PERIOPERATIVE

Perioperative
 Preoperative
 Intraoperative
 Postoperative

PERIOPERATIVE

Operating Room Attire

- Consist of scrub dress, head cover, mask and shoe cover. Sterile gown and gloves are
added for scrubbed team

PURPOSE
- to provide effective barriers that prevent the dissemination of microorganisms to the
patients and to protect personnel from infected patients
- Scrub Dress- worn only in the operating suite.
- Head Cover- is used to cover hair completely.
- Shoes- should be clean and conductive, washable and soft- soled covered by shoe
cover.
- Mask- is put on by all personnel before coming into the operating room and must be
worn over nose and mouth.
- Sterile gown- are worn over scrub attire.
- Sterile Gloves- are worn to complete the attire for scrubbed team members.

Position For Surgery

 Supine Position
 Modified Trendelenburg Position
 Modified Reverse Trendelemburg Position
 Lithotomy Position
 Prone Position
 Lateral Position
 Modified Fowler’s Position
Surgical Scrub
- Is the removal of as many bacteria as possible from the hands and arms by mechanical
washing and chemical disinfection before participating in an operation. The surgical scrub is
done just prior to gowning and gloving for each operation.
Purpose
- To help prevent the possibility of contamination of operative wound by bacteria on
the hands and arm.

Brush Stoke Method

- A prescribed number brush strokes, applied lengthwise of the brush or sponge, is used for
each surface of the fingers, hands, and arm. Scrub the nails of one hand 30 strokes, all sides
of each fingers 20 strokes, the back of the hand 20 strokes, the palm of the hand 20 stroke,
the arm 20 strokes for each third of the arm, to inches above the elbow.
Gowning
Purpose:
1. To exclude skin as a possible contaminant and to create a barrier between sterile
and unsterile areas.
2. To permit the wearer to come within the sterile fields.
3. To carry out sterile technique during on operative procedure.
Draping
- Is the procedure of covering patient and surrounding areas with a sterile barrier to create
and maintain an adequate sterile field during operation.

Intraoperative
Roles of the Operating Room Team Members
Surgeon
-a qualified medical practitioner who specializes in surgery.
Anesthesiologist/anesthetist
- a medical qualified doctor who had administer an anesthetic to induce
unconsciousness in the patient before surgical operation.
Scrub Nurse
-assist in the surgical procedure as member of the operating team.
Circulating Nurse
-practice opening sterile packs following sterile technique
-set up a sterile field in OR
-observe an OR nurse prepare a sterile table and submit a written reaction
 Preparation of OR

 Before preparing the OR the CN must know the OR schedule and must be familiar
with the type of procedure to be done, since the choice and placement of the table
and equipment will defend on the type of operation performed.
 The CN is responsible for the selection and arrangement of both sterile and
nonsterile supplies. Supplies should be arranged for maximum efficiency.
 When preparing the OR, the CN should test all lights and x-rays viewers. Suctions
must be tested to be sure that they are ready for later use.

Handling Sterile Supplies

 The CN is responsible for opening the outer wrapper of sterile supplies that will be
used during the operative procedure. In doing so the nurse adhere strictly to the
principles of aseptic technique.
Care of the patient prior to surgery
 Before the patient is brought into the OR the CN should identify the patient and
check his chart. The patient is asked to state his name, and ID band is checked. If the
patient has no ID band, a nurse from the ward must identify the patient and placed a
band on him. The preoperative medication must given a chance to work.
Assisting the Anesthesiologist
 When the anesthesiologist is ready to give anesthetic, the circulator must have the
suction available and turned on. The CN must stay beside the patient and available
to assist as request.
 It is important at this time to let the anesthesiologist do all the talking to the
patient.

Preparation of the Operation

Positioning the patient for surgery

This is done only after the anesthesiology states that the patient can be positioned.
Either the circulator or the anesthesiologist will assist the surgeon in positioning the patient
depending on the type of surgery and the team member’s responsibilities.
Preparation of Operative Site

 The CN should on the spotlights when getting ready to preparation the operative site
so that the site may be observed closely.
Assisting the Scrub Nurse
 The CN helps the surgeon or surgeons into their gowns by pulling the gowns over
their shoulders and tying the back ties. The CN should also be available to help the
SN needs more drapes or other supplies.
Duties during Surgery
 During any procedure the CN must:

1. Be aware of emergency procedures.

2. Anticipate the needs of the scrub team and have all equipment and supplies ready,
including, sterile saline solution (if needed), dressing.
3. Keep the operating room meat. This will provide a safe environment for the scrub
team and the patient.
4. Complete specimen cards and labels. Complete the required records. Because these
record are permanent, they must be legible.

Counting Sponges
 Sponges are counted at least three times before surgery, as the cavity is being closed
and when the skin is being closed. The CN and the SN have this very important
responsibility. A miscount could be fatal if a sponge is inadvertently left in the
wound.

Postoperative
Postanesthesia Recovery
 The Postanesthesia Care Unit (PACU) is located either within or just adjacent to the
OR suite. If adjacent, there must be a two-way intercom into the OR including an
emergency alarm for assistance. The room is well-equipped with life-saving
equipment and is staffed by highly knowledgeable, skilled personnel.
 Purpose
- to provide a safe environment, away from other patients and family,
where postanesthesia patients are assistance to return to their preanesthetic state
by skilled personnel. It may not be possible to return them completely to that state
because of surgical trauma, loss of fluids and alterations o body processes.

