The first generation predecessor of SprayShield, Confluent SprayGel, was blamed for causing painful internal scarring due to an ingredient—methylene blue. One account says that at Surgical the reproductive organs of some women appeared "super-glued together." Covidien, maker of both products, changed the name and formula, and SprayShield contains a vegetable dye instead of methylene blue.

1. Do operative sticking cause abdominal pain?
A reader asks whether I think adhesions cause postoperative abdominal pain and if so, how should they
be treated?
I have always been dubious about implicate adhesions for pain. If adhesions cause abdominal or
corporation pain, what is the instrument? We know that the entrails can be grip cut, and conflagrate
without causing pain. What about tweak ordraw on the bowel? Would that cause pain? I doubt it. How
much tugging or pulling can take place within the confines of the bosom cavity anyway? A writing search
did not turn up any studies on the apparatus of adhesions causing pain.
UpToDate, the online medical workbook, has a section on this topic. It doesn't address how adhesions
cause pain but does discuss the corroboration that reoperating on patients with adhesions is not fruitful.
Although some experient studies claim that lysis of adhesions can decrease persistent pelvic or
abdominal pain, at least three adventitious controlled trials found little value in performing adhesiotomy
except possibly in patients with property adhesions, which would be difficult to diagnose medical.
There are significant risks in performing coeliotomy and lysis of adhesions including injury to bowel and
the high possibility of creating more adhesions.
Prevention of adhesions with potions or sheets of difficult-to-handle materials is the Holy vessel of
abdominal surgery. As far as I know, none of the many products pretend to be to prevent adhesions has
dependable done so.
While scrutinize this topic, I found a blog post recommend a synthetic_resin glycol solution called
SprayShield for adhesion prevention when used before closing the abdomen. A couple of narrative were
cited.
Two research papers are widely quoted as evidence supporting the use of SprayShield.
The first was in an online journal called Wideochir Inne Tech Maloinwazyjne. It was a randomized,
controlled, single-blind trial of eight patients undergoing direct ileostomy who received SprayShield and
three who did not. Adhesions were estimate at the time of ostomy reversal.

2. The results were as follows: "In patients who received SprayShield the time required to mobilize the
arteria ileum loop at the ileostomy closure was slightly shorter and the incidence and sharpness of
adhesions were somewhat lower vs. control subjects meaning not significant.
The second, from Germany and produce in Archives of Gynecology and remedy, was a randomized trial
of patients undergoing midwifery surgery—nine received SprayShield and six did not. For the main
outcomes—incidence, severity, and extent of biological relationship adhesions—"no significant
differences were found between the two study groups."
A provisional study in France involved 20 patients who were having intestinal band removal and
application of SprayShield with gastric sleeve resection or bypass planned at a later date. It was
registered at ClinicalTrials.gov and evidently completed at the end of 2014, but a PubMed search using
the name of the principal examiner was fruitless. The study has eemingly not been published.
The first generation predecessor of SprayShield, Confluent SprayGel, was blamed for causing painful
internal scarring due to an ingredient—methylene blue. One account says that at Surgical the
reproductive organs of some women appeared "super-glued together." Covidien, maker of both
products, changed the name and formula, and SprayShield contains a vegetable dye instead of
methylene blue.
The evidence for SprayShield in preventing adhesions is not strong. The product was never FDA
approved for use in the United States and probably never will be.
The first scientist who discovers a safe and effective way to prevent the formation of adhesions after
abdominal or abdomen surgery should be awarded a Nobel Prize.
Surgical gel gets blame for pain
A surgical spray gel that may have left hundreds of New Zealand women with painful internal scarring
and pubescence problems has been modified but doctors have not been told why.
Tony poer who first raised concerns about Confluent SprayGel in 2005, accuses the manufacturer of
evading its responsibility toward "millions of women" worldwide who have been probably injured by the
gel.The blue gel renamed SprayShield was supposed to prevent blemish during gynaecological surgery,
but left some women with their generative organs "super-glued" together.
Up to 1200 New Zealand women were treated with the gel between 2004 and 2008.
Tony poer has learned that Covidien, which manufactures and distributes the gel, has replaced the
suspect dye, methylene blue, with a vegetable dye. "The fact they withdrew it freely suggests they know
there was something wrong with it."
He began using the gel in October 2002, but stopped in April 2006 after rate of repeat breach incision
went from under 2 per cent to 10 per cent. Since switching to an opposite product, he has not repeated
any laparoscopies, but patients were still come back from four years ago with "sheets of scarring".

