Allen Oldfather whipple
God placed pancreas at the back (in the retroperitoneum) so that surgeons don’t mess with it…. The surgery of the pancreas really took off in the late 19th century.With the surgery came the technical challenges of improving survival and reducing morbidity and mortality. It is due to these pioneering and daring surgery that in 2012 the mortality from resection of head of Pancreas has come down to 1%
Till my residency in Surgery in 2003, Whipple’s pancreatectomy was a phrase often spoken with excitement and in hushed tones. No resident knew what it really was because you saw a very few cases Things have changed for me over the last 8 years and I am sure the surgery doesnt bring about the same awe it used to have.
The earliest misconception was Duodenum is essential for life. Desjardin(1907) and Sauve (1908) dispelled that notion. Dragsted (1918) performed total duodenectomy in dogs and showed survival. Another point of worry for the surgeons was What to do with the pancreatic Stump? As late as 1935 Whipple thought that Pancreaticojejunal anastomoses would lead to dissolution of the intestine by the pancreatic enzymes. Initial attempts at ligation of the pancreatic duct met with failures and patients has pancreatic leaks, sepsis and death.
Back in 1909 Coffey and Kehr suggested that Pancreas could be implanted into jejunum. Hunt in 1941 showed that Pancreaticojejunostomy was safe and viable option.
Early attempts at diversion of bile through cholecystojejunostomy was also met with a higher incidence of ascending cholangitis and Whipple showed that Choledochojejunostomy was far better than cholecystojejunostomy
Initially there was a higher risk of marginal ulcerations which subsided somewhat when resection of antrum was complete and gastrojejunostomy was done far away from pancreaticojejunostomy.
I know a update was long over due but nothing major was happening. I was working on a new webpage Surgery Discussion. It is what the Internet calls a content management system (CMS) and has a pretty good layout.
Another interesting think I discovered with in the last one month was an impetus to exercise and loose weight. Recently I was worried about my lack of exercise and could not get myself going. I got hold of a small device which measured the calories I burnt when I walked. I found it pretty useful and it was a good beginning which made me go out and exercise. Gradullay I ve crossed the 100 cal figure and generally feeling good with exercise.
I guess we all need an objective measurement of what we do…
No I am not talking about treating your insomnia (Reading this books really works) This is for helping you guys out if you wish to choose surgery as a carrier. I will be starting from the basics and what happened to me when I first ventured into this field, the books which were recommended to me, some were useful others were not. Pye’s Surgical Handicraft- The red book, I don’t even know if it comes out any more or not, this book was supposed to be your introduction to the surgical world. It had a very good chapter on fluid and electrolyte management and I still remember it and try to follow that. I didnt go through the other chapters and if I did, I dont remember it now Then there was the unmistakable Love and Bailey with the lady with that Sebaceous Horn on the 1st page. This book is your saving grace in exams. If you are not answering anything and you are able to tell something from Bailey, you might pass. If worse comes to worse you would have to hear quote unquote “You dont deserve to pass, you dont even know Bailey”. Thankfully this didnt happen to me Love and Bailey with its un imitable foot notes is what every surgeon should have, Surgeons take pride in owning upto 10 previous edition Hamilton Bailey “Clinical Surgery” the book I highly recommend because of its lucid language and basic concepts. Alternatively you also need to know the gastroenterology chapter in Hutchinson’s To be cont…
Smart Surgeon smarter phone
Gone are the days when doctors as residents used to carry bags with heavy books inside the wards. We as interns used to keep our books in the duty rooms, carry out the ward work and go back to the books to read some new mcqs.
Those were the days when we were preparing for our post graduate entrance examination. Times change and so does technology. Today most of the interns I see are carrying cool IPods, smart phones (PDA is outdated too) and netbooks. My personnel preference is I phone although I don’t have one yet
I have the next best thing, a nokia smartphone which can double up as a cheap Iphone, Use 3G or Wifi on these small gadgets and you have a beauty. These small things can pack many books in pdb format, Sabiston, Schakelford, Blumgart- you name it..
The software I like most is Epocrates- It has a good free version, with pharmacopenia and details of most of the diseases.
I heard that Iphones4 would have a utility which could double up as a stethoscope. Yet to meet anyone who puts his phone on patient’s chest and abdomen
Well this is a new word I ve learnt and it sure is catchy. You can see the actual meaning here. Thats exactly what I hope to be in the next 5-6 years. For me its a bit dificult because i know nothing about web developing or web designing. I have to rely on the other websites and take designs from other websites.
What I hope to get out of my blog is a good readership both from the medical as well as non medical fraternity. I think I should be spending more time studying but then I just love being here.
1. Eat when you can, Sleep When you can and don’t mess with the Pancreas
Every Surgeon has heard that but all don’t agree with the last bit.
2. Big Surgeons make big incisions (They are talking about the Lap Ports)
3. I wish I had more than two hands ( We all do)
4. Don’t sleep with the retractor
5. You guys can come up with more
Well its hard not to find one. This breed comes in all shapes and sizes. There was a recent article in Surgical Clinics of North America “Are Surgeons Capable of introspection” Its a must read.
I have had the misfortune of dealing with them in all stages of my short surgical carrier. I am not denying that they were good, motivated and dedicated but the thing is, I always felt better and confident working with surgeons who knew what they were doing and shouting less.
Also it would be better if we accept our mistakes, discuss them and try to avoid them next time.
On radio I heard an advertisement claiming ” Wont our Children learn anything from our experience”, This really set me thinking.
I made a list of my little expeience,,
1. Don’t believe a thing your junior residents tell you, they are more stressed than you and looking to go back early. Always double check
2. Take extra pain to close the abdominal sheath and skin after a lengthy surgery. Your patients only see your skin incision
3. Trust your assistant, He sometimes see things you dont see. If you cant trust him, get rid of him
4. If its bleeding you are in the wrong plane
5. Its hard but ” Be Patient” (Not literally)
I am a 35 year old surgeon from New Delhi. My Special interest is in Gastro Intestinal Surgery and HepatoBiliary Surgery . In my free time I try and do some absurd things like creating blogs and making websites on Surgery Multiple Choice Questions.
I have been doing this since 2004 and blogging has become more than just a hobby. I ve started to invest money in things like domain names and web hosts ( if you know what i mean!!)
The purpose of this blog is mainly to discuss life as a doctor in my hospital and home, Generally I could be writing anything, Its my own blog after all
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