Dr Đorđe Bajec, General surgeon at the Bel Medic Hospital

Major Surgeries, Minor Incisions

Bel Medic General Hospital is the only hospital in Serbia that has a complete centre for minimally invasive surgery. The goal of the centre is to eliminate the need for conventional surgery through the development, testing and implementation of less invasive procedures. Bel Medic provides surgery in all medical fields: VATS, laparoscopic surgery, arthroscopy and endoscopic spinal surgery

We spoke with professor Đorđe Bajec about the advantages and opportunities of minimally invasive access in abdominal surgery. Dr Bajec is a general surgeon at Bel Medic Hospital and president of the Serbian National Association of Bariatric Surgeons.

What is the difference between open abdominal surgery and laparoscopic surgery?

– Laparoscopic surgery, or keyhole surgery, is minimally invasive surgery that is associated with several advantages over traditional open surgery. In an open procedure, one large abdominal incision is made to expose the tissues and structures inside for examination and surgery.

In a laparoscopic procedure, on the other hand, only a small incision of up to 1.5 cm in length is made in the abdomen, usually around the belly button area. Scars from open surgeries are not only an aesthetic problem but also a health problem, because they significantly distort the structure of the anterior abdominal wall. Since the overall trauma to the skin and muscles is reduced, less post-operative pain and disability, a shorter hospital stay, and a quicker recovery period are major advantages that laparoscopic surgery offers when compared to traditional operations.

What kinds of operation can be performed using laparoscopic surgery?

– Twenty years ago indications for laparoscopic surgery were related exclusively to gallbladder operations. Technology and the experience of surgical teams today have reached such a level that the majority of procedures in abdominal surgery can be done laparoscopically. This includes all urgent conditions such as gall bladder inflammation, ulcer perforation, appendicitis and so on.

How is it possible to remove organs such as the spleen, or a gallstone through an incision of just a few millimetres?

– There are special instruments that can mulch tissue of the different organs or gallstones. Small tissue parts are then easily removed through an incision of less than 12mm.

Technology and the experience of surgical teams today have reached such a level that the majority of procedures in abdominal surgery can be done laparoscopically

You are one of the leading experts in bariatric surgery in this part of Europe. What are the results of laparoscopic bariatric surgery?

– The World Health Organisation has recognised extreme obesity as a disease, because it seriously threatens health, primarily as a risk factor for the development of cardiovascular disease, type two diabetes and other diseases.

In recent years extreme obesity has reached epidemic proportions, as confirmed by the fact that bariatric surgery is ranked in second place in the U.S. among all operations in the abdominal cavity. Extreme obesity is the result of complex interactions between genetics and the environment. It is usually very difficult for extremely obese patients to lose weight with conventional methods, such as diet, physical activity and medication. Bariatric surgery has proved to be very effective in this case. Reducing stomach volume and consequently, the food intake mass can be permanently reduced, and the risk of comorbidities is significantly decreased.

How much weight can be lost after bariatric surgery?

– Patients who have a BMI (body mass index) more than 60 can reach an ideal weight within a year or two, while those with a lower BMI can do it even faster. Most people are aware of gastric bypass surgery and gastric banding as popular options for bariatric surgery. However, gastric sleeve resections have grown in popularity over the last five years.