Dr. Atul K. Madan is a surgeon with UT Medical Group who specializes in laparoscopic surgery, and he's ready to answer your questions.
Q: What is laproscopic surgery? How does it different from a normal surgery?
Dr. Madan: Laparoscopic surgery is surgery through small incisions (1/2 to 1 cm). We use a camera and small instruments to perform our surgery. Laparoscopic surgery differs from normal surgery by the small incisions. These smaller incisions mean less pain and less scarring. Patients go home and get to work faster.
Q: What procedures can you do via laproscopy?
Dr. Madan: Many abdominal procedures can be performed via laparoscopic surgery including gallbladder, colon, appendix, spleen, and kidney removal. By the well-trained surgeon, laparoscopic surgery offers some inherent advantages: less pain, shorter hospital stay, smaller incisions, and faster recovery.
Q: Can you go through this surgery twice?
Dr. Madan: Yes.
Q: Are there more complications with laparoscopic than regular surgery? Is it better and safer than regular surgery?
Dr. Madan: The risks of surgery are the same with open surgery. Injury to bowel, bleeding, injury to the biliary ducts, etc.
Q: Can it be performed at any hospital?
Dr. Madan: The hospital must have the correct equipment before any surgeon can perform laparoscopic procedures.
Q: A friend of mine had a hernia repaired laparoscopically, but my doctor said he cannot fix mine that way. Why not?
Dr. Madan: Whether a surgeon can perform a procedure with the laparoscope depends on his/her skill as well as patient factors. If your surgeon cannot perfom your surgery, you may ask for another opinion.
Q: My mother had a hysterectomy with regular surgery. Now she needs another operation in the same place. Can the doctor do it with laparoscopic surgery?
Dr. Madan: Previous surgery used to be a contraindication for laparoscopic surgeon. As long as your surgeon has experience in operating with patients who have had previous surgery, it may be possible. Some surgeons still do not operate laparoscopically on patients with previous surgery due to the lack of comfort level.
Q: I have a friend who has been diagnosed with Colon Cancer. What are your thoughts about doing this procedure through these small incisions?
Dr. Madan: Many surgeons do not perform laparoscopic surgery for cancer. They fear that the surgery is not equal to open surgery. Recent data has shown that this fear is unfounded and laparoscopic surgery may actually be better in some cases. Most importantly, you need to go to a surgeon who is experienced in laparoscopic colon surgery.
Q: Is this covered by insurance?
Dr. Madan: Laparoscopic surgery is covered by almost all insurance companies.
Q: What's an inguinal hernia? The doctor says my husband has it. Can it be fixed?
Dr. Madan: An inguinal hernia is a hernia in the groin. It can be fixed laparoscopically or open. Both have advantages. If he has hernias on both sides the laparoscopic surgery is better. If he has a hernia on one side, the return to work is less with laparoscopic surgery
Q: Can his regular doctor fix it? How much will it cost?
Dr. Madan: A surgeon can fix it. Cost depends on many things mostly hospital charges.
Q: How long will it take to get out of the hospital?
Dr. Madan: After an inguinal hernia repair, most patients leave the same day.
Q: Where do I get information on what surgeons in my area are better laparoscopic surgeons or who are the most comfortable with this type of procedure?
Dr. Madan: There are many organizations that list laparoscopic surgeons. The most well known is SAGES (www.sages.org). They do not necessarily list which surgeon is more experienced or more comfortable. Always ask your surgeon's experience.
Q: I had this surgery done for blocked fallopian tubes and the doctor states he did not remove all of the scar tissue and tumors, is it advisable to go through the surgery again for a second opinion?
Dr. Madan: I do not perform gynecology surgery although getting a second opinion is never a bad idea. For a second opinion, the UT Medical Group website lists a number of fine gynecology surgeons: http://www.utmedicalgroup.com/pages/depts/obgyn_Gynecology.html
Q: My friend (who has colon cancer) is also concerned about scars. Is there anything that can done (or used) to help reduce the scarring?
Dr. Madan: There are certain material that can be placed in the abdomen to reduce scarring (adhesions). Although many adhesions are attached to the actual incision, smaller incisions usually mean less adhesions. Laparoscopic surgery reduces the external scarring.
Q: On TV you mentioned gastric bi-something surgery. What is that and how do you do it laparoscopically?
Dr. Madan: A gastric bypass is for morbid obesity. It involves making a stomach into a small pouch and bypassing some of the intestine to help weight loss.
Q: How much do you have to weigh to gave the bypass? I have about 50 pounds and am diabetic. Does that matter?
Dr. Madan: It depends on your height and weight. Most patients end up being about 100 pounds overweight; however with diabetes, we operate on patients with a lower weight because this surgery can actually help reduce the medications needed for diabetes. The surgery can actually "cure" diabetes for some patients.
Q: Is there a laparoscopic surgery that can be done to fix or improve Polycystic ovaries?
Dr. Madan: Polycystic ovary (PCO) disease has many causes. If obesity is causing PCO, then obesity surgery will help.
Q: Can laproscopic surgery be used to repair an old gastric bypass?
Dr. Madan: It is extremely difficult and only very few surgeons in the world would perform that procedure. Please feel free to contact my clinic (901-448-6635) to make an appointment.
Q: You've mentioned several surgeries that can be performed laparoscopically. Are there more complications with this option?
Dr. Madan: Most of the complications are inherent to any surgeries. In the hands of the well-trained surgeons, laparoscopic surgery has the same or less complications.
Q: Do you do laproscopic for adhesions? And colon surgery?
Dr. Madan: Yes, but it cannot always be completed laparoscopically.
Q: Well I'm not thin at all but I don’t think I would be considered obese. How do I find out if I'm considered obese and would benefit form this surgery?
Dr. Madan: Our website www.utmedicalgroup.com has a BMI calculator. BMI (Body Mass Index) will help determine your "level of obesity". Surgery is reserved for patients over a BMI of 35 depending on their other health problems. Click to use our BMI calculator
Q: Can laparoscopic surgery be done at any of the hospitals here in Memphis?
Dr. Madan: Not all the hospitals have the appropriate equipment to do complex laparoscopic surgery.
Q: In your interview you indicated that laparoscopic surgery was used for abdominal surgery. How far along is the technique and equipment for doing heart bypass and the other thoracic surgeries?
Dr. Madan: We already do thoracic procedures with minimally invasive surgery. Heart surgery with minimally invasive techniques is starting soon.
Q: I have had a problem with reflux in the past and someone told me there is a way to treat it with surgery?
Dr. Madan: Reflux can be treated with a laparoscopic Nissen fundoplication depending on the severity of symptoms. Most patients leave the hospital in one day and usually do not have to take any more reflux medications.
Q: Are there many surgeons in Memphis doing this Nissen surgery?
Dr. Madan: As far as I know, few surgeons in Memphis are doing this surgery laparoscopically. If a surgeon has not been trained in laparoscopic surgery, it can be a quite difficult operation.
Q: Valve replacement?
Dr. Madan: Valve replacement is not being performed with minimally invasive surgery at this time in any large scale. My guess is in the future we will see more of these procedures.
News Channel 3: We would like to thank Dr. Madan for being our guest today. This has been a very educational chat. If you need further information you can contact the Doctor at his clinic (901) 448-6635 or visit Obesitymemphis.com. We hope to have him back for another chat soon.
