Something to Discuss with Your Surgeon

[Guest guest]

Thank you tom for that valuable information

[Guest guest]

Hi all:

I was surfing the web last night, trying to find any info on leak

testing. I never did find any, but I did find an article I thought I

should bring to everybody's attention.

Apparently, the electrical cauterizing/cutting tool used extensively

today in both lap and open surgeries can sometimes cause burns to

tissues that the surgeon does not even touch. These burns happen for

a variety of reasons that are explained in detail in the article.

While the burns can occur in both open and lap surgeries, those that

happen during open surgeries are, (according to the article), not

very dangerous, because they are almost always immediately seen by

the surgeon, who can then treat the area, and prevent anything really

bad from happening.

When they occur during lap surgeries, however, they often do so out

of the field of vision of the camera. This can cause some really

nasty results, including fecal peritonitis, which has a 25% mortality

rate even with the best antibiotic therapies.

I want to stress that these " electrosurgical burns " are very rare,

yet they do happen. In fact, " [a]t the 1995 meeting of the Society

of Laparoendoscopic Surgeons, 13% of members surveyed indicated that

they currently had one or more malpractice cases in litigation that

involved a laparoscopic electrosurgical procedure. " And, " n

response to the rising number of malpractice claims, some malpractice

insurers have increased their rates by 15–20% for surgeons who

perform these procedures. "

These burns can occur even in operations conducted by the most highly

skilled surgeons, and there is no current way to eliminate the risk

entirely. There are, however, several things that surgeons and

hospitals can and should do to minimize the risk -- which is why I am

bringing it up at all.

If you are planning on having your DS done by lap, you might want to

print out this article and discuss it with your doc, just to be sure

that he/she is aware of these issues and that everything that can be

done to minimize the risk is being done.

Here's the link to the article, which is entitled " Avoiding

Electrosurgical Injury During Laparoscopy: An Emerging Patient

Safety Issue. "

http://www.obgyn.net/english/pubs/features/els-104-wht.htm>

Tom

[Guest guest]

Thank you so much for this information. I haven't even had a consult yet

and have pretty much been trying to gather up as much information as

possible before going to my consult so that I am able to ask all the right

questions. Not to mention that I would like to be as informed as possible

since this is something that's truly very serious. I've been trying to

avoid getting so wrapped up in all the good things and turning a blind eye

towards anything negative (don't get me wrong....I still want to do

this.....I just want to know everything that I'm in for...both good and

bad!)

:-)

M Palmer

(Phone)

(Fax)

kpalmer@...

> Something to Discuss with Your Surgeon

>

> Hi all:

>

> I was surfing the web last night, trying to find any info on leak

> testing. I never did find any, but I did find an article I thought I

> should bring to everybody's attention.

>

> Apparently, the electrical cauterizing/cutting tool used extensively

> today in both lap and open surgeries can sometimes cause burns to

> tissues that the surgeon does not even touch. These burns happen for

> a variety of reasons that are explained in detail in the article.

>

> While the burns can occur in both open and lap surgeries, those that

> happen during open surgeries are, (according to the article), not

> very dangerous, because they are almost always immediately seen by

> the surgeon, who can then treat the area, and prevent anything really

> bad from happening.

>

> When they occur during lap surgeries, however, they often do so out

> of the field of vision of the camera. This can cause some really

> nasty results, including fecal peritonitis, which has a 25% mortality

> rate even with the best antibiotic therapies.

>

> I want to stress that these " electrosurgical burns " are very rare,

> yet they do happen. In fact, " [a]t the 1995 meeting of the Society

> of Laparoendoscopic Surgeons, 13% of members surveyed indicated that

> they currently had one or more malpractice cases in litigation that

> involved a laparoscopic electrosurgical procedure. " And, " n

> response to the rising number of malpractice claims, some malpractice

> insurers have increased their rates by 15-20% for surgeons who

> perform these procedures. "

>

> These burns can occur even in operations conducted by the most highly

> skilled surgeons, and there is no current way to eliminate the risk

> entirely. There are, however, several things that surgeons and

> hospitals can and should do to minimize the risk -- which is why I am

> bringing it up at all.

>

> If you are planning on having your DS done by lap, you might want to

> print out this article and discuss it with your doc, just to be sure

> that he/she is aware of these issues and that everything that can be

> done to minimize the risk is being done.

>

> Here's the link to the article, which is entitled " Avoiding

> Electrosurgical Injury During Laparoscopy: An Emerging Patient

> Safety Issue. "

>

> http://www.obgyn.net/english/pubs/features/els-104-wht.htm>

>

>

> Tom

>

>

>

>

> ----------------------------------------------------------------------

>

[Guest guest]

Re: burn leaks during lap surgery

That's the very reason why many Lap Drs. who are trained in advanced

lap techniques do a leak test **intraoperatively** before they close

(my Dr explained this in his patient binder and told the ladies to

tie their hair back as the dye used can stain hair blue).

.... it doesn't mean that a leak cant happen post op too.. but again

that's why they do a leak test 24 hrs **post op** also.

Its doubly important that the lap surgeon didn't just do a three day

seminar on basic lap techniques but has advanced training and a

fellowship under his wings. The more well trained the DR the better

likelihood he would follow the simple safety techniques that avoid

burn leaks by maintaining their equipment properly. Each type of

surgery has its own particular risks..this one can be avoided in the

hands of a well trained surgeon.

