Entries in surgery (83)


Can Surgery Stop Epileptic Seizures?

Jupiterimages/Thinkstock(LONDON) -- Epilepsy sufferers living with a certain form of the disease may find hope in a new study that found surgery is effective at stopping seizures that can't be controlled by medication.

The study, published in next week's edition of The Lancet, evaluated the outcome of epilepsy surgery for 615 adults with refractory epilepsy, the type that can't be controlled by medication. Researchers led by Jane de Tisi of University College London found that 52 percent of patients were free of major seizures five years after surgery and 47 percent were free of them 10 years after surgery. About 30 percent of the study participants no longer needed any medication to control seizures.

Patients who had temporal lobe surgery were less likely to experience a recurrence of seizures than patients who had procedures in other parts of the brain.

Neurologists not involved in the research said the study is one of the only ones that followed patients for that long a period of time. It is important work, they added, because it highlights how effective surgery can be for adults and children with medically refractory epilepsy.

Although they believe the surgery is effective in controlling seizures, many seizure patients don't elect to have an operation. Some study patients lived with their uncontrolled seizures for more than 20 years.

In a comment accompanying the study, Drs. Ahmed-Ramadan Sadek and William Peter Gray of Southampton University Hospitals wrote that while the research validates epilepsy surgery as an effective treatment option that's been used for the past two decades, the process still needs improvement.

They added that there should be a better way to identify which patients will benefit from surgery, and there should be improvements in the surgery itself that will lead to better success rates.

Copyright 2011 ABC News Radio


Medicare Patients Get Costly Surgery before Death

Jupiterimages/Thinkstock(NEW YORK) -- Nearly one of every three Americans on Medicare undergoes surgery in their last year of life, according to a new study. Those numbers are leading some to question whether pursuing these costly and invasive procedures is the right thing to do for dying patients.

The study, published in The Lancet, analyzed more than 1.8 million claims for Medicare patients who died in 2008, and found that 32 percent of them had an operation in the year before they died. Nearly one in five had a surgical procedure in the last month of life and one in 10 went under the knife in the last week of life.

Dr. Ashish Jha, the study's author and an associate professor of health policy at the Harvard School of Public Health, said it's well known that patients get lots of health care at the end of their lives, but this study is the first to show how many of them are getting costly, invasive surgery, and then dying.

"This level of surgical intensity doesn't seem to be having much in the way of benefit for the population," Jha said. "Our sense is that there are probably lots of unnecessary procedures that go on at end of life."

The study found that a patient's likelihood of getting surgery varied greatly depending on their age and where they lived. Surgery was more common for 65-year-olds than for patients in their 80s and 90s. Operations also became more likely in regions with greater availability of hospital beds and higher levels of Medicare spending.

All this surgery didn't necessarily prolong life. Areas where doctors did lots of operations had higher patient death rates.

Ken Thorpe, a professor of health policy at Emory University, said doctors and health care systems should reevaluate the kinds of interventions they give to patients who may not live long enough to really benefit from their treatments.

"Researchers are finding that these aggressive procedures have the same outcomes as less invasive, less expensive treatments," he said. "This study shows us there's an enormous opportunity to basically save money and provide less intervention, and still have the same quality of care and life expectancy."

The study also suggests that more dying people have surgery not because they want it or need it to save their lives, but because American medical culture encourages aggressive care like surgery, even at the end of a patient's life.

Jha said it's impossible to tell from the Medicare claims analyzed in the study whether or not surgery was really necessary or whether patients and their families wanted an operation. But he said it underscores a general hesitation by doctors to discuss a difficult subject with their patients: that they might die.

"A lot of physicians struggle to talk about prognosis, whether people are going to live or die. Instead they focus on trying to make little things better," Jha said. "Some of these procedures are a distraction from what might really be important for patients, like being able to spend time with family, being able to say goodbye to people they love, or what their quality of life will look like."

Experts say this study highlights the need for doctors and patients to talk about palliative care options as well as more aggressive treatments like surgery.

"We need to provide patients options for how aggressive they want to be toward the end of life," Thorpe said.

Copyright 2011 ABC News Radio


Conjoined Twins: Doctors Debate Ethics of Separation Surgery

Jupiterimages/Thinkstock(CLEVELAND) -- The decision to separate conjoined twins would be easy if it guaranteed a better life for both babies.  But the possibility of one or both twins dying or becoming severely disabled because of the surgery or the separation's effects weighs heavily on parents and doctors, according to a new report.