Equipment
 Sphygmomanometer
 Lighting
 Poles for intravenous solutions
 Electrical outlets
 Shelf
 Drawers
 Emergency Equipment
 Cardiac board
 Clock for cardiac arrest
 Cardiac arrest cart including emergency drugs, fire alarm, fire distinguisher and/or
hose

Care for Patient in PACU

 Vital signs
 Color (nails, ears and general overall skin color)
 Skin
 Level of Consciousness
 Fluid and electrolyte balance
 Dressings, tubes, drain, or cats
 Position
 Safety measures
 Physician’s Order.
 Comfort for the patent
 Reporting and recording

Postoperative Complications

Circulatory Problems
Shocks
 Shocks – can be often be prevented by attention to fluid balance and the
administration of blood or blood substitutes during and after surgery. There are
several causes of shock, although it usually occurs as the results of a combination of
two or more factors.
Category of Shock
 Hematogenic – caused by blood loss
 Neurogenic – caused by vasodilatation and reflex inhibition of the heart brought
about by an insult to the Nervous System.
 Cardiogenic – results from cardiac failure or an interference with heart functions and
in MI or coronary thrombosis.
 Vasogenic – cause by iffuse vasodilatation; blood circulates poorly through dilated
vessels and is not as available to the vital centrs; may occur in anaphylaxis.
 Toxic or Bacteremic – thought to be caused bny toxic fact that enters the
bloodstream from infection.
 Psychic – results from extreme pain, deep, far, or sudden severe emotional
disturbance.
Signs and Symptoms
 The person in shock appears nervous and apprehensive at first, but later becomes
apathetic.
 The skin is cold and moist, lis are cyanotic.
 Increased PR and RR
 Decreased temperature and BP
Treatment
 Hematogenic shock – restoration of blood volume
 Other types – checking of the airway and administration of oxygen, checking or
changing patient’s position to relieve and assist pain, urinary volume, and
medication
 Drugs – ephedrine, phenylephrine (neo-synephrine), isoproterenol (isuprel) and
atropine.
Hemorrhage
 May be either evident or concealed. Primary hemorrhage occurs at the time of
surery, intermediary hemorrhage occurs within the first few hours of surgery and
secondary hemorrhage occurs some time after surgery.
Symptoms
 Apprehensive
 Restless
 Thirsty
 Skin is cold, pale and moist
 Temp falls
 Increased PR and RR
 Decreased BP
 Lips and conjunctiva becomes pallid
 He will see spots before his eyes and hear ringing in hs ears
 Weak but conscious
Treatment
 The patient should be given oxygen, and rate of intravenous drip should increased
 Feet must be elevated
 Monitor BP
Femoral/Phlebitis or Thrombosis
 Occurs most frequently after operation on the lower abdomen or in the severe septic
diseases, such as peritonitis and ruptured ulcer.
Signs and Symptoms
 The primary symptoms include pain in the calf of the leg with swelling occurring
within 1 to 2 days. The patient has a slight fever, sometimes with chill and sweat.
Treatment
 Administer adequate fluid after surgery to prevent concentration of blood
 Early ambulation is necessary
 IOOB (intermittent positive pressure breathing) is also beneficial
 Pulmonary Problems
Atelectasis
 When the mucos plug closes one of the bronchi entirely, there is a collapse of the
pulmonary tissue beyond that point.
Signs and Symptoms
 If lung tissue is involved, the patient will demonstrate the ff:
 Dyspnea
 Cyanosis
 Prostration and pleural pain
 Fever
 Tachycardia
 Anxiety
Labored respirations
Treatment
 Removal of fluid or air by needle aspiration and sedation

Urinary Problems
Urinary Retention

 – may occur following any operation, but it occurs frequently after of rectum, anus,
vagina or lower abdomen. The cause is thought to be a spasm of the bladder
sphincter
 Urinary Incontinence – frequent complication in the aged.
Discharge of Patient
 Discharge of the patient from the PACU usually determined
▪ 1. stabilization of VS
▪ 2. level of consciousness
▪ 3. Effect of surgery
 The patent is transported to the ward on a stretcher, or hospital bed by one or more
persons with postanesthesia recovery experience.
 This individual must give a complete report of the patient’s status to the ward nurse.
This includes the patient’s name, surgical procedure, types of anesthetic, overall
evaluation of vital signs, drugs and Iv solutions administered and status of dressing,
drains or tubes. After assisting the ward personnel as necessary, the PACU individual
returns to the postanesthesia recovery development.
 Surgical Procedures

Reproductive

 VASECTOMY
A vasectomy is surgery to cut the vas deferens, the tubes that carry a man’s sperm
from his scrotum to his urethra. The urethra is the tube that carries sperm and urine out of
the penis. After a vasectomy, sperm cannot move out of the testes. A man who has had a
successful vasectomy cannot make a woman pregnant.
Procedure

 After the scrotum is shaved and cleaned, the surgeon will give a shot of local
anesthesia.
 The surgeon will then make a small surgical cut in the upper part of
the scrotum, and tie off and cut apart the vas deferens. The surgeon will use
stitches or a skin glue to close the wound.
 You may have a vasectomy without a surgical cut. This is called a no-scalpel
vasectomy (NSV).
 The surgeon will find the vas deferens by feeling your scrotum and then give
local anesthesia.
 The surgeon will then make a tiny hole in the skin of the scrotum and seal off
the vas deferens. The surgeon will usually pull the vas deferens through the
tiny hole in order to tie off and cut it apart. It will not need stitches.
Why the Procedure is Performed
 Vasectomy may be recommended for adult men who are sure they want to prevent
future pregnancies. A vasectomy makes a man sterile (unable to get a woman
pregnant).
 A vasectomy is not recommended as a short-term form of birth control. The
procedure to reverse a vasectomy is a much more complicated operation.
Vasectomy may be a good choice for men who:
 Are in a relationship, and both partners agree they have all the children they want.
They do not want to use, or cannot use, other forms of birth control.
 Are in a relationship, and their partner has health problems that would make
pregnancy unsafe for her
 Are in a relationship, and one or both partners have genetic disorders that they do
not want to risk passing on to their children
Vasectomy may not be a good choice for men who:
 Are in a relationship, and one partner is unsure about their desire to have children in
the future
 Are in a relationship that is unstable, going through a stressful phase, or is very
difficult in general
 Are thinking about having the operation just to please their partner
 Are counting on fathering children later by storing their sperm or by reversing their
vasectomy
 Are young and still have many life changes ahead
 Are single when they want to have a vasectomy. This includes men who are
divorced, widowed, or separated.
 Do not want, or have a partner who does not want, to be bothered by having to use
other forms of birth control during sexual activity

