Fear of Surgery

Fear is one of the most common reactions from patients when they are offered Metabolic Surgery.
This is understandable. The layman's view of surgery is always associated with pain, complications, disability and even death.

What they don't realise is that surgery has completely changed over the last twenty years. Nowadays it is high tech and minimally invasive. The equipment we have now is beyond the imagination of surgeons 20 yeats ago. We can cut without bleeding, we can seal without stitching, we can do amazing things through the tinniest holes.

Patients today can get up and walk around immediately after surgery. They can drink. They can go to toilet. Much surgery today is day surgery or only one night stay in hospital. The risk is very very much reduced. The pain and disability is minimal.

Surgeons paid a very high price to achieve this revolution.

On the other hand living with Diabetes and Obesity detracts so uch from life. Both longevity and quality are seriously compromised. The complications from Diabetes are horrible. They include blindness, kidney failure, amputation, heart disease, stroke and many more.

Why not give yourself a chance to have a normal and healthy life once again.

There is a raging debate over the internet about which way minimally invasive surgery should go. The contenders are 1. NOTES which is natural orifice surgery, 2. Singapore port surgery where evrything is done through the umbilicus and 3.Mini or neeldescopic surgery.

The issues are, which has less pain, which gives the best scarring and which is the safest. The Jury is still out on this debate.

My own preference stays with the mini or neeldescopic technique using 2 and 3 mm instruments. As you can see in this picture, the puncture wounds are hardly visible after some months. I think it also wins hands down on safety. As for pain, the differences are probably minimal between the 3 approaches and statistically significant differences will be difficult to show.

Mini or neeldescopic technique is ideal for operations like gall bladder removal, hernia repair, appendicectomy and perhaps even funduplication in slim individuals.

http://gallbladdercancer.wordpress.com/2009/09/16/ca-19-9/

Today I learnt something new about CA 19-9 the Cancer antigen. I have a 70 year old lady who had a markedly raised CA 19-9. We investigate very thoroughly to look for a malignancy,

I read the website above and found this:

CA 19-9 is elevated in most patients with advanced pancreatic cancer, but it may also be elevated in other cancers, conditions, and diseases such as colorectal cancer, lung cancer, gall bladder cancer, gall stones, pancreatitis, cystic fibrosis, and liver disease. Other causes of bile duct obstruction may also cause very high CA 19-9 levels, which fall when the blockage is cleared. It is often a good idea, if the bile ducts are blocked, to wait a week or two after the blockage is removed or treated to check CA 19-9 levels

CT scan did not reveal any pancreatic cancer in this case but she had multiple gallstones and thickened gall bladder wall.  One of the stones must have dropped into the bile duct and temporarily caused a rise in CA 19-9.

The lady agreed to have neeldescopic cholecystectomy.

It's strange how history repeats itself. Once more I may be operating once again in Deutschland. Professor Stefan Saad is a brilliant German surgeon whom I used to  work with in Cologne at the Krankenhaus in Merheim. He is now Chefartz at the Hospital in Gummersbach.

We have now organized to work together on bariatric surgery. Patients who prefer to be operated in Germany may have their sleeve resections and bypass operations done at this hospital. It has excellent fascilities and prices are very reasonable even by Singapore standards.

Had a really productive week in Doha. This time we completed 32 operations in one week. On the first day alone we did 9 cases and 7 operations were done just the day of my departure. The rest of the days we were plaqued by unavailability of operating rooms. Nevertheless it was a good result from a weeks visit.
The picture shows a happy Palestinian patient and her 2 lovely daughters. Many of the patients have had gastric banding and were being converted to sleeve resection. One patient had a migrated band which we removed endoscopically through the stomach.
There is still a 2600 waiting list and every clinic at least 10 new patients added to it. It will take at least 2 years to get to any patient registering now.