<>Posted Wednesday, October 8, 2003 @ 12:38 PM
The following article shows that laparoscopic surgery has the same amount of readmissions for adhesion, regardless if the previous surgery was laparoscopic or open... A very interesting article and I know from over 3000 gasless-laparoscopies I had only one admission because of adhesions.
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
<><>New adhesiolysis cases:Initial Surgery last Tuesday: Right pelvic wall Before surgery: Fully covered with bowel adhesions
Right pelvic wall Second look: Complete adhesion free right pelvic wall
Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
Last Friday we had gasless adhesiolysis on a patient from UK, She had adhesions after a longitudinal laparotomy, that could be managed well.
Regards --------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
<>Posted Friday, October 29, 2004 @ 09:08 AM and she was adhesion free on her second-look. I am amazed about the SprayGel... it holds up more than I expected. --------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
<><>New cases, New cases, More New Cases, etc., etc.,
http://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=4uuoUAUKLsLe81IveeSMond0Ox&forum=2&thread=1221 Posted Friday, October 29, 2004 @ 09:53
Please see above what happens, if surgeons don't use any adhesion barriers...
And here you can see that even if using the best adhesion barrier available (SprayGel), but WITH carbon dioxide, adhesiolysis surgery is in most cases USELESS.
Another conclusion: I strongly believe that the adequate covering of the wounded area with SprayGel is only possible with gasless laparoscopy. I am also very sure that our results will remain the best as long as no other surgeon performs Lift-laparoscopy for adhesion surgery.
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
<>Posted Saturday, July 31, 2004 @ 09:59 AM The patient from last Friday had her second-look which showed excellent results... no adhesions in the areas of the adhesiolysis... Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
<> Posted Sunday, August 29, 2004 @ 09:22 AM the second look was adhesion free status, the days after surgery the patient went for shopping in Aschaffenburg...
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
<>Posted Friday, June 18, 2004 @ 03:34 PM Today was his second look and he was adhesion free. Four hours after gasless laparoscopy this 73 years old man went for shoping to the shop across the street...
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
<><>and some more adhesiolysis cases..http://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=uZSxZujguoVXw51FSCSFV0ttyI&forum=42&thread=20840
<><><>
ADHESIONS/ SUCCESS RATE OF SURGERY/ 3RD LOOK LAPAROSCOPY
Second looks and another case of gasless adhesiolysis... h ttp://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=tnjl3AdriV49Cr9ORM2y649tY3&forum=2&thread=1555
Posted Friday, March 11, 2005 @ 04:50 PM She, her parents and Hilary were touring around all the time and today they had their second-looks. Hilary and Leslie are adhesion free ! Candy had her second-look and was adhesion free on all the surgical areas. She went to the apartment just 3 hours after surgery. Regards
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
<><>and another 2 adhesiolysis cases from US
http://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=tnjl3AdriV49Cr9ORM2y649tY3&forum=2&thread=1480
<>Posted Friday, February 18, 2005 @ 02:19 PM today we did the secon looks. Both, Leiza and Frank were adhesion free on our previous surgical areas.
Regards
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
<><>Another adhesiolysis
http://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=tnjl3AdriV49Cr9ORM2y649tY3&forum=2&thread=1410
Posted Friday, January 28, 2005 @ 06:25 PM
In a 4 hours surgery we managed to take all the adhesions down, and covered the wounded area with 4 kits SprayGel. Let's look toward her second look...
By the way, we have plenty of cases for adhesiolysis also from other countries and Germany that are not reported here. Every week there are at least 3 adhesiolysis cases, so our gasless adhesiolysis gruop is growing rapidly... and by this the number of patiens and our experience with SprayGel.
Regards
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
<>Posted Friday, February 4, 2005 @ 05:59 PM and in the second-look Joyce was adhesions free ... On Wednesday, they go back home .. Regards
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
<><>New adhesiolysis case: Dusti
http://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=tnjl3AdriV49Cr9ORM2y649tY3&forum=2&thread=1359
<>Posted Saturday, January 22, 2005 @ 10:06 AM Dusti was adhesion free on her second look... Another proof of our succes concept of adhesion surgery with gasless laparoscopy and SprayGel...
