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HBP and constipation. Found large pelvic mass. Tested negative for cancer. Should I go for surgery?

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General & Family Physician
Practicing since : 2009
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Hi. I am a 64 yr old femal, 5'2" 265#, I have Hi BP (avrg 145/80), am pre-diabetic controled with Metformin. have a very low vit D level, hI triglycerides and colesterol and divroticulosis. Due to an unusual bout of constipation I went to the ER and a large pelvic mass was found (aprox 10x6 cm). I have seen an oncologist who believes it is not cancer due to the CT, Ultra sound, xray it is fluid filled and cancer blood test was a very low normal. I will be having surgery to remove and byopsy very soon. I have also had the gastric sleeve recommended by the oncologist, the GYN and the Gastic Dr. that I have seen. They all recommend that I have both surgeries at the same time. My primary dr. does not recommend that I have the Sleeve at this time. He feels I should concentrate on the mass and put off the gastric sleeve. All my Drs are new as I have been uninsured for about 3 years and have just now obtained insurance. all these drs are new to me and although I like and respect each of them, I am torn about the decisions I need to make. I really need to loose the weight and believe if I do many of my medical problems will go away. however i realize the rish involved in this type of surgery and want some help deciding what i should do. Can you recommend or tell me the options and risk.
Posted Sat, 2 Mar 2013 in Digestion and Bowels
Answered by Dr. Shoaib Khan 2 hours later
Hello. Thank you for writing to us.

Gastric sleeve is recommended for patients who are extremely obese (BMI 40 or more). Although effective, it does have a few adverse effects: acid reflux, vomiting, esophageal spasms, extreme pain, etc. These symptoms are easy to battle, but cause frustration and extreme discomfort in some.

Your primary doctor expresses concern as the mass has not been diagnosed yet (confirmed only after biopsy). He could be concerned because:
-If the mass turns out to be cancerous, and has spread to your esophagus or stomach (there will be tissue left after removing the effected part) and if it has spread elsewhere we might have to surgically remove the effected part (losing more of your GIT)
-Recovery from one surgery is a lot in itself, and will require a lot of strength and time
-Each surgery has its own complications and adverse effects (if we pile both up, we might make it more difficult to control)

Once cancer has been ruled out and you have recovered from the surgery involving removal of mass, then we could go in for the gastric sleeve without having other concerns.
Yes, reduction of weight will help in the regression of most of your problems, but the procedure having its own adverse effects should not clash with the other surgery. You wouldn't have to wait for more than 3-6 months for the gastric sleeve procedure after the surgery involving removal of the mass.

I hope I have helped in providing you with information on this. It is completely up to you to decide if you can wait another 3 months after one surgery, and reduce the chances of complications with surgeries (if they occur) to pile up.

Or go ahead with both at once, as the doctors are experienced professionals and can handle a patient with two procedures at once; during and after the surgery.

Please feel free to write back to me for any further information. I would be glad to explain in the most elaborate way possible.

Best wishes.
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