 HYSTERECTOMY
 (from Greek ὑστέρα hystera "womb" and εκτομία ektomia "a cutting out of")
is the surgical removal of the uterus, usually performed by a gynecologist.
Hysterectomy may be total (removing the body, fundus, and cervix of the
uterus; often called "complete") or partial (removal of the uterine body while
leaving the cervix intact; also called "supracervical"). It is the most commonly
performed gynecological surgical procedure.
 Removal of the uterus renders the patient unable to bear children (as does removal
of ovaries and fallopian tubes), and changes the hormonal levels of the female
considerably, so the surgery is normally recommended for only a few specific
circumstances:
 Certain types of reproductive system cancers (uterine, cervical, ovarian)
or tumors
 Severe and intractable endometriosis (growth of the uterine lining outside
the uterine cavity) and/or adenomyosis (a form of endometriosis, where the
uterine lining has grown into and sometimes through the uterine wall
musculature) after pharmaceutical or other surgical options have been
exhausted
 Postpartum to remove either a severe case of placenta praevia (a placenta
that has either formed over or inside the birth canal) or placenta percreta (a
placenta that has grown into and through the wall of the uterus to attach
itself to other organs), as well as a last resort in case of excessive postpartum
bleeding
 For trans men, as part of their gender transition
 For severe developmental disabilities
 TRANSURETHRAL Resection of Prostate

 Transurethral resection of the prostate (TURP) is surgery to remove all or part of the
prostate gland, to treat an enlarged prostate.

Why the Procedure is Performed

 The prostate gland often grows larger as men get older. This is called benign
prostatic hyperplasia (BPH). The larger prostate play causes problems with urinating.
Removing part of the prostate gland can often make these symptoms better.
 Before you have surgery, your doctor will suggest you make changes in how you eat
or drink. You may also be asked to try taking medicine. Your prostate may also need
to be removed if taking medicine and changing your diet do not help your
symptoms.
TURP is one of the most common procedures for this problem. But other less
invasive procedures are also available. Your doctor will consider the size of your
prostate gland, your health, and what type of surgery you may want.

Prostate removal may be recommended if you have:

 Difficulty emptying your bladder (urinary retention)

 Frequent urinary tract infections
 Bleeding from the prostate
 Bladder stones with prostate enlargement
 Extremely slow urination
 Damage to the kidneys

Risks
 Risks for any surgery are:
 Blood clots in the legs that may travel to the lungs
 Breathing problems
 Infection, including in the surgical wound, lungs (pneumonia), or bladder or
kidney
 Blood loss
 Heart attack or stroke during surgery
 Reactions to medications
 Additional risks are:
 Problems with urine control (incontinence)
 Loss of sperm fertility (infertility)
 Erection problems (impotence)
 Passing the semen into the bladder instead of out through the urethra
(retrograde ejaculation)
  Urethral stricture (tightening of the urinary outlet from scar tissue)
 Transurethral resection (TUR) syndrome (water buildup during surgery)
Damage to internal organs and structures

Before the Procedure

 You will have many visits with your doctor and tests before your surgery:
 Complete physical exam
 Visits with your doctor to make sure medical problems, such as diabetes, high blood
pressure, and heart or lung problems, are being treated well
 If you are a smoker, you should stop several weeks before the surgery. Your doctor
or nurse can help.
 Always tell your doctor or nurse what drugs, vitamins, and other supplements you
are taking, even ones you bought without a prescription.
During the weeks before your surgery:
 You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve,
Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and other drugs like
these.
 Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

 Do not eat or drink anything after midnight the night before your surgery.
 Take the drugs your doctor told you to take with a small sip of water.
 Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

 You will stay in the hospital for 1 to 3 days.
 After surgery, you will have a Foley catheter in your bladder to remove urine. The
urine will look bloody at first. It will clear with time. A bladder irrigation solution may
be attached to the catheter to continuously flush the catheter. This helps keep it
from getting clogged with blood. The bleeding will gradually decrease, and the
catheter will be removed within 1 to 3 days.
 You will be able to resume a normal diet right away.
 You will need to stay in bed until the next morning. Afterwards, you will be asked to
move around as much as possible.
 Your nurse will help you change positions in bed, show you exercises to keep
blood flowing, and recommend coughing/deep breathing techniques. You
should do these every 3 to 4 hours.
 You may need to wear special compression stockings and use a breathing
device to keep your lungs clear.
 You may be given medication to relieve bladder spasms.
 Cesarean section

 — also known as a C-section — is a surgical procedure used to deliver a baby

through an incision in the mother's abdomen and a second incision in the mother's
uterus.
 A C-section may be planned ahead of time if you develop pregnancy complications or
you've had a previous C-section and aren't considering vaginal birth after C-section
(VBAC). Often, however, the need for a first-time C-section doesn't become obvious
until labor has already started.