--------------------Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
<><>What about worst cases ???? http://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=tnjl3AdriV49Cr9ORM2y649tY3&forum=2&thread=3645
<>Posted Monday, February 12, 2007 @ Even in worst cases, where nearly the complete abdomen is covered by adhesions: and the bowel is completly adherent to the abdominal wall, so dissection is always very dangerous: Application of SprayGel as an adhesion barrier... and in the second look: the bowel is sufficiently sutured, no infection or reformation of adhesions occured... Daniel Kruschinski, MD EndoGyn.com, Adhesions.de, Hysterectomy.de, Fibroids.de, Endometriosis.de, Lift-laparoscopy.com © by EndoGyn Ltd.
<><><> Miracle in our hands...Miracle in our hands...
Adhesions/ Success Rate of Surgery/ 3rd Look Laparoscopy
SUCCESS RATES OF SURGERY... an excurs, by Daniel Kruschinski http://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=C87Qw6AqpnylVQtQr54IENBc5F&forum=2&thread=275
Surgery without an adhesion barrier is useless! http://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=C87Qw6AqpnylVQtQr54IENBc5F&forum=2&thread=1220
Surgery with carbondioxide and SprayGel might be USELESS too. http://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=C87Qw6AqpnylVQtQr54IENBc5F&forum=2&thread=1221
Why is the 3rd-look laparoscopy extremely important? http://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=C87Qw6AqpnylVQtQr54IENBc5F&forum=2&thread=1392
Another case of a 3rd look as an important tool in reducing... http://www.endogynserver.com/cgi-bin/210/cutecast.pl?session=C87Qw6AqpnylVQtQr54IENBc5F&forum=2&thread=1694
<><><><><><><><>
IHRT: Note the difference in the number of cases in this "abstract" vs the hundreds of adhesiolysis cases Daniel Kruschinski claimed to have performed with 99.9% adhesion free 2nd & 3rd look procedures for the Spraygel(TM) clinical study YOU never knew you were taking part in?
Adhesiolysis in Severe and Reccurent Cases of Adhesions Related Disorder (ARD) - A Novel Approach Utilizing Lift (Gasless) Laparoscopy and SprayGel™ Adhesion Barrier
"ABSTRACT"... http://www.ump.com/Featured-Articles/Kruschinski-Adhesiolysis-Cr.pdf
We investigated the feasibility and outcome of adhesiolysis in patients with severe and reccurent adhesions using lift (gasless) laparoscopy and a SprayGelTM adhesion barrier at the Institute for Endoscopic Gynecology (EndoGyn®). The design included a prospective evaluation of lift (gasless) laparoscopic adhesiolysis in combination with a SprayGelTM adhesion barrier. A new score for bowel adhesions was developed and applied. All 35 patients with severe and reccurent adhesions underwent a liftlaparoscopic adhesiolysis with the Abdo-LiftTM and SprayGelTM adhesion barrier, a second-look laparoscopy at Day 7 and, in case of continuation of pain, a third-look laparoscopy within 6 months after the initial surgery. All patients were operated upon without conversion to laparotomy.The reduction in the adhesion score of adhesions at the second-look laparoscopy was overall (sum) 89.8% (90.1% reduction in extent, 89.3% reduction in severity, and 89.9% reduction in grade). Five patients (14.3%) had a third-look laparoscopy within 6 months after the initial surgery, in which four cases of adhesion reformation were confirmed. However, the scores were reduced compared to the initial surgery, especially in grade (94.2%) and severity (93.2%). In these analyses, SprayGelTM was uniquely effective in improving the success rates of adhesiolysis when combined with lift (gasless) laparoscopy and good hemostasis techniques. Adhesiolysis with Abdo-LiftTM and SprayGelTM had unparalleled efficacy in the adhesiolysis procedure even in those patients in whom other solutions have not worked. An overall reduction of adhesions by 89.9% at second-look laparoscopy was found. Even if five patients (14.3%) required a third-look laparoscopy where four cases of adhesion reformation were confirmed, the scores were reduced when compared to the initial surgery, especially in grade and severity.
The Use of SprayGel™ in the Procedures SprayGel™ is a synthetic, absorbable adhesion barrier for use in abdomino-pelvic procedures. SprayGel™ consists of two polyethylene glycol (PEG) solutions with complementary end-functional groups. It is prepared and applied to the surgical site through the SprayGel™ Laparoscopic Sprayer through a 5-mm wide applicator.
