Severe abdominal wall adhesions
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Severe Abdominal Wall Adhesions. Dan Geisler, MD, FACS, FASCRS Minimally Invasive Surgery Symposium. Severe Adhesions. Why? Why me? What am I thinking?. Disclosures. CovidienSpeaker. Benefits of M.I.S. Blah, Blah, Blah. Benefits of M.I.S. Blah, Blah, Blah Quicker recovery

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Severe Abdominal Wall Adhesions

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Severe abdominal wall adhesions

Severe Abdominal Wall Adhesions

Dan Geisler, MD, FACS, FASCRS

Minimally Invasive Surgery Symposium


Severe adhesions

Severe Adhesions

  • Why?

  • Why me?

  • What am I thinking?


Disclosures

Disclosures

  • CovidienSpeaker


Benefits of m i s

Benefits of M.I.S.

  • Blah, Blah, Blah


Benefits of m i s1

Benefits of M.I.S.

  • Blah, Blah, Blah

  • Quicker recovery

  • Decreased pain

  • Improved cosmesis


Benefits of m i s2

Benefits of M.I.S.

CANCER

  • Decreased negative effect on immune response

  • Decreased blood loss ?=?Transfusion

  • Decreased incidence of wound infection

    • Adjuvant therapy


Benefits of m i s3

Benefits of M.I.S.

  • Blah, Blah, Blah

  • Decreased adhesions

  • Decreased post-op SBOs


Severe abdominal wall adhesions

Time

What is it worth?

  • OR?

  • LOS?

  • Reoperation Rate?


Benefits of m i s4

Benefits of M.I.S.

  • Blah, Blah, Blah

  • Decreased adhesions

  • Decreased post-op SBOs

  • Improved function - IPAA

  • Improved QOL – IPAA

  • Crohn’s Disease

@ 1 & 5 Years

BJS May, 2009


Postop adhesions

Postop Adhesions

  • AVOIDANCE is best


Lap versus open

Lap Versus Open

N=40

IPAA

28 laparoscopic versus 12 open

  • Incisional Adhesion Score p=0.004

  • Total Abdominal Adhesion Score p=0.002

  • Adnexal Adhesion Score p=0.023

    • American Fertility Society Score

Hull, Joyce, Coffey, Geisler

Br J Surg Feb, 2012


Benefits of m i s5

Benefits of M.I.S.

Hull TL, Joyce MR, Geisler DP, Coffey JC

  • Adhesions after laparoscopic and open ileal pouch-anal anastomosis surgery for ulcerative colitis

  • Laparoscopic IPAA was associated with significantly fewer incisional, abdominal and adnexal adhesions in comparison with open IPAA

Br J Surg 2012, Feb; 99(2): 270-5


Difficult abdomen

Difficult Abdomen

  • Patients

  • Patience


Difficult abdomen1

Difficult Abdomen

  • Judicious

  • Know when to say when

  • Benefits?


Dense adhesions

Dense Adhesions

  • Open?

  • Veress?

  • Cut-down?

  • Other options…


Dense adhesions1

Dense Adhesions

Arung W, Meurisse M, Detry O

World J Gastroent. 17(41)


Dense adhesions2

Dense Adhesions

CO2


Dense adhesions3

Dense Adhesions

  • Consequences and complications of peritoneal adhesions.van Goor H. Colorectal Dis. 2007 Oct;9 Suppl 2:25-34.

  • Missed inadvertent gastrointestinal injuries during abdominal operations: characteristics, diagnosis, and treatment. Khoury W, Abu-Abeid S, Person B, Klausner JM, Kariv Y. Am Surg. 2012 Jan;78(1):46-50.

  • Medico-legal consequences of post-operative intra-abdominal adhesions. Ellis H, Crowe A. Int J Surg. 2009 Jun;7(3):187-91. Epub 2009 Apr 21.

  • Laparoscopic lysis of adhesions.Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal RJ. Colorectal Dis.World J Surg. 2006 Apr;30(4):535-40 2007 Oct;9 Suppl 2:25-34


Dense adhesions4

Dense Adhesions

  • Why not SILS?

  • More room than a traditional cut-down

  • Improved local lysis of adhesions


Adhesions

Adhesions

Conclusions

  • Avoid

  • Laparoscopy

  • Anti-adhesion barriers = SepraFilm

    • Open

    • Laparoscopic


Thank you

Thank You


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