Receiving a medical diagnosis that requires a surgery is a scary thing. A flurry of questions arise. Where should I go to seek medical attention? Which surgeon should I see, and what type of procedure do I need? A barrage of advertisements from TV, radio, newspapers, billboards and the Internet come pouring in, as does advice from friends who may have had a similar diagnosis. The situation can be overwhelming.
If you’ve been diagnosed with an inguinal hernia, for example, you may wonder: Is it better to have open surgery, for which you probably will need only local anesthesia with sedation? Or a minimally invasive procedure, which requires general anesthesia but may lead to slightly faster recovery with less pain and scarring? How do you weigh the risks and benefits?
Helping patients do just that is one of the most important parts of my job. As a general surgeon, I treat a wide range of conditions that require surgery. Over the past 20 years as a medical student, surgical resident, minimally invasive surgical fellow and now attending surgeon, I have seen a lot of procedures emerge and become mainstream, considered the standard of care. I’ve also seen many that seemed promising but are no longer in existence because they have proven ineffective, obsolete or even dangerous.
Nowadays, thanks to continual efforts to improve and refine surgical techniques, surgeons can perform procedures with big incisions, small incisions, multiple incisions, single incisions or even no incisions. These procedures can be performed with a robot or a laparoscope, through the mouth, abdomen, vagina or anus.
Weighing benefits, risks
To help my patients choose the procedure that’s right for them, I talk with them about the different risks and benefits of each one. When we talk about “better outcomes,” it’s important to understand how they’re better: improved functioning, shorter recovery, less pain or just a better cosmetic result? And at what cost? Would you undergo a procedure that claims to have fewer scars, but could be more dangerous and less durable?
For example, a patient with a small pancreatic tumor might be better off having a minimally invasive procedure involving only small incisions. Such a procedure could offer certain benefits: less scaring, less pain and faster recovery. But sometimes the advantages of an open procedure outweigh those benefits. For a patient with a larger tumor, an open procedure could allow the surgeon greater ability to protect nearby organs and blood vessels to which the tumor may have become attached.
Similarly, an open procedure could be a better choice for an older inguinal hernia patient, for whom general anesthesia is likely to carry a greater risk of side effects. But for a younger patient focused on minimizing her scar and getting back to work as soon as possible, a laparoscopic procedure might be better.
Whatever your condition, the first step in making the right decision is picking a surgeon you feel comfortable with: one who will sit down and explain things to you and give you an honest opinion on what he or she thinks is the procedure most tailored to your particular condition. You want someone who will take the time to explain all the options and alternatives. It will ease your anxiety and make your recovery much smoother. The best procedure for you may have been developed in the last year, or be a tried and true approach that has been used and perfected over the past 80 years.
Jonathan A. Myers, MD, is a general surgeon at Rush University Medical Center. His clinical expertise includes bariatric surgery, gastrointestinal surgery and gastroesophageal reflux disease (GERD).