Why it's done

 Sometimes a C-section is safer for you or your baby than is a vaginal delivery. Your
health care provider may recommend a C-section if:
 Your labor isn't progressing. Stalled labor is one of the most common
reasons for a C-section. Perhaps your cervix isn't opening enough despite
strong contractions over several hours — or the baby's head may simply be
too big to pass through your birth canal.
 Your baby's heartbeat suggests reduced oxygen supply. If your baby isn't
getting enough oxygen or your health care provider is concerned about
changes in your baby's heartbeat, he or she may recommend a C-section.
 Your baby is in an abnormal position. A C-section may be the safest way to
deliver the baby if his or her feet or buttocks enter the birth canal first
(breech) or the baby is positioned side or shoulder first (transverse).
 You're carrying twins, triplets or other multiples. When you're carrying
multiple babies, it's common for one or more of the babies to be in an
abnormal position. In this case, a C-section is often safer — especially for the
second baby.
 There's a problem with your placenta. If the placenta detaches from your
uterus before labor begins (placental abruption) or the placenta covers the
opening of your cervix (placenta previa), C-section is often the safest option.
 There's a problem with the umbilical cord. A C-section may be
recommended if a loop of umbilical cord slips through your cervix ahead of
your baby or if the cord is compressed by the uterus during contractions.
 Your baby's head is too large for your birth canal. Some babies are simply
too big to safely deliver vaginally.
 You have a health concern. Your health care provider may suggest a C-
section if you have a medical condition that could make labor dangerous,
such as unstable heart disease or high blood pressure. In other cases, a C-
section may be recommended if you have an active genital herpes infection
 or another condition that your baby might acquire while passing through the
birth canal.
 Your baby has a health concern. A C-section is sometimes safer for babies
who have certain developmental conditions, such as excess fluid in the brain
(hydrocephalus).
 You've had a previous C-section. Depending on the type of uterine incision
and other factors, you may be able to attempt a vaginal delivery after a
previous C-section. In some cases, however, your health care provider may
recommend a repeat C-section.
Risks
 Recovery from a C-section takes longer than does recovery from a vaginal birth. And
like other types of major surgery, C-sections also carry a higher risk of complications.
 Risks to your baby include:
 Breathing problems. Babies born by C-section are more likely to develop
transient tachypnea — a breathing problem marked by abnormally fast
breathing during the first few days after birth. Elective C-sections done before
39 weeks of pregnancy or without proof of the baby's lung maturity may
increase the risk of other breathing problems, including respiratory distress
syndrome — a condition that makes it difficult to breathe.
 Fetal injury. Although rare, accidental nicks to the baby's skin can occur
during surgery.

Risks to you include:

 Inflammation and infection of the membrane lining the uterus. This condition —
known as endometritis — may cause fever, chills, back pain, foul-smelling vaginal
discharge and uterine pain. It's often treated with intravenous (IV) antibiotics.
 Increased bleeding. You may lose more blood with a C-section than with a vaginal
birth. Blood transfusions are rarely needed, however.
 Reactions to anesthesia. After regional anesthesia, it's possible to experience a
headache caused by a leak of the fluid around the spinal canal into the tissues of the
back. Allergic or adverse reactions to the anesthetic also are possible.
 Blood clots. The risk of developing a blood clot inside a vein — especially in the legs
or pelvic organs — is greater after a C-section than after a vaginal delivery. If a blood
clot travels to your lungs (pulmonary embolism), the damage can be life-threatening.
Your health care team will take steps to prevent blood clots. You can help, too, by
walking frequently soon after surgery.
 Wound infection. An infection at or around the incision site is possible.
 Surgical injury. Although rare, surgical injuries to nearby organs can occur during a
C-section. If this happens, additional surgery may be needed.
 Increased risks during future pregnancies. After a C-section, you face a higher risk of
potentially serious complications — including bleeding, placenta previa and tearing
 of the uterus along the scar line from the prior C-section (uterine rupture) — in a
subsequent pregnancy than you would after a vaginal delivery.
What you can expect:

 During the procedure

An average C-section can usually be done in less than an hour. In most cases, your
spouse or partner can stay with you in the operating room during the procedure.
 Preparation. Before the C-section, a member of your health care team will cleanse
your abdomen. A tube (catheter) may be placed into your bladder to collect urine. IV
lines will be placed in a vein in your hand or arm to provide fluid and medication. A
member of your health care team may also give you an antacid to reduce the risk of
an upset stomach during the procedure.
 Anesthesia. Most C-sections are done under regional anesthesia — one which
numbs only the lower part of your body. A common choice is a spinal block, in which
pain medication is injected directly into the sac surrounding your spinal cord.
Another option may be epidural anesthesia, in which pain medication is injected into
your lower back just outside the sac that surrounds your spinal cord. If you receive
regional anesthesia, you'll be awake during the procedure and will be able to hear
and see the baby right after delivery. In an emergency, general anesthesia is
sometimes needed. With general anesthesia, you won't be able to see, feel or hear
anything during the birth.

 Abdominal incision. The doctor will make an incision through your abdominal wall.
It's usually done horizontally near the pubic hairline (bikini incision). If a large
incision is needed or your baby must be delivered very quickly, the doctor may make
a vertical incision from just below the navel to just above the pubic bone.
 Uterine incision. After the abdominal incision, the doctor will make an incision in
your uterus. The uterine incision is usually horizontal across the lower portion of the
uterus (low transverse incision). Other types of uterine incisions may be used
depending on your baby's position within your uterus and whether you have
complications, such as placenta previa — when the placenta partially or completely
blocks the uterus.
 Delivery. If you have epidural or spinal anesthesia, you'll likely feel some movement
as the doctor gently removes the baby from your uterus — but you shouldn't feel
pain. The doctor will clear your baby's mouth and nose of fluids, then clamp and cut
the umbilical cord. The placenta will be removed from your uterus, and the incisions
will be closed with sutures.

