000, Paris, France. 
Dr. C.Y. Liu’s practice is limited to gynecological laser laparoscopic surgery, and he maintains a practice at St. Vincent’s Medical Center in New York and Chattanooga Tennessee. 
Adhesion Specialist
Dr. C.Y. Liu OBGYN M.D. FACOG, FACS
View Curriculum Vitae

CONSIDERING SURGERY

http://www.adhesionrelateddisorder.com/adhesion3.html If surgery is recommended for you, it's important to know what your options are and what questions to ask your primary-care physician and surgeon. If you learn all you can, you'll be sure that you're making the right decision.
Jason Bodzin, M.D., F.A.C.S., director of the Inflammatory Bowel Disease (IBD) Institute at Sinai Hospital in Detroit, advises you to follow a four-step process:

• Examine your options. 
• Talk to your surgeon. 
• Talk to patients who have had the operation. 
• Weigh all the factors in making your decision. 

Knowing What to Ask
Before consenting to surgery, the first question you should ask is: "Is this surgery necessary, or are there other medical options that I can try?" For instance, many people with IBD have avoided surgery by combining total parenteral nutrition (intravenous feeding) with medications. 6-MP, an immunomodulator drug, often successfully heals fistulas that once required surgery.
You'll also want to know:

• Are there other surgical options? 
• What risks will I face by having the operation? 
• How will the operation improve my condition? 
• How long will my recovery take? 
• Will I require medications following surgery? 
• Whom do you recommend as a surgeon? As anesthesiologist? 

Choosing a Surgeon
Many sources can help you find a surgeon: 

• Friends, relatives, neighbors 
• Your primary-care physician 
• American Board of Medical Specialties (ABMS): (800) 776-CERT. (The ABMS can tell you whether a surgeon is board-certified.) 
• American College of Surgeons: (312) 664-4050, Ext. 391 
• The American Society of Colon and Rectal Surgeons: (708) 290-9184 
• Your local CCFA chapter 
• Your health insurance carrier 
• Your local hospital, or your state or county medical association -- all can provide lists of board-certified surgeons. 

Once you've compiled a list of two or three possible surgeons, ask the following questions about each one: 

• Is he experienced with the particular operation you need? (This is particularly important if you are undergoing a fairly new procedure, such as an ileoanal anastomosis.) 
• Does she treat many IBD patients? 
• Is he affliated with the hospital you want to be in? 
• Is she affiliated with a medical school or is she a member of its clinical faculty? 

You'll also want to know: 

• Where the surgeon trained, what his specialization is, and whether he belongs to any professional organizations or has published any professional articles. (To get this information, ask the surgeon directly or go to the library.) 
• Whether the hospital frequently performs your kind of surgery and whether the staff is well-versed in IBD.

Getting a Second Opinion:
It is always wise to get a second opinion. In fact, many insurance companies require it. Before seeking a second opinion, you may want to get copies of all your medical records. However, any physician can request these for you.
If you receive conflicting opinions, visit a third surgeon or review the situation with your primary-care physician. Though this process can be frustrating and time-consuming, it will give you peace of mind.

ADHESIONS AND ADHESIOLYSIS

Really well written paper that is full of hope, current statistics and exciting new areas of research regarding the prevention of adhesions. Happy New Year! 

Stephen M. Kavic, MD, Suzanne M. Kavic, MD, Michael S. Kavic, MD

INTRODUCTION

Scar tissue is an expected result of trauma, and this is no less true inside the abdominal cavity as on its surface. Abdominal and pelvic surgical procedures, which are a form of controlled trauma, commonly result in the development of adhesions. Although typically involving the peritoneal surface, adhesions may develop between any 2 surfaces during the healing process. Adhesions may develop between adjacent solid organs, the intestines, fallopian tubes, omentum, or the abdominal wall.

Perhaps due to the lack of effective prevention, adhesions have traditionally received little attention in the literature. However, adhesions are shockingly common after open general and gynecologic procedures. In the largest autopsy series of abdominal adhesions, which included 752 subjects, over 44% had adhesions (67% in patients with prior surgery, and 28% in patients without surgery).¹ After multiple laparotomies, the incidence of adhesions may even be as high as 93%.²

Read the rest http://laparoscopy.blogs.com/prevention_management_3/2010/10/adhesions-and-adhesiolysis.html

A review of the problematic adhesion prophylaxis in gynaecological surgery

Abstract

Background

Adhesions lead to considerable patient morbidity and are a mounting burden on surgeons and the health care system alike. Although adhesion formation is the most frequent complication in abdominal and pelvic surgery, many surgeons are still not aware of the extent of the problem. To provide the best care for their patients, surgeons should consistently inform themselves of anti-adhesion strategies and include these methods in their daily routine.

