General surgeon in Rawalpindi

Choosing a surgeon in a city with no shortage of them

Rawalpindi is not short of surgeons. Between Holy Family Hospital, Benazir Bhutto Hospital, the DHQ, the cantonment hospitals and dozens of private setups along Murree Road and in Saddar, a patient with gallstones has plenty of doors to knock on. That abundance is not always a comfort. When every clinic says the same thing in the same words, the decision stops being about information and becomes about whoever a relative happened to recommend.

So it is worth being concrete about what is different here rather than making the usual claims. Three things.

The first is the technique. Most units in the city perform gallbladder removal through four separate incisions with carbon dioxide pumped into the abdomen. That is a good operation and it works. But the gas irritates the diaphragm, and because the diaphragm shares nerve supply with the shoulder, patients spend the following days with a referred pain in the right shoulder that has nothing to do with their wound. The approach used here is one incision of 1 to 2 cm with no gas at all and no division of muscle, which removes that problem entirely and takes the risk of a later port site hernia close to zero.

The second is that this is Dr. Khan's own hospital rather than a facility he rents theatre time in. The surgeon who sees you in the OPD is the surgeon who operates, the theatre team is the same team every week, and a patient who telephones at nine in the evening reaches people who have the notes in front of them.

The third is that both sets of board examinations have been sat. The FCPS from the College of Physicians and Surgeons Pakistan and the MRCS from the Royal College of Surgeons in the United Kingdom. What those qualifications actually require is explained here, along with how to verify them yourself rather than taking a website's word for it.

What patients arrive with

The pattern in this city

After 25 years of OPD in Rawalpindi some patterns are hard to miss, and two of them are worth flagging because both are avoidable.

People present late, and the operation gets harder

A very large number of patients arrive having had episodes of right upper abdominal pain for months or years. They have been managing it with antacids from the chemist, with restricted eating, and with the assumption that it is gas or a stomach problem. By the time the scan is done and the stones are found, several attacks have already happened.

The consequence is surgical rather than moral. A gallbladder that has been inflamed repeatedly becomes thick walled, scarred and stuck to the structures around it. The planes a surgeon works along get obliterated. That turns a 40 minute day case into a longer, more difficult operation with a higher chance of needing conversion to a larger incision. The same gallbladder, treated after the first or second attack, is straightforward.

The herbal flush costs people months

Patients regularly arrive having spent weeks on olive oil and lemon regimens, or on preparations bought on a relative's recommendation, and having passed soft green pellets in the stool which they were told were their stones. They were saponified oil. The stones are still there, visible on the repeat scan, and in the meantime the gallbladder has had two more attacks.

Medical dissolution does genuinely exist, but it works only for small purely cholesterol stones in a gallbladder that still empties well, takes months to years of tablets, succeeds in a minority of carefully selected patients, and the stones usually come back once treatment stops. Diet control reduces how often you get attacks. Neither removes a stone. The full picture on gallstones is here.

Who tends to be affected

The recognised risk factors are unremarkable and worth knowing: being female, increasing age, pregnancy and multiple pregnancies, obesity, rapid weight loss including after crash dieting, diabetes, a family history of gallstones, and a diet heavy in fried food and saturated fat. That last item describes a good deal of ordinary cooking in this part of the country, which is one reason gallstone disease is such a routine part of general surgical work here.

Beyond gallbladder

Other general surgery for Rawalpindi patients

Gallbladder work is the best known part of the practice but the OPD covers general surgery in full, both elective and emergency.

• Hernia repair for inguinal, umbilical and incisional hernias with mesh reinforcement, under general or local anaesthesia.
• Hysterectomy under spinal or general anaesthesia with full assessment beforehand and structured follow up.
• Laparotomy and major abdominal surgery for bowel obstruction, perforation, trauma and abdominal malignancy.
• Urethral stricture repair for obstruction, straining and poor urinary flow.
• Circumcision including medically complex patients, among them those with haemophilia and other bleeding disorders.
• Tumour surgery and abscess drainage, from superficial collections to deep tissue, under local or general anaesthesia.

Second opinions are routine. Patients arrive having been told elsewhere either that they need an operation or that their case is too risky to attempt, and both conclusions deserve examining. If the honest answer is that no surgery is needed, that is the answer you will get.