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FAQs

FAQs

Common to all surgeries

Is post operative antibiotic mandatory for Healing?

No. In all routine surgeries one dose of a broad spectrum antibiotic single intravenous dose is enough if given during surgery. If not infected, routinely antibiotics need not be given. Healing is the body response and it immediately starts after incision is given.

Definitely, for the nutritional value of milk and vitamins in fruits required for healing, but if the patient is not in a habit of taking them previously, it’s not mandatory. Usual nutritious diet is sufficient.

No. On the contrary, early ambulation and walking and minimum activities not exerting pressure on the operative site promotes healing.
I don’t think any doctor would advocate alcohol onsumption but it’s directly not linked to healing.  However, it can cause constipation which can be troublesome in the postoperative period.
Yes, especially if the surgery is under general anaesthesia, patients should quit smoking, which they should anyway.
No. It’s no longer recommended but definitely CLOPIDOGREL should be stopped five days prior to surgery and patients should be on alternate anticoagulation therapy as advised by the Cardiologist.
Yes. After proper control one can undergo any major surgery without any added risk of complications.
Both, in able hands, depending on the site, condition of the patient, magnitude and expected duration of surgery.
Surgeons don’t get pleasure in unnecessarily giving a long incision. It is completely dependent on the exposure required and optimum incision is given.
Most definitely. But in clean surgeries, non infected healing, scar is usually not bad. Some patients have a tendency to form bad scars which can be treated later on.
It may vary from the same evening after some surgeries to a few days after some. But “Normal diet”, if it is advised, includes all what the patient was taking previously. If any restrictions are needed to be followed, they will be separately advised.
Contrary to the common belief, most certainly. Vitamin C is one of the most important factors of healing.
Certainly, if advised by the surgeon for the anti-inflammatory action of the drug, not only analgesia.
Not always. Yes, surgical site infection is a very common cause but usually it takes a few days to develop. There are other common reasons like:
  • Chest infection
  • Urinary tract infection
  • Thrombophlebitis at the iv cannula site
  • Deep vein thrombosis due to immobilisation 
  • Others.
Definitely depends on the site and magnitude of surgery but usually after a few days from discharge from the hospital, travel is not contra-indicated.

Gallbladder (Cholecystectomy)

When should I think I may have gallstones?

When you have any one or few of these:
Pain in the right side of the abdomen, just below the ribs
Pain in the middle of the abdomen below sternum
Pain in the abdomen radiating to the right shoulder or between shoulder blades.
Flatulence and bloating of the abdomen which is not responding to usual medicines.
Repeated episodes of indigestion, acidity and nausea.

Definitely, for the nutritional value of milk and vitamins in fruits required for healing, but if the patient is not in a habit of taking them previously, it’s not mandatory. Usual nutritious diet is sufficient.

No. On the contrary, early ambulation and walking and minimum activities not exerting pressure on the operative site promotes healing.
I don’t think any doctor would advocate alcohol onsumption but it’s directly not linked to healing.  However, it can cause constipation which can be troublesome in the postoperative period.
Yes, especially if the surgery is under general anaesthesia, patients should quit smoking, which they should anyway.
No. It’s no longer recommended but definitely CLOPIDOGREL should be stopped five days prior to surgery and patients should be on alternate anticoagulation therapy as advised by the Cardiologist.
Yes. After proper control one can undergo any major surgery without any added risk of complications.
Both, in able hands, depending on the site, condition of the patient, magnitude and expected duration of surgery.
Surgeons don’t get pleasure in unnecessarily giving a long incision. It is completely dependent on the exposure required and optimum incision is given.
Most definitely. But in clean surgeries, non infected healing, scar is usually not bad. Some patients have a tendency to form bad scars which can be treated later on.
It may vary from the same evening after some surgeries to a few days after some. But “Normal diet”, if it is advised, includes all what the patient was taking previously. If any restrictions are needed to be followed, they will be separately advised.
Contrary to the common belief, most certainly. Vitamin C is one of the most important factors of healing.
Certainly, if advised by the surgeon for the anti-inflammatory action of the drug, not only analgesia.
Not always. Yes, surgical site infection is a very common cause but usually it takes a few days to develop. There are other common reasons like:
  • Chest infection
  • Urinary tract infection
  • Thrombophlebitis at the iv cannula site
  • Deep vein thrombosis due to immobilisation 
  • Others.
Definitely depends on the site and magnitude of surgery but usually after a few days from discharge from the hospital, travel is not contra-indicated.
Definitely depends on the site and magnitude of surgery but usually after a few days from discharge from the hospital, travel is not contra-indicated.
Definitely depends on the site and magnitude of surgery but usually after a few days from discharge from the hospital, travel is not contra-indicated.
Definitely depends on the site and magnitude of surgery but usually after a few days from discharge from the hospital, travel is not contra-indicated.
Definitely depends on the site and magnitude of surgery but usually after a few days from discharge from the hospital, travel is not contra-indicated.
Definitely depends on the site and magnitude of surgery but usually after a few days from discharge from the hospital, travel is not contra-indicated.
Definitely depends on the site and magnitude of surgery but usually after a few days from discharge from the hospital, travel is not contra-indicated.
Definitely depends on the site and magnitude of surgery but usually after a few days from discharge from the hospital, travel is not contra-indicated.

