Posted Wednesday, October 8, 2003 @ 12:40 PM    

The SCAR2 feasibility study, presented today at the Annual Meeting of the European Society of Human Reproduction and Embryology was designed to follow in the footsteps of the groundbreaking SCAR study4, which examined the burden of adhesion-related readmissions over ten years following gynaecological and lower abdominal laparotomies (open surgery) in 1986. At the time of that original research, laparoscopic surgery was in its relative infancy and adhesion-related admission data for this type of procedure were not included. For the new study, researchers identified all gynaecological surgeries (laparotomies and laparoscopies) carried out over a twelve-month period (April 1996 - March 1997) and then tracked all readmissions in the subsequent four years.

"Many surgeons and gynaecologists hoped that less invasive surgery using laparoscopic techniques could reduce the risk of adhesions and their complications, something which is particularly important for women, given the associated risk of infertility", said Mr Adrian Lower, principal investigator and consultant gynaecologist based at the London Clinic.

"What our research shows, however, is that adhesion prevention strategies must be adopted even during laparoscopic procedures since in many gynaecological procedures re-admission due to adhesion-related complications was just as common as with open surgery," continued Mr Lower.

In total, 15,197 women undergoing laparascopic procedures and 8,849 women undergoing laparotomy procedures were identified. The researchers found that for laparoscopic sterilisation procedures the risk of an adhesion-related readmission was very low. However, for other laparoscopic procedures - which make up over 40% of gynaecological laparoscopies undertaken in Scotland and were undergone by 6, 276 women in this study - the risks of adhesion related readmissions are significant. Laparoscopic (keyhole) surgery
Type of Surgery Definite Readmission Risk
Adhesiolysis or adhesion-related procedure within 1 year of laparoscopy Possible Readmission Risk
Possibly due to adhesions within 1 year of laparoscopy
Low Risk
Fallopian tube / sterilisation procedures 1 in 500 1 in 40
Medium / High Risk
Therapeutic/diagnostic procedures & adhesiolysis 1 in 70 / 1 in 80 1 in 10 / 1 in 7

As far as traditional laparotomy surgery is concerned, the new research confirmed the findings of the original SCAR study, in that the burden of adhesion-related readmissions remains a significant problem, with operations on the ovary and Fallopian tubes carrying the highest risk of readmission.

Laparotomy (open) surgery
Type of Surgery Definite Readmission Risk
Adhesiolysis or adhesion-related procedure within 1 year of laparoscopy Possible Readmission Risk
Possibly due to adhesions within 1 year of laparoscopy
Uterine surgery 1 in 170 1 in 20
Fallopian tube surgery and ovarian surgery 1 in 120 / 1 in 50 1 in 7 / 1 in 6

"As surgeons, we know that using adhesion reduction strategies can reduce the risk of post-operative complications. Given the scale of the problem and the impact we know that adhesions can have upon our patients' lives, we must continue to do everything we possibly can to prevent adhesions as part of good surgical technique. For surgical procedures with a known risk of adhesion-related problems this means we should be considering routine use of adhesion-prevention therapies," concluded Mr Lower.

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Notes to Editors

Preventing adhesions: A number of physical barriers have been developed for use during surgery to help prevent adhesions. However, these have had limited uptake in open surgery and are generally difficult to use in laparoscopic surgery. One key challenge is that these physical barriers (gels, sprays or film-like sheets placed between neighbouring organs in the peritoneal cavity) may reduce adhesions where they are placed, but do not prevent adhesions developing elsewhere in the abdomen. The ideal adhesion-reduction agent should be easy to use in all types of surgical procedure and capable of reducing adhesion formation at the operating site and throughout the peritoneum. Ongoing research suggests that Adept® (icodextrin 4%) may be closest to this ideal profile. A non-viscous liquid, Adept can be used for both open and laparoscopic surgery, and is compatible with a wide range of antibiotics used during and after surgery. Adept is simple to use, being instilled slowly at the end of surgical procedures and used during surgery as an irrigant. A 1.5 litre bag of Adept (enabling 500ml to be used during procedures with 1000ml remaining for instillation at the end of surgery) costs £44.00.

*The Scottish morbidity record system was used as the basis for both the SCAR2-feasibility study and the original SCAR study in 1986. It was selected because it is a robust system to track the progress of patients through the health service.

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References:
1. Adhesion-related readmissions following gynaecological laparoscopy or gynaecological laparotomy in Scotland. An epidemiological study of 24,046 patients. A Lower, R Hawthorn, D Clark, A Knight and A Crowe on behalf of the SCAR panel. Presented at the 19th Annual Meeting of the European Society of Human Reproduction and Embryology, Madrid, Spain, 1 July 2003.
2. Menzies D, Ellis H. Intestinal obstruction from adhesions - how big is the problem? Ann R Coll Surg Engl 1990; 72:60-3
3. Hershlag A, Diamond MP, DeCherney AH. Adhesiolysis. Clin Obstet Gynecol 1991; 34: 395-402
4. Lower AM, Hawthorn RJS, Ellis H et al. The impact of adhesions on hospital readmissions over ten years after 8489 open gynaecological operations: an assessment from the Surgical and Clinical Adhesions Research Study. Br J Obstet Gynaecol. 2000; 1071.(7): 855-862.