The lap complication curve is directly related to the experience of

the surgeon. Do your research and get the best qualified surgeon you

can. If he doesnt post his complication rate (including leaks) ask!

mary bmi 68

corona, ca

pre op 6/27/01 dr rabkin

cigna ppo

[Guest guest]

Can you say what specific fellowsips, certifications, etc. I should

look for? Has anyone researched Dr. Elariny in Fairfax, VA?

> Re: burn leaks during lap surgery

>

> That's the very reason why many Lap Drs. who are trained in advanced

> lap techniques do a leak test **intraoperatively** before they close

> (my Dr explained this in his patient binder and told the ladies to

> tie their hair back as the dye used can stain hair blue).

>

> ... it doesn't mean that a leak cant happen post op too.. but again

> that's why they do a leak test 24 hrs **post op** also.

>

> Its doubly important that the lap surgeon didn't just do a three day

> seminar on basic lap techniques but has advanced training and a

> fellowship under his wings. The more well trained the DR the better

> likelihood he would follow the simple safety techniques that avoid

> burn leaks by maintaining their equipment properly. Each type of

> surgery has its own particular risks..this one can be avoided in the

> hands of a well trained surgeon.

>

> The lap complication curve is directly related to the experience of

> the surgeon. Do your research and get the best qualified surgeon you

> can. If he doesnt post his complication rate (including leaks) ask!

>

> mary bmi 68

> corona, ca

> pre op 6/27/01 dr rabkin

> cigna ppo

[Guest guest]

" Can you say what specific fellowsips, certifications, etc. I should

look for? "

Something like " Fellow in Laparoscopic Surgery " ... then you know

that they have that much more supervision in thier area of

specialty...you'll be able to judge yourself when reading the

CURRICULUM VITAE if its posted, if not request it.

Since's Elariny group is Advanced Laparoscopic and General Surgery

Associates, ask what advanced lap training he's had.. its a fair

question.

mary bmi 68

corona, ca

pre op 6/27/01 dr rabkin

cigna ppo

[Guest guest]

Dr. Elariny was my surgeon. I had surgery 4/12/01. I have had no

complications and a smooth surgery. I had the full DS and have lost

41lbs to date. He, as I understand it, was a lap surgeon before

starting the DS and by this time has done I would say 70 or so DS

surgeries.

> > Re: burn leaks during lap surgery

> >

> > That's the very reason why many Lap Drs. who are trained in

advanced

> > lap techniques do a leak test **intraoperatively** before they

close

> > (my Dr explained this in his patient binder and told the ladies

to

> > tie their hair back as the dye used can stain hair blue).

> >

> > ... it doesn't mean that a leak cant happen post op too.. but

again

> > that's why they do a leak test 24 hrs **post op** also.

> >

> > Its doubly important that the lap surgeon didn't just do a three

day

> > seminar on basic lap techniques but has advanced training and a

> > fellowship under his wings. The more well trained the DR the

better

> > likelihood he would follow the simple safety techniques that

avoid

> > burn leaks by maintaining their equipment properly. Each type of

> > surgery has its own particular risks..this one can be avoided in

the

> > hands of a well trained surgeon.

> >

> > The lap complication curve is directly related to the experience

of

> > the surgeon. Do your research and get the best qualified surgeon

you

> > can. If he doesnt post his complication rate (including leaks)

ask!

> >

> > mary bmi 68

> > corona, ca

> > pre op 6/27/01 dr rabkin

> > cigna ppo

[Guest guest]

> Its doubly important that the lap surgeon didn't

> just do a three day seminar on basic lap techniques

> but has advanced training and a fellowship under

> his wings. The more well trained the DR the better

> likelihood he would follow the simple safety techniques

> that avoid burn leaks by maintaining their equipment

> properly.

Absolutely! Of course, a leak test won't tell anything if it's the

liver, spleen, a kidney, or some other internal organ that is burned,

but it's certainly an excellent precaution.

I think your warning about training applies equally for surgeons who

do open as well. During my surfing, I found videotapes advertised

which purport to be all a surgeon needs to learn to perform the RNY.

I have no idea if any surgeon would rely on such a thing as his/her

only instruction, and I certainly hope NOT, but just the thought

makes me shudder!

> Each type of surgery has its own particular risks..this

> one can be avoided in the hands of a well trained surgeon.

Well, not entirely, according to the article. But it certainly can

be lessened to a great extent.

> Do your research and get the best qualified surgeon you

> can. If he doesnt post his complication rate (including

> leaks) ask!

Again, excellent advice for those seeking both lap and open. And if

he/she seems reluctant to tell you ... well ... you'll have to decide

for yourself what to do if this situation arises, but I know what I'd

do.

Tom

Panniculectomy, Dr. Anthone, 11/10/2000

Open DS, Dr. Anthone, 03/30/2001

11/10/2000....384

03/30/2001....360

04/19/2001....338

04/22/2001....334.5

05/03/2001....328

05/14/2001....319

05/18/2001....316

Currently ~309

~75 Ugly Pounds, GONE FOREVER!!!!!!!!!!!!!!!!

USC DS Support Group: http://groups.yahoo.com/group/ds_usc>

[Guest guest]

Since's Elariny group is Advanced Laparoscopic and General Surgery Associates, ask what advanced lap training he's had.. its a fair question.

You can read about Dr Elariny's training and experience at the web site.

alagsa.com