Prepared by Roselyn Macdonald, roselyn99@hotmail.com, after having surgery with Dr Kruschinski in late October, 2004.

As you read this information, there are three big advantages that Dr Kruschinski offers any adhesions patient, and which to my knowledge nobody else can, or will, offer. These are precisely and exactly WHY you SHOULD go to Dr K for your surgery and why it is very likely not only to get rid of your pain(s) but also to be the last surgery you’ll ever need for adhesions. As a patient myself who has had 18 years of adhesions and some 5 laparotomies (bad cut from the belly button straight down all the way each time) and some 4 or so laparoscopies with gas, I can tell you this truly. Your post operative pain will be nothing at all like previous surgeries because the spray gel keeps all cut surfaces sliding happily past each other. No ripping and tearing pain such as I had previously thought was ordinary and common (which of course it is for any of you who have not had Dr K’s wonderful work done on you). 

The hospital where you will have the surgery and initial recovery stay is a first class hospital with 2 beds or 1 beds per room and is very modern, clean and nicely appointed. The standard of nursing care is very very high. The hospital has an excellent patient-care status – as well as a private post-operative recovery room for one-on-one care. There are cultural differences to be sure; but nothing that will prevent the patient from receiving high quality care – nor from enjoying their stay! Most of the nurses speak English very well! There were just a few words we had problems with – but not many. I had no problem understanding them! They were all very sweet and helpful.

Roselyn Macdonald's view on gasless surgery:

1. Cost effective
   1. No expensive CO2 gas
   2. SprayGel / SprayShield greatly reduces length of hospital stay for surgical patients, see 5a.
   3. Ditto b. for less outpatient follow-up and very much less chance of needing repeat adhesion surgery in future years, see 5 b.
   4. Significantly less specialized training of surgeons as technique in gas-less laparoscopy is largely the same as in ordinary open laparotomy, see 2 a.
2. Uses normal
   1. Already familiar instruments
   2. More direct hand contact with operative surfaces than in the old laparoscopy with gas
   3. Easy changing of instruments without loss of gas
3. No CO2 damage to cells
   1. No risk of hypoxemia, acidosis. Global acidosis or global necrosis on the cells of the peritoneum
   2. Therefore MUCH less risk of adhesions from any of the items in “a” above, and Much less risk of adhesions even just from the CO2 alone
4. Ability to use local anaesthesia
5. Absolutely no blind puncture injuries
   1. All work is done directly under vision
6. SprayGel / SprayShield keeps all surfaces slippery
   1. Greatly reduces post operative pain, patient requires less pain medication, feels better sooner and consequently has a much shorter hospital stay (in my case a difference of 2 nights instead of an average of 10 nights)
   2. Dramatically reduces if not eliminates re-formation of adhesions
   3. Less adhesions or no adhesions means a significant chance of no further surgery

 It is vitally important to understand that:

• The gas-less laparoscopy uses a machine called the Abdo-lift which is carefully calibrated to lift the abdominal wall to an acceptable level of pressure which does not damage muscles, nerves and tissue. It is the Abdo-lift which gives a clear view of the surgical field thus cancelling the need for the harmful CO2 gas.
• The SprayGel / SprayShield is only properly effective when used in conjunction with the gasless laparoscopy. This is because the SprayGel / SprayShield is a fine jet of spray which will be blown about by the high pressure CO2 gas and will thus merely spot the cut surgical surfaces of the patient haphazardly here and there, rather than giving a dense even blanket coverage. This dense blanket coverage is vital for the spray-gel to keep ALL of the cut surgical surfaces of the patient from sticking together whilst healing and thus creating more adhesions.
• Furthermore the cold CO2 gas naturally causes cells to constrict and thus prevents the SprayGel / SprayShield from infiltrating the tissues properly. This also prevents the spray-gel from doing it’s job effectively.
• It is also, of course, vital that good surgical techniques are used throughout, especially in the fight to prevent adhesions.

This document was prepared by Roselyn Macdonald who is not a medical person at all, but a patient with an 18 year history of adhesions starting in the first instance with endometriosis. She has had a large number of very skilfully and excellently performed laparoscopy’s and laparotomy’s over the 18 years with the overriding problem always being adhesions with partial bowel obstructions necessitating many hospital stays. She whole heartedly endorses the pioneering work of Dr. Daniel Kruschinski in Germany, who is the first person in all of the long 18 years who is not only willing, but eager to operate on cases like myself who are almost certainly going to be difficult and time consuming. The reason he does not run away from adhesions? Hopefully obvious to you from reading the above, he really does have the answer. I am happy to speak to anyone medical, patient or just curious. 
My phone number is +44 1202 545 614. 

Don't forget, gasless laparoscopy and SprayGel / SprayShield work together

Although adhesions can occur anywhere, the most common locations are within the abdomen, the pelvis, and the heart.

Pelvic adhesions:

• Pelvic adhesions may involve any organ within the pelvis, such as the uterus, ovaries, fallopian tubes, or bladder, and usually occur after surgery.
  Adhesions between anterior uterine wall

  

  Adhesions between uterus ,adnexa and bowel posteriorly

  

• Pelvic inflammatory disease (PID) results from an infection (usually a sexually transmitted disease) that frequently leads to adhesions within the fallopian tubes.
• A woman’s eggs pass through her fallopian tubes into her uterus for reproduction.
• Tubal adhesions can lead to infertility and increased incidence of ectopic pregnancy in which a fetus develops in the tube.

