Questions I Asked My MALS Surgeon

Here’s an edited sample email I sent one of my surgeons. I’m including it in case it might be helpful to other MALS patients.

Dear (Surgeon),

I hope you’ll bear with me on a few questions to about MALS surgery.

In my research on MALS, I’ve learned that there are different approaches to doing a MALS surgery. Some seem to have much better results, especially the ones that have these components: 

  • Open surgery instead of laparoscopic

  • Significant cutting back of the ligament

  • Removal of damaged celiac ganglia nerves

From other patients, I’ve heard a lot about unsuccessful surgeries.

I’ve gotten a lot of encouragement to see Dr. Richard Hsu at Vascular Experts in Danbury, CT. I’m told by his office that he has done more than 500 MALS surgeries and currently does around 4 per week. He seems to be one of the the main surgeons to re-do unsuccessful MALS surgeries, especially ones where scar tissue grows back and just makes the problem worse.

I’m told that Dr. Hsu has adjusted his technique over time as he has learned more about what brings MALS patients the best long-term success. If I understand this correctly, his changes include:

  • Splitting the ligament all the way back to the spine

  • Spending a good deal of time getting all of the damaged nerves. After severing the nerves, he removes the nerve sheath a certain distance back on the remaining nerve

 

My questions are:

  1. Would you be willing to consult with Dr. Hsu about how your approach differs from his? From what I understand, he’s very willing and eager to discuss the knowledge he’s gained.

  2. If your approach differs from Dr. Hsu’s, would you help me understand that difference?

  3. Could you tell me how many total MALS surgeries you’ve done?

  4. Of all your MALS patients, how many are confirmed to be successful one year later? (I’m told that unsuccessful surgeries show symptoms again between 3-6 months afterward.)

  5. What complications have any of your MALS patients had after surgery?

  6. What long-term affects might I expect after my surgery, especially with the removal of the celiac ganglion nerves? Will it affect my ability to feel digestion, gas, cramps, diarrhea, etc.? 

  7. Do the nerves regenerate?

  8. How is pain managed after leaving the hospital? What medications are typically used?

  9. If I need follow up care from a surgeon after I return to home (out of state), who would you recommend? I’d like to go ahead and establish care with him/her now.

Thanks again for your patience with my questions!