23.5.2008 von admin.

The following is part of an article in the Daily Mail of 30 October 2007 called “STILL IN PAIN AFTER YOUR OP”. ………… “The failure to tackle this problem has cost us dear. Around 75 per cent of small bowel obstructions - fatal in 10 per cent of cases if not dealt with promptly - are adhesion-related.

Between 20 and 40 per cent of secondary infertility - women unable to conceive a second time - is because of adhesions, and some women are crippled with chronic pelvic pain caused by adhesions which can bind several organs together, causing traction and tugging on nerves.

The usefulness of adhesiolysis - surgery to cut loose the adhesions as a means of relieving severe abdominal or pelvic pain - is questionable in many cases.

Studies indicate it’s a blunt tool in terms of pain relief, and in 85 per cent of cases adhesions will re-form afterwards.

And this is just as likely to occur following keyhole surgery. “I think we all hoped that by doing things by keyhole surgery we’d reduce the chance of adhesions,” says Geoffrey Trew, a consultant in reproductive medicine and surgery at London’s Hammersmith Hospital.

“We assumed that because it’s less invasive, fewer adhesions wold be created because there would be no direct handling or rubbing of tissues, no packing the abdomen with big swabs and no drying out of tissues - all of which will cause adhesions.”

Instead, in colorectal and gynaecological surgery in particular, patients are just as likely to get adhesions with keyhole surgery because THE ABDOMEN IS BEING FILLED WITH VERY DRY CARBON DIOXIDE GAS TO VIEW THE BODY’S INTERNAL STRUCTURES. THIS GAS DRIES OUT THE DELICATE PERITONEAL SURFACES WHICH LINE THE ABDOMEN.

However, even though the vast majority of surgery patients will go on to develop adhesions, most of these will be dormant and won’t cause problems. They may not be discovered until another operation is carried out - often years later.

This makes the subsequent surgery “much harder, lengthier and more risky,” says Malcolm Wilson, a general surgeon at Manchester’s Christie Hospital, because the adhesions must be cut through. This runs the risk of perforating the bowel, for example, to which they may have stuck.

Mr Trew is keen to raise awareness about adhesions among surgeons. “There is an abysmal lack of awareness of the scale of the problem,” he says.

“Many surgeons are deluded when they claim their patients won’t get adhesions, because they are inevitable unless surgeons take scrupulous steps to minimise them.” He urges patients who may be considering surgery to discuss with their surgeon the adhesion risk of the proposed operation.”

…………….

I think this is what Dr Kruschinski has been saying for some years.

As for discussing the risk of adhesions before an operation, I think most of us did not do this because we had never heard of adhesions until it was too late.

jip

Doc_kru:

This is the fatalism of our health systems and surgeons, it takes always some time until other surgeons realise the problem, one is pointing out since years…Thank you

Sybelsmom:

Dear Dr. Kruschinski, How true it is!!! Maybe they ought to get their heads out of the sand and get in touch with you and observe what you do. It seems like a great idea to me!!!!!

Jan 

****************

Please read about the problems and complications due to carbondioxide gas:

Medical statement for the question:“Why does it take so long to establish gasless Laparoscopy”By Steven Eubanks, MD, Professor of surgery in: “Much Remains to Be Learned”

“Gasless laparoscopy received significant attention in the early 1990s but failed to receive widespread acceptance. The lack of popularity of gasless laparoscopy was partially the result of the fact that the working space created by gasless retraction devices was inferior to that created by pneumoperitoneum.”

This is what we at EndoGyn have changed in the past 15 years by developing an abdominal wall lifting system, that enables the surgeon the same vision as at laparoscopy with Carbondioxide, namely the Abdo-Lift™

“A greater factor in the reluctance to adopt gasless techniques was the belief by most surgeons that there were few clinically significant deleterious effects of carbon dioxide pneumoperitoneum. Many of these negative effects were known but rarely observed by individual surgeons. This situation is somewhat analogous to the time during which deep venous thrombosis (DVT) prophylaxis was less common, and many surgeons would claim hundreds or thousands of cases performed without witnessing a DVT or pulmonary embolus in any patient. Careful follow up, objective studies, and published results provided the surgical community with a more thorough understanding of the magnitude of the problem. This understanding subsequently led to widespread use of prophylactic measures for patients at risk for DVT.

“One would hope that studies such as this (Laparoscopic associated hypercoagulable state leads to thrombosis, Ikeda et al, 2004) would inspire clinicians and investigators to pursue a deeper understanding of an approach that affects several hundred thousand patients each year.We truly have much yet to learn.

Original article
http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1356905&blobtype=pdf

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23.5.2008 von admin.