Breast lump and Breast Cancer

What does a breast lump feel like?

Breast lump is felt like a discrete solid mass with sharp margins when the breast is pressed with the palm. It is usually mobile inside the breast tissue. It can be painful on touch or painless. In young females breast is usually NODULAR, which means multiple small nodules felt in the breast which doesn’t qualify as a lump. It can be single, more than one and occur on one side or both the breasts.

It can occur at any age but usually young adults and adolescent girls have breast lumps.

It can occur at any age but usually young adults and adolescent girls have breast lumps.
Pain in the breast on pressing or even without it is called mastalgia. It is a hormone dependent condition usually occurring in young females. The pain can also increase with the onset of menstruation and subside in mid cycle. Yes, a surgeon’s evaluation is necessary but usually resolves with simple medical treatment and sometimes with advancement of age.
Early changes in breast, which is also known as fibroadenosis as well as small lumps can be treated with medicines. Usual medicines given are devoid of any side effects and do not interfere with menstruation. Sometimes if it doesn’t respond to this therapy, hormonal drugs can be given but menstruation ceases during therapy which again commences after the treatment is over. However, discrete lumps and big lumps often require surgical removal.
Technically, a lump once removed cannot recur but due to constant structural changes in the breast and female hormonal milieu, new lumps can form later on.
Absolutely not. This surgery has no such implications.
The more the lump grows the more normal breast tissue and milk ducts it will damage and also surgery will become more extensive giving a bigger scar. So, significant sized breast lumps must be surgically removed and biopsy of the removed lump should be done.
No, formed breast lumps do not go unless surgically removed.
If the position of the lump is favourable, not extremely big in size and if it is mobile, it can be taken out by an incision along the circumference of the areola which eventually leaves no scar.
Generally, it is not. The extension of the breast towards the armpits on both sides is known as AXILLARY TAIL. It is normal breast tissue but due to hormonal effects, especially Estrogens, sometimes this tissue becomes bulky which can be on any one side or both sides. It usually doesn’t require treatment if both breasts are normal, but surgery can be done to remove the extra fatty tissue if it is causing any problem or for cosmesis.
ny history of breast, ovarian or endometrial cancer in anybody amongst your first degree relatives is very important and you must be very careful and vigilant about any changes in the breast and consult a surgeon if you have the slightest doubt. There are genes like BRCA1 and 2, regarding which you can read if you are enthusiastic, but most importantly, examine your breasts.
It’s very simple which all mothers should do themselves and also teach their daughters how to do. There are these few steps which should take just about a minute to complete:
  • Look at both the breasts in the mirror to appreciate any significant disparity in size, any changes in skin, any retraction of nipple and any fullness.
  • Feel both the breasts with the palm of your opposite hand applying gentle pressure.
  • Follow the same with the pads of your fingers applying little firm pressure.
  • Squeeze both the nipples to look for any pain or discharge.
  • Use the tip of four fingers to examine the opposite sided underarms and look for any lump, for both sides.
Any abnormality if detected, do not delay to consult a Surgeon.