After the procedure

 After a C-section, most mothers and babies stay in the hospital for about three days.
To control pain as the anesthesia wears off, you may use a pump that allows you to
 adjust the dose of IV pain medication. Soon after your C-section, you'll be
encouraged to get up and walk. Moving around can speed your recovery and help
prevent constipation and potentially dangerous blood clots. The catheter and IVs will
likely be removed shortly after the C-section as well.
 While you're in the hospital, your health care team will monitor your incision for
signs of infection. They'll also monitor your appetite, how much fluid you're drinking,
and bladder and bowel function.
 Discomfort near the C-section incision can make breast-feeding somewhat awkward.
With help, however, you'll be able to start breast-feeding soon after the C-section.
Ask your nurse or the hospital's lactation consultant to teach you how to position
yourself and support your baby so that you're comfortable. Remember that trying to
breast-feed when you're in pain may make the process more difficult. Your health
care team will select medications for your post-surgical pain with breast-feeding in
mind. Continuing to take the medication shouldn't interfere with breast-feeding.
 Before you leave the hospital, talk with your health care provider about any
preventive care you may need, including vaccinations. Making sure your vaccinations
are up to date can help protect your health and your baby's health.

 ORCHIECTOMY
is the surgical removal of one or both testicles, or testes, in the human male. It is
also called an orchidectomy, particularly in British publications. The removal of both
testicles is known as a bilateral orchiectomy, or castration, because the person is no
longer able to reproduce. Emasculation is another word that is sometimes used for
castration of a male. 

Purpose
 An orchiectomy is done to treat cancer or, for other reasons, to lower the level of
testosterone, the primary male sex hormone, in the body. Surgical removal of a
testicle is the usual treatment if a tumor is found within the gland itself, but an
orchiectomy may also be performed to treat prostate cancer or cancer of the male
breast, as testosterone causes these cancers to grow and metastasize (spread to
other parts of the body). An orchiectomy is sometimes done to prevent cancer when
an undescended testicle is found in a patient who is beyond the age of puberty.
 A bilateral orchiectomy is commonly performed as one stage in male-to-female
(MTF) gender reassignment surgery. It is done both to lower the levels of male
hormones in the patient's body and to prepare the genital area for later operations
to construct a vagina and external female genitalia.

Procedure
 All patients preparing for an orchiectomy will have standard blood and urine tests
before the procedure. They are asked to discontinue aspirin-based medications for a
 week before surgery and all non-steroidal anti-inflammatory drugs (NSAIDs) two
days before the procedure. Patients should not eat or drink anything for the eight
hours before the scheduled time of surgery.
 Most surgeons ask patients to shower or bathe on the morning of surgery using a
special antibacterial soap. They should take extra time to lather, scrub, and rinse
their genitals and groin area.
 Patients who are anxious or nervous before the procedure are usually given a
sedative to help them relax.
 CANCER. Patients who are having an orchiectomy as treatment for testicular cancer
should consider banking sperm if they plan to have children following surgery.
Although it is possible to father a child if only one testicle is removed, some surgeons
recommend banking sperm as a precaution in case the other testicle should develop
a tumor at a later date.
 GENDER REASSIGNMENT. Most males who have requested an orchiectomy as part
of male-to-female gender reassignment have been taking hormones for a period of
several months to several years prior to surgery, and have had some real-life
experience dressing and functioning as women. The surgery is not performed as an
immediate response to the patient's request.
 Because the standards of care for gender reassignment require a psychiatric
diagnosis as well as a physical examination , the surgeon who is performing the
orchiectomy should receive two letters of evaluation and recommendation by
mental health professionals, preferably one from a psychiatrist and one from a
clinical psychologist.

Aftercare
 Patients who are having an orchiectomy in an ambulatory surgery center or other
outpatient facility must have a friend or family member to drive them home after
the procedure. Most patients can go to work the following day, although some may
need an additional day of rest at home. Even though it is normal for patients to feel
nauseated after the anesthetic wears off, they should start eating regularly when
they get home. Some pain and swelling is also normal; the doctor will usually
prescribe a pain-killing medication to be taken for a few days.
 Other recommendations for aftercare include:
 Drinking extra fluids for the next several days, except for caffeinated and
alcoholic beverages.
 Avoiding sexual activity, heavy lifting, and vigorous exercise until the follow-
up appointment with the doctor.
 Taking a shower rather than a tub bath for a week following surgery to
minimize the risk of absorbable stitches dissolving prematurely.
 Applying an ice pack to the groin area for the first 24–48 hours.
  Wearing a jock strap or snug briefs to support the scrotum for two weeks
after surgery.
Risks
 Some of the risks for an orchiectomy done under general anesthesia are the same as
for other procedures. They include deep venous thrombosis, heart or breathing
problems, bleeding, infection, or reaction to the anesthesia. If the patient is having
epidural anesthesia, the risks include bleeding into the spinal canal, nerve damage,
or a spinal headache.
 Specific risks associated with an orchiectomy include:
 loss of sexual desire (This side effect can be treated with hormone injections
or gel preparations.)
 impotence
 hot flashes similar to those in menopausal women, controllable by
medication
 weight gain of 10–15 lb (4.5–6.8 kg)
 mood swings or depression
 enlargement and tenderness in the breasts
 fatigue
 loss of sensation in the groin or the genitals
 osteoporosis (Men who are taking hormone treatments for prostate cancer
are at greater risk of osteoporosis.)

 TUBAL LIGATION

 Tubal ligation is a permanent voluntary form of birth control (contraception) in

which a woman's fallopian tubes are surgically cut or blocked off to prevent
pregnancy.
 Tubal ligation, or getting one's "tubes tied," refers to female sterilization, the surgery
that ends a woman's ability to conceive. The operation is performed on the patient's
fallopian tubes. These tubes, which are about 4 in (10 cm) long and 0.2 in (0.5 cm) in
diameter, are found on the upper outer sides of the uterus. They open into the
uterus through small channels. It is within the fallopian tube that fertilization, the
joining of the egg and the sperm, takes place. During tubal ligation, the tubes are cut
or blocked in order to close off the sperm's access to the egg.

