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Re: pelvic and abdominal adhesionsFrom: ENDODOK@aol.comTue Apr 19 11:15:02 2005
I was an advocate of 2nd look as endorsed by the late Prof. Kurt Semm.( I remember well a story he told about a colleague(male) who had had 4 surgeries for recureent adhesiosn. He pleaded with Semm to operate on him because of his vast experience with adhesiolyis . Prof Semm determined that the pt's complaints were primarily RUQ, so when he scoped him the only adhesiolysis performed was in this region. He then left a foley cath throufh the abdominal wall, re-scoped him 2 days later via this access"port' & found gelatinous adhesions which were lysed, and the pt. subsequently remained asymptomatic.) At 2 weeks PO, very dense adhesions were often seen, so I proceeded at 1 week. One case was as cemented as it was before the adhesiolysis. The final experience on a patient with dense adhesions was re-look at 4 days , and she too was almost "cement" The bottom line is that adhesion formation commences within hours of the initial surgery and if one is going to "re-look" sooner is better than later. J. Glenn Bradley MD
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