Screening is the word used to evaluate the breast or any organ or the person, to detect cancer at a very early stage. So, for people with high risk of breast cancer should undergo regular screening, as a matter of fact all ladies above 40 years of age should. It includes:

  • Self examination as it has been discussed.
  • Mammography
It is essentially a specialized high resolution X-Ray of the breast, done for both sides simultaneously. It gives detailed information regarding the nature of the breasts, any lump if present, the likelihood of the lump being cancer (reported according to a standard reporting criteria called BIRADS) and also both the axillae. But it is ideal for women above the age of 40 years, in young females, because of the density of breast tissue; MRI is a better mode of investigation.
Mammography gives adequate information about breast lumps and also regarding the likelihood of it being malignant. But MRI gives a clear picture about the ductal system, apart from all of the above. So, both investigations are done according to the suspicion of the disease, symptoms of the patient and treatment planned.
  • Family history of breast or ovarian cancer.
  • Any hormonal treatment taken for any reason like infertility or long term usage of oral contraceptive pills.
  • Previously treated for breast, ovarian or uterine cancer.
  • Pregnancy and breastfeeding (lactation) are known natural protective factors, so those who have not, are generally at a higher risk than normal.
If you find anything of these, you must immediately consult a Surgeon:
  • Hard, immobile lump present in the breast or armpit.
  • Recent significant change in the nature or increase in size of any existing lump.
  • Skin of the breast is dimpling like the skin of an orange.
  • Pain in the lump or in the armpit.
  • Bloody discharge from the nipple.
  • Retraction of the nipple, the nipple appears like it is pulled inwards.
  • Any ulceration in the skin along with the lump.
Any one of the above needs immediate attention.
Removal of the whole affected breast along with the tumour, underlying tissues and lymph nodes in the under arms is called MRM (Modified Radical Mastectomy). Post operatively Chemotherapy is required. Hormone and Radiation therapy depends on the detailed biopsy report, type and extent of the tumour. It is the most widely performed surgery for breast cancer. Preserving the breast partly, removing the tumour with adequate margins and removing lymph nodes from the under arms is a procedure known as BCS (Breast Conservation Surgery). It has to be followed by Chemotherapy and Radiation therapy. Hormone therapy depends again on the nature of the cancer.  Which procedure should be opted for depends upon primarily on the choice of the patient if both the procedures are indicated. If she wants to retain her breast partly and the location, nature and extent of the tumour are favourable, she can opt for breast conservation. If it is a large tumour with local invasions into the nearby muscles and deeper tissues, it is advisable to get the whole breast removed. However, with recent advancements, initial Chemotherapy can be given and breast conservation surgery can be done in locally advanced tumours with later chemo radiation which is purely dependent on the patient’s choice and the Surgeon’s discretion.
Yes, if it is detected in an early stage and full treatment has been completed as per standard protocol, survival rate is very good and in most patients it can be cured.
Chemotherapy attacks all fast growing cells which include the hair and intestinal mucosa apart from cancer cells. So, loss of hair is common, but TEMPORARY. After the treatment is over, all patients get back thicker hair than before.
Most certainly. There are flap surgeries (involving tissue transposition including skin and muscle from your own body like abdomen, shoulder or torso) and implant surgeries (foreign implants like silicon) which can be done to regain the shape of the breast after complete removal.
Yes. Breast still has to be removed to avoid very distressing local complications, ulcerations and fungation of the tumour (Tumour bursting outside the skin of the breast). Chemotherapy and radiation therapy should be taken as advised by the Oncologist.
Ideally, lifelong. But the frequency decreases periodically ranging from weekly in the immediate postoperative period followed by monthly, then yearly to three yearly after completing five years without any recurrence. Follow up includes clinical examination, biochemical tests and radiological evaluations.
PET scan is done in the follow up period to look for any residual tumour or early recurrence. Initially it can be done to see if any other organ is involved and assess the spread of cancer to plan the treatment accordingly. Before surgery, if the patient has no symptoms to suspect a spread to any part of the body, CT scan of the chest and abdomen is often enough.
The most common spread is in the lymph nodes located in the same side axilla (underarms). Common sites of distant spread are bones (mostly vertebral column) and lungs; however, in later stages if not treated properly, it can spread to liver, brain and other organs.
Yes, and it is very aggressive, much rarer than women, commonly occurs in old age and needs very urgent attention the moment a suspicion arises.