PURPOSE
 Tubal ligation is performed in women who want to prevent future pregnancies. It is
frequently chosen by women who do not want more children, but who are still
sexually active and potentially fertile, and want to be free of the limitations of other
types of birth control. Women who should not become pregnant for health concerns
or other reasons may also choose this birth control method.
 Diagnosis/Preparation
 Preparation for tubal ligation includes patient education and counseling. Before
surgery, it is important that the woman understand the permanent nature of tubal
ligation as well as the risks of anesthesia and surgery. Her medical history is
reviewed, and a physical examination and laboratory testing are performed. The
patient is not allowed to eat or drink for several hours before surgery.

Aftercare
 After surgery, the patient is monitored for several hours before she is allowed to go
home. She is instructed on care of the surgical wound, and what signs to watch for,
such as fever, nausea, vomiting, faintness, or pain. These signs could indicate that
complications have occurred.

Risks
 While major complications are uncommon after tubal ligation, there are risks with
any surgical procedure. Possible side effects include infection and bleeding. After
laparoscopy, the patient may experience pain in the shoulder area from the carbon
dioxide used during surgery, but the technique is associated with less pain than mini-
laparotomy, as well as a faster recovery period. Mini-laparotomy results in a higher
incidence of pain, bleeding, bladder injury, and infection compared with
laparoscopy. Patients normally feel better after three to four days of rest, and are
able to resume sexual activity at that time.
 The possibility for treatment failure is very low—fewer than one in 200 women
(0.4%) will become pregnant during the first year after sterilization. Failure can
happen if the cut ends of the tubes grow back together; if the tube was not
completely cut or blocked off; if a plastic clip or rubber band has loosened or come
off; or if the woman was already pregnant at the time of surgery.

 MASTECTOMY

 A surgical procedure that removes the breast, surrounding tissue, and nearby lymph
nodes that are affected by cancer.

PURPOSE
 The purpose for mastectomy is the removal of breast cancer (abnormal cells in the
breast that grow rapidly and replace normal healthy tissue). Modified radical
mastectomy is the most widely used surgical procedure to treat operable breast
cancer. This procedure leaves a chest muscle called the pectoralis major intact.
Leaving this muscle in place will provide a soft tissue covering over the chest wall
 and a normal-appearing junction of the shoulder with the anterior (front) chest wall.
This sparing of the pectoralis major muscle will avoid a disfiguring hollow defect
below the clavicle. Additionally, the purpose of modified radical mastectomy is to
allow for the option of breast reconstruction , a procedure that is possible, if
desired, due to intact muscles around the shoulder of the affected side. The
modified radical mastectomy procedure involves removal of large multiple tumor
growths located underneath the nipple and cancer cells on the breast margins.

Diagnosis/Preparation
 mastectomy is a surgical procedure to treat breast cancer. In order for this
procedure to be an operable option, a definitive diagnosis of breast cancer must be
established. The first clinical sign for approximately 80% of women with breast
cancer is a mass (lump) located in the breast. A lump can be discovered by monthly
self-examination or by a health professional who can find 10–25% of breast cancers
that are missed by yearly mammograms (a low radiation x ray of the breasts). A
biopsy can be performed to examine the cells from a lump that is suspicious for
cancer. The diagnosis of the extent of cancer and spread to regional lymph nodes
determines the treatment course (i.e., whether surgery, chemotherapy, or radiation
therapy, either singly or in combinations).
 Staging the cancer can estimate the amount of tumor, which is important not only
for diagnosis but for prognosis (statistical outcome of the disease process). Patients
with a type of breast cancer called ductal carcinoma in situ (DCIS), which is a stage 0
cancer, have the best outcome (nearly all these patients are cured of breast cancer).
Persons who have cancerous spread to other distant places within the body
(metastases) have stage IV cancer and the worst prognosis (potential for survival).
Persons affected with stage IV breast cancer have essentially no chance for cure.

Aftercare
 After breast cancer surgery, women should undergo frequent testing to ensure early
detection of cancer recurrence. It is recommended that annual mammograms,
physical examination, or additional tests (biopsy) be performed annually. Aftercare
can also include psychotherapy since mastectomy is emotionally traumatic. Affected
women may be worried or have concerns about appearance, the relationship with
their sexual partner, and possible physical limitations. Community-centered support
groups usually made up of former breast cancer surgery patients can be a source of
emotional support after surgery. Patients may stay in the hospital for one to two
days. For about five to seven days after surgery, there will be one or two drains left
inside to remove any extra fluid from the area after surgery. Usually, the surgeon will
prescribe medication to prevent pain. Movement restriction should be specifically
discussed with the surgeon.
 Risks
 There are several risks associated with modified radical mastectomy. The procedure
is performed under general anesthesia, which itself carries risk. Women may have
short-term pain and tenderness. The most frequent risk of breast cancer surgery
(with extensive lymph node removal) is edema, or swelling of the arm, which is
usually mild, but the presence of fluid can increase the risk of infection. Leaving
some lymph nodes intact instead of removing all of them may help lessen the
likelihood of swelling. Nerves in the area may be damaged. There may be numbness
in the arm or difficulty moving shoulder muscles. There is also the risk of developing
a lump scar (keloid) after surgery. Another risk is that surgery did not remove all the
cancer cells and that further treatment may be necessary (with chemotherapy
and/or radiotherapy). By far, the worst risk is recurrence of cancer. However,
immediate signs of risk following surgery include fever, redness in the incision area,
unusual drainage from the incision, and increasing pain. If any of these signs
develop, it is imperative to call the surgeon immediately.