Laparoscopic adhesiolysis not recommended for chronic abdominal pain

Lancet

04/10/2003
by Harvey McConnell

The increasingly popular laparoscopic adhesiolysis cannot be recommended as treatment for adhesions among patients with chronic abdominal pain.

This call is made by Dutch clinicians following a multi-centre randomised trial who found, after one year, that there was no statistical difference in pain relief between women who had laparoscopic adhesiolysis or those who had no treatment at all.

Laparoscopic adhesiolysis, which treats severe abdominal pain by the removal of adhesions–is both controversial and not evidence based adds the report by Dr Dingeman Swank and colleagues from Groene Hart Hospital, the Netherlands. Their original hypothesis was that laparoscopic adhesiolysis leads to substantial pain relief and improvement in quality of life in patients with adhesions and chronic abdominal pain.

Chronic abdominal pain is a diagnostic and treatment challenge, the clinicians point out, and among many women the cause is not identified. Laparoscopy can exclude other causes of pain among 35 to 56% of patients, leading to the supposition that adhesions are the only explanation.

Treatment was concealed from patients. Pain was assessed for one year by visual analogue score (VAS) score (scale 0 to 100), pain change score, use of analgesics, and quality of life score.

After diagnostic laparoscopy to confirm adhesions, patients were randomly allocated laparoscopic adhesiolysis (52) to remove adhesions, or no intervention (48). Both groups reported substantial pain relief and a significantly improved quality of life, but there was no difference between the groups (mean change from baseline of VAS score at 12 months: difference 3 points).

The clinicians found that in both groups, the maximum pain relief was obtained at three months but had waned at six months.

Dr Swank and colleagues conclude that diagnostic laparoscopy is a safe procedure and reveals curable disorders in patients with chronic abdominal pain. “However, laparoscopic adhesiolysis is associated with morbidity and provides no more relief of chronic pain than diagnostic laparoscopy alone. Its value lies not in the adhesiolysis but in the diagnostic aspect of the procedure.”

Lancet 2003;361:1247-51.

This are Dr. Kruschinski’s comments to the conclusions of this study:

“However, laparoscopic adhesiolysis is associated with morbidity and provides no more relief of chronic pain than diagnostic laparoscopy alone. Its value lies not in the adhesiolysis but in the diagnostic aspect of the procedure.”

The study says only something about the “magic” effect of surgical tools at all. Pain has multiple factors and if you apply one tool like a surgery, therapeutic or diagnostic, it does work, as patients are influenced by the procedure itself and they think the adhesiolysis was effective. If the patients however have evident adhesions, they will get in pain one day, maybe after some more time or they will end up with a bowel obstruction.

In my opinion this study is unethical as it’s for sure that this procedure with or without removal of adhesions causes harm to the patients (unnecessary surgical intervention and morbidity) !!! and says anything…

Additionally as they are speaking about carbon dioxide laparoscopy without any sufficient adhesion barrier, it might be that most of the patients got their adhesions back and therefore
both groups had got the same adhesion score as before surgery, one group with adhesions and with adhesiolysis (which might come back after inadequate surgery) and the other group with
adhesions without adhesiolysis, so maybe the conclusions of this study could be, that the adhesiolysis didn’t work at all and thus both groups have similar initial pain relief which will be for sure followed with adhesions complication if the patients have adhesions.

To obtain results if a successful adhesiolysis provides pain relief, would be extremely important. Fo such a study one would need a well designed study protocoll with an adhesiolysis and a second look laparoscopy to be able to describe if the adhesiolysis was successfull or not. Thus they would be able to conclude if a successful adhesiolysis gives adequate results in pain relief and other symptoms of adhesions like re-surgery for adhesions or bowel obstruction.

I think for ARD sufferers there should be only one conclusion from this publication:
” It’s better not to have any surgery than a surgery that doesn’t work !”
But of course a surgery with a surgeon who can provide a successful adhesiolysis is always better than to wait in pain till the next bowel obstruction with emergency laparotomy …

Daniel Kruschinski

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23.5.2008 von admin.

Why a new website?

We thought it is important to support an unique treatment option, that is yet not aproved by the US FDA which has already given so many ARD sufferers “their life back” and here we are and we want to “shout it from the rooftops..:”

“The old doctor speaks latin, the new doctor speaks english and the good doctor speaks the language of people …”

Your disease is so serious that it bothers you in your every day life?
Maybe your doctor and your family doesn’t take it serious anymore?
Maybe your doctor is saying “no way you can still have adhesions…”?

The doctors at EndoGyn® consider your pain as real…

They believe that you are suffering from pain…
They know that your pain is not in your head…
They consider your disease seriously…
They are specialized in advanced laparoscopic surgery…
They will try to do the best and to help you at surgical, medical and mental levels…
They include the recent modern technologies to achieve the best results for the patients…

Patients support group of EndoGyn®

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