Complex Abdominal Surgery and Reoperative Abdominal Surgery. Role of Hepatobiliary Surgeon in Difficult Cases

Abdominal Surgery

Complex abdominal surgery is a unique subspecialty in general surgery (if you will), in which patients are often referred to a tertiary facility by their community general surgeons to receive a higher level of surgical expertise.  Complex abdominal surgery usually requires multiorgan resection such as EN bloc resection of the stomach, small bowel, colon, liver, adrenal gland, and/ or pancreas.  The need for complex abdominal surgery is often triggered by an intra-abdominal malignancy/cancer.  For example, soft-tissue retroperitoneal sarcoma which involves the stomach, transverse colon, left lobe of the liver, and spleen.  This multiorgan resection requires extensive surgical experience in abdominal surgery, availability of subspecialty supporting services such as interventional radiology, advanced gastroendoscopist, and comprehensive critical care/ICU service.  Many smaller community hospitals do not have such components to deliver care with end goal of achieving best outcomes.  Those patients are referred to a tertiary surgical facility to undergo complex abdominal resection for cure whenever possible.  The expected postoperative complications and mortality rate are higher following a complex abdominal surgery, when compared to a simple operation such as a gallbladder resection, groin hernia repair, or umbilical hernia.  The patients are also anticipated to spend more days in the hospital, maybe even in the intensive care unit (ICU) for several days.

Similarly, reoperative abdominal surgery is a unique subspecialty within the general surgery field, in which patients require another operation after multiple prior abdominal operations for other reasons.  For example, a patient with a large recurrent symptomatic incisional hernia following an open colon resection for cancer, open hysterectomy for a large fibroid, and two prior failed hernia repairs with synthetic mesh implantation.  This type of operation requires extensive surgical skills, mature clinical judgment, and extended operative time beyond what normally seen with simple abdominal operations.  Reoperations/redo operations are also associated with increased potential for intra- and post complications, mortality rate, and the need for discharge to a rehabilitation facility.  After each operation, scar tissue forms within the abdominal cavity, which makes subsequent operations much harder.  In many patients,  the scar tissues are very dense and difficult to lyse.  This is why, reoperations within the abdomen tend to be done at a tertiary facility with lots of supporting subspecialties and more sophisticated equipments.

Hepatobiliary surgeons such as Dr. Iswanto Sucandy are equipped with skills and expertise to undertake major complex abdominal operations such as liver and biliary cancer surgery.  Liver surgeons are familiar with resection and reconstruction of major vascular structures.  Liver surgeons are also familiar in handling very sick patients with associated medical comorbidities. This unique skillsets are needed in many reoperative abdominal surgery cases.  Liver surgeons are considered the most skillful surgeon in the hospital and they are usually the “go to consultant” by their colleagues. Dr. Iswanto Sucandy accepts many patients from other referring facilities around the Tampa Bay Area for complex abdominal and reoperative surgical cases.  This may include adrenal cancer, complex bowel fistula, chronic mechanical bowel obstruction, complex reoperative hernia repair, and complex abdominal mass/tumors.  For example, resection of an adrenal cancer encroaching into the right lobe of the liver is technically similar to resection of a large primary/metastatic liver cancer, which can even be done minimally invasively using the Da Vinci robot.  A liver surgeon does not necessarily only/exclusively treat liver cancers.  A Liver surgeon often performs complex operations to remove/repair non-hepatic organs.

We are happy to extend our surgical expertise to treat patients with complex abdominal surgical problems/reoperative abdominal surgery from Tampa Bay Area.  It is not unusual to hear that these patients are being shifted from hospital to hospital, just because it is difficult to find a surgeon with appropriate/adequate skills and expertise to handle the case.  These are “tough cases”.  In our practice, approximately 20% of patients present with complex abdominal diseases and the need of abdominal reoperation involving multiorgan resections.  We are equipped with various supporting subspecialties and advanced equipments to handle even the most complex surgical cases.

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