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Don?t tell doctor what to do

india Updated: Oct 06, 2006 00:07 IST

THE CONFERENCE of gastroenterology surgeons from all over the country at the Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) brought forth one important piece of information for the general masses: “Do not let your doctor go for endoscopic or laparoscopic management of gall stones or other biliary system diseases, as sometimes you may need open surgery.” The continued medical education (CME) on biliary diseases was part of  the conference that got underway on Thursday and marked the opening of the XVI National Conference of the Indian Association of Surgical Gastroenterology.

This advice to consider surgery is relevant for people in this part of the world if one goes by what Dr VK Kapoor, head of the department of surgical gastroenterology, SGPGIMS has to say: “In north India, biliary diseases, including gallstones, occur more than in the southern parts of the country.

Dietary habits, genetic predisposition and few other factors are to blame for higher occurrence of biliary system diseases, especially, gallstones, in northern regions of the country” Though the advise was actually for surgeons, asking them not to follow a patients’ request for endoscopic or laparoscopic management as these much hyped procedures are popular for being less traumatic procedures. Bile is the greenish-yellow fluid (consisting of waste products, cholesterol, and bile salts) secreted by the liver cells to perform two primary functions—to carry away waste and to break down fats during digestion.

The biliary system consists of bile ducts, gallbladder and associated structure.

Dr SM Chandramohan from Chennai, advised the surgeons in the audience saying “Do not go in for laprascopic or endoscopy procedures for removal of gallstones or any other obstructions in biliary system just for the heck of it, or just because they have become popular. Sometimes open surgery is more suitable for a patients according to his condition or the state of the disease. If the biliary system is approached without proper diagnosis and there is a gall bladder cancer on the way, malignancy may spread fast. So, study the patient and his disease properly before selecting a procedure.” Gallstones form when bile stored in the gallbladder hardens into stone-like material. Too much cholesterol, bile salts, or bilirubin (bile pigment) can cause gallstones. Dr SP Kaushik from Chandigarh, who was formerly the head of the department of surgical gastroenterology, SGPGIMS, said it was the duty of the surgeon to talk in detail with a patient about a procedure, its complications or side-affects. “A surgeon must communicate thoroughly with the patient.”

Dr Kaushik talked about complications of benign biliary diseases. Dr AN Supe was the chairperson of the first session of the CME and Dr SM Chandramohan spoke on open surgery. Dr G Choudhuri talked about endoscopic management; Dr R Pradeep from Hyderabad discussed laparoscopic management, while Dr OJ Shah from Srinagar talked about biliary ascariasis. The session on choledochal cyst was chaired by Dr SK Mathur from Mumbai and Dr GR Verma (Chandigarh), Dr Richa Lal (SGPGIMS) and Dr Shailesh Shrikhande (Mumbai) discussed the topic. This was followed by a session on complications of biliary intervention chaired by Dr SS Sikora from Cochin and Dr P Garg (Delhi), Dr Adarsh Chaudhary (Delhi) and Dr AN Supe (Mumbai) shed light on the topic. In the final two session, Dr TD Yadav (Chandigarh), Dr Sanjay Nagral (Mumbai), Dr Sanjay Govil (Banglore), Dr V Sitaram (Vellore), Dr VA Saraswat (SGPGIMS), Dr SS Sikora (Cochin) and Dr Biju Bottakat (SGPGIMS) made presentations. The conference ends on October 8.