 MYOMECTOMY

 Myomectomy is the removal of fibroids (non-cancerous tumors) from the wall of the
uterus. Myomectomy is the preferred treatment for symptomatic fibroids in women
who want to keep their uterus. Larger fibroids must be removed with an abdominal
incision, but small fibroids can be taken out by laparoscopy orhysteroscopy .
 Usually, fibroids are buried in the outer wall of the uterus, and abdominal surgery is
required. If they are on the inner wall of the uterus, uterine fibroids can be removed
using hysteroscopy. If they are on a stalk (pedunculated) on the outer surface of the
uterus, laparoscopy can be performed.
 Removing fibroids through abdominal surgery is a more difficult and slightly more
risky operation than a hysterectomy. This is because the uterus bleeds from the sites
where the fibroids were removed, and it may be difficult or impossible to stop the
bleeding. This surgery is usually performed under general anesthesia, although some
patients may be given a spinal or epidural anesthesia.

Purpose
 A myomectomy can remove uterine fibroids that are causing such symptoms as
abnormal bleeding or pain. It is an alternative to surgical removal of the whole
uterus ( hysterectomy ). The procedure can relieve fibroid-induced menstrual
symptoms that have not responded to medication. Myomectomy also may be an
effective treatment for infertility caused by the presence of fibroids.
 Diagnosis/Preparation
 Surgeons often recommend hormone treatment with a drug called leuprolide
(Lupron) two to six months before surgery in order to shrink the fibroids. This makes
the fibroids easier to remove. In addition, Lupron stops menstruation, so women
who are anemic have an opportunity to build up their blood count. While the drug
treatment may reduce the risk of excess blood loss during surgery, there is a small
risk that smaller fibroids might be missed during myomectomy, only to enlarge later
after the surgery is completed.

Aftercare
 Patients may need four to six weeks of recovery following a standard myomectomy
before they can return to normal activities. Women who have had laparoscopic or
hysteroscopic myomectomies, however, can usually recover completely within one
to three weeks.

Risks
 The risks of a myomectomy performed by a skilled surgeon are about the same as
hysterectomy (one of the most common and safest surgeries). Removing multiple
fibroids is more difficult and slightly more risky. Possible complications include:
 infection
 blood loss
 weakening of the uterine wall to the degree that future deliveries need to be
performed via cesarean section
 adverse reactions to anesthesia
 internal scarring (and possible infertility)
 reappearance of new fibroids

There is a risk that removal of the fibroids may lead to such severe bleeding that the
uterus itself will have to be removed. Because of the risk of blood loss during a
myomectomy, patients may want to consider banking their own blood before
surgery ( autologous blood donation ).

GASTROINTESTINAL
 APPENDECTOMY
 An appendectomy is surgery to remove the appendix.
 The appendix is a small, finger-shaped organ extending from the first part of the
large intestine. It is removed when it becomes inflamed or infected. A perforated
 appendix can leak and infect the entire abdominal area, which can be life-
threatening.
 An appendectomy is done under general anesthesia, which means you are asleep
and do not feel any pain during the surgery. The surgeon makes a small cut in the
lower right side of your belly area and removes the appendix.
 The appendix can also be removed using minimally invasive techniques. This is called
a laparoscopic appendectomy. It is performed with small incisions and a camera.
 If the appendix ruptured or a pocket of infection (abscess) formed, your abdomen
will be thoroughly washed out during surgery. A small tube may be left in the belly
area to help drain out fluids or pus.

Why the Procedure is Performed

 The symptoms of appendicitis vary. The condition can be hard to diagnose, especially
in children, the elderly, and women of childbearing age.
 Most often, the first symptom is pain around your belly button.
 The pain may be vague at first, but it becomes sharp and severe.
 The pain often moves into your right lower abdomen and becomes more
focused in this area.
 Other symptoms include:
 Fever (usually not very high)
 Reduced appetite
 Nausea and vomiting

Risks
 Risks for any anesthesia include the following:
 Reactions to medications
 Problems breathing
 Risks for any surgery include the following:
 Bleeding
 Infection
 Other risks with an appendectomy after a ruptured appendix include the following:
 Longer hospital stays
 Side effects from medications

After the Procedure
 Patients tend to recover quickly after a simple appendectomy. Most patients leave
the hospital in 1 - 3 days after surgery. You can resume normal activities within 2 - 4
weeks after leaving the hospital.
 Recovery is slower and more complicated if the appendix has ruptured or an abscess
has formed.
 Living without an appendix causes no known health problems.
 GASTRECTOMY
 Gastrectomy is surgery to remove part or all of the stomach.
 The surgery is done while you are under general anesthesia (asleep and pain-free).
The surgeon makes a cut in the abdomen and removes all or part of the stomach,
depending on the reason for the operation.
 Depending on what part of the stomach was removed, the intestine may need to be
re-connected to the remaining stomach (partial gastrectomy) or to the esophagus
(total gastrectomy).

Why the Procedure is Performed

 Gastrectomy is used to treat bleeding, inflammation, non-cancerous tumors, or
cancer.

Risks
 Risks of any anesthesia include:
 Severe medication reaction
 Problems breathing
 Risks of any operation include:
 Bleeding
 Infection

After the Procedure
 How well you do after surgery depends on the reason for the surgery and your
underlying condition.

 SPLENECTOMY
 is surgery to remove a diseased or damaged spleen. This organ is in the upper part of
your belly, on the left side. It helps your body fight germs and infections. It also helps
filter your blood.
 The spleen is removed while you are under general anesthesia (asleep and pain-
free). Your surgeon may do either an open splenectomy or a laparoscopic
splenectomy.

