MAJOR OR MINOR SURGERY

MAJOR SURGERY OR MINOR?

A lot of you do not know why an illness needs major surgery and another is a minor surgery. Probably you think it has got to do with money. NO sir. Surgical cases are categorized as minor or major depending on the difficulty of the procedure, the need to anesthetitize ( whether general anesthesia or local anesthesia), the need for assistant surgeons and nurses, the complication of the procedure and instruments to be used.

Acute Appendicitis cannot be done in the clinic as in excision of cyst of the breast because the procedure entails opening of the abdomen, pulling out a portion of the intestine ( which is painful), using spinal anesthesia and the need for the patient to stay in the hospital to recover from the surgery.  If medicine can come up with a procedure wherein we can send the patient home after surgery for Acute Appendicitis, this illness will become a minor thing.

Many surgical procedures can become a minor procedure if we can send the patient home as soon as it is finished. Few years from now, gall bladder surgery could become a minor surgery since our postoperative recovery period is becoming shorter and shorter. Twenty years from now, probably, we can do heart surgery in the morning and the patient can go home in the afternoon.

We used to have patients who had been operated for goiter to stay in the hospital for a month or two. Back in the sixties, I still can remember my relatives who stay in the hospital for months because of an illness especially when it entails surgery.

There are some surgical procedures today that could easily become clinic procedures  in the future.

Herniorrhapy or the surgery for hernia is one. Since the procedure is only repair of the abdominal wall defect, this can easily be done in the clinic if we can instill anesthesia lesser than spinal.

Another is hemorrhoidectomy or the surgery for the almoranas. I have done some in the clinic but they were the small ones not those who are as big as the tomato. The problem with the big ones is that they bleed profusely and if done outside of the operating room, the procedure is very scary.  The amount of anesthesia is so great that the possibility of cardiac arrest is there.

We surgeons always think of doing a cheaper surgery. If we can spare the patient of so much expense, we will do the procedure in the clinic if it can be done without risk