 MADRID, Spain - Fidel Castro himself told surgeons not to perform a colostomy, opting instead for a course of surgery that produced a complication leaving the Cuban leader in far worse condition, according to a newspaper report Wednesday.
After removing an inflamed piece of Castro's large intestine in an operation last year, the doctors connected the remainder directly to his rectum, rather than attaching a colostomy bag, El Pais said, quoting two medical sources at Madrid's Gregorio Maranon hospital. The operation failed when a suture burst. "The Cuban dictator and his advisers are the ones who decided on the surgical technique that has led to the complications," the paper said.
| Dumb, dumb, dumb. Surgery for diverticulitis should almost (99%) always be concluded with a temporary, diverting colostomy. You let the affected region of the bowel heal with rest and then you do a second procedure to re-attach the plumbing. |
While the newspaper article did not name the sources, one of the journalists who wrote it told The Associated Press that both were doctors at the hospital. The journalist, Oriel Guell, said none of the information in articles published Tuesday and Wednesday came from surgeon Jose Luis Garcia Sabrido, who flew to Cuba in December to treat the 80-year-old Castro.
 Garcia Sabrido, the hospital's chief surgeon, declined comment Wednesday but said in an interview posted on CNN's Web site that El Pais' account of Castro's condition being grave was wrong. "According to my information, there is even some progressive improvement," Sabrido was quoted as saying. "The only truthful parts of the newspaper's reports are the name of the patient, that he has been operated on, and that he has had complications. The rest is rumors."
| "Please don't ruin me with all the proper-thinking progressives!" |
A Cuban diplomat in Madrid said Tuesday that the newspaper's report was "an invented story." "It's another lie and we are not going to talk about it. If anyone has to talk about Castro's illness, it's Havana," said the diplomat, who spoke on condition of anonymity in line with normal diplomatic practice.
Experts say it's possible Castro and his surgeons went for the riskier procedure to spare him the indignity of being temporarily attached to a colostomy bag for waste removal. In standard colostomies, patients are dependent on such bags for approximately six weeks.
| That's about right. It's unsightly and it causes some real, if transient, pyschological problems for some patients. Can only imagine Fee-del thought himself too good to dump into a bag. |
Attempting to reattach the colon to the rectum is an inherently trickier surgical procedure, since waste can leak into the abdomen, causing infection.
| Plus the first surgery is inherently dirty -- you're resecting an infected region of large bowel. Even if you empty the large bowel prior to surgery you still have pus and bacteria all over. A primary anastamosis (reattaching the colon to the rectum) is risky because, if the anastamosis breaks down, you get rapid peritonitis and abscess formation. Not good; antibiotics frequently don't fix that. Plus you get into a situation, particularly with VIPs, where you temporize in your care -- he's such a big shot that you don't want to break bad news, so you wait and hope antibiotics and bowel preps will work. They don't, and now you're in worse trouble. |
"It sounds like they took a gamble and they lost," said Dr. Peter Shamamian, an associate professor of surgery at New York University School of Medicine, referring to Castro's surgeons. Though Shamamian said it was difficult to speculate on Castro's condition, he said colostomies are a standard procedure that do not usually result in serious complications.
| Which is why we do them in this situation -- they work. |
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