Laparoscopic surgery in Belize.

" Medical services in Belize have rapidly advanced over the past 5 years to the point where many Belizeans who used to pursue medical treatment abroad, are now doing it at home. And some visitors to Belize, as well as expatriates living here, are now choosing to do some medical procedures – especially laparoscopic surgery – in Belize. As a candidate for elective gall bladder surgery, this writer experienced it first hand. ." 

The gallbladder is a sac located under the liver. It stores and concentrates the bile produced in the liver, which aids in the digestion of fats. Bile is released from the gallbladder in response to food, especially fats, in the upper small intestine (duodenum). Conditions which slow or obstruct the flow of bile out of the gallbladder result in gallbladder disease.

The two main types of gallbladder disease include: Cholecystitis (inflammation of the gallbladder) and Cholelithiasis (gall stones).

Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. Gallstones can be as small as a grain of sand or as large as a ping-pong ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination.

Symptoms include abdominal fullness, gas, abdominal pain, severe pain located on the right side or in the upper middle of the abdomen. Pain often but not always follows meals. Women who have had gallbladder attacks compare the pain with that of childbirth.

Gallstones can block the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine. Bile trapped in these ducts can cause inflammation in the gallbladder, the ducts, or, rarely, the liver. Most physicians will advise patients suffering from gallstones to have the gallbladder surgically removed.

I had suffered indigestion and gas, the doctors call it dyspepsia), for a number of years. I had to be on daily medication (omeprazol) for acid reflux in my stomach. The third week of April 2004 I ate too much at lunch. That night I hardly slept because of severe pain. Monday morning found me tearing down to Belize City looking for an ultrasound. A very attractive and pleasant Radiologist Dr. Virginia Smith attended to me.

“We have stones today, lots of them,” announced Virginia within seconds of applying the transducer to my right side. The stones were small but numerous – on the screen they looked like a string of pearls. My gall also had a thickened wall. I informally asked what she would do if she had my condition and she quite frankly told she would take it out. “Sooner or later it will have to come out”, were her words.

Major surgery is feared by any sane person. The thought of being put to sleep and be cut open with the possibility of never making it back gives anyone pause. But as my Dad used to say, “No hay mal que un bien no traiga”, so for me it was a golden opportunity to take stock and get my affairs in order. Being an “A” type personality, I decided to go ahead and have it taken out like yesterday.

I interviewed a couple of surgeons for the assignment after getting advice from a few of my doctor friends. When considering surgery it is good to have doctor friends who will give you unbiased and honest appraisals of their colleagues’ credentials and track record. You cannot be shy about scrutinizing the background and reputation of the individuals that will be manipulating very sharp instruments inside your abdomen.

Gallbladder surgery is relatively safe when done by competent physicians, however it is not the easiest procedure to master. Damage to the common bile duct is the leading cause of malpractice suites in the U.S.A. If damage is done, serious complications can result.

I had considered Universal Health Services but the surgeon I know there, Victor Lizarraga was out of the country at the time. So I interviewed the new kid on the block, Dr. George Gough. George specializes in laparoscopic surgery and does surgery at Belize Medical Associates – the top private hospital in Belize. He is also Associate Professor at St. Luke’s University School of Medicine just outside the capital Belmopan City.

Doctor Gough’s frankness and down-to-earth demeanor immediately impressed me. He answered all my questions and gave me referrals to check out. After mulling about it for about a week, I decided to let him do the surgery, assisted by another surgeon Dr. Gregorio Pot. I went ahead and selected Doctor Nerida De Paz as my anesthesiologist.

When my Dad had his gallbladder removed 30 years ago, it was done via a long incision – about 8 inches on the side. This is called open Cholecystectomy. Today laparoscopic surgery is the preferred method as the recovery time is shorter and you spend less time in the hospital.

During a laparoscopic surgical procedure, four small incisions of up to half an inch are made in the abdominal wall, and plastic tubes called ports are placed through these incisions. Carbon Dioxide gas is infused into the abdomen inflating the stomach like a balloon. This makes space for the instruments.

A tiny camera and cutting and holding instruments are then introduced through the ports. The camera transmits an image of the organs inside the abdomen onto a television monitor. The surgeon is not able to see directly into the patient without the traditional large incision. The video camera becomes a surgeon's eyes in laparoscopic surgery, since the surgeon uses the image from the video camera positioned inside the patient's body to perform the procedure.

The surgeons will ask your permission to convert to an open operation if problems are encountered.

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