Two-year-old twins joined at the head were the focus of the report on the bioethics of separation surgery.  The girls, who were unnamed, shared kidneys and veins that drain blood from their brains, making separation surgery a risky undertaking unlikely to benefit both of them equally.  But leaving them joined could also threaten their health, not to mention their independence.

"In this case, every ethical principle is sort of turned on its head," said Dr. Devra Becker, a plastic surgeon at UH Case Medical Center in Cleveland and senior author of the report published Monday in the Plastic and Reconstructive Surgery journal.  Those principles, including informed consent, the duty of doctors to heal and avoid harm, and the tenet that health care resources should be distributed fairly, form the framework of Becker's report.

The girls traveled with their parents to Rainbow Babies and Children's Hospital in Cleveland from Italy for separation surgery.  They are craniopagus twins -- the rarest form of conjunction affecting one in 2.5 million births.  Based on published cases, the odds of both twins surviving separation surgery are 33 percent -- the same odds for both twins dying.

"Few will debate the benefit of separation if the surgical risk is [zero].  Similarly, few will advocate for separation if the procedure guarantees the deaths of the twins," Becker and colleagues wrote in the report.  "The ethics of separation becomes more complex when the morbidity of separation lies between [zero] and 100 percent or if one twin will benefit more from the separation than the other."

Following the risky, not to mention expensive procedure, the larger twin would need a kidney transplant or lifelong dialysis to live.  The smaller twin would be at risk for brain damage.  But left together, the girls were at risk for kidney failure and cardiovascular disease.

The procedure could also give both twins the chance for a normal life.

After thoroughly weighing the risks and benefits, the Italian twins' parents and the medical team decided to move forward with the procedure.  The larger twin, who would be left without kidneys, would go on dialysis until she was strong enough for a transplant.  And the risk of brain damage in the smaller twin would be minimized by doing the procedure in stages.  The benefits of separation for both twins, both medical and otherwise, outweighed the risks.

But during the procedure, the surgeons noticed the layer of tissue covering the twins' brains was dangerously tight -- a twist that tipped the risk-benefit scale.  The surgery was aborted, and both twins recovered.

Copyright 2011 ABC News Radio


Study: Anesthesia Exposure before Age 2 Could Disrupt Development

Photodisc/Thinkstock(ROCHESTER, Minn.) -- Infants who are put under for surgery more than once before the age of 2 may be at increased risk of learning disabilities later in life, according to research from the Mayo Clinic in Rochester, Minn.

The use of general anesthesia in infants undergoing surgery is currently considered very safe, but mounting evidence -- first in animals and more recently in humans -- suggests that repeated exposure to anesthetics in the first few years of life could cause brain damage if carried out during certain key developmental periods.

The Mayo Clinic study, published Monday in the journal Pediatrics, tracked the medical and school records of a thousand children born between 1976 and 1982 in Rochester, Minn., 350 of which were given general anesthesia at least once in the first two years of life.

Among infants who had had more than one surgery during those years, almost 37 percent experienced a learning disability later in life, compared with only 21 percent in the children who did not undergo surgery.  Even for those children who had only one surgery during infanthood, the rate of learning disability was slightly higher, at 24 percent.

Learning disabilities seemed to center on speech and language difficulties, says Dr. Randall Flick, Mayo Clinic pediatric anesthesiologist and lead author of the study.

Researchers controlled for characteristics that might also affect development later in life such as birth weight, gestational age and maternal education level, by matching each of the 350 study subjects to two control children in the same population who shared similar characteristics.

"Kids who were exposed were three times as likely to later need a special education program to address speech and language difficulties than kids who weren't exposed to anesthesia," he says.

The research is preliminary, and shouldn't change surgical protocol at this time, the authors say.  But even the possibility that anesthesia is damaging to infants' brains is disquieting for physicians and parents, especially because infant surgery is so seldom elective -- surgery in infants is almost always medically necessary.

Copyright 2011 ABC News Radio


Want Pippa Middleton's Butt?

Chris Jackson/Getty Images(MIAMI) -- Pippa Middleton stole the show at the royal wedding of her big sister, Kate, to Prince William. Now she is stealing the hearts of plastic surgery patients everywhere -- or, rather, her rear end is.