Abdominal Hernias

What are hernias?
Hernia might appear like one, but it is not a tumour or any abnormal tissue or growth. It is the protrusion of normal tissue, most commonly intestines and fatty tissue associated with it, through any defect into an abnormal space.
The most common sign of a hernia is that a swelling appears on standing, walking or straining and disappears on either lying down or with minimum effort.
Yes, it is one of the most common surgical problems.
Yes. In young people, hernias can occur most commonly due to increase in abdominal pressure; like sudden lifting of very heavy weight.
Groin hernias are commonest in men. Groin is the area of junction between the abdomen and thighs on both sides. Here, hernias occur most commonly in men, they are called inguinal hernias. Inguinal hernias can be direct or indirect, but the treatment is the same and the only thing which is important from a patient’s perspective is, the direct variety is commonly found in elderly and the indirect variety in the younger age group.
There are other hernias as well:
1. Incisional hernias
It is the bulging of intestines or other abdominal content through the defect in a scar of any previous surgery. Any abdominal surgery like gallbladder or appendix, caesarean section or even a previous hernia surgery can result in such types of hernias.
2. Epigastric hernias
Any bulge of the abdomen due to protruding of abdominal contents in the midline of the abdomen from below the chest up to the umbilicus is called Epigastric hernia.
3. Umbilical/Para-umbilical hernias
There is often a bulge in the umbilicus (belly button) of many people irrespective of gender, which they tend to ignore, but it’s actually a hernia.
4. Femoral hernias
A relatively less common variety of hernia, mostly seen occurring in women in the upper thigh but it should be treated as soon as possible to avoid complications.
In middle aged or elderly, people often tend to ignore urinary symptoms and straining for a period of time can lead to direct inguinal hernias. Not only can that, if kept ignored, even cause a recurrence after surgery. The common urinary symptoms are: Poor stream: The urinary stream becomes thin and even with a good amount of pressure, it falls closer to the body than usual.
Straining: Need to apply pressure to urinate.
Hesitancy: Feeling of the urge to urinate very often.
Dribbling: Urine dribbles during the act of micturition or even otherwise.
Urgency: Unable to hold urine even for a short time during urge.
Frequency: Number of times the person goes for urination throughout the day.
Urge incontinence: Can’t hold urine and urine leaks when bladder is full.
Nocturia: Getting up a number of times at night from sleep to pass urine.
Never ignore these symptoms and must get consultation from a Surgeon/Urologist and treated at the earliest.
You must undergo treatment and don’t ignore it.
Surgery is an emergency if you have any of these:
1. The swelling doesn’t disappear on lying down which previously used to happen.
2. Trying to negotiate it causes extreme pain.
3. Skin overlying the hernia has become red, swollen, thinned out or extremely tender.
4. Abdomen is getting bloated and causing pain.
5. Can’t pass flatus (Gas)
6. Multiple episodes of vomiting
Hernia is a mechanical defect which needs to be repaired in whatever way, so it’s a technical job. So yes, surgery is the only treatment.
Mesh is a woven material of threads (suture material like prolene) which never get absorbed in the body and it induces tissue reaction so that the hernia repair becomes solid and permanent.
Yes, it’s most commonly used and there is a variety of mesh available within a wide range of quality, material and price, but the essential function is the same.
Without the mesh also, hernias can be repaired with equal efficacy where the surgeon does a procedure called ‘Darning’, which serves the purpose of the mesh but doesn’t have the implications of using a mesh.
For hernias, both are standard procedures and give good results in safe hands, but it is always advisable to choose the procedure according to the patient, the condition of the hernia and other factors. There are few conditions of the heart, lungs and kidneys where laparoscopy is not advisable but in all other patients, the choice should be made after a thorough discussion with your surgeon.
It might be technically challenging for the surgeon but it is not contra-indicated and you must be open to the fact that if not possible, open surgical repair will have to be done.
No, hernia surgery has no such implications.
In the long term, there are no restrictions and any amount of physical labour, running, gym and weight lifting, swimming, to the extent of rock climbing is also not restricted.
But, for the first 6-8 weeks after surgery, no strenuous activity, no lifting of heavy weight should be done and also cough and constipation must be avoided.
You can start limb physiotherapy from the next day, ambulation and standing as well; but pressure on the abdomen is not allowed for the next 6 weeks and you must wear an abdominal binder if you have undergone abdominal wall ventral hernia surgery.
No, the most common cause of scrotal swelling after surgery is ‘Seroma’ formation, which means collection of lymph in the scrotal sac. It requires no treatment and disappears with time. The best way to prevent it is to wear tight underwear or scrotal support for a week after surgery.
Yes. The area below the scar may remain numb for a long time which may recover fully or may persist partly.
Restrictions of strenuous activity and lifting heavy weight will remain for 6 to 8 weeks, after which any range of movement, any activity has no restrictions.

