Essential Guide to Having Surgery - Surgery abroad with Globe Health Tours.

1 An Essential Guide to Having Surgery

An Essential Guide to Having Surgery

This guide is intended to be a brief aid to any possible surgical intervention patients may require. Because Goble Health Tours can facilitate and assist you to obtain many hundreds of different operations, procedures and invasive investigations, this guide can not and does not reflect on any one procedure or speciality. It covers a broad range of topics frequently encountered by patients when faced with the prospect of surgery. But, if you are specifically looking for cosmetics procedures, you should also read our Guide to Cosmetic Surgery. The information contained here will of course apply equally to all kinds of operations and procedures including cosmetic surgery.

An Introduction to Globe Health Tours

Globe Health Tours is not a medical company. We therefore do not and can not offer you a medical or surgical opinion. However, we can assist you in finding a suitably qualified specialist, clinic or hospital which can offer you an opinion and treatment should you choose to embark on this. Globe Health Tours does not own (wholly or partly) any hospitals, clinics or any other medical institution and does not employ doctors to provide treatments such as surgery. All treatments and operations are done by specialists and in hospitals which are completely independent from us. So what exactly do we do?

Globe Health Tours will initially ask you for as much of your medical details as you can provide. Clearly, the more details we can obtain, the better a judgement we can make on where to send your particular query so that you can obtain an idea on who can best treat you. All institutions that we suggest are thoroughly and rigorously scrutinised and vetted. They all must conform to internationally recognised standards and offer “world class” medical and surgical facilities. Only after reaching these standards does price become an issue. For us, the price of the operation is never the first issue as you can easily find a cheaper option somewhere else in the world. However, you may not be able to guarantee standards and training in such institutions yourself. Nevertheless, we aim to find the best treatments available globally for a fraction of the costs of similar treatments available in Western countries.

The actual treatments are carried out by highly qualified and experienced surgeons. Operations are not carried out by trainees although in teaching hospitals, it may be possible for trainees to assist or observe such procedures with the consent of patients. Most specialists will have trained wholly or partly in developed parts of the world such as UK, USA and Europe. All of these specialists should be able to converse in English as well as perhaps some other languages.

Making the Decision to Travel Abroad

When considering surgery abroad, you may already have discussed your specific symptoms and problems with your local doctor or specialist. You may therefore have a diagnosis and even a treatment plan. If this is the case, you will most likely already have a degree of knowledge about your illness and options for treatment. In this instance, you will need to decide on where best to obtain treatment. Alternatively, you may not have had an opportunity of discussing your symptoms with a doctor and therefore you may not have a diagnosis or treatment plan. In this instance, you are encouraged to at least seek an opinion locally to establish a “working diagnosis”, if at all possible. Once you have obtained this, you will have a better understanding of your requirements. For those patients who cannot obtain any local diagnosis, Globe Health Tours can facilitate a full consultation with a specialist who can then arrange tests and any other suitable investigations which may be required to reach this point.

Having now considered your working diagnosis, do you elect to have treatment or surgery locally or do you travel abroad? Before answering this question, you need to carefully consider why you would wish to seek treatment in another country and how best to arrange such a daunting trip.

The reasons you may wish to travel abroad for surgery include;

the lack of waiting lists: this is in contrast to UK National Health Service (NHS) waiting lists which can range from a few weeks to over a year for non-urgent elective operations. Many other countries where healthcare is arranged and subsidised by the state have similar waiting lists.
cost effectiveness: if you choose not to have surgery in the UK or USA, you can potentially have the same procedure carried out by equally well qualified and experienced surgeons, but for a fraction of the cost.
the particular operation, treatment or investigation may not be available locally due to the lack of facilities.
the treatment required may be a new or “state of the art” procedure or investigation requiring cutting edge facilities and therefore available at only a few super-specialised centres around the world.
a concern about safety of your local hospital facilities. This may include sterilisation of equipment or hospital acquired infections such as MRSA, E. coli or C difficile. You may therefore prefer to have surgery at a hospital with considerably lower incidences of these sorts of problems.
your wish to access an opinion or treatment from a particular surgeon, hospital or institution which is a world renowned centre of excellence for specific problems or procedures.

However, you are urged to balance these reasons with reasons why you should stay nearer to home. Only then can you truly make an informed decision on what the most suitable option for you might be.