The sister-in-law of Britain's apparent future king is the inspiration behind the latest trend in cosmetic surgery, called the "Pippa butt lift."

The name Pippa Middleton held marginal significance until the April 29 wedding of William and Kate, when Middleton, 27, wowed the crowd in a form-fitting bridesmaid dress by Alexander McQueen that left royal wedding watchers asking two things: could her gown have been padded and, if not, how do I get that back?

Facebook groups and blogs dedicated to Pippa's posterior soon popped up, earning Middleton the moniker, "Her Royal Hotness."

Now that plastic surgeons around the world are offering the procedure, patients are flooding in, each of them seeking the same thing: the best royal seat in the house.

"In that wedding gown, she created a stir," Miami plastic surgeon Dr. Constantino Mendieta told ABC’s Good Morning America. "People want those dimensions."

Mendieta, author of the book The Art of Gluteal Sculping, says 80 percent of his cosmetic work is now butt lifts, with 20 percent of those requests made specifically for achieving Middleton's rear end.

"She's got a nice rump that's not too big," Christina Valdez, a 28-year-old single mother from Miami, told GMA. "Her frame just looked incredible in that dress."

Valdez was so intrigued by Middleton's look that she too became a patient of Mendieta, requesting the "Pippa butt lift."

Valdez says she felt confident the cosmetic benefits of the surgery would outweigh the risks that come associated with any plastic surgery procedure, including, for her own butt lift, having to gain weight because new fat is easier to shape and mold.

"I've always had a little bit of a complex with my stomach and trying to fill in the back side a little more," she said. "I would absolutely love to be able to wear a nice fitted dress and have my waistline back and a nice rump to go with it."

In a surgery that lasted two hours, Mendieta injected fat from Valdez's stomach into her backside in order to slim her waist and contour her rear into perfect Pippa fashion. Six weeks later, despite not being able to sit for long periods of time and knowing there is a chance her rear will shrink in the months to come, Valdez said she is happy.

"I love the results," she said. "It looks beautiful, feels great and I feel sexy."

As for why she did not just turn to padding or different clothes to achieve a similar look, Valdez has a quick answer.

"At the end of the day, the clothes come off," she said. "I want it to be mine and be sexy and not have to worry about stuffing my backside."

Copyright 2011 ABC News Radio


Buyer Beware: Uncertified Doc Botches Surgery

ABC News(NEW YORK) -- After going into surgery for a simple repair of her breast implants, Dinora Rodriguez, 40, awoke from the procedure to find that her plastic surgeon had left her with conjoined breasts. Without her knowledge or permission, the surgeon had also nip/tucked her eyelids, leaving Rodriguez with eyes that to this day cannot close all the way.

Rodriguez learned the hard way -- you always have to vet your plastic surgeon.

"A friend had recommended the doctor to me. My biggest mistake is that I didn't check any of her credentials. I found out later that she had done really bad surgeries on some other people too," Rodriguez told ABC News.

The doctor in question was licensed to practice as a plastic surgeon in California, where Rodriguez lives, but she was not board certified by the American Board of Plastic Surgery.

After a year of pain and disfigurement, Rodriguez sued her doctor for malpractice and says she found out that the corrective surgery on her breasts was not even necessary in the first place.

"She told me that she needed to replace the implants because they were leaking and I believed her. She gave me a good price on the surgery and I said yes," she said.

Now Rodriguez has become the poster child for a new safety campaign spearheaded by the new president of the American Society of Plastic Surgeons (ASPS), Dr. Malcolm Roth. The campaign, announced Monday at the annual ASPS conference, warns against "white coat deception" – basically, just because a doctor has a white coat, and even an M.D., doesn't mean they are qualified to perform plastic surgery.

In 48 states it is currently legal in the United States for doctors who are not certified by the board of plastic surgeons to practice cosmetic and plastic surgery.

"This means that we have other physicians creeping in who have taken a course and think they can do plastic surgery," said Roth. "It's not the same as going through six years in training specifically in plastic surgery, plus the continual training and code of ethics that are required for those who are board certified," he said.

"People spend months or years making a decision on which care they're going to purchase – it's no different when having a procedure performed. Plastic surgery is elective, there's plenty of time to do your homework and that's really all we're asking: do your homework," Roth said.