Appendicitis

I have been advised surgery for acute appendicitis. Can I avoid it?

It’s you who is bearing the pain, so you have to decide whether to bear it or get rid of it. Within the first 48 hours of acute attack, it is best if the appendix is operated. Yes, for the time being it can be treated with medicines including antibiotics and if the pain and infection settles, surgery can be done later.
But two things must be kept in mind:
There will be another attack definitely
It will be more severe than the first time in all probabilities.

The most frequently asked dilemma.
Acute Appendicitis is a clinical diagnosis. The surgeon decides on a clinical examination. If clinically it has all signs of appendicitis and the symptoms and parameters match, one must go ahead with surgery.

No. Appendix is not always easily visible on ultrasound because of its position behind the intestines and also acute appendicitis might not give radiological features at a very early stage.
Apart from pain:
Fever
Chills
Vomiting
Loss of appetite
Diarrhoea, etc.
There is no hard and fast rule of pain in any infection or inflammatory condition. Pain is most commonly in the periumbilical ( near the naval) or right iliac fossa ( right lower most part) and can migrate. It is usually very sharp, like a stab of a knife. You would feel better if you lie in a fully flexed position like a baby in mothers womb and it will not be relieved on usual medications.
It doesn’t burst inside, but yes it can get perforated. The tip or base if it gets obstructed or gangrenous, it can perforate causing spread of infection, pus, severe pain and thus making the surgery even more urgent and inevitable.
Yes, of course. If the patient is stable and having no added specific contraindications, both open and laparoscopy can be done in emergency to remove the appendix.
No, it’s common to have mild infection and pus discharge after this surgery if the appendix was very badly infected. Simple dressings, antibiotics and care heals it in a week to ten days time and it doesn’t usually require hospitalisation.
Previously it was thought that appendix has no function, it is vestigial ( read useless). But recent researches have proven it has a role and some functions especially in gut immunity, but that is only when it is functioning. After an acute attack it is no longer functioning and only the complications remain, so there is no point of keeping it. The digestion process and all other functions go on as before, un altered.
In the US, it is, but in our country we still trust our doctors more.
Yes, ultrasound or CT can be done to rule out the three major conditions which can mimic the pain of appendix:
Right sided ureteric stone
Right sided ectopic pregnancy in females
Right sided twisted ovarian cyst in females
After the surgery once the surgeon allows you to have diet, gradually escalate it and within few days you are allowed to have everything you were taking before.
Hope and pray. This is a disease which doesn’t occur due to any faulty habits or dietary reasons. It can be treated, not purposefully avoided.

Don’t listen to the stories of others who had intestinal complications, repeated surgeries, appendix couldn’t be found and all of those. Yes, I have encountered such patients operated elsewhere, handled them all, but those are rare exceptions. If you have an acute attack of appendicitis, get operated wherever you are and get fit within a few days.

Scrotum & Testes

I have in the testicular area. Is it an early sign of a hernia?
No. not necessarily. There can be various reasons for this kind of pain including very commonly, simple urinary tract infection which can be treated with antibiotics and other supportive measures.
First, get it examined by a surgeon whether it is a hydrocoele or something else. Yes, treatment for hydrocoele is surgery but it is a short, day care surgery and can be done giving local anaesthesia.
If it is a hydrocoele, it does not merit an urgent surgery, until it causes serious discomfort to the patient. But yes, there is no medicine to treat it and surgery is the easy and only option.
No, normally all the problems in this region can be diagnosed clinically. If there is a diagnostic dilemma then ultrasound can be done.
NEVER IGNORE THIS. It is a matter of very serious concern. You should immediately consult a surgeon and he should be properly evaluated to find the location of the testis by ultrasound / MRI. It Should be operated and brought back into the scrotal sac as soon as possible. If it is too high up inside the abdomen for a long time or the child has crossed a certain age then the function of the testis has to be assessed and if found non functional, must be removed.
You must get yourself checked by a surgeon and if required an ultrasound with a doppler test must be done. We might be dealing with a recurrent partial torsion of the testis.
The testis can rotate and thus twist the cord which in turn can partially or completely cut off its blood supply. If not treated immediately, it can even result in loss of that testis forever. It is an emergency and no delay in decision making or initiating the treatment should be there. It normally happens in children or young adults.
Treatment is Surgery, and if done within the right time frame, the testis can be de-rotated, fixed (both the sides should be fixed) and can be saved. Delay might result in sacrifice of the affected testis.
Check for DIABETES. In middle aged men this is often the starting presentation of uncontrolled and undiagnosed diabetes.
No. Immediately get operated on and the affected testis should be removed and a biopsy should be done. Further treatment is decided as per the biopsy report of the removed testis and definitely assessment of the whole body by radiology and / or biochemical parameters. Needle biopsy is strictly NOT to be done.

