OBGYN.net
Conference Coverage
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http://www.obgyn.net/avtranscripts/aagl2000_wiseman.htm |
"Adhesions"
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Dr.
Larry Demco: “Good
morning again, this is Dr. Demco reporting from the 29th Congress of the
AAGL. This morning I’d like
to interview Dr. David Wiseman who is the Chair and Founder of the International
Adhesion Society. Dr.
Wiseman, adhesions are a serious problem not only for doctors but for
patients, could you give us some idea of the scope of the problem?” Dr.
David Wiseman: “The
scope is enormous and it’s under-appreciated.
Almost everyone having surgery will form adhesions and a number of
studies have been done to that effect showing that up to 95% or even 100%
of patients having some type of surgery will form adhesions.
The question is how many of those patients will have problems due
to adhesions? There are varying numbers on that depending on the type of
surgery that is performed. A
recent paper published in the LANCET about a year ago shows that the
number of hospital re-admissions for adhesion related complications rivals
that for the number of procedures formed either for cardiac bypass,
appendectomy, or hip replacement. Everyone
has heard of the cardiac bypass operation or a hip replacement or an
appendectomy but very few people know what an adhesion is.
So that gives you an extent of the problems and those are the
severe ones that occur relatively in a short time, within five years. The numbers are probably much greater if you take the time
out and adhesions can occur at any time.
We know of cases where people who report problems due to adhesions
seventy years later after having an appendectomy when they were a young
child.” Dr.
Larry Demco: “It’s
a funny situation, this variance in the presentation has led to a lot of
the problems of even the doctors viewing their idea about adhesions.
I know general surgeons mainly associate adhesions with bowel
obstruction. From in your
Society in review of your patients, what symptoms do the patients most
often present with when they do have adhesions?” Dr.
David Wiseman: “First
of all, the majority of people that we come into contact with are people
that have already had several operations for adhesions so it’s well
established what their problems are and their problems are, first of all,
bowel obstruction, either partial or full obstruction, and/or some kind of
abdominal pain. Now it’s
important to understand that not all pain is caused by adhesions and not
all adhesions cause pain but probably a bowel obstruction type of syndrome
is most common and then pain. There
is another group of patients in the infertility world that will report
infertility most probably without those kinds of complications but if the
infertility is due perhaps to adhesions, say endometriosis related, then
those patients may end up after several operations in the bowel
obstruction chronic pelvic pain category.” Dr.
Larry Demco: “I’ve
done some work with adhesions myself and we’re actually mapping which
adhesions hurt and which ones do not.
It’s quite interesting to see that from our research we’ve seen
that the bowel is not much different from your arm.
If you break an arm, any little movement while you’re getting it
to the hospital causes severe pain in the arm.
If you don’t even treat the arm but put it in a cast, the pain in
your arm will disappear. We
found that when looking at mapping adhesions in the abdomen that similar
procedures are done if the structure is movable and attaches itself to the
peritoneum, it’s very painful. Something
that’s fixed is a problem that seems to be corrected and those are not
the source of the pain. So
it’s interesting and a lot of work has to be done in this.
In what research capacity that you’ve seen looks most promising
for your prospective?” Dr.
David Wiseman: “Unfortunately,
the research isn’t that extensive and it’s limited to the kinds of
things that you’re talking about. In terms of establishing the causes of
the pain and obstruction, it’s very limited.
It has begun recently with the advent of the conscious pain mapping
type procedures that you’re describing but really we don’t know very
much about this at all. There
are some other promising avenues that are related to it that suggest there
may be pain nerve fibers that grow within the adhesions. We know that
they’re there but we don’t know if they’re hooked up and if
they’re functioning. So the
whole problem as to why adhesions cause problems or whether the adhesion
that’s there is really causing the pain or if there’s something within
that - a hidden endometriosis, for example, or a scar that’s entrapping
a nerve deep down in the tissue, we really don’t understand any of that.
The majority of the work is being done by medical device and
pharmaceutical companies that are trying to prevent adhesions but
they’re really not addressing the fundamental issues such as the one
that you’ve described.” Dr.
Larry Demco: “Let’s move
on to the prevention of adhesions. Can
you give us a short summary on what’s available for that?” Dr.
David Wiseman: “Certainly,
really in the United States there are two products available; one is
INTERCEED made by Johnson & Johnson ETHICON, the other one is
Seprafilm made by Genzyme. In
Europe there’s a product called ADEPT made by ML Laboratories.
There’s a product called INTERGEL, which is ETHICON, which is in
Europe and other countries, and there are a number of companies that are
developing products, which look quite promising, some of which were
presented here. I presented
two products - one from Europe, IMEDEX, and one from the 3M Company and
then there was another presentation by a company called CONFLUENT which
also has a very promising product. These
are incremental or perhaps quantum advances in what we know about how to
prevent adhesions but we’re still a long way off.” Dr.
Larry Demco: “It
seems that the adhesion story seems to be two-fold and looks like
there’s a lot of research that has to be done on both the cause of the
pain of adhesions and further research to see how we could prevent them.
I’d like to thank you very much, and I would like to support your
society in any way that I can.” Dr.
David Wiseman: “Thank
you very much.” Please remember to contact our web site for more details:
www.adhesions.org |