Rodriguez ended up settling her malpractice suit out of court. She says the compensation she received barely covered her reconstructive surgery she needed. Because the surgeon had cut across the two separate "pockets" that normally hold breast tissue, the implants were able to touch in the middle, said Dr. Steven Teitelbaum, a plastic surgeon in Los Angeles who did Rodriguez's reconstructive surgery.

Unfortunately, because the first surgeon had removed too much skin from Rodriguez's eyelids during the procedure she says she had never asked to have done, there is nothing that can be done to reconstruct her lids -- she will never again be able to fully close her lids and must take medication for the rest of her life to moisten her eyes. Because the first surgeon cut through nerves and muscle, she also has shooting pains in her ribs surrounding her breasts.

The number of non-board certified plastic surgeons practicing is on the rise, Teitelbaum said, because the public is demanding more plastic surgery and with insurance reimbursements so low, many non-plastic surgeons are offering cosmetic procedures in an attempt to maintain their income.

And with the rising number of unqualified plastic surgeons practicing, he says the number of patients suffering from less-than-ideal surgeries is also increasing.

So what can a patient do to check out their doctors before going under the knife?

First and foremost, make sure the doctor is board certified in plastic surgery specifically, which you can do by searching the doctor's name on the ASPS website, Roth said.

In order to be board certified, doctors who do their residency in plastic surgery must pass a rigorous set of written and oral examinations. While they can legally practice plastic surgery even if they don't pass these tests, they will not get board certification.

Another important question to ask of your surgeon is whether they have hospital privileges if needed to perform their procedures, Roth says.

"If the nearby hospital won't let them practice under their roof, then something might be up," he says. "Probably, the physicians at the hospitals don't believe that this physician has adequate training."

Copyright 2011 ABC News Radio


Conjoined Twins Survive 13-Hour Separation Surgery

Jupiterimages/Thinkstock(MEMPHIS, Tenn.) -- At 8 months old, Joshua and Jacob Spates continue to fight but, according to doctors, they have already beaten the odds.

They were born in January at Bonheur Children’s Hospital in Memphis, Tennessee, three weeks early and conjoined.  The brothers were attached to each other at the lower spine and pelvis, an unusual connection that made them what are known as pygopagus twins.  Only 15 percent of conjoined twins are connected in this way and, even before their birth, doctors could see in X-rays of their mother’s womb the challenges that would come should they dare to attempt separation surgery.

Yet, surgeons decided to go forward with the life-or-death operation last month.  When doctors finally separated them on Aug. 28 after a 13-hour surgery, they became one of only two dozen sets of conjoined twins in the world to be successfully separated.  The operation involved the delicate detachment of the spinal cord and column, as well as muscles and other tissues.

Joshua and Jacob are not completely out of the woods yet.  They are expected to remain at the hospital for some time while they recover, and they will receive clinical care and rehabilitation therapy until they are healthy enough to go home.

Copyright 2011 ABC News Radio


Peyton Manning’s Surgery, the Go-To Procedure for Herniated Discs

Medioimages/Photodisc/Thinkstock(NEW YORK) -- Indianapolis Colts quarterback and four-time MVP Peyton Manning is out of the game after having neck surgery Thursday—his third surgical procedure in the past 19 months. In a statement released Thursday, the team said Manning had a “single level anterior fusion” procedure, which was “uneventful.”

The procedure is a common one, said Dr. Andrew Hecht, chief of spine surgery at the Mount Sinai School of Medicine in New York City, who works with players from the New York Jets and the New York Islanders.

“I see these procedures not only in professional athletes, but in many different types of individuals,” Hecht said.

Hecht said such surgery is the go-to procedure for patients with a herniated disk for whom other less invasive methods, such as medication and physical therapy, have not worked. A herniated disk puts painful pressure on the nerves of the spinal cord and can cause numbness or weakness in the arms. Manning, 35, had surgery in May to repair a bulging disk in his neck and recently reported pain in his upper back and neck.

“The goal of the surgery is to decompress the nerves, to relieve that painful pressure,” Hecht said.

In an anterior cervical fusion, doctors make an incision into the neck, remove the disk between two vertebrae in the spine and put a piece of bone and a metal plate in its place.

