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

Bound By Secrecy? Victims: Bound By Pain! is a triumphant and heartrending story, told with a sense of humor and wit, of a mother trying to find hope and healing for her beloved daughter. It is an inspiring story of perseverance-against all medical odds-and the final triumph over an horrible illness. The writing of Melissa's trying journey opens the windows of knowledge and ressource to adhesion related disorder, (ARD), forever unmasking this prevalent, yet medically hushed condition.

Pelvic Pain

The most common problem for women with endometriosis is pain, which can significantly impair the quality of life. The pain experienced around menstruation (dysmenorrhea) can be so debilitating that up to 25% of women with the condition can be incapacitated for two to six days of each month. In severe cases, regular activities may be curtailed for up to two weeks per month. Sleeping problems have been reported in three quarters of patients, mostly due to pain. Studies suggest that endometriosis is the cause of about 15% of cases of pain in the pelvic region in women. (i.e. the lower trunk of the body.)

Timing of Pain In addition to during menstruation, endometrial pain can occur at other times of the month. A survey published by the Endometriosis Association reported the following findings on the timing of endometrial pain:

• 71% of women reported pain within two days after their periods started.
• 47% reported pain in the middle of a cycle. (A sharp pain during ovulation may be due to an endometrial cyst located in the fallopian tube that ruptures as the egg passes through.)
• 40% reported pain at other times of the month.
• 20% reported continual pain.
• 7% said there was no pattern.
• Many women with endometriosis experience pain during intercourse.(dyspaerunia)

Location of Pain Nearly all women with endometrial pain experience it in the pelvic area (the lower part of the trunk of the body). The pain is often a severe cramping that occurs on both sides of the pelvis, radiating to the lower back and rectal area and even down the legs. Occasionally, however, pain may also occur in other regions if endometriosis effects other part of the pelvic area, such as the bladder or intestine.

Severity of Pain The severity of the pain also varies widely and does not appear to be related to the extent of the endometriosis itself. In other words, a woman can have very small or few implants and have severe pain, while those with extensive endometriosis may have very few signs of the disorder except for infertility. Large cysts can rupture and cause very severe pain at any time.

Infertility

The medical literature indicates that endometriosis may account for as many as 30% of infertility cases. Some evidence suggests that between 30% and 50% of women with endometriosis are infertile. Often, however, it is difficult to determine if endometriosis is the primary cause of infertility, particularly in women have mild endometriosis. In an attempt to determine the chances for infertility with endometriosis, researchers have come up with a staging system based on findings during diagnostic surgery. [See Staging of Endometriosis.] It should be noted that endometriosis rarely causes an absolute inability to conceive, but, nevertheless, it can contribute to it both

directly and indirectly.

ENDOMETRIAL CYSTS.

Endometrial cysts may directly cause infertility in a number of ways.

• If implants occur in the fallopian tubes, they may block the egg's passage.
• Implants that occur in the ovaries prevent the release of the egg.
• Severe endometriosis can eventually form rigid webs of scar tissue (adhesions) between the uterus, ovaries, and fallopian tubes, thereby preventing the transfer of the egg to the tube.

IMMUNE FACTORS AND THE INFLAMMATORY RESPONSE. Even in early stage endometriosis, investigators have observed increased immune system activity…

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• The procedure requires making small incisions at the navel and above the pubic bone.
• The laparoscope (a hollow tube equipped with camera lenses and a fiber optic light source) is inserted through the incision at the navel (the umbilical incision).
• A probe is then inserted through the second incision allowing the physician to directly view the outside surface of the uterus, fallopian tubes, and ovaries.
• One or two additional small incisions can be made on either side of the lower abdomen through these incisions.
• Surgical instruments or other devices are passed through these accessory incisions to destroy or remove abnormal tissue.
• Implants can be removed by excision (surgical removal) using a laser or scissors or by destroying the area with lasers or with electricity (or electrocautery).

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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

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