RPLND & adhesions & bowel obstruction

[zoltar]

hey there

i had an RPLND on april 30th with no problems. the 35 nodes removed all tested negative and i have been pretty much good to go in the last 5 1/2 months. until last week. i started having really intense stomach pains and major abdominal distension.

anyway, i was admitted to the ER for 5 days and they saw i had a partial bowel obstruction due to (they're guessing) adhesions from surgery. i had a battery of tests while in the hospital (upper GI, small intestine etc) they seemed to think everything was normal...meaning no obstruction could be witnessed and thank god no NG tube. after i started downing clear liquids and soft foods with no problems they sent me home. even though, it feels like my intestines are bruised and my abdomen is still clearly distended. i can eat but everything is not entirely right down there.

so, has anyone dealt with this before? they think i have adhesions which led to a partial obstruction with no apparent visual proof and now, out of the hospital, still having symptoms but able to eat food.


thanks

[Fish]

Hi Zoltar:

Adhesions are fairly common following any abdominal surgery, let alone something as invasive as an RPLND. Lot's of folks get adhesions, but in many cases, they don't cause any problems. Bowel obstruction often results in vomiting and loss of appetite (of course the exact symptoms depend on the level of the obstruction.

There are a number of conditions that could cuase the symptoms you describe, including irritable bowel disease, Chrohn's disease, stress-related spasms of the colon, even a temporary intussusception (part of the intestine "telescopes" into an adjacent part, although this is very unlikely), or temporary twist, that have resolved. If you had a temporary issue, it could take a while for the intestines to recover.

If your symptoms continue, you should see a gastroenterologist. I'm glad you have gotten some releif. But if you still think something is "not right" keep pressing the docs for answers. You know your body better than anyone.

[Kev332]

I ended up with an "ileus" (bowel obstruction) after my RPLND,,, but that was about 8 days post op.

I was in the hospital for about 5 days for my RPLND,,, they sent me home, and then 2-3 days later i starting having the worst pain ever in my abdomen.. Ended up going to the ER where they admitted me and i stayed in the hospital for another week. Not fun! They had to put the NG tube back in etc.... now thats something i'll never forget.

I do remember that it took a very long time for my insides to get back to normal.... I would still have the occasional "cramping" in my abdomen after i would eat. That went on for a few months. Eventually the pain went away.

Hang in there Zoltar. If you're still not feeling right in a couple weeks, maybe you should head back to the doctor.

-Kevin

[premct]

Hi there,

I had an RPLND at Sloan in early March 2006 and then had to have the NG Tube back in because of an obstruction. After getting out of the hospital after 18 days, I ended up having another bowel obstruction in early January of 2007 and left the hospital 5 days later. Both times, the NG Tube had to go back in.

The doctors say that this could happen at any point because of the adhesions. So, feel free to ask me any questions you have. My main advice, do everything slowly when you are in the hospital (don't pound the ice chips, drink too much fluids initially).

[zoltar]

adhesions cont.

thanks for the words guys. i was out of the hospital after five days and basically it took about a week to two weeks for everything to feel better down there. i'm hoping this is a more isolated incident but understandably it could crop up at various times.

nobody really talked to me about adhesions before having my rplnd. in fact, i'd never heard of them. had i known i would have pushed harder for doing this laproscopically which i would think would reduce the risk (not entirely) of messing things up down there.

thanks again.

[MRMRSU]

Hey Zoltar! You're just a hop, skip & jump away from where I am in Orange County. Sorry to hear of your woes with adhesions...Andy's surgeon had warned of bowel obstructions that could surface days, weeks, months or even years after any abdominal surgery (not just isolated to RPLND). None to report for us, but I do hope that you will find full relief soon.

My hubby Andy had his RPLND at Hoag in late April, after numerous consults with USC Norris. He had complications of a different sort, but I agree with Fish and Kevin that if you're not 100% in a bit, you should see a gastroenterologist. As for your hindsight push for a laparoscopic-RPLND, well you may have had a different set of trials and turbulations with that as well...ah, to have a crystal ball . Take care Zoltar and best wishes for your recovery.

[Margaret]

thanks for the words guys. i was out of the hospital after five days and basically it took about a week to two weeks for everything to feel better down there. i'm hoping this is a more isolated incident but understandably it could crop up at various times.

nobody really talked to me about adhesions before having my rplnd. in fact, i'd never heard of them. had i known i would have pushed harder for doing this laproscopically which i would think would reduce the risk (not entirely) of messing things up down there.

thanks again.

I agree with maria about new problems from the lapro. In fact, Dr. S at Sloan feels that too many small cells can get left behind during lapro and does not feel comfortable with it yet. I think you made the right choice for yourself and I am just sorry that you had to go through a second set of issues. I hope you are on the mend now and feeling goo!

