There is a saying…”You cannot make an omelette without breaking an egg”
But in surgery we try to do just that! Surprisingly in most cases , surgery goes well with most having a successful outcome and no major complications. More importantly, surgeons have become a victim of their own success with Community expectations that we can always make an omelette without breaking an egg. Unfortunately, despite our best efforts, things do happen. Sometimes very bad things. But by and large, the egg stays intact.
Why do bad things happen? Well there are a number of reasons. For starters, no one person is the same. Despite the model not changing for centuries, we are all different in our own ways. Everyone comes in their own individual packages. Different factors like age, weight and medical conditions attached increases the complexity of the case. Some common problems include:
- General medical conditions that may be present. Each condition affects an individual differently with varying effects on different body systems. For example high blood pressure may lead to an individual having a heart attack but another having kidney failure. Others may have had a stroke or poor circulation in the legs. Combination of medical conditions may increase the risks exponentially. So someone with diabetes and high blood pressure will have far more reaching problems than another with high blood pressure
- The anatomy of the body is also different. Whilst we know where the major blood vessels and nerves run and where major organs like the lungs, heart and kidneys are placed in the body, there are variations to this. Rarely some people are born with the heart on the right side of the chest, others with the appendix on the left side of the tummy. Occasionally, the kidneys instead of being high in the back, can be low down in the pelvic area. So sometimes surgeons can get fooled by the anatomy being different if they are not aware of it. Our anatomy books are drawn with the various organs nicely drawn and painted in different colours. Pity there is no colour coding when we operate inside the body.
- Body changes with age……sad but true. You know the saying “ everything heading south”. And it is not south of the border to Mexico as John Wayne would say! Well folks..our systems alter with age. Wear and tear as the guarantee brochures say. I think we all recognise that the body of a 70 year old is not the same is that of a 50 let alone a 20 year old. For one thing the blood vessels are different and so blockages like thrombosis, heart attacks, strokes can be more common. The older, the more likely there are medical conditions that affect the outcome.
- Racial characteristics also add to the mix. Some ethic and racial groups can have different problems. One example is the formation of keloid scarring is more common in the Asian population. Thalassaemia resulting in anaemia is a risk for those from Southern Europe and also Asians. If present may lead to problems if not recognised.
- Previous interference. Yes, you read it. Once interfered with, nothing is the same again. One example is previous surgery. Anyone who has had a cut will need to heal. In healing, there is scar tissue formation. This can lead to things being stuck together especially inside the tummy. Sometimes the bowel or bladder can be very stuck and repeat surgery can lead to inadvertent trauma to these organs. Traumatizing bowel is very traumatic for any surgeon if not planned for. For bowel surgeons taking bowel out it is expected and normal. No issues. But for a poor gynaecologist taking a womb out or an obstetrician delivering a baby by caesarean section, it can be worse than meeting Freddy. Unfortunately no amount of scanning or MRI or x rays can tell us where and how severe the scarring is, until we are in there. Other organs can be involved including major blood vessels, the ureter, bladder and so in the tummy, which is where I mainly do my operation. So these are organs very dear to my heart.
- Yup gremlins. They are everywhere. The ones that saved the world from the aliens in “War of the Worlds”. You got it folks, I am talking about “Germs”, on the skin, in the bowels in fact on any surface you like to think of. If only we can use those wipes to get rid of them. In fact the wipes can’t eradicate them totally if you read the fine print. We are now getting more “superbugs” in our effort to eradicate all germs. They can lead to infection, wound breakdown and cause misery for all. People who are on steroids for things like asthma, arthritis, those with diabetes or simply being overweight are just some examples of people at higher risk of such difficulties.
- There I have said it. Unfortunately weight can be a major issue. Many who are overweight commonly have other medical problems like diabetes. Poor wound healing and infection are more frequent. Also with surgery in order to get to the area of interest, we commonly have to make bigger cuts to get us to where we need to go especially if the areas are deep inside the tummy. This also leads to larger raw areas causing increased bleeding and also for those nice gremlins to find and colonise. Fact is that the higher the weight, the greater the risks in any surgery.
- Idiosyncratic reactions to medications. Commonly called allergies but this is only part of the spectrum. One rare example is a person who has a genetic deficiency of an enzyme called acetylcholinesterase . They take a long time to wake up from an anaesthetic. The nightmare of anaesthetists as they can spend a long time waking up. Like medication allergies, this is only discovered when it happens. There is no test for this.
Stuff ups. I cannot blame the individual patient for all that goes wrong. Sometimes we do stuff up. You have all heard of the wrong body part being operated on or removed, things left behind inside body cavities etc. We have developed over time systems to try and reduce this risk. For example there is now :
- The “time out process” where prior to starting an operation, all members of the
team identify the patient and the procedure that needs ti be performed. This
reduces the risk of operating on the wrong person or body part.
- There is an increasing use of disposable equipment as opposed to re sterilising it.
Our sterilising techinques have also changed.
- Regular checks during an operation are undertaken to ensure equipment and
sponges are accounted for.
- More judicious use of antibiotics to reduce the risk of over treatment and allowing
for the rise of superbugs.
Never 100% fool proof, these measures have helped to contribute to reduction of risks to patients
This is not an essay (though it looks like it) of everything that can go wrong or why they do, but just to try to highlight the possible areas that can cause complications. Other important factors include individual drug use especially smoking, the part of the body that the operation is being undertaken, the type of operation and a person’s emotional state at the time of procedure etc. etc. etc.
Sometimes bad things just happens! Not due to negligence, poor surgical skills nor poor patient conditions, the outcome is not great. Luckily this does not happen often but should that happen, I believe it is important that everyone is up front , not only in explaining what happened but what can be done about it.
It is important that you should feel free and brave to broach this subject with your doctors at any time. I believe in being open about these issues as I believe a good understanding on your part goes a long way to avoid any fears you may have. Furthermore, by knowing about the issues that you face, you may also just be able to do things to minimize that risk for yourself. Remember that having an operation should be considered a team effort not only on the part of the doctors and nursing staff but also by yourself. Everyone has to play their part to ensure a safe and successful outcome for you.
Aaahh….just off to make another omelette
These notes reflect my personal opinion and are intended for general advice only. It should not be used for any one individual case. You should consult your own doctor to determine the appropriate management of your own individual situation. No part of these notes can be used or reproduced in any manner without my express consent