most complex/advanced general surgical procedure
- Thread starter Pegasus82
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Whipple's a good choice - it's the highest paid GS operation if you're looking for something objective.
Of course, one of the whipple guys at my program says he thinks the needle loc breast biopsy is the hardest operation in GS. 🙂
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I'd agree with the Whipple or the Esophagectomy with colonic interposition as the most difficult cases.
Then again, I wouldn't necessarily want a general surgeon without additional training doing either one of those on me (just because you can get privileges to do something doesn't necessarily mean you should).
Then again, I wouldn't necessarily want a general surgeon without additional training doing either one of those on me (just because you can get privileges to do something doesn't necessarily mean you should).
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I would argue that draining butt puss in the ER is one of the most emotionally complex gen surg procedures.....
Otherwise, I think that any case that involves the liver or pancreas will make the general surgery residents sweat a little bit, or basically any case that is long with a generally poorer outcome/higher morbidity and mortality.
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I recently did a redo/redo/redo Crohn's patient with multiple enterocutaneous fistulas and the densest adhesions i've ever seen. More difficult than any whipple i've ever done.
Once did an appendectomy on a child's B cirrhotic with the craziest varices ever. Also extremely challenging.
I think it's impossible to classify what is the most difficult case. Whatever you name - there will always be one more challenging. That's the fun of general surgery!
Once did an appendectomy on a child's B cirrhotic with the craziest varices ever. Also extremely challenging.
I think it's impossible to classify what is the most difficult case. Whatever you name - there will always be one more challenging. That's the fun of general surgery!
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A Whipple is definitely one of the most complex gen surg operations. However, for the cost of a Whipple, you can do 4 lap choles and be home by noon. The lap choles go home that day, while the Whipple sticks around for a week or two and often has complications. My point is that while the Whipple is a cool procedure, it won't pay the bills in private practice.
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Ughh...I fixed an enterovaginal fistula a few months ago. Poor 26 y/o girl had tons of adhesions from gastroschisis and a temporary colostomy for NEC as an infant that complicated her hysterectomy by OB/GYN. Lo and behold she pops a small bowel fistula to her vaginal cuff 2 weeks later. Just imagine how much fun it was going back into that belly. Thankfully, a wound infection was her only post-op complication...I kept waiting for sucus to start draining from someplace, but fortunately it never did.
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The most complex I've done lately was a liver resection for a ruptured hepatocellular carcinoma. The 80 y/o guy had his whole blood volume in his belly and was in PEA by the time he got to the OR. Liver resections with the patient in shock pre-operatively are not for the faint of heart. Quite to my surprize, he walked out of the hospital about 10 days later. I saw him in the office last week. He's doing great. It's better to be lucky than good!
