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Severe Abdominal Wall Adhesions

Severe Abdominal Wall Adhesions. Dan Geisler, MD, FACS, FASCRS Minimally Invasive Surgery Symposium. Severe Adhesions. Why? Why me? What am I thinking?. Disclosures. Covidien Speaker. 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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  1. Severe Abdominal Wall Adhesions Dan Geisler, MD, FACS, FASCRS Minimally Invasive Surgery Symposium

  2. Severe Adhesions • Why? • Why me? • What am I thinking?

  3. Disclosures • Covidien Speaker

  4. Benefits of M.I.S. • Blah, Blah, Blah

  5. Benefits of M.I.S. • Blah, Blah, Blah • Quicker recovery • Decreased pain • Improved cosmesis

  6. Benefits of M.I.S. CANCER • Decreased negative effect on immune response • Decreased blood loss ?=?Transfusion • Decreased incidence of wound infection • Adjuvant therapy

  7. Benefits of M.I.S. • Blah, Blah, Blah • Decreased adhesions • Decreased post-op SBOs

  8. Time What is it worth? • OR? • LOS? • Reoperation Rate?

  9. 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

  10. Postop Adhesions • AVOIDANCE is best

  11. 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

  12. 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

  13. Difficult Abdomen • Patients • Patience

  14. Difficult Abdomen • Judicious • Know when to say when • Benefits?

  15. Dense Adhesions • Open? • Veress? • Cut-down? • Other options…

  16. Dense Adhesions Arung W, Meurisse M, Detry O World J Gastroent. 17(41)

  17. Dense Adhesions CO2

  18. 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

  19. Dense Adhesions • Why not SILS? • More room than a traditional cut-down • Improved local lysis of adhesions

  20. Adhesions Conclusions • Avoid • Laparoscopy • Anti-adhesion barriers = SepraFilm • Open • Laparoscopic

  21. Thank You

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