One of the liquids contains a dilute concentration of methylene blue, allowing for visualization of the barrier when applied. When the SprayGel™ liquids are mixed, they form a bio compatible hydrogel within seconds. The sprayer used in laparoscopic procedures is single-use and disposable and has a unique venting capability for safety and a flexible tip for greater control. The hydrogel persists for about 1 week, after which it is degraded by hydrolysis and
excreted via the kidneys.9,10
Operative Procedure
As a result of using the Abdo-Lift™system, the SprayGel™ application
occurred in an air environment. We also used specially developed instrumentation,
like a bipolar clamp and scissor (Fig. 1), that allows coagulation and cutting at one step and thus avoids bleeding. These special instruments allow coagulation without danger to surrounding tissue(namely, the bowel) as the bipolar energy is applied only between the two jaws of the instrument without spreading. Excellent hemostasis was assured with the use of these bipolar
scissors. We also consistently rinsed the bowels with Ringers solution and used a drain.
For the adhesiolysis applied an average of 4.5 SprayGel™ kits (ranging from 3 to 8). Extensive
photo documentation was done on each patient showing the progression and results of the surgeries (Fig. 2).
Second-Look Laparoscopy (SLL)
Evaluation
In our center, we followed up all surgeries with a SLL at 7 days to catch
and lyse any reforming adhesions before they became vascular. SLL served as the
second evaluation point for the effects of SprayGel™ on these adhesiolyses.
TS (Third Look) RESULTS
Three novel aspects are found in our approach: the use of SprayGel™, a gasless
technique, and special instrumentation.
Because SprayGel™ is colored a methylene blue, it enabled excellent visualization of the covered areas as well as a reference point to evaluate adhesion reformation during the SLL.
As mentioned previously, the adhesions were all scored by the same operator to ensure uniformity of the result assessment. Our analysis indicates a 90.1% reduction in extent, a 89.3% reduction in severity, and a 89.9% reduction in grade of adhesions at second look. The overall (sum) reduction was 89.8% (Table 6). The results at initial, SLL, and third-look laparoscopy (TLL) are shown in Tables 5, 6, and 7,
respectively. Five patients (14.3%) had a TLL within 6 months after the initial surgery due to continuation of pain and discomfort. Four (11.4%) of these patients had reformed adhesions; however,
the scores were reduced, especially in grade and severity, compared to the initial surgery (Table
6). The results of the TLL indicate a 87.7% reduction in extent, a 93.2% reduction in severity, and a 94.2% reduction in grade of adhesions. The overall (sum) reduction was 91.5% (Table 6). The surgical times
for the initial procedure were an average of 256 min (ranging from 93 min to 780 min), 28 min (ranging from 17 min to 110 min) at SLL, and 67 min (ranging from 34 min to 163 min) at the TLL. The amount of SprayGel™ kits used were an average of 4.54 (ranging from 2 to 8) in the initial procedure, none at SLL, and 1.41 (ranging from 1 to 3) in the TLL. A follow-up questionnaire (Table 8) was sent to the patients
via e-mail at 3 months, 6 months, and 12 months following the initial surgery.
Discussion
Our analysis was set to evaluate patients with severe and reccurent of postoperative adhesions. Our research indicates that combining good hemostasis, the use of lift (gasless) laparoscopy, and the use of SprayGel™ as a surgical adjunct, we realized a high reduction in adhesion formation in these patients.
Multiple studies have been conducted to assess the efficacy of laparoscopy versus laparotomy, as well as to assess the efficacy of laparoscopic adhesiolysis. Gutt et al. conducted a comparative
study to assess the benefit of laparoscopy based on published clinical and experimental data. Of 15 studies spanning 1987 to 2001, 9 concluded that fewer adhesions resulted from
laparoscopies than laparotomies. Fewer adhesions to trocar sites than laparotomy sites were reported in 7 of these studies.
3 A multicenter collaborative study of early second-look procedures after operative laparoscopy including adhesiolysis published by Diamond et al. described adhesion reformation and de novo adhesions to be frequent occurrences. At the second-look procedure, 97% were affected by reformed adhesions at 66% of the originally lysed sites. De novo adhesions occurred in
12% of patients.2 In another retrospective study to evaluate the degree of adhesion formation
at laparoscopic surgery, Mettler et al. examined a subgroup of patients who had undergone previous surgery for adhesiolysis. Of this group, 24% showed a more severe adhesion score,
57% showed the same, and 19% showed less. These findings exceeded the severity
of another group in the same study that did not have any pre-existing adhesions.
