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

This fact necessitates the search for barrier that can be used in the perioperative period. 

There have various barriers or adjuvants that have been used but none have conclusively proven to be effective in various studies. 

CLASSES OF ADHESION-REDUCTION ADJUVANTS AND THEIR PROPOSED MECHANISM OF ACTION

I. Fibrinolytic agents (fibrinolysis, stimulation of plasminogen activators) 
Fibrinolysin 
Streptokinase 
Urokinase 
Hyaluronidase 
Chymotrypsin 
Trypsin 
Pepsin 
Plasminogen activators 

II. Anticoagulants (prevention of clot and fibrin formation) 
Heparin 
Citrates 
Oxalates 

III. Anti-inflammatory Agents (reduce vascular permeability, reduce histamine release and, stabilize lysozomes) 

Corticosteroids 
Nonsteroidal anti-inflammatory agents 
Anti-histamines 
Progesterone 
Calcium channel blockers 
Colchicine 

VI. Antibiotics (prevent infection) 
Tetracyclines 
Cephalosporins 

V. Mechanical Separation (surface separation, hydroflotation) 

A. Intra-abdominal Instillates: 
Dextran 
Mineral oil 
Silicone 
Vaseline 
Crystalloid solutions 
Carboxymethylcellulose 
Hyaluronic acid 
Chelated hyaluronic acid 
Poloxamer 

B. Barriers: 
Endogenous tissues: 
Omental grafts 
Peritoneal grafts 
Bladder strips 
Fetal membranes 
Exogenous materials: 
Fibrin glue 
Polytetrafluoroethylene 
Oxidized cellulose 
Oxidized regenerated cellulose 
Gelatin 
Rubber sheets 
Metal foils 
Plastic hoods 

Modified from Diamond MP, DeCherney AH: Pathogenesis of adhesion formation/reformation: Application to reproductive pelvic surgery. Microsurgery 1987: 8: 103 and Diamond MP, Hershlag A: Adhesion formation/reformation: in Treatment of postsurgical Adhesions, Wiley-Liss, Inc. 1990: 23-33. 

A broshure on SprayShield application can be opened and downloaded.

Please click on the picture below: