When I look down at the scar that’s the badge of my life-saving surgery at 10 days old to remedy infant pyloric stenosis (IHPS), I think to myself, Wow, surgery has certainly changed during my lifetime!
A 10 cm long scar was once quite common, bumpy and lumpy, separating pairs of ½ cm pock-like stitch scars 2 cm apart (3.5” and 1” for those still non-metric). In fact, some IHPS survivors report having scars up to twice as long – and/or not nearly as tidy as mine. Today the same surgery almost never leaves a scar like this anymore, and quite often nowadays it’s done by a careful and skillful surgeon whose “visiting scard” becomes almost invisible!
The progress has been made on many fronts: the diagnostic tools, the hospital routines and stays, the use of general anesthetics, surgical techniques, infection control, the relationship between the parents and the medical world… the list could go on.
My surgery in early infancy made a large impact on my inner self, largely caused I believe by the total traumatic effect of the way things were two generations ago. Infant surgery then must have shocked and deeply distressed countless parents as well as the subconscious memory of the babies concerned. The medical world then as now was trained to ignore what was happening (in the name of “science” of course) in order to be able to sleep at night and work the next day. What else could be done?
I am writing these posts not to ask for sympathy or to vent my anger, but to raise the level of awareness of issues that many people like myself have struggled with – even though we are a relatively small minority overall.
Today I want to celebrate the trend from open surgery to “minimal access surgery” (MIS or “keyhole surgery”) to treat many relatively common conditions that are relatively straight-forwardly remedied, like my IHPS and maladies such as a diseased appendix or gall bladder. Today a growing number of surgeons have gained the skills to work on many abdominal organs and other parts of the body through small access punctures rather than much bigger and more damaging incisions.
The innate conservatism of many medical specialists is indicated by the level of resistance to MIS that is noticeable even on public websites. Many of these voices seem to totally disregard or discount the benefits of MIS and warn against the undoubted hazards of reduced visibility and workspace.
In fact, a number of studies which I have on file have shown that even disregarding the undoubted cosmetic benefits of reducing the degree to which an infant is left with scarring, the benefits of MIS in what is technically fairly straight-forward infant surgery are considerable: equivalent safety, equivalent operating times, equivalent complication rates during and after surgery, and equivalent costs, faster resumption of normal feeding, and shorter hospital stays.
The differences were not large, but leave little room for argument when the feelings of the parents and the cosmetic benefits to the voiceless baby are considered.
There are a few comments I need to add.
1 MIS can only be done by well-trained surgeons with a fairly high level of supervised experience, and these are often only to be found in larger cities and hospitals. The trend to restrict infant surgery to specialist pediatric surgeons and hospitals is to be applauded.
2 Although MIS leaves infants with minimal scars that often become hard to spot after a year or so, as the child grows these will always grow and may become largish and indented pits not much less disfiguring than incision scars.
3 Children are less affected by having scars from surgery or accident than by their parents’ not helping them to understand and accept themselves, their body and story.
4 Just like we are each unique, our scars heal differently, regardless of whether they are caused by a cut, a stab, a burn, or an injury repair. Some of us heal tidily, the scars of others become keloid (large, raised, shiny and angrily pink), and many become indented. This is true also of MIS scars.
5 For some conditions such as IHPS, surgery is the accepted treatment, as it’s quick and has the least complications. But for mild and slow developing cases of IHPS, medical treatment should certainly be considered if (a) the parents feel distressed by their baby having surgery or (b) if they can expect that their child could possibly have later “issues” with their surgery.