Adhesiolysis – Worst Cases, Case #1 – Adhesiolysis #1

“Worst Cases” describe the most difficult cases we ever had and which evidently needed more than one procedure.

Most of these cases had a real unique surgical history with a horrible prognosis and were left alone by the medical system with no other treatment options than psychotherapy and drugs.

This female patient is 31 years old. She was a prima ballerina with the age of 3 to 10 and fencing from the age of 10 to 14, even with a lot of won prizes. And she was professional horse riding till the age of  sixteen.1998 with the age of 16 she got perforated appendicitis with all symptoms but doctors treated her for 5 days as she had gastritis until she got an abscess and severe peritonitis with life-threatening septicemia and an emergency surgery with a longitudinal laparotomy!

Followed from 1998 till 2000 by recurrent inpatient admissions because of pain, nausea and vomiting.In January 2000 she has got another longitudinal laparotomy for bowel obstruction due to a bride.

2000-2004 stil recurrent pain, nausea and vomiting.

November 2004 Re-Re-Re Laparotomy with adhesiolysis and postoperative abscess and wound infections.

November 2009 the patient was admitted for the first time to our center. We have perfomed a lift-laparoscopic adhesiolysis, which included a partial adhesiolysis of the entire abdominal wall adhesions, followed by a 2nd look laparoscopy.

TO BE CONTINUEED – PLEASE SCROLL DOWN!


ADHESIOLYSIS #2

Some of the cases with “Frozen abdomen” are so severe that they present not only adhesions to the abdominal wall and between the bowel loops, but have all organs and bowel loops surrounded by a very dense connective tissue, glueing the organs together and causing constrictions of the bowel.

Those patients need a “Multi-Step-Adhesiolysis” according to the EndoGyn concept and are informed after the first procedure that we will work upon their symptoms in different abdominal quadrants by setting-up a multistep adhesiolysis according to their symptoms.

The first step always includes full adhesiolysis of the abdominal wall as these adhesions are often causing bowel obstructions. Also a partial interluminal adhesiolysis of the bowel loop adhesions is included in the first step.

So in January 2010 the patient was admitted again and we performed the 3rd look procedure on January 18th, 2010, followed by 7 other laparoscopic procedures due to an infection and to avoid reformation of adhesions.

We had to keep the patient for 31 days in the hospital and she had all together 8 surgeries performed.

– 18/01/2010: Gasless Lift-Laparoscopy as 3rd look

– 20/01/2010: 4th look
– 25/01/2010: 5th look
– 27/01/2010: 6th look
– 29/01/2010: 7th look
– 01/02/2010: 8th look
– 05/02/2010: 9th look
– 09/01/2010: 10th look

Please check the text under the images!

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ADHESIOLYSIS #3
The patients symptoms improved, but she still could not eat solid food and so we decided together to perform the next step in October 2010, which included the lower quadrant around the bladder.

Please check the text under the images!

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ADHESIOLYSIS #6
After the last procedure in October 2010 the patient had 17 month without surgeries with partially better periods, but was till not fit to start daily activities and start working.February 2012 and October 2012 ADHESIOLYSIS #4 and #5 were performed, cleaning the left and right side of her entire abdomen and a huge amount of interluminal adhesions at her bowel.

Although the pain got better, she experienced periods of nausea and vomiting, so we decided together to go to the last part of her abdomen, to the pelvic areas, where small bowel was adherent to the uterus.

In February 2013 we perfomed ADHESIOLYSIS #6 with an excellent result for the pelvic organs and the bowel adhesions. Only few interluminal adhesions without constrictions were left, as the risk of a bowel perforation was too high.Please check the text under the images!

NOTE: This patient had all together 6 sets of adhesiolysis surgery with a 2nd look, unfortunately at Adhesiolysis #2 there was an infection that had to be cleared with additional 2nd look surgeries. Anyway at the end we have reached an excellent result for her entire abdomen and bowel with any bowel resection or or bowel perforatio.

ALL steps were performed by Lift-Laparoscopy and the last adhesiolysis with only one kit of SprayShield. Postoperatively we could start already with some solid food which was not possible for a very long time. She will need to keep some diet for 4-6 weeks after surgery and than will add different dishes. The diet contains also daily lactulose and and milk products to keep the bowel moving everyday. Totally forbidden is fast-food, grilled meat, vegetables, except of carrots, hot dishes, no garlic or onions, very little salt and no other spices.

STAY TUNED – we will report  on her progress!