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Surgery, gall bladder, facts

Don’t Worry If Your Surgeon Has A Personality Like Dracula’s

 By Dr. Gifford Jones  Tuesday, October 12, 2010

What’s the best way to have your ? Who should do it? Where should it be done? This year an estimated 700,000 North Americans will have this operation. But before you submit to the surgery make sure you’re an informed patient. Like the ad for Holiday Inns “There should be no surprises”.

Today the method of choice is laparoscopy. This procedure was initiated six years ago. It’s popular because its small incisions mean less pain and a faster recovery for patients.

But in up to 10 per cent of laparoscopic gallbladder surgeries unexpected findings make it risky to continue. To avoid serious complications surgeons then switch to the traditional approach and remove the gallbladder through a large abdominal incision.

But how can surgeons predict which gallbladder patients are more likely to face this problem?

A report from Washington University School of Medicine in St. Louis has identified several risk factors that help to pinpoint such vulnerable patients before surgery.

The study involved 628 patients who underwent laparoscopic gallbladder surgery. The major risk factor was a previous history of gallbladder inflammation.

Patients at risk were also those who had suffered 10 or more gallbladder attacks, patients more than 65 years of age and males.

Pay particular attention to this point. Researchers found that surgeons were more likely to switch to a large incision if they had performed fewer than 50 laparoscopic gallbladder surgeries.

None of the 628 patients suffered injury to the common bile duct. This was due, in part, to the surgeon’s willingness to switch to a large incision at the first sign of difficulty.

But these operations were done in a university teaching hospital where there are more controls. This may not be the case in a small hospital.

The common bile duct carries bile from the liver to the stomach. Injury to the duct always results in a longer hospital stay. This complication can occur in traditional gallbladder operations but is more likely in laparoscopic surgery. _ 0*0*0* The gallbladder is located underneath the liver on the patient’s right side. The organ stores bile until the stomach needs it to digest fats. Gallstones develop when cholesterol, a component of bile, separates from the bile and hardens.

It’s been said that wise generals know when to retreat. So do experienced surgeons. The most common reason in laparoscopic surgery is obstruction of the surgeon’s view.

During laparoscopic surgery, doctors operate using long©handed instruments and a miniature video camera that are inserted through four half©inch incisions. The video camera projects a magnified image from inside the body to T.V. monitors, where surgeons focus their attention.

Bleeding, dense adhesions or inflammation may block the surgeon’s view. In 66 per cent of cases dense adhesions related to inflammation from previous gallbladder attacks that forced the surgeon to switch to a large incision. Bleeding caused switching in 12 per cent of cases.

Researchers found that 7 per cent of patients scheduled for surgery were in the high risk category. These patients had a 30 per cent chance of having to switch from a laparoscopic technique to the traditional incision. Those patients in the low risk group had less than one per cent chance of conversion.

If your surgeon recommends laparoscopic cholecystectomy you’ll face far less post©operative pain. There’s practically no chance of a post©operative hernia. And since some hospitals are performing laparoscopy cholecystectomy as an outpatient procedure patients can go home the same day.

But it’s vital you clarify certain points with the doctor. Don’t be shy about asking where he learned the procedure. Was it during his or her surgical residency? Or did he take a course in a non©university setting where he operated on pigs?

The most important question, “How many has he done? The learning curve is slow in laparoscopy procedures. So if he hasn’t performed at least 50 don’t agree to the procedure unless he plans to have a surgeon assist who is more experienced in the technique.

It’s always preferable if you have a surgeon who communicates easily and has a great personality. But if he or she has the personality of Dracula, but the reputation of being an experienced surgeon, don’t change to another doctor. Never forget it’s his hands, not his bedside manner, that’s doing the surgery. Á A report in the Annual of Surgery proves that experience counts. 54 per cent of all pancreatic cancer surgeries done in Maryland between 1988 and 1993 were performed at John Hopkins. The death rate was 2.2 per cent. For those done at smaller hospitals the death rate was 8.9 per cent. Ô

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Dr. Gifford Jones  Bio
Dr. Gifford Jones Most recent columns

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He’s been a ship’s surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: http://www.mydoctor.ca/gifford-jones

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