Severe attack of upper back pain - Forum

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Re: Severe attack of upper back pain - Ärzteforum

Post#11 »

The uneasiness is there, but I think that all surgeons have warts. I can attest from my own experience, that it is best to get the operation at home. I am being pampered by all the nurses. There is some problem with the constant flow of visitors and well wishers, but that is really pleasant, most of the time.

The best surgeon

Re: Severe attack of upper back pain - Ärzteforum

Post#12 »

My recommendation (~3000 lap choles)
Have one of surgeons do your lap chole with a cholangiogram. If it's positive for a stone find a colleague that you trust to do your elective post op ercp & papillotomy. I was not clear from your original posting wether there is a definite stone in the cbd of 3mm in size or wether the CBD is 3mm in diameter. If your LFT's are normal and your CBD is 3mm an US finding of possible cbd stone is probably overcall by your radiologist and needs at most an intraoperative cholangiogram (which will probably be neg). If your US guy is calling a CBD stone of 3mm then I would still have only a lap chole with intra-op cholangiogram and if pos for a stone then find a trustworthy ercp-ist post-op.

Biliary surgeon

Re: Severe attack of upper back pain - Ärzteforum

Post#13 »

I have had my 2 surgeries in hospitals away from the hospital I was operating in at the time. I think the nurses would go out of their way to torture me by making me do all the things I routinely make my patients do. I also would prefer not to have visitors when I am only partially clad, and probably having nausea, vomiting and even diarrhea.

I had a full executive physical (flex sig, mammos, treadmill, pulmonary functions, labs and full physical) last week at a hospital 100 miles away-it was free and they did all that in 1/2 day, so I thought it was a bargain.

It sounds like you came through surgery a lot better than I do.


Re: Severe attack of upper back pain - Ärzteforum

Post#14 »

Personally I would find a surgeon who is comfortable and competent with doing laparoscopic common duct explorations.

I know this viewpoint is in the minority with a lot of surgeons out there. But I do believe that the mortality and morbidity of ERCP even in expert hands is not insignificant. With proper equipment and a some experience, a laparoscopic common duct exploration can be accomplished as easily and efficaciously as an open procedure with less morbidity. It is also more cost effective than performing both a laparoscopic procedure and an ERCP.

The problem is that many surgeons have abdicated the primary management of common duct stones to the gastroenterologist. Just as there was a learning curve for doing laparoscopic common duct explorations, there is a learning curve for doing laparoscopic common duct explorations. However, if every patient with common duct dilitation and/or abnormal liver function test is referred by the surgeon for preoperative ERCP or if a surgeon does not do routine intraoperative cholangiograms then it will hard for that surgeon to obtain a reasonable experience in doing common duct explorations.

I really believe that a laparoscopic approach should be the first step in dealing with most cases of choledocholithiasis. If you must travel to obtain the care which you feel the most comfortable with, then by all means get on the plane.


Re: Severe attack of upper back pain - Ärzteforum

Post#15 »

I have not stones in my biliary sistem,but I feel like you,in spite of my pars do lap.chol well and cholangiography also well.But,now you are a patient and you must choose the surgeon,anybody in the world,see operate to him,and you must take the risk. As you know,if your CBD is 3 mm.,it's rare a lithiasis there and ,if there is,the stone must be delivery spontaneously(with pain and analgesic).Also,you know,one must avoid open the CBD of 3mm.,because no forceps can be put inside,without risk.And the T tube and closure is other problem. So,I think you need a laparoscopic cholecistectomy with intraop cholangiography,that will not show stone,and all is fine.No laparosc.coledocothomy,no ERCP no sphincterothomy.Only wait for best times.

Come to Santiago,I can operate you.I do the first Chile and I have now near 700,0 mortality,0,5 % conversion,0 injury of CBD,0.6 % reop,etc)The hospital fee is in the best place of Chile,one day,cholangiography included,US $2500.Surgeon and anesthesiologyst is free .


Re: Severe attack of upper back pain - Ärzteforum

Post#16 »

I can tell you my own experience. I had three years ago a third episode of right upper quadrant acute pain (the first two, one year before) and I decided to get an ultrasound which showed my gallbladder plenty of stones!!!! and probably one small in the common duct. I carried out 2 months of treatment with anti-spasmodic medication and stric diet. Then I got a new ultrasound with the same result but without stone in common duct. I planned my surgery: laparoscopic cholecistectomy with one of my friends (who is an excellent endoscopic surgeon too) with intraoperative cholangiography, assisted by my two regular assistants when I perform lap chole. And "stand by" other of my friends (probably the best "open" surgeon of my group) if the first surgeon needs to transform the surgery in open cholecistectomy or if he thought that he couldn't make later an ERCP. The happy end: the first surgeon resolved all during lap chole because I hadn't stones in common bile duct. A week later I came back to my work in the hospital and a month later I took a short vacation in Laguna, Brasil and I ate all you can imagine: shrimp, Caipirinha, chocolate, and so on. Finally, if the second ultrasound would have showed stones in common duct I would have preferred ERCP prior to the lap chole.


Re: Severe attack of upper back pain - Ärzteforum

Post#17 »

I finished my experience with 60 patients with choledolithiasis treated by laparoscopic way:70 % transcistic,30 choledocotomy with and without T tube. May be good for the patient,but for the surgeon and his coronary and nervous sistem is very bad.I had no mortality,but 1 reoperated for biliary peritonitis,long time in the operatory room(never less 2,5 hrs),many destroyed forceps included cholangioscope,biliary fistula,same postoperative hospital stay that open CBD expl. ...Beside,if the patients do not well,the judge ask to my Chilean Surgical Society if this surgery is Stanard or "experimental" The directory of my society,and many others,reply enjoy,that this operation is not standard... It's true that there are surgeons very much skill that others,but,I had see many,many surgeons,and never see one performing knots with his ears!

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Re: Severe attack of upper back pain - Ärzteforum

Post#18 »

I wish you a fast recovery and lack of complications. I hope that you do not have too much pain. I agree with your recommendations. A few years ago I performed an open cholecystectomy (just before the introduction of LC) on one of my best friends- a surgoen who did not want to be operated in his hospital. He actually brought with him the suture material to close the wound.. and was out of bed after 3 hours, walking around our wards and monitoring the well being of other patients. A few month later he develop an incisional hernia.


Re: Severe attack of upper back pain - Ärzteforum

Post#19 »

Thanks to all for your advice. I forgot to mention that I am 43, 6 feet 2 inches (188 cm) tall, and weigh 155 lb (70 kg.). (Why should I have gallstones ???) The CBD was 3mm. and the possible CBD stone even smaller. The severe back pains are still gone, so I can procrastinate a bit longer. I suspect that even if there was a CBD stone, it is probably there no longer. A simple lap chole, even without the cholangiogram, would probably suffice. I'll let you all know when I take the plunge.


Re: Severe attack of upper back pain - Ärzteforum

Post#20 »

My vote is for lap chole with the best MD you can find. A 3mm stone will usually pass. A 3mm CBD should not be manipulated. It was not clear which is 3mm.

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