4/15/08
A couple of days ago I received a message from a patient of mine, who is a moderator for an online support group in Dallas. The topic that was hot on her site was revision surgery: the when, how, who, why, (and even more so) WHY NOT?
She had written a very nice discussion about the need for patients to make the best of the pouch "tool" they carry before they fix on revision surgery as the solution, but it was not clear to the group why surgeons are mostly hesitant to take on revision surgery. Since this is a common question, I’ll use my first blog on our website to share the background on why surgeons (and well informed patients) try to stay away from revison surgery.
The main reason that revision surgery is WAY more risky has to do with the scar tissue that inevitably forms from the first surgery. This scar tissue is a natural result of any surgical manipulation, and it causes two significant problems:
1) The scar means that the stomach pouch is stuck densely to the surrounding organs, such as liver, spleen, pancreas. In order to "re-work" the stomach pouch it is necessary to separate out all that scar tissue (often very difficult) with the potential of tearing or perforating one of the delicate tissues that is stuck together.
2) Most revisions require re-stapling or cutting across some of the old scar tissue that is on the pouch itself. Cutting across the scar is not so hard, but then we need that scar to heal properly to avoid a leak. Because scar tissue does not heal as reliably as tissue that’s never been traumatized before, the leak rate from revision surgery is 10 times higher or more, in comparison to primary (first time around) surgery. Even if a leak is not lethal, it results in lots of anxiety, pain, and loss of time for the patient and the surgeon.
So bottom line is that revision surgery is very hard to do well, and even when it is done well it is a rather risky undertaking. This is why a lot of surgeons are hesitant to take that on.
Thanks for reading!
DoctorJP@hotmail.com