Abdominal adhesions:

• Abdominal adhesions are a common complication of surgery, occurring in up to 93% of people who undergo abdominal or pelvic surgery.
• Abdominal adhesions also occur in 10.4% of people who have never had surgery.
• Most adhesions are painless and do not cause complications.
• However, adhesions cause 60%-70% of small bowel obstructions in adults and are believed to contribute to the development of chronic pelvic pain.
  Bowel adhesions

  

  

• Adhesions typically begin to form within the first few days after surgery, but they may not produce symptoms for months or even years.
• As scar tissue begins to restrict motion of the small intestines, passing food through the digestive system becomes progressively more difficult.
• The bowel may become blocked.
• In extreme cases, adhesions may form fibrous bands around a segment of an intestine. This constricts blood flow and leads to tissue death.

De novo adhesions

• De novo are new adhesions that may form at a site of direct surgical trauma such as an incision.
• They may also develop at locations away from the site of surgery, for example, around the adnexa at the time of a cesarean section.
• Adhesions may also reform following adhesiolysis or adhesiectomy.
  

Three broad types of adhesions exist, but the underlying pathophysiology is similar for each:

• Filmsy
• Vascular
• Cohesive

Read more

Symptoms may include:

• pain
• cramps
• intermittent vomiting
• difficulty with passing gas or having a bowel movement
• swelling of the abdomen

Symptoms vary depending on the tissues involved.

For example, in the gastrointestinal tract, bowel obstructions may occur.

Mechanical small bowel obstruction after previous surgery can be the most severe effect of adhesions.

In the uterus and in the pelvis, adhesions can cause infertility and other reproductive problems. The adhesions can block the ends of the fallopian tubes causing infertility.

Doctors associate signs and symptoms of adhesions with the problems an adhesion causes rather than from an adhesion directly.

As a result, people experience many complaints based on where an adhesion forms and what it may disrupt.

Typically, adhesions show no symptoms and go undiagnosed. These adhesions cause no problems at that moment , but they can obstruct the intestine in about 2 percent of all patients. These obstructions can occur several years later.

Most commonly, adhesions cause pain by pulling nerves, either within an organ tied down by an adhesion or within the adhesion itself.

• Adhesions above the liver may cause pain with deep breathing.
• Intestinal adhesions may cause pain due to obstruction during exercise or when stretching.
• Adhesions involving the vagina or uterus may cause pain during intercourse.
• It is important to note that not all pain is caused by adhesions and not all adhesions cause pain.
• Small bowel obstruction (intestinal blockage) due to adhesions is a surgical emergency.
  • These adhesions trigger waves of cramplike pain in your stomach. This pain, which can last seconds to minutes, often worsens if you eat food, which increases activity of the intestines.
  • Once the pain starts, you may vomit. This often relieves the pain.
  • Your stomach may become tender and progressively bloated.
  • You may hear high-pitched tinkling bowel sounds over your stomach, accompanied by increased gas and loose stools.
  • Fever is usually minimal.
• Such intestinal blockage can correct itself.

However, you must see your doctor. If the blockage progresses, these conditions may develop:

• Your bowel stretches further.
• Pain becomes constant and severe.
• Bowel sounds disappear.
• Gas and bowel movements stop.
• Your belly will grow.
• Fever may increase.
• Further progression can tear your intestinal wall and contaminate your abdominal cavity with bowel contents

Intra-abdominal adhesions are usually the result of surgical or gynecologic operations, pelvic inflammatory disease (gonococcal or chlamydial), appendicitis or endometriosis. Adhesions may be responsible for chronic persistent abdominal pain without associated pelvic pathology. Though adhesions probably cause pain by entrapment of expansile viscera, the relationship of adhesions to abdominal pain is still controversial. In contrast, mechanical small bowel obstruction after previous surgery demonstrates unequivocally the most severe effect of adhesions. Patients with chronic or recurrent abdominal pain and a history of numerous abdominal surgical procedures are often denied treatment if they are not obstructed or symptomatic of intermittent bowel obstruction.

 Read more

But even during laparoscopy, which is a form of minimally invasive surgery, wound surfaces can be formed during certain procedures, such as for example endometriosis or myoma operations.

These surfaces can adhere to each other, thus forming adhesions.

These adhesions can later cause problems such as pain, adhesion of the uterine tubes (infertility) or of other organs (intestines / ovaries / uterus).

They thus have the potential to cause chronic problems and pain requiring tedious treatment measures, and possibly even adhesiolysis, a follow-up surgical procedure to remove these adhesions.

The long-term success of many different surgical procedures can be improved by the use of barriers that act as “internal bandages” and prevent adhesions

Many of the available mechanical barriers in use today are derived from either industrial materials or animal sources.

SprayShield™ (formerly SprayGel™) is a new barrier substance from Covidien to prevent postsurgical adhesions.
SprayShield™, a largely water based tissue friendly material, fills the need for an effective, safe, easy-to-use system for successful postoperative adhesion prevention.

SprayShield™ is a smooth, water based, coating material also known as a hydrogel.

This material is formed from two water based polyethylene glycol (PEG) solutions that mix at the site of the injury.

The solutions are sprayed using an applicator that is designed for minimally invasive surgical instrumentation.

SprayShield™ is prepared and applied to the surgical site through the SprayShield Laparaoscopic Sprayer through a 5mm trocar.

The SprayShield Laparoscopic Sprayer, a single-use, disposable, has a unique venting capability for safety and a flexible tip for greater control.

The SprayShield Laparascopic Sprayer is attached to the SprayShield Air Pump, which is a reusable, self-contained air pump.

During an operation a surgeon sprays SprayShield™ onto the internal surfaces most at risk for adhesions.

This coats and protects the tissues likely to form adhesions. After the internal wounds are healed, the coating breaks apart and is naturally cleared from the body in the urine. The material is very inert and highly compatible in the body. Since no human or animal based products are used in SprayShield™, the potential risk to the patient is reduced.

FOR MORE DETAILS ON SPRAYSHIELD PLEASE VISIT: