title: Adhesiolysis in severe and reccurent cases of adhesions related disorder (ARD) - a novel approach utilizing lift (gasless) laparoscopy and SprayGel adhesion barrier.
abstract: We investigated the feasibility and outcome of adhesiolysis in patients with severe and reccurent adhesions using lift (gasless) laparoscopy and a SprayGel adhesion barrier at the Institute for Endoscopic Gynecology (EndoGyn). The design included a prospective evaluation of lift (gasless) laparoscopic adhesiolysis in combination with a SprayGel adhesion barrier. A new score for bowel adhesions was developed and applied. All 35 patients with severe and reccurent adhesions underwent a lift-laparoscopic adhesiolysis with the Abdo-Lift and SprayGel 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, SprayGel was uniquely effective in improving the success rates of adhesiolysis when combined with lift (gasless) laparoscopy and good hemostasis techniques. Adhesiolysis with Abdo-Lift and SprayGel 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.
authors.affiliation: Institute for Endoscopic Gynecology (EndoGyn), Seligenstadt, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kruschinski
authors.forename: Shirli
authors.initials: S
authors.lastname: Homburg
authors.forename: Fabian
authors.initials: F
authors.lastname: D'Souza
authors.forename: Patrick
authors.initials: P
authors.lastname: Campbell
authors.forename: Harry
authors.initials: H
authors.lastname: Reich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020776:Endoscopes, Gastrointestinal; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005240:Feasibility Studies; D005260:Female; D005740:Gases / Q000627:therapeutic use; D006801:Humans; D007410:Intestinal Diseases / Q000517:prevention & control* / Q000601:surgery*; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009779:Occlusive Dressings; D055502:Secondary Prevention; D000267:Tissue Adhesions / Q000517:prevention & control* / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D005740:Gases