Am Surg. 2014 Mar;80(3):261-9.

A Comparative Analysis between Laparoscopic and Open Adhesiolysis at a Tertiary Care Center.

Davies SW1, Gillen JR, Guidry CA, Newhook TE, Pope NH, Hranjec T, Sawyer RG, Hallowell PT.

Author information

Abstract

Laparotomy has been the favored approach regarding surgical management of small bowel obstruction (SBO); however, laparoscopy may offer improved outcomes. Patients undergoing laparoscopic lysis of adhesions (LOA) at our institution for SBO will have lower postoperative morbidity and 30-day mortality. Patients undergoing LOA at our institution, from 2000 to 2011, were reviewed. Categorical data were analyzed with χ(2) or Fisher's exact tests. Continuous data were analyzed with Student's t test or Wilcoxon rank sum. One hundred two (38 laparoscopic, 64 open) LOA cases were selected. Perioperative contamination and conservative management were higher in the open group. Open cases had a greater incidence of intensive care unit (ICU) admissions and longer length of stay. Stratified analysis determined a strong association between perioperative contamination and a higher incidence of ICU admission, perioperative contamination and longer LOS, and conservative management and longer LOS. Finally, patient outcome did not differ between those treated by surgeons trained in minimally invasive surgery (MIS) compared with those not trained in MIS. Careful consideration of surgical approach and timing is called for in all patients with SBO; however, whenever possible, laparoscopic preference should be given to most patients in an expeditious fashion irrespective of MIS training.

PMID:

 

24666867

 

[PubMed - in process]

Should You Get A J-Pouch?

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.

adhesiologicums adhesions blog: Adhesiolysis in Canada

adhesiologicums adhesions blog: Adhesiolysis in Canada

Adhesiolysis in Germany Dr. Matthias Korell and Dr. Jens Pagel

Adhesiolysis in Germany Dr. Matthias Korell and Dr. Jens Pagel

Dr. Matthias Korell
Johanna-Etienne Hospital Neuss

On Hasenbergstraße 46 
41462 Neuss 
North Rhine-Westphalia
Germany

Phone : 02131/5295-5002 
Fax: 02131/5295-5003 

PD Dr. Matthias Korell practiced as:

• Specialist in Obstetrics u.Geburtshilfe
• PD Dr. Matthias Korell speaks: German.Vocational group is senior consultant or senior doctor. 
• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 Dr. Jens Pagel

St. Joseph's Hospital Department of Obstetrics and Gynecology

Asberger Strasse 4 
47441 Moers 
North Rhine-Westphalia
Germany

Phone : 02841/107-2430 
Fax: 02841/107-2000 

Dr. Jens Pagels practiced as:

• Specialist in Obstetrics u.Geburtshilfe
• Dr. Jens Pagels speaks: German. Vocational group is senior consultant or senior doctor. 

Adhesion Related Disorder International Human Rights Team IHRT: CryoLife Receives FDA Approval to Begin Clinical Trials for PerClot® in the U.S.

Adhesion Related Disorder International Human Rights Team IHRT: CryoLife Receives FDA Approval to Begin Clinical Trials for PerClot® in the U.S.

Surgery. 2014 Feb;155(2):234-44. doi: 10.1016/j.surg.2013.08.018. Epub 2013 Nov 14.

Histone deacetylase inhibitors decrease intra-abdominal adhesions with one intraoperative dose by reducing peritoneal fibrin deposition pathways.

Cassidy MR1, Sherburne AC1, Sheldon HK1, Gainsbury ML1, Heydrick S1, Stucchi AF2.

Author information

Abstract

BACKGROUND:

We previously demonstrated that postoperative peritoneal injury and inflammation contribute to adhesiogenesis. Recent evidence suggests that in addition to their role of interfering with the acetylation status of nuclear histone proteins, histone deacetylase inhibitors (HDACIs) including valproic acid (VPA) can target nonhistone proteins to resolve inflammation and modulate immune cells. We hypothesized that HDACIs could reduce adhesions.

METHODS:

Seventy-two rats underwent laparotomy with creation of 6 peritoneal ischemic buttons to induce adhesions. A single intraperitoneal (IP) dose of 50 mg/kg VPA was administered intraoperatively, whereas controls received vehicle. To evaluate the timing, 25 rats underwent ischemic button creation with either an intraoperative or a delayed IP dose of VPA at 1, 3, or 6 hours postoperatively. On postoperative day 7, adhesions were quantified. To investigate mechanisms, ischemic buttons were created in 24 rats and either VPA or saline was administered in 1 intraoperative dose. At 3 or 24 hours later, peritoneal fluid was collected and fibrinolytic activity measured. Alternatively, button tissue was collected 30 minutes postoperatively to measure tissue factor, fibrinogen, and vascular endothelial growth factor (VEGF) by real-time polymerase chain reaction or Western blot.

RESULTS:

A single intraoperative dose of VPA reduced adhesions by 50% relative to controls (P < .001). Delayed dosing did not reduce adhesions. In operated animals, peritoneal fibrinolytic activity was not different between groups. Tissue factor mRNA was downregulated by 50% (P = .02) and protein by 34% (P < .01) in animals administered VPA versus saline. VPA decreased fibrinogen protein by 56% and VEGF protein by 25% compared with saline (P = .03).

CONCLUSION:

These findings suggest that VPA rapidly reduces the extravasation of key adhesiogenic substrates into the peritoneum. A single, intraoperative intervention provides an ideal dosing strategy and indicates an exciting new role for HDACIs in adhesion prevention.

Copyright © 2014 Mosby, Inc. All rights reserved.

PMID:

 

24239397

 

[PubMed - indexed for MEDLINE]