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Daniel Kruschinski, MD
www.endogyn.net

Posted Thursday, October 9, 2003 @ 00:53 AM  

Thanks for the informative article ..........I know Melissa's excellent results are due to the fact that we made the trip to Germany for surgery with you------gasless surgery------- .........the results were unbelieveable, incomprehensible, as we had no idea the CO2 had been such a defeating factor in her prior surgeries!!! (To say nothing of her bowel being ignored in both surgeries).....!!!!! And............guess what? Neither surgeon mentioned the risk factor involved by introducing CO2 into the abdomen.. .......and I sure did not know to ask!...........When you explained to me via email prior to our journey that Melissa would have a big advantage, as the AbdoLift would be used, I still did not realize the impact and difference until after her surgery!

Melissa can now eat and drink anything and everything she wants, as her bowel FUNCTIONS like it should!!!!!!!!!.........She no longer walks around doubled over, holding her stomach.......

I hope you can find a doctor/surgeon to take the challenge.............as there is no comparison to the outcome of gasless surgery!

Dr. Kruschinski, we felt we were lost and drowning in a world of unconcern.........no one cared...........the prior surgeries Melissa had were not successful (in fact her condition became worse), we were so tired and weary of it all I can never thank you enough!!! Keep up the good work .........and thank you so much for being a caring physician that expects a GOOD outcome for the patient after performing surgery!! Thank you also for informing others, via this website, that the key to becoming adhesion free is to make plans for gasless surgery.......

.....Thank you Dr. Kruschinski.....

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Karen
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Posted Thursday, October 9, 2003 @ 02:24 AM    

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Daniel Kruschinski, MD
www.endogyn.net

Posted Thursday, October 9, 2003 @ 10:22 AM    

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Daniel Kruschinski, MD
www.endogyn.net

Posted Thursday, October 9, 2003 @ 11:58 PM  

How true it is that the surgeon is the key factor when considering surgery. .........unfortunately it seems many that suffer from adhesions have (and still are) learning this the hard way---by having surgery after surgery and coming away disappointed and still in pain... I know, because this is what happened to Melissa.

Today I spoke with a woman that has had multiple surgeries and she is still in severe pain. She has also had different surgeons, but yet has never been informed by any of her doctors/surgeons of the risk factor involved with CO2. She told me she became upset when reading Melissa's story, as a light bulb went off in her head
when reading about CO2 in the article...........(that ah-ha moment)! She told me she has gone from being glad about reading it, to very angry, as she is now convinced she has been duped into believing she is an 'extreme' case, always needing more surgery!

She then lamented not having SprayGel or the AbdoLift available in the US. I assured her there has to be a talented surgeon behind the "tools"........

Many are sitting back waiting for the approval of SprayGel, and yet, that alone does not assure us of being free of adhesions! The product will only be as good as the surgeons' application process and the successful adhesiolysis prior to that application! Also, what is our hope in the US regarding the dissuse of CO2? It seems we are aeons away from that happening anytime soon.

Dr. Kruschinski,......I would like to point out too, and maybe you can expound on something you shared with Melissa and me about "filmy" adhesions. You had Melissa's surgery photos and you stated that she had many thick, dense adhesions and also many "filmy" adhesions. While speaking to us about the filmy ones, you stated that many surgeons doing an adhesiolysis do not even consider the filmy adhesions as adhesions! This subject came up in our conversation today and the lady that called me said her doctor says the thin, filmy adhesions are not a problem. I have referred her to adhesions.de, so maybe you can do a topic concerning this issue???

When a local doctor/surgeon was viewing Melissa's photos he pointed at an area of filmy adhesions and asked, "Are those adhesions, too?"....................(Your words rang in my ear one more time)

My wish is that each person suffering from the pain of adhesions can make their way to see you Dr. Kruschinski..............you are one in a million!!!! Thank you and GUCCI for making this site available and bringing education from the surgery room into our living rooms!!!!!

You are making huge positive waves for adhesion sufferers, not only by performing skilled adhesiolysis, but also by providing a caring forum for adhesion sufferers to "Talk to the Doc"..............this is exceptional............and I thank you so much for the time you invest in reaching out, not only with the skilled hand of a surgeon, but also with an educating hand and a hand of sincere compassion!!!! Big thanks to David (Gucci) for making this forum possible!!

Okay, good night to everyone and big group hug!!!!!!!!!!

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Karen
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