Dr. Mark Knaub, a spinal surgeon at Penn State Hershey Medical Center, said recovery can take two to four months for someone with an average, non-strenuous job. But for an athlete playing a contact sport such as football, that recovery time can be much longer—up to nine months, in some cases. Knaub said that’s because doctors must make sure that the athlete’s bones have fused.

“Sometimes recovery is accelerated in professional athletes,” Knaub said. “But I’d be surprised if Manning made it back to the field this season.”

The Colts said they’re not estimating a date for Manning’s return to the game.

Copyright 2011 ABC News Radio


Penis Amputee Receives No Damages in Kentucky Trial

Comstock/Thinkstock(SHELBY COUNTY, Ky.) -- A unanimous jury ruled in favor of the Kentucky doctor who amputated a portion of Phillip Seaton's penis during an October 2007 circumcision to treat inflammation.

The jury unanimously found that Dr. John Patterson exercised appropriate care when he removed a portion of Seaton's penis after finding cancer and ruled 10-2 against Seaton's claim that Patterson did not properly obtain consent to him before removing his penis.

"We feel the interest of justice has been served," Clay Robinson, Patterson's attorney, told ABC News. "When you hear about someone going in for a circumcision and it turned into a partial amputation, there's going to be a reaction, but it was a pretty clear-cut case. There was no liability here."

Seaton signed a consent form for a routine circumcision. Within the signed forms, a disclaimer included language that recognized Patterson's right to perform any further surgery he deemed necessary if unforeseen conditions arose, Robinson said.

Seaton, 64, sued Patterson in 2008 for removing part of his penis without his permission. The trial got under way Monday in Shelby County, Ky., Circuit Court. Seaton and his wife, Deborah, sought more than $16 million in damages for "loss of service, love and affection."

But Robinson said the surgeon felt he had no other options but to remove the penis immediately.

The tip of Seaton's penis "had the appearance of rotten cauliflower" because it was so inundated with cancer, Robinson told the courtroom on Monday. The defense attorney also told the jury that Patterson only removed about an inch of the penis during the initial surgery before another surgeon removed the rest of his penis at a later date.

Partial penectomy, or a partial removal of the penis; Mohs surgery, a precise surgery used to remove several types of skin cancer; laser and radiation therapies were all options when treating penile cancer, said Dr. David Crawford, a professor of surgery at the University of Colorado Health Sciences Center.

Because the surgeon said the cancer was so severe, Robinson told the courtroom that Patterson could treat it only by surgically removing the organ.

Seaton also sued Louisville's Jewish Hospital, where the surgery was performed. The hospital settled out of court for an undisclosed amount.

Copyright 2011 ABC News Radio


Doctors Face High Risk of Malpractice Claims

Jupiterimages/Thinkstock(BOSTON) -- Almost every physician in the U.S. will face a malpractice claim during his or her career, according to a new study published in the New England Journal of Medicine.

Researchers led by Dr. Anupam Jena, a physician at Massachusetts General Hospital and Harvard Medical School, analyzed malpractice data over a 14-year period for all physicians covered by a large malpractice insurance provider.  They estimated more than 75 percent of doctors in specialties with a low risk of malpractice and 99 percent of doctors in high-risk practices will be sued.

"If you consider a doctor who is 30 years old and just starting a career and in a high-risk specialty, there is about a 100 percent chance that by the age of 65 he will have faced a claim," said Jena.  "We find that across all specialities, the annual risk of a claim is substantial -- 7.4 percent of all physicians had a malpractice claim every year during the study period."

The study also found that while the risk of a malpractice claim is high, about 80 percent of claims never result in any payment to plaintiffs.  Average payments ranged from $117,832 for dermatologists to $520,923 for pediatrics.

Neurosurgeons, thoracic/cardiovascular surgeons and general surgeons face the highest risk of a malpractice claim, while general practitioners, pediatricians, and psychiatrists face the lowest risk.

While the monetary costs of claims are low compared to risks, Jena said doctors pay an extremely high price in other ways.

"There are substantial costs associated with those claims," Jena said.  "There are the costs of defending the claim [and] the losses in productivity while doctors spend time with their defense.  Patients may suffer by not being able to see their doctors, and there also [are] the effects of stress and potential damage to reputations."

Copyright 2011 ABC News Radio

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