Reasons not to travel abroad include;

staying in a country or environment that is familiar to you. This is especially important when you are unwell and perhaps not feeling as physically or mentally strong as usual.
having a more accessible support network closer to home such as family and friends.
having easier access to your doctor, surgeon and local hospital if repeated trips for investigations or follow ups are expected due to the nature of your problem.
minimal travel time.
the cost of travelling and accommodation.

Once you have considered these options, you need to consider the relevant facts about your particular treatment and about surgery generally. Some basic knowledge of side effects and risks of complications is useful to know and applies to all surgical procedures. Clearly, you need to discuss the specifics of your operation with your chosen specialist before you decide to proceed. The Globe Health Tours website consists of hundreds of pages which cover many different specialties and operations. For a more detailed analysis of these operations, please read the relevant pages after reading this guide.

The Risks of Surgery

Considering the thousands of operations carried out each day all over the world, the chances of something serious going wrong are low. Mild and minor issues do arise more frequently whereas serious or life threatening events fortunately occur less often. Naturally, the occurrence of complications and their severity depends on many things.

These include;

the nature of your surgery: clearly, open heart surgery is going to be more risky than an arthroscopy of the knee.
your general level of fitness: younger, healthier, fitter and more mobile patients have inherently less risk for the same procedure when compared to older, less mobile patients. Younger patients will therefore be mobilised and rehabilitated earlier and quicker.
smoking: smokers are at higher risk of suffering from complications. Compared with non-smokers, there is also a delay in wound healing.
the extent and severity of your illness: the less well your condition makes you and the more complications there are already, the more difficult will be the surgery, carrying a higher chance of side effects or complications.
being grossly overweight: the more obese you are, the greater the risks of surgery. The more weight you can loose pre-operatively, the greater your chances of success.
being grossly underweight: those who are malnourished, whether this is deliberate (e.g. anorexia nervosa) or not will be at greater risk from the effects of surgery.
experience of your surgeon: the skill of the surgeon clearly plays a part on the rate of complications. The more experienced a surgeon, the more likely you are to have a successful outcome. The outcome also depends on the training received by the surgeon.
the occurrence of adverse events previously: if you have undergone a similar procedure in the past and suffered a complication, you are more likely than average to have a similar problem. This is particularly true for reactions to medication including anaesthesia.

Risks of Surgery

The following list outlines in more detail the possible risks involved in all types of surgery. This list cannot be exhaustive as different procedures will have the potential to cause specific problems depending on the nature and site of the procedure. For example, the actual risks involved in a Transurethral Resection of Prostate (TURP) will clearly be different to those of a Breast Augmentation procedure. But the anaesthetic risks may be similar depending on the patients involved.

Anaesthetic Risks

Some patients may suffer from an adverse reaction or response to anaesthesia. This mainly occurs with General Anaesthesia (GA) where patients are artificially put to sleep for the duration of the operation. However, patients can also react to the sedation given before GA or to local anaesthetics.

Examples of problems that may arise as a result of anaesthesia include;

arrhythmias – an abnormal heart beat pattern. This may cause palpitations, a feeling of light headedness, dizziness, fainting, nausea and breathing problems.
airway obstruction: this may be caused by a direct effect on the airways resulting in obstruction of the airways, spasm of the vocal cords or by incorrect intubation. The anaesthetist will use plastic tubes sometimes called “airways” or “intubation tubes” to ensure air entry into the lungs occurs. Rarely, a tracheotomy is required. This is when an incision is made into the trachea (the upper airway leading to the lungs) in the throat to bypass the obstruction. A tracheotomy tube is then inserted into the incision in order for air to flow to and from the lungs.
blood clots (thrombosis): this can occur as a result of anaesthesia and is a risk of surgery generally. It is therefore discussed separately and in detail below.
brain damage: this can occur for a number of reasons but all involve either a reduction of the blood circulation flowing to the brain or a lack of oxygenation of the blood in the lungs. Either way, the brain is starved of vital oxygen and brain cells called neurons start to fail and die. This is a permanent effect.
death: this is always a risk for all patients but particularly for those who are seriously unwell. But fortunately, death occurs rarely for the more “routine” procedures.
heart attack: this may be linked to an effect of the anaesthetic itself, though clearly, many other causes for heart attacks may exist such as blood clots or heavy loss of blood.
malignant hypertension: this is a rare complication of general anaesthesia. The body temperature rises sharply and uncontrollably. Blood pressure and heart rate also rises steeply. If untreated, this condition can be fatal.

nerve damage.

stroke: this can occur as a result of an irregular heart beat which causes blood clots to form. These can travel up to the circulation of the brain and become lodged there causing a thrombotic stroke.
temporary paralysis: patients undergoing a GA are frequently given muscle paralysing drugs in order to keep the patients muscles relaxed and free of tension during the operation. These drugs may take time to wear off and can cause a paralysis of any part of the body. Fortunately, this is short lived and patients eventually recover fully once the effects of the drug have worn off.