Varicose Veins

I have prominent veins on both of my legs. Is it varicose?
Not necessarily. When we are in an upright position, the blood flows through the veins in a direction from below to above (against gravity), so there are valves to guide the flow unidirectionally and the calf muscles pump it. When these valves get damaged, there is increased pressure in the veins due to back flow resulting in the veins becoming prominent, visible and tortuous.
School teachers
Policemen
Surgeons
Yes, they are the people who are more vulnerable to get varicose veins because of their professional need for prolonged standing but anybody can.
Yes, most certainly. The appearance of swelling in both feet or legs after walking or standing can be the early signs of varicosity in legs.
There are various treatments available for this condition all depending on the stage and should be discussed with the patient before proceeding with any of them.
Conservative:
No surgery is done. It is for early varicose veins. There are two major valves, one in the groin and one behind the knee, known as SFJ and SPJ respectively. If they are fine, we can start non operative therapy, when only non significant valves are damaged ( perforator incompetence) at an early stage which are mostly located around the ankle. wear compression stockings with pressure gradients some vasodilator drugs avoid prolonged standing etc
Intervention:
There are now various less invasive techniques like RFA ( Radio frequency ablation), foam or sclerosant injections to treat non complicated varicose veins.
Surgery:
I always do the conventional surgery if one / both of the two major valves are damaged. It has NO COMPLICATIONS AND ZERO RECURRENCE.
It is one of the most common presentations of varicose veins.
When you have such a bleeding, lie down and lift your legs for sometime till it stops and consult a surgeon as soon as possible.
No. Ulcers are not the common complications but yes, if it happens, it refuses to heal without treating the varicosities.
COLOUR DOPPLER. It is a specialised ultrasound for the blood vessels. non-invasive, not costly and very accurate.
Never. First the blockade must be treated with medicines and complete rest. After it has fully recovered, then only one should proceed.
It is not unusual. In pregnancy, the major veins in the abdomen ( mainly the IVC, the largest one draining all veins from both legs and abdomen) get compressed resulting in varicosities in lower limbs. It might go after delivery, might not; but during pregnancy all activities should be continued and just this condition should be taken care of by simply elevating the foot end of the bed.
With conservative or minimally invasive techniques ( they are very effective standard treatments) it might, if the risk factors continue. But after the formal surgery, it doesn’t.
Most certainly, from the next day itself.
No bed rest is at all required. All the routine activities and walking can be resumed from the very next day, of course with a bandage on which is generally removed after a few days.

The Tuberculosis Myth

What is Tuberculosis?
Tuberculosis is primarily a disease of the lungs which can spread to other organs, is a FACT. But, Tuberculosis cannot occur primarily anywhere else in the body other than lungs. If any other body part has tuberculosis, the lungs must have also been affected or it has definitely spread from the lungs.

are MYTHS.
In my clinical practice, I have encountered tuberculosis in:
Most commonly in lymph nodes in the neck appearing as a swelling or a pus collection
Very commonly, in small intestines
large pus collections in the abdomen often requiring surgery, which arise from spine known as Psoas abscesses.
In long standing ulcers and sinuses
In sinuses at the back known as Pilonidal sinuses
In peri anal fistulae
Skin
Umbilical sinuses
Laparoscopic port sites. [my Research topic]
TREATMENT:
The key to the treatment lies in suspecting and diagnosing it. Treating these kind of tuberculosis infections become difficult because:
Often patients are severely immunocompromised
And unlike the lungs;
They often require Surgery
They often don’t respond to first line treatment because of the atypical type of bacteria causing them and thus require second line unconventional therapy.