Hepato-Biliary surgery

[DrDude]

This is one of the fellowships I haven't read much discussion about.

What are your opinions about the pros and cons of being a hep-bil surgeon?

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[Winged Scapula]

Cons:

sick patients
turf wars with Surgical Oncologists, Transplant Surgeons and General Surgeons
academic practice
restricted geographical practice (ie, you cannot be a HPB surgeon in the middle of no-where)

Pros:
sick patients (some people like that sort of stuff)
academic practice (hard to do in the community)
interesting cases

 

[tussy]

another con: patients generally have poor outcomes. 5 year survival of pancreatic cancer is 15%, resected colorectal mets 30%, etc. So you do a long, painful operation and get negative margins and the cancers just come back. I would find that discouraging.

On the upside - very cool operations, interesting anatomy and physiology.

 

[ESU_MD]

there is nothing good about this field unless you want to go into academics.

From a residents standpoint- the cases are mildly interesting at best.

From private practice- a waste of your time. why waste 8hrs doing a whipple or liver resection for $1200, plus all the post op care, worrying about your patient etc... better off doing scopes & hernias & port a caths and going home at 3pm.

The biggest disadvantage is that alot of these liver pts have hep c- and there aint no cure for that when the resident puts the needle through your finger.

the only people suitable for this field are academic-minded folks who really like the cases, etc..

in my opinion....... you can have it.

5 liver cases were WAY too many for me...

 

[Winged Scapula]

...better off doing scopes & hernias & taking out port a caths and going home at 3pm.

Fixed it for ya.

Taking out ports pays nearly as much as putting one in with much less time and potential for complications. I stopped putting them in when I realized that it only paid around $350.

Let the IR guys put them in; you can be doing something else for the time and more money.

 

[Castro Viejo]

This is one of the fellowships I haven't read much discussion about.

What are your opinions about the pros and cons of being a hep-bil surgeon?

Much love to HPB surgeons since they handle some pretty interesting and difficult to navigate anatomy, but I never liked any of those operations. The Whipple? Some in General Surgery consider that the specialty's Holy Grail... I used to walk out of those rooms feeling like I just spent the last six to eight hours with a morbidly obese woman sitting on my face the whole time. I don't know what that really means, but I just had a really bad friggin' headache everytime.

Give me a redo-redo fem-peroneal bypass with vein ANY day (good luck finding the vein).

 

[Winged Scapula]

Heh...

I actually liked doing Whipples, if only because my PD and I got along well and he played great music in the OR.

Must be the reason I logged 19 of 'em.

Livers? That's another story.

 

[geekgirl]

good or bad, depending on you, but agree:

this is a field that requires an academic setting.

yes, the pts are often sick

the anatomy is good, the surgeries are slick, the property is high value real estate, and the physiology is awesome. i will never be bored by trying to figure out how these organs work

sure pancreatic outcomes suck, but liver resections do much better. particularly for metast colon cancer, much better than 30% survival rates - at least 50% at 5 years according to some series, some as high as 75% or more with reasonable disease-free survival. so you can offer some of these pts a cure.

and you can do HPB through surg onc. MSK has a HPB track of their surg onc fellowship. that bypassess turf wars and such.

 

[DrDude]

On a related note, what about those "Upper GI Surgery" fellowships?

Is there any distinct advantage to doing such a fellowship or does a GS residency prepare you enough to do operations considered "Upper GI Surgery"?

 

[Winged Scapula]

On a related note, what about those "Upper GI Surgery" fellowships?

Is there any distinct advantage to doing such a fellowship or does a GS residency prepare you enough to do operations considered "Upper GI Surgery"?

Dunno sounds like a marketing thing to me (which is the reason I chose to do my fellowship). Looks like its mostly endoscopy with some MIS (ie, GBP, Nissens, etc.) stuff thrown in.

It would depend on your residency. We did tons of Nissens in mine (Children's Hospital with lots of neurologically impaired kids), as well as GBP. The more advanced upper GI laparoscopic cases would be done by the MIS or Bariatric fellows, but you should at least have the basics down from any general surgery residency.

Pretty soon you'll start to see fellowships in hernia surgery or central GI.🙄

 

[core0]

Pretty soon you'll start to see fellowships in hernia surgery or central GI.🙄

Hmm http://www.shouldice.com/:rolleyes:

 

[Winged Scapula]

Hmm http://www.shouldice.com/:rolleyes:

How could I forget about The Shouldice Clinic....I suppose what they do there could qualify as a fellowship.

Best part is Patient Reunions!😀

 

[Neuronix]

Hey man, get off their page. Can't you see at the bottom where it clearly states:

This is a Canadian web site. It's content is intended only for residents in Canada.

The nerve of some Americans... With their knowldge of its vs. it's and reading about our clinics. Srsly.

 

[transplantgator]

Hepatobiliary is a solid specialty, but is generally reserved for those interested in academic practice. You can go about this via a HPB fellowship, Surg Onc, or Transplant (depending on if that program does lots of livers, and non-transplant related hepatobiliary procedures).

Its a great specialty, but it is competitive once your out in the world. My center has HPB performed by surg onc, a gen surgeon, and transplanters. If you are interested in the procedures and multi-disciplinary care for these patients, then its a great field.

You can find cons for any surgical subspeciality or any subspecialty for that matter. What subspecialty doesnt have its share of difficult cases or challenging patients?