Generally, patients who smoke, are obese, have serious heart or lung disease, or have diabetes are at greatest risk of having complications from the effects of anaesthesia.

Aspiration

Aspiration occurs if you vomit and inhale the vomit into your airways and potentially into the lungs. As vomit is an acidic substance, it is highly irritating to these organs. Aspiration of vomit can cause mild irritation and discomfort. This may or may not lead to a cough which can become chronic. More seriously, aspiration can lead to infections of the lungs (aspiration pneumonia) and airway obstruction.

Blood Loss (Haemorrhage)

Some loss of blood is common for most surgical procedures. Generally, this is mild, totalling just a few millilitres and is of no consequence. No action will be taken by the surgical team. However, occasionally, there is greater loss of blood. This may occur as a result of;

the type of surgery you are having. the severity of the condition/illness you suffer from. the presence of blood clotting problems and defects, e.g. in those with severe liver disease. a surgical error during the operation. the leakage of blood from a vessel or organ after the operation. the breakdown of internal sutures. This can lead to internal bleeding which may not be recognised for some time.

Our body’s can cope with a substantial loss of blood volume without serious complications. But, if the haemorrhaging continues, there will come a time when not enough blood remains in order for the circulation to function properly. The body is then at risk of going into Hypovolaemic Shock. The failing circulation struggles to continue. The heart rate goes up but the blood pressure falls. During the operation, these and other vital signs are continually monitored by the anaesthetist. He/she will then determine whether any interventions are required and will also inform the surgeon of any potential haemorrhage if the surgeon is not already aware. Interventions may involve administering medication, giving intravenous fluids or giving a blood transfusion. The surgeon will of course try to stem the loss of blood from whatever site.

If haemorrhaging occurs after surgery is completed, a second operation may be required to stem and control internal bleeding. Fortunately, this is uncommon.

Blood Clots (Thrombosis)

Blood clots are also listed as a complication of anaesthesia. However, they can also occur independently from the effects of anaesthetic and so are listed here as a separate complication of surgery. Clots or thromboses can occur anywhere in the blood circulation but most commonly develop in the deep veins of the lower legs or thighs. They are then called Deep Vein Thrombosis (DVT).

Symptoms of DVT can include;

none – no obvious symptoms may be present,
pain and/or tenderness in calf or back of thigh,
a redness of the calf or thigh,
swelling of the calf or thigh.

These symptoms are usually one sided (unilateral) though rarely, clots can form in both legs. If a blood clot is diagnosed, blood thinning drugs known as anti-coagulants are given to patients to try to prevent further clots from forming. The body is then able to resorb the clot already present, thus reducing any further complications. If the DVT is not detected soon enough complications can arise. Even if a diagnosis has been made and treatment is initiated, sometimes, complications can still arise. The main issue with DVT’s is the potential for a fragment of the clot to break away and travel through the circulation. This fragment can then become lodged in distant areas almost anywhere in the body’s circulation. The result of this very much depends on where the clot ends up and how big it is. Occasionally, clots may become lodged in the circulation of the lungs. This is called a Pulmonary Embolism (PE). This is potentially a fatal problem. Diagnosis and treatment must be rapid. Clots may also become lodged in the brain causing strokes.

All patients undergoing surgery are at risk of clots. But, certain factors increase the risk of patients developing clots further.

These factors include;

immobilisation (for any reason),
cancer,
pregnancy,
orthopaedic surgery,
any pelvic surgery,
cancer surgery,
liposuction of legs,
any major surgery,
having a general anaesthetic,
long haul flights (before and after an operation),
prolonged immobilisation after surgery,
other co-existing medical conditions,
being overweight,
smoking,
use of the combined oral contraceptive pill,
having a previous blood clot.

Active steps to reduce DVT risk must therefore be taken for all patients. Clearly, the extent to which this is carried out depends on the presence of the above higher risk factors. Measures which may reduce the risk of clot formation include;

the administration of drugs to reduce clot formation immediately after surgery and for the time patients remain immobile (prophylactic anti-coagulants), using surgical support stockings after surgery, encouraging early mobilisation and rehabilitation of patients after surgery, advising patients of the various lifestyle factors well before operations. Such factors include weight loss and smoking cessation, stopping the use of the combined oral contraceptive pill in women approximately 1 month before any major surgery, the wearing of surgical support stockings on all flights before and after surgery, adequate hydration of patients on all flights. This means drinking plenty of fluids and avoiding alcohol before and during the plane journey, following the airlines advice on flights regarding muscular exercises of the feet, ankles, calves and thighs and to keep as active as possible during the journey.