Read the rest: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303068/

Adhesion prevention in gynaecological surgery.

J Obstet Gynaecol Can. 2010 Jun;32(6):598-608.
Adhesion prevention in gynaecological surgery.
[Article in English, French]
Robertson D, Lefebvre G, Leyland N, Wolfman W, Allaire C, Awadalla A, Best C, Contestabile E, Dunn S, Heywood M, Leroux N, Potestio F, Rittenberg D, Senikas V, Soucy R, Singh S; Society of Obstetricians and Gynaecologists of Canada.
SourceToronto ON.


Abstract
OBJECTIVES: To review the etiology and incidence of and associative factors in the formation of adhesions following gynaecological surgery. To review evidence for the use of available means of adhesion prevention following gynaecological surgery.


OPTIONS: Women undergoing pelvic surgery are at risk of developing abdominal and/or pelvic adhesive disease postoperatively. Surgical technique and commercial adhesion prevention systems may decrease the risk of postoperative adhesion formation.


OUTCOMES: The outcomes measured are the incidence of postoperative adhesions, complications related to the formation of adhesions, and further intervention relative to adhesive disease.


EVIDENCE: Medline, EMBASE, and The Cochrane Library were searched for articles published in English from 1990 to March 2009, using appropriate controlled vocabulary and key words. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, cohort studies, and meta-analyses specifically addressing postoperative adhesions, adhesion prevention, and adhesive barriers. Searches were updated on a regular basis and incorporated in the guideline to March 2009. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.


VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care SUMMARY STATEMENTS: 1. Meticulous surgical technique is a means of preventing adhesions. This includes minimizing tissue trauma, achieving optimal hemostasis, minimizing the risk of infection, and avoiding contaminants (e.g., fecal matter) and the use of foreign materials (e.g., talcum powder) when possible. (II-2). 2. The risk of adhesions increases with the total number of abdominal and pelvic surgeries performed on one patient; every surgery needs to be carefully considered in this context. (II-2). 3. Polytetrafluoroethylene (Gore-Tex) barrier is more effective than no barrier or oxidized regenerated cellulose in preventing adhesion formation. (I). 4. Oxidized regenerated cellulose (Interceed) adhesion barrier is associated with a reduced incidence of pelvic adhesion formation at both laparoscopy and laparotomy when complete hemostasis is achieved. Oxidized regenerated cellulose may increase the risk of adhesions if optimal hemostasis is not achieved. (II-2). 5. Chemically modified sodium hyaluronate/carboxymethylcellulose (Seprafilm) is effective in preventing adhesion formation, especially following myomectomies. There is insufficient evidence on the effect of sodium hyaluronate/carboxymethylcellulose on long-term clinical outcomes such as fertility, chronic pelvic pain or small bowel obstruction. (II-2). 6. No adverse effects have been reported with the use of oxidized regenerated cellulose, polytetrafluoroethylene, or sodium hyaluronate/carboxymethylcellulose. (II-1). 7. Various pharmacological agents have been marketed as a means of preventing adhesions. None of these agents are presently available in Canada. There is insufficient evidence for the use of pharmacological agents in preventing adhesions. (III-C).


RECOMMENDATIONS: 1. Surgeons should attempt to perform surgical procedures using the least invasive method possible in order to decrease the risk of adhesion formation. (II-1B ). When feasible, for example, a laparoscopic surgical approach is preferable to an abdominal approach, and a vaginal or laparoscopic hysterectomy is preferable to an abdominal hysterectomy. 2. Precautions should be taken at surgery to minimize tissue trauma in order to decrease the risk of postoperative adhesions. These precautions include limiting packing, crushing, and manipulating of tissues to what is strictly required for safe completion of the procedure. (III-B). 3. Surgeons could consider using an adhesion barrier for patients who are at high risk of forming clinically significant adhesions (i.e., patients who have endometriosis or pelvic inflammatory disease or who are undergoing a myomectomy). If there is a risk of ongoing bleeding from the surgical site, oxidized regenerated cellulose (Interceed) should not be used as it may increase the risk of adhesions in this situation. (II-2B).


PMID:20569542[PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/20569542