'Scarring more painful than original illness'

The Dominion Post
Last updated 05:00 08/06/2009


NATALIE SLADE/Dominion Post
SCARRED: Carla Gardiner had to have a four-hour operation to remove the scar tissue caused by anti-scarring gel during her initial surgery.


Carla Gardiner, 35, had surgery in 2005 for severe endometriosis, a condition in which abnormal growths develop in pelvic organs, causing inflammation, scarring and pain.
"It [the endometriosis] was so bad I would be on the floor in the foetal position howling with period pain. I needed codeine just to get through the day."
About a week after the operation, she developed an infection and spent a week in Wellington Hospital hooked up to a drip.
In fact, Ms Gardiner had probably suffered chemical peritonitis her internal organs had become inflamed by Confluent SprayGel, which was supposed to prevent scarring.
She recovered, and initially, the surgery seemed to have worked. But when she began getting bad period pain and intermittent bleeding a couple of years later, she went back to her specialist, Hanifa Koya.
It was then that she learned her problem could have been caused by the gel.
She had repeat surgery in March last year a four-hour operation to remove scar tissue.
Both operations have cost her insurance company about $30,000. Her insurance premiums have skyrocketed in recent years, but since the endometriosis diagnosis, no other company will agree to cover her.
Belinda Colley, 32, has had three operations since 2004: the first for endometriosis and two more to remove scarring caused by anti-scarring gel.
All her operations were covered by insurance, but she is angry she had to go through so much "unnecessary pain".
"It astounds me that they have never admitted liability when it's patently obvious their product was faulty.
"The scarring was worse than the endometriosis. Hanifa said it was like a spider-web ... everything was stuck together."
Newtown artist Mika Still, 34, had surgery for severe endometriosis in Wellington Hospital in 2004 after a referral from her private specialist.
"For the first couple of months after the operation, I was in very bad pain ... but I thought that was to be expected with major surgery.
"But then I started to feel something wasn't right. I had this dull ache all the time."
In 2007, she consulted Mrs Koya. Surgery revealed there was no endometriosis but her fallopian tubes were "super-glued" to her pelvic wall with multiple layers of scar tissue.
"That explained the pain."
Ms Still did not blame surgeons for using the gel because they thought they were doing the right thing.
"But it makes me angry that no-one was monitoring it ... it goes against medical ethics, firstly do no harm."
http://www.stuff.co.nz/national/health/2480461/Scarring-more-painful-than-original-illness

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Fluid and pharmacological agents for adhesion prevention after gynaecological surgery

Fluid and pharmacological agents for adhesion prevention after gynaecological surgery

Fluid and pharmacological agents for adhesion prevention after gynaecological surgeryThe use of fluids and pharmacological agents (medicinal drugs) to prevent the formation of adhesions (scar tissue) that may interfere with becoming pregnant after surgery of the female pelvis.Adhesion formation is a condition in which bodily tissues that are normally separate grow together. This can occur after surgical procedures such as operations on the female pelvis to remove a cyst, treat endometriosis, remove a tubal pregnancy, or remove a fibroid (a benign tumour of the womb). This scar tissue can have serious effects on the woman's future fertility as it can lead to blockage of her tubes. Careful tissue handling at the time of surgery and control of the blood loss are important ways of reducing scar tissue, however, over the years other methods have been developed to minimise the risk of scar tissue formation. Surgeons have tried using different types of drugs or leaving different types of fluids inside the pelvis at the end of surgery to prevent tissue surfaces from sticking to each other. Fluids include dextran, icodextrin (Adept), SprayGel, and fluids containing the chemical hyaluronic acid (Intergel, auto-crosslinked hyaluronic acid, Sepracoat). Drugs that have been tried include steroids (anti-inflammatory drug), the anti-coagulant heparin, promethazine, and noxytioline.This review aimed to evaluate the role of these different agents in the prevention of adhesion formation. The results showed that there is currently insufficient evidence to recommend the use of steroids, icodextrin, SprayGel or dextran. The review did show that fluids that contained hyaluronic acid may help lower the chance of scar tissue forming; however, more studies are needed to confirm this. There are also some major safety issues concerning the use of one of these agents (Intergel), which has been withdrawn from the market due to reports of serious side effects such as allergic reactions and pain.A major problem with studies in this review is that most of them did not look at the rate of pregnancy following the use of these substances. Since the occurrence of pregnancy is the gold standard for measuring how well these agents work to preserve fertility, it is important that future studies take this into consideration.http://www.cochrane.org/reviews/en/ab001298.htmlMain resultsThere is no evidence of benefit from the use of steroids, dextran or other pharmacological agents in any of the outcomes. The use of hyaluronic acid agents may decrease adhesion formation (OR 0.31, 95% CI 0.19 to 0.51) and prevent the deterioration of pre-existing adhesions (OR 0.28 (95% CI 0.12 to 0.66). There is insufficient evidence for the use of icodextrin 4% or SprayGel as adhesion-preventing agents. None of the studied agents has been shown to improve the pregnancy rate when used as an adjunct during pelvic surgery.Authors' conclusionsThe current evidence for the use of fluid and pharmacological agents for the prevention of adhesions is limited. There is no evidence on any benefit for improving pregnancy outcomes when pharmacological and fluid agents are used as an adjunct during pelvic surgery.There is insufficient evidence for the use of the following agents: steroids, icodextrin 4%, SprayGel and dextran in improving adhesions following surgery.There is some evidence that hyaluronic acid agents may decrease the proportion of adhesions and prevent the deterioration of pre existing adhesions. However, due to the limited number of studies available, this evidence should be interpreted with caution and further studies are needed.Full studyhttp://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001298/frame.htmland who do they as one of the references??????METTLER!!!!
Posted by IHRT at 6/20/2008 01:26:00 PM 0 comments Links to this post
Labels: Adept, adhesion barrier, adhesion prevention, Adhesion related disorders, adhesions, endometriosis, postoperative complications, SprayGel, surgeons, surgery