Sudden Drop in Blood Pressure (Hypotension)

A small reduction in blood pressure (BP) is often detected during surgery and is considered normal. But a sudden and sharp drop in BP due to a large haemorrhage may occur. This can lead to irregular and abnormal heart rhythms and possible heart attacks.

Infection

The risk of infection varies greatly. The points which determine the risk of infection include;

type of procedure being done,
the site in the body being operated on,
the cleanliness of the operating theatre,
the arrangements for sterilising surgical equipment,
the cleanliness of the general hospital wards,
the skill of the surgeon,
the general state of the patient,
the general approach of the whole hospital team to infection control measures.

The actual risk of infection is therefore impossible to quantify. The vast majority of infections which do occur after surgery tend to be minor and are easily controlled and treated with antibiotics. Such infections include minor wound infections. Antibiotics are often administered during or after an operation prophylactically (as a precautionary step) for high risk operations such as bowel or orthopaedic surgery.

But occasionally, more serious infections due arise. These may require intravenous antibiotics. Serious infections may not only delay the natural healing and recovery process, but can also compromise the success of the operation and threaten the life of the patient. This will clearly have an impact on the timing of the hospital stay. Serious infections include a post operative pneumonia, an infected prosthetic or implant, peritonitis (infection of the lining of the abdomen) or a serious soft tissue infection causing breakdown of internal sutures and possible failure of the operation.

The list above highlights some of the general reasons why infections may occur. The following list contains factors more specifically related to individual patients which may increase the chances of infections. These include;

smoking,
being overweight,
having some co-existing medical conditions, e.g. diabetes,
taking certain medications, e.g. steroids, immunosuppressants,
having complex surgery,
having bowel surgery,
having surgery using implants or prosthesis,
having excessive blood loss during surgery,
delayed immobilisation.

Loose Sutures

Most surgical procedures require the use of some device or technique to hold the two cut surfaces together, so that tissue healing may begin. Commonly, sutures (stitches) or staples are used. Sutures can be used to hold the cut ends of organs and skin in place. These can often be loose or fail completely. This can lead to bleeding, hernia or dehiscence (breakdown) of the wound. This may require further surgery.

Failure of Surgery

Despite the surgeons best efforts, the procedure itself may fail to resolve the problem. There may be many reasons for this. This cannot be discussed here in any detail as the outcome of the surgery itself depends on;

your underlying condition and it’s severity, the nature of the surgical procedure proposed, the skill and experience of the surgeon, and many other factors.

Conclusion

Taking all of the above general risks of surgery into considerations and combining these with the specific risks for the procedure proposed for you will give you an indication of the overall risks and chances of success. This is a vital step for you to take in order for you to make an informed decision on whether to proceed to surgery and whether to go abroad or stay nearer to home. Patients are strongly advised to ensure that all outstanding questions or issues are answered or resolved before agreeing to surgery. Globe Health Tours would like all patients to always consider the following questions;

1. What is my diagnosis? How confident am I about this?

2. What are my options for treatment?

3. Do I really need surgery?

4. What are the risks of surgery and how likely are they?

5. What is expected in the rehabilitation period after surgery?

6. What lifestyle factors do I need to change before and after surgery?

7. Has my doctor’s or surgeon’s view about my treatment plan changed since having a more detailed assessment?

8. Should I stay close to home or travel abroad for surgery?

9. If I need to travel abroad, can I arrange this myself or should I ask a company such as Globe Health Tours to facilitate this?

10. How can Globe Health Tours help me?

Only once these questions have been successfully answered can patients truly be ready for surgery abroad. Not surprisingly, Globe Health Tours can facilitate the whole process. It must be stressed again however that Globe Health Tours can neither encourage nor discourage individual patients from travelling abroad or having surgery. Clearly, all clinical decisions must be made and taken by patients themselves with the relevant advice from appropriate doctors, surgeons, specialists, clinics or hospitals. This process is sometimes known as “informed consent” and is vital for all successful operations.

Finally, patients must be free to choose a surgical or other option for treatment, be free to choose the timing of their treatment, be free to choose the location of their treatment and must not be coerced in any way.