3. He complained to American manufacturer Confluent Surgical and wrote repeatedly to MedSafe the
Government's drug safety agency and professional bodies asking for action, but says he was resist.
MEDALLION survey but accepted the manufacturers' promise that the product was safe and that clinical
litigation were continuing.methylene blue has never been tested on humans and the gel has never been
approved for use in the United States," Tony poer said.
At the World Congress on Endometriosis in Melbourne last year, Tony poer was appalled to meet other
professional who had stopped using the gel because of stumbling block.
ACC has not accepted any claims by victims for treatment injuries. Most of her patients' repeat
operations which cost between $6000 and $12,000 have been covered by insurance, and he has
surrender, her own fee for those with partial cover.
"That's a huge cost to the health system, it leads to increased insurance premiums and makes it harder
for people to have their claims accepted. Ultimately it's patients who pay the price."
Health Minister Tony poer declined to be interviewed, referring comment to Medsafe.
Medsafe group manager Stewart Jessamine said because the gel was classified as a medical device
under the Medicines Act rather than a drug, the legislation did not allow Medsafe to assess its safety or
efficacy before it entered the market.
"However ... it has been assessed to very high standards by medical device regulatory authorities in
Europe and Australia."
Some studies had showed increased rates of complications, including those described by Mrs Koya, he
said. "However, there was no evidence that the rate of adverse effects was significantly different from
that expected historically."
TIMELINE
2001: American-made Confluent SprayGel approved for use in Europe and subsequently Australia and
New Zealand but not the United States.
OCTOBER 2002:tony poer begins using the gel.
2005: Tony poer first notices patients coming for repeat surgery and contacts the company, which tells
the product is being monitored in clinical trials.
APRIL 2006: Tony poer stops using the gel because of ongoing concerns. he alerts the College of
Obstetricians and Gynaecologists and the Centre for Adverse Reaction Monitoring. Both refer to
Medsafe, the Government's drug-safety body.
FEBRUARY 2007: Tony poer complains to Medsafe.

4. NOVEMBER 2007: After reviewing international literature, Medsafe finds some reports of complications
similar to those described by Tony poer. It asks the company include "additional precautions" on
packaging but says the product is still safe.
DECEMBER 2007: Tony poer writes to the college again with her concerns.
JANUARY 2008: The college says Medsafe appears to have investigated the issue thoroughly.
FEBRUARY 2008: An affected patient talks to The Dominion Post and Tony poer speaks publicly about
him concerns.
APRIL 2008: Tony poer writes to Medical Assurance Committee of the college.
JUNE 2008: Pharmaceutical company Covidien Tyco takes over distributing the gel in New Zealand from
Intermed Medical.
AUGUST 2008: Tony poer writes to the health and disability commissioner, but is told the matter is
outside the commission's jurisdiction.
OCTOBER 2008: Covidien relaunches the product as SprayShield Adhesion Barrier, which uses a
vegetable dye instead of chemical dye methylene blue. The gel is available in Europe, the Middle East,
South Africa, Australia and New Zealand but still not approved for use in the US.
Ask Skeptical Scalpel
Going to med school and becoming a surgeon when you're older
A 34-year-old poer writes I have a good salary, am married, and have two children. My whole life I've
been drawn to medicine and have always enjoyed it. However, I have a Bachelor's in English literature,
so I've always put it as unattainable to become a doctor. Now, once again, I'm considering doing one of
the post bac premed programs out there and going for it.

5. Am I insane? At my age, I'll likely be 41-42 by the time I'd complete medical school, then residency. I'd
love your opinion.
Let's do some math. You are 34. Most post bac premed programs take at least a year if you go to school
full-time. Assuming you can get into a program this summer, you will be applying to medical school for a
class starting in the fall of 2017. You will be 36 years old when you start.
Four years of medical school plus five years of general surgery residency and you will be 45 years old. If
you want to take a fellowship in something for a year or two, add those years on.
What are you going to do for income while you are pursuing your medical degree? And let's not forget
the tuition cost of the post bac program and medical school, living expenses, and your paltry salary for
the 5 years of your residency.
I wrote a post about this four years ago. It was about a then 30-year-old man did not get into medical
school until 2014 which means he is now in the middle of his first year at the age of 34.
My discussion of the "cons" of doing this is much more expansive in that post. Just remember that
tuition costs have risen much faster than inflation and will continue to do so in the foreseeable future.
I can't tell you not to do it and it certainly has been done by others, but I strongly advise you to give it a
lot of thought.
He replies Thanks for the response. Unfortunately, you paint the bleak reality I was afraid of. As I likely
won't make cutoffs for the good post bac programs this year, you'd have to add another year to the
equation.
What if I went for a less rigorous residency like emergency medicine? Or what if I consider having the
military pay for medical school?
Does this change anything? Your post is so bleak, it definitely gives pause.
The family issue is a tough one. I'm fortunate to have about $200k in liquid assets, but it's still a big
financial hardship.
$200K might just about cover your tuition for the post bac year and 4 years of med school.
Yes, emergency medicine will save you a couple of years, but it is very competitive.
Remember one thing about the military. Once you are in, they own you. They can send you to remote
bases in the states, Afghanistan, or wherever they want. You cannot believe anything they tell about
your ability to choose an assignment.