1 One of the factors that has long been noted to cause peritoneal adhesion formation
is tissue desiccation. The gas used to create a pneumoperitoneum has 0.0002% relative humidity and is delivered through trocars restricted with instruments, creating a forceful jet streaming effect.15 This effect causes peritoneal cell vapor pressure changes, resulting in rapid surface drying of the peritoneum and an increase in solute concentration and in peritoneal fluid viscosity.
14 The “cold dry” gas alters peritoneal cell integrity and increases peritoneal cell trauma and death, which can lead to adhesion formation.15 This principle is validated with a study that found fewer adhesions with extraperitoneal endoscopic surgery and more with intraperitoneal laparoscopic surgery.14,16 Lift (gasless) laparoscopy is specially indicated for operations of long duration, interventions in high-risk patients, procedures requiring precise surgical technique, and procedures demanding complex suturing. Therefore, these patients were ideal candidates
to use these techniques. We observed that SprayGel™ persists in the body during the entire critical wound healing period (5 days to 7days postoperatively).11 In addition, it is prepared quickly (within seconds), evolves no heat, degrades cleanly with a predictable rate, and is also useful in open procedures.12,13
The PEG substrate also helps SprayGel™ not to promote or potentiate bacterial infection— a side effect that causes adhesion formation. 14 The methylene blue color of the product greatly helps with easy visualization during the adhesiolysis procedure. We have determined that the sevenday period is the most optimal to check for adhesions because it allows enough time for de novo adhesions to form and is also at the point where SprayGel™ has undergone significant resorption. Alternately, adhesions that reformed could be removed very easy with aqua dissection without any bleeding.
At our center, we perform SLL at 7 days postoperatively for all patients and provide on-site housing to facilitate this process. In our opinion, an early SLL is an important step in assuring a successful outcome. To offer a TLL for patients
who continue to experience pain or discomfort offers the patient a reassurance to evaluate or to cure adhesion-related symptoms.
Although our initial results are very encouraging, we recognize that several limitations are present in this analysis. All procedures were done in a single center and monitored by a single reviewer, who was not blind to the patient treatment. No control group was used and long-term follow up of all patients has yet to be completed. We used more than one novel approach in these procedures - namely, a new adhesion barrier, SprayGel™, as well as a lift (gasless) technique, and other special instrumentation (bipolar scissors and clamps).
Because we observed SprayGel™ at SLL and adhesion reformation in some patients with a TLL, even though they were adhesion-free at the second look, we must evaluate whether adhesions
would develop once the SprayGel™ completely dissolves. Finally, we recognize that with this type of analysis design, surgeon bias can creep into the analysis.
CONCLUSIONS
Our experience has shown that when compared to other surgical adjuncts, SprayGel™ is uniquely effective in improving the success rates of adhesiolysis when combined with lift (gasless) laparoscopy and good hemostasis techniques.
This data demonstrates that SprayGel™ performs with unparalleled efficacy in abdominal adhesiolysis even in those patients in whom other solutions have not worked.
Our analysis indicates that even in severe adhesions where surgeons usually avoid surgery, a laparoscopic approach is reasonable. With lift (gasless) laparoscopy, a SprayGel™ adhesion barrier, and the concept of second- and third-look laparoscopy, we were able to reduce adhesions in a high percentage of patients (91.4% as an average of the scores of extent, grade, and severity).
Thus, a reduction of adhesion reformation and associated symptoms such as pain and bowel obstructions with emergency surgeries results in a better quality of life for this group of patients.
Further analysis, especially in a long term follow up, is needed and will be reported.
Adhesiolysis in Severe and Reccurent Cases of Adhesions Related Disorder (ARD)
http://www.ump.com/Featured-Articles/Kruschinski-Adhesiolysis-Cr.pdf
1.) What Are Adhesions... © 2006, Confluent Surgical, Inc. http://www.spraygel.com/spraygel/whatareadhesions.htm?session=P8tWwfp8i9Pehq7IHhCMtw8nWw
Confluent Surgical Company Information... Copyright © 2007 Confluent Surgical Inc. http://www.confluentsurgical.com/company.html
Till then...Toodle Doo, Doc Kru!
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