[DAWN82]

ok, i am reading sooooo much about these obstructiona
do they almost always happen? because ALOT of people on this site ( as far as i can see) have experienced and adhesion or obstruction. this too now is scaring me is there anything that can be done to prevent it? besides not having surgery?

Dawn

[dadmo]

Dawn:
It dosen't happen to everyone, Jaymo had no adhesions or obstructions.

[concussed1]

ok, i am reading sooooo much about these obstructiona
do they almost always happen? because ALOT of people on this site ( as far as i can see) have experienced and adhesion or obstruction. this too now is scaring me is there anything that can be done to prevent it? besides not having surgery?

Dawn

Dawn,
A quick search on PUBMED yielded this article:

http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/cjs/vol-50/issue-4/pdf/pg291.pdf

Here's the summary of the article:
The formation of peritoneal adhesions continues to plague patients, surgeons and society. Although research in this area is ongoing, there is currently no method that is 100% effective in adhesion prevention, nor is there any way to permanently remove them once they have formed. As our understanding of the specific mechanisms involved in peritoneal repair evolves, it seems likely that specific targets for adhesion prevention will be identified and evaluated.
The bioresorbable membrane Seprafilm is currently the most effective adjuvant to decrease adhesion formation, and this barrier may be considered for use in patients in whom the formation of adhesions postoperatively is particularly undesirable. The long-term outcomes with this agent remain unknown. Newer products are being developed that seem promising, but their efficacy has yet to be proven in clinical trials. Until then, surgeons should continue to be meticulous in their operative technique and should seek to minimize injury to the peritoneal surface.

Key points about this article:
- they make no explicit mention of RPLND as a candidate surgery, although it could be inferred that RPLND could benefit from some sort of biological film
- lots of cellular physiology jargon - it interests me, but may be a bit complicated for some people

In my own opinion, it is a good idea to discuss your concern regarding adhesions with your surgeon, and ask questions about the efficacy of these biological films (e.g., Seprafilm) and/or meticulous surgical technique for the prevention of adhesions. Adhesions aside, you want to educate yourself about all the procedures related to TC; that's one major reason why we are all on this forum. Once you educate yourself, you are better equipped to ask the important questions. And if your surgeon is worth his salt, he will respect your concern, and your effort to learn, and hold a decent conversation with you and your family.

I have a vested interest in this topic as I will be undergoing my RPLND in early November. Unfortunately, I do not have the benefit of Dr. Foster or Dr. Sheinfeld's expertise as I live in Hamilton, Ontario. Having said that, my surgeon is also a Ph.D. (as are most of the experts in this field), and is willing to collaborate with other experts in order to ensure that I am receiving the best care possible.

All the best, and keep on asking questions!

[veryworriedmom]

treatment in canada

Hi Concussed, I dont know where you are being treated but the best place close to you is Princess Margaret in Toronto. They are the experts in TC and all treatment there should be covered by OHIP. They would consult with sloan. Good Luck

[MRMRSU]

DO NOT EAT TOO SOON POST-RPLND. I continue to tell guys this whenever I can. Scott will vouch for me and why I believe this piece of information is so important!!!

[Manny]

Can you define what you mean by "Don't eat too soon after the surgery"? I also saw a post from PREMCT that said "Don't pound on the ice-chips / liquids after surgery".

I go for RPLND surgery in 3 weeks. What should I plan on doing vis a vis ice-chips / liquids on Day 1 / Week 1? A liter a day - is that too much too soon? And how soon is too soon for mushy / solid foods - does one wait 3 days, 4 days? Will the hospital "force" me to eat / drink sooner than the body is ready - and do you have specific suggestions on when to start taking on liquids / mushy / solid foods?

Will I be on IV through the entire 7 day period I am at the hospital?

[dadmo]

Don't worry about eating too soon. The folks at Sloan will monitor you very carefully. This may be hard to believe but they won't allow you to have anything but ice chips for the few days. My son was in for 10 days and got nothing to eat until day 9.

[Margaret]

For the first 3-4 days do not eat or drink anything. Not even a drop of water. I know you will want to, but it is better if your bowels do not try and process or digest anything. You will be on IV fliuds so you will be okay for a few days.

But if you are at Sloan K, they will be very careful about this anyway. But no cheating .

Once the doctor hears LOTS of bowel sounds (he will listen for gas and movement sounds in your abdomen) then sip on some water or apple juice. He needs to be sure your bowels are awake after surgery. If they are not awake and you introduce food or fluid, your body will reject the food and make you very sick , so please don't risk it.

Once you are done with the RPLND and back on foods, make sure you eat NO fat for 2 weeks following. All fat free foods and zero meats or nuts. In fact, no nuts for 6 months following the surgery. I know it seems harsh but you will be rewarded with feeling good and healing fast. Let me know if you have any questions that I may be able to answer.