28 Oct 2011
By: SELINA LUM
THE risk of intestinal perforation in liposuction is very, very low, said an Italian plastic surgeon yesterday at a coroner’s inquiry into a property company boss’ death from the procedure in 2009.
Dr Alberto Di Giuseppe, 57, a clinical professor of plastic surgery at the University of Ancona in Italy, said there was nothing wrong with the way Dr Jim Wong had done the operation.
Pointing to the more than 400 procedures carried out by Dr Wong without incident, Dr Di Giuseppe said the family doctor was experienced, and a review of 20 of his cases had shown good results.
Dr Wong, 36, had carried out a liposuction operation on Mr Franklin Heng, 44, on Dec 30, 2009, and later injected some of the extracted fat into his chest.
After the surgery of more than three hours, Dr Wong returned from a toilet break to find Mr Heng pale and unresponsive. He died in hospital without regaining consciousness.
An autopsy found the cause of death to be multiple punctures of the intestines from liposuction.
But Dr Di Giuseppe, called by Dr Wong to be an expert witness at the inquiry – a fact-finding exercise, rather than a determination of who was to blame – thought differently.
His opinion was that the cause of death is still undetermined, as other factors cannot be ruled out.
He said the major cause of death in liposuction – around one-quarter of fatalities – was pulmonary thromboembolism, a blockage of the main artery of the lung by a blood clot.
The other causes are perforation of the abdomen, anaesthesia or sedation, and fat embolism – in which fat globules enter the bloodstream after some trauma and travel to the brain.
The plastic surgeon said bowel perforation occurred in Mr Heng’s case, but it was probably not the cause of death, as no bleeding or septic shock was found.
He told the inquiry that in medical literature, if a patient suffered punctured intestines during liposuction, it would show up as abdominal pains from two to 10 days after the surgery.
Senior State Counsel David Khoo asked what could be said about the skills of a doctor who performed the procedure.
Dr Di Giuseppe said Vaser liposuction – the kind done on Mr Heng, which uses ultrasound to melt fat before it is sucked out – accounts for a quarter of liposuction cases.
He said he was not aware of any incidents of punctured intestines in Vaser cases in 10 years, until Mr Heng’s and that of a diabetic woman who had the procedure done at the Singapore General Hospital.
“I have no idea how to find out more about how it happened, why it happened in people with surgical experience. But it happened. I have no explanation.”
When Mr Khoo told Dr Di Giuseppe that a possibility of inexperience cannot be excluded, the plastic surgeon reiterated that Dr Wong was experienced, and his training was correct.
“What happened that day I do not know,” he said.
Dr Di Giuseppe also expressed surprise that Singapore’s regulations did not require an anaesthetist to be present during liposuction in clinics.
He said this was unusual, as this was the practice in countries such as Italy, Britain and the United States.
Email: selinal@sph.com.sg
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