Our strategy for adhesions prevention

Since March 2001 we have been using this novel spray substance SprayShield™, (formerly SprayGel) to prevent adhesions following gynaecological surgical procedures. 

In general, adhesions are formed after all surgical measures involving laparotomy. 

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 new gel substance (SprayShield™) is sprayed onto the wound surfaces, where it remains in place for some days after surgery. 

Since adhesions are formed within 7 days of surgery, the barrier system thus prevents formation of adhesions. 

After this period, SprayShield™ is then broken down and simply absorbed by the peritoneum and excreted from the body via the kidneys. 

The carbon dioxide customarily used to insufflate the abdomen during laparoscopy converts the entire peritoneum into an acidic environment. 

This thus results in oxygen being withdrawn from the tissues and can cause cells to die, with formation of global wound surfaces in the peritoneum and abdominal organs

By using gasless laparoscopy, we avoid insufflation with carbon dioxide, which has been shown by recent studies — for the aforementioned reasons — to be a co-factor adhesion formation. 

But since wound surfaces are always formed during surgery because of tissue layers being separated, the formation of adhesions can additionally be prevented on such surfaces by spraying them with SprayShield™. 

Hence in the gasless laparoscopy technique and SprayShield™ we have an ideal combination that helps to prevent the occurrence and formation of adhesions. 

Dr Kruschinski has now performed adhesiolysis on around 500 cases using the technique of gasless adhesiolysis with spray gel application 

Adhesions are known to form as soon as three hours after the completion of a surgical procedure – and will continue to form for up to about seven days. 
If any adhesions have formed during this critical time period, they can easily be "swept down" by the surgeon during a second look laparoscopy – and more SprayShield can be applied, if needed. 

Dr. Daniel Kruschinski is one of the very few surgeons in the world, who performs a second look laparoscopy (SLL) about seven days after the initial surgical procedure. 

In Dr. Kruschinski's experience the risk of adhesions resulting in the need for a subsequent surgery is greatly reduced. He has mastered the required advanced microsurgical laparoscopic techniques and has logged thousands of hours in performing very difficult, time-consuming, risky surgical procedures. 

Repeat surgery for adhesions in these cases is usually less extensive and does not usually involve the same amount of dissection that led to the formation of adhesions in the first place

Here are some of Dr Kruschinski’s results in general

 About 84,9 % are adhesion free at the 2nd laparoscopy at 7 days postoperative. 

• In those patients who have small adhesion attachments to the surgery sites at the second look laparoscopy 7 days post-operatively, these attachments are removed very easily by simply touching them with an instrument. 
  
• Only 10% developed pain after surgery and had a third look laparoscopy in which adhesions were seen to be the cause of pain, the scores were reduced when compared to the initial surgery, especially in grade and severity. In other cases there were other reasons fo pain like adnexal tumour etc 
  
• Thus the success rate of the gas less adhesiolysis with SprayGel /SprayShield in patients being adhesion and pain free is about 85%.

For Photos of Our Technique of Gasless Adhesiolysis with SprayShield™ and SprayGel™ please click on the links below And for images with SprayGel™ and SprayShield™ in our Endoscopy Atlas Severe bowel adhaesions & Extremely severe bowel adhesions

Since December 2008 we are using the new SprayShield™ by COVIDIEN. 

SprayGel™ was modified in some parts, so the resorption was promised to be shorter (5-7 days) than it was with SprayGel™(7-14 days). And the blue colour is not due to methylenblue anymore but a simple colour used frequently in food = Brilliant Blue FCF; http://en.wikipedia.org/wiki/Brilliant_Blue_FCF. 

Here you can find the first clinical results: www.SprayShield.net