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Common Daycare Surgeries! February, 2007.

Often a surgeon is asked – “doctor is it a minor surgery?” And the surgeon has the inclination to say yes, just to reassure the excited and nervous patient. By labling a surgery as “minor” there may be a tendancy to forgo mandatory but simple precautions that have to be taken in every surgery. Every surgery under any kind of anaesthesia may lead to serious and even fatal complications either on the operating table itself or after the surgery in the next few days or rarely after several months or years. It is therefore necessary that the surgeon takes every possible precaution to ensure successful outcome and good result after any surgery.

Is Surgery needed?
Any surgery on any patient has to be performed only if the surgeon is convinced that it is necessary to relieve or cure some condition that the subject is suffering from and therefore is beneficial to the patient. Often times a patient comes to the surgeon and asks for a surgical operation thinking that he has a correctable disease. But if the surgeon is of the opinion that operation is not needed, he would refuse to do it and explain why. An unscrupulous surgeon, however, would be willing to do the surgery since he will earn some money, even when he is convinced that it is an unnecessary procedure. This can particularly happen in the field of Plastic or Cosmetic Surgery. In such instances, after the surgical operation the patient may be very dissatisfied with the outcome and may then blame the surgeon.

Preoperative examination and evaluation.
Several years back (1965-66) when I started my surgical practice a patient came to me seeking surgery for a small lump on his forehead. On examination, I told him that it is a simple condition called “lipoma” ( a mass of fat) and that it can be easily removed under local anaesthesia and as daycare surgery. He was a young and healthy person without any family history of Diabetes. I asked him to have a urine examination for sugar, taking a sample of urine 1 ½ to 2 hours after lunch or heavy breakfast. Though he pressurized me to operate immediately since he was from another city, I told him to come next day with the urine report straight to the Hospital for surgery. Next day the patient arrived with the report which showed that his urine was loaded with sugar. I suggested that he go to a physician to get his diabetes controlled before we perform the operation. This patient went away and never came back to me. In those days of my early practice, every surgery however small was important for me and I had missed an opportunity to do an operation in my private practice! But I was happy, I did not operate in a severe diabetic for it could have led to serious complications like severe infection and even fatality due to spread of infection to the brain (Cavernous sinus thrombosis).

Every patient slated for any kind of surgical operation has to have a thorough medical examination, including a detailed history, details of any past illnesses, family history, a personal history including any drug sensitivity and finally a complete general and systemic (various systems like heart, lungs digestive etc) examination. Even when all these are perfectly normal, it is mandatory to do few laboratory tests like a urine analysis, blood counts, blood sugar estimation and also nowadays HIV test too, all these with the patient’s consent. On demand the doctor should be patient enough to explain why these tests are needed. Only after these steps the surgeon can decide if the patient is medically fit to undergo the planned surgery. In case of any medical problem like BP, Diabetes or allergic asthma etc these conditions have to be brought under control before surgery can be safely performed.

In our next Newsletter we will explain in some detail some common general surgical procedures.

Be healthy; be well informed and be proactive in health matters.

Dr. M.Mohan Rao, MBBS,MS,FICS,MCH,

Director & Senior Surgeon (Retired but not tired),
Dr. U Mohan Rau Memorial Hospital.


Updated on 01.02.2007.

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