Procedure cuts time, money from peptic ulcer surgery

October 24, 1990|By Sue Miller | Sue Miller,Evening Sun Staff

William R. Sebra, a 48-year-old Aberdeen man, suffered from a peptic ulcer that would not respond to medicine and a diseased gall bladder that would make him violently ill if he ate his favorite dish -- fried chicken.

University of Maryland Medical Center specialists took care of both of his problems last Thursday night in a two-in-one, four-hour long procedure that gives surgeons a live video picture of the patient's insides and permits them to ease the trauma, pain and cost of traditional surgery.

Sebra became the first person in the country to have peptic ulcer surgery with a device called a laparoscope, a thin tube inserted in the navel, used with tiny grasping and cutting instruments to bring the patient relief, according to Dr. Karl A. Zucker.

A three-man surgical team snipped small nerves that trigger the production of acid in the stomach that cause peptic ulcers. That took 2 1/2 hours.

Then, the surgeons gently pulled the gall bladder away from the liver and other internal structures, drained its fluid and pulled it out through the tube.

Sebra was the 325th person to have his gall bladder removed at the UM Medical Center using the laparoscope. A year ago, the Baltimore hospital was the first in the Northeast to experiment with the minimum-cutting technique that results in speedier recovery for a patient.

"This man is going back to work in a day or two," Zucker, who headed the team that performed the double procedure, said yesterday. "He went home Saturday morning."

Zucker and Dr. Robert W. Bailey, one of his associates, were trained to do the ulcer surgery, known as vagotomy, using the laparoscope at the University of Nice in France this past summer. The third team member is Dr. Scott Graham, who recently came to UM from Yale Medical School.

"This is not new surgery, it's a new approach that has a much less traumatic effect," Zucker stressed. "Normally, the operation would require a 6- to 10-inch incision, five to seven days hospitalization and four to six weeks recovery time.

"Now, the patient needs only a half-inch incision in or near the navel for the insertion of the laparoscope and four small holes for instruments. And, we're talking about one- to two days at the most in the hospital, which would pare between $3,000 and $4,000 from a patient's total bill."

With the patient under general anesthesia, doctors make the half-inch incision at the navel and carbon dioxide is pumped into the abdomen to expand it.

The laparoscope, which has a tiny lens at one end and a miniature video camera at the other, is then inserted into the navel. It transmits images from inside to video monitors in the operating room.

The surgeons then cut tiny punctures in the upper abdomen. And, they insert tiny sheaths or tubes into these punctures which serve as guides for the surgical instruments which are about a sixth of an inch in size. The instruments are used to locate the nerves near the stomach or the gall bladder.

Bailey said the hospital will continue to adapt the use of the laparoscope to other type of surgeries so that more patients can benefit. Already, the specialists have employed it to remove an appendix, cancerous lymph nodes near the pelvis in six or seven patients and bowel obstructions in three patients.

Some of these operations were performed at the Baltimore VA Medical Center on Loch Raven Boulevard, where Zucker is assistant chief of surgery. AT UM, he is an associate professor of surgery and director of surgical endoscopy.

For 5 to 10 percent of the 20 million Americans who have peptic ulcer disease, medication is not enough. If left uncontrolled, the lining of the stomach or the duodenum -- which lies just below the stomach -- can perforate and bleed. That can be fatal.

Each year, about 25,000 vagotomies are performed to stop the progression of the disease. Digestion is not disrupted after some of the small nerves that stimulate acid production are cut.

Symptoms of peptic ulcer disease include pain in the upper abdomen, nausea and vomiting. This disorder affects men more often than women.

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