Why the Procedure is Performed

 Some conditions that may require spleen removal are:
 Trauma to the spleen
 Blood clot (thrombosis) in the blood vessels of the spleen
  Diseases or disorders of blood cells, such as idiopathic thrombocytopenia
purpura (ITP), hereditary spherocytosis, thalassemia, hemolytic anemia,
and hereditary elliptocytosis. These are all rare conditions.
 Sickle cell anemia
 Abscess or cyst in the spleen
 Lymphoma, Hodgkin's disease, and leukemia
 Other tumors or cancers that affect the spleen
 Cirrhosis of the liver
 Hypersplenism
 Splenic artery aneurysm (rare)

Risks
 Risks for any surgery are:
 Blood clots in the legs that may travel to the lungs
 Breathing problems
 Infection, including in the surgical wound, lungs (pneumonia), bladder, or
kidney
 Blood loss
 Heart attack or stroke during surgery
 Reactions to medicines
 The risks or problems that may occur during or soon after this surgery are:
 Injury to nearby organs, such as the pancreas, stomach, and colon
 Increased risk for infection after splenectomy (post-splenectomy sepsis or
other infections -- children are at higher risk than adults for infection)
 Collapsed lung
 Blood clot in the portal vein (an important vein that carries blood to the liver)
 Risks are the same for both open and laparoscopic spleen removal.

Before the Procedure

 You will have many visits with your doctor and several tests before you have surgery.
Some of these are:
 A complete physical exam
 Screening blood tests, special imaging tests, and other tests to make sure you
are healthy enough to have surgery
 Transfusions to receive extra red blood cells and platelets, if you need them
 Immunizations, such as pneumococcal (Pneumovax), meningococcal vaccine,
Haemophilus vaccine, and flu vaccine
 If you smoke, you should stop smoking several weeks before this surgery. Spleen
removal is major surgery, and smoking will increase your risks of problems.
 Always tell your doctor or nurse:
 If you are or might be pregnant
  What drugs, vitamins, and other supplements you are taking, even ones you
bought without a prescription

During the week before your surgery
 You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), clopidogrel
(Plavix), vitamin E, warfarin (Coumadin), and any other drugs like these.
 Ask your doctor which drugs you should still take on the day of your surgery.
On the day of your surgery
 Do not eat or drink anything after midnight the night before your surgery.
 Take the drugs your doctor told you to take with a small sip of water.
 Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
 You or your child will spend less than a week in the hospital. Your hospital stay may
be only one or two days after a laparoscopic splenectomy. You should heal in four to
six weeks.

 PANCREATICODUO-DENECTOMY
 Pancreaticoduodenectomy (also called a Whipple procedure) refers to the surgical
removal of part of the common bile duct, the gallbladder, the duodenum, the
pancreas down to its middle section, and sometimes part of the stomach. The lymph
nodes that surround these organs are removed in the presence of a malignancy. The
middle part of the small intestine (jejunum) is then attached to the remaining parts
of the pancreas and bile duct so that pancreatic secretions (digestive enzymes) and
bile still flow into the intestinal tract. Pancreatic cancer must be relatively confined.

Reason for Procedure

 Pancreaticoduodenectomy is performed to remove diseased pancreatic tissue and to
relieve the severe pain produced by these diseases.
 Pancreaticoduodenectomy is used to treat localized pancreatic cancer, acute or
chronic inflammation of the pancreas (pancreatitis) that does not respond to medical
treatment, hormone-secreting tumors (insulinomas), cancer of the small chamber
formed by the union of the common bile duct and pancreatic duct (ampulla of
Vater), pancreatictrauma, and pancreatic cysts.

How Procedure is Performed

 Pancreaticoduodenectomy is a major surgical procedure that requires
hospitalization. It is performed under general anesthesia, and a urinary catheter is
usually inserted to facilitate bladder elimination.
 The surgeon makes an incision across and through the upper abdominal wall (wide
transverse subcostal approach) to expose the pancreas and other abdominal organs
as needed. Most commonly, the head of the pancreas and varying amounts of its
 neck and body, the gallbladder, the end of the common bile duct, and the upper part
of the small intestine (duodenum and proximal 10 centimeters of the jejunum) are
removed. Sometimes part of the stomach (distal third with the right half of the
greater omentum) and the lymph nodes that surround the pancreas and small
intestine (peripancreatic and hepatoduodenal nodes) will also be removed. Blood
vessels (arteries, veins) and lymphatic ducts are tied off as these tissues are
removed. The surgeon then connects the remaining portion of the pancreas to the
small intestine and the remaining bile duct so that the pancreatic duct secretions
and bile can empty into the intestinal tract (pancreatojejunostomy). Temporary
abdominal drains (Jackson-Pratt and Volker drains) may be put in.
Abdominalsutures and drains will be removed on an outpatient basis 2 to 3 weeks
after surgery.

Complications
 Complications of pancreaticoduodenectomy may include leakage from the
pancreatic duct, abdominal pain, bleeding (hemorrhage), creation of an abnormal
channel out of the bile duct (biliary fistula), decreased blood flow to the abdominal
tissues (mesenteric ischemia), development of pockets of infection (abscess) within
the liver or abdomen, fluid accumulation in the intestine (chylous ascites), puncture
of the stomach (gastric perforation), and twisting of the small intestine (jejunal
torsion).
 The pancreas may become inflamed (acute pancreatitis). An abnormal channel may
form through the pancreatic duct (pancreatic fistula) in nearly 2% of cases. Death
rarely occurs from either of the latter two complications.

 COLECTOMY
 is a surgical procedure to remove all or part of your colon. Your colon, also called
your large intestine, is a long tube-like organ at the end of your digestive system.
Colectomy may be necessary to treat or prevent diseases and conditions that affect
your colon.
 There are various types of colectomy operations. Colectomy that involves removing
the entire colon is called total colectomy. Colectomy to remove part of the colon
may be called subtotal colectomy or partial colectomy. Removing the right or left
portion of the colon is called hemicolectomy. Surgery to remove both the colon and
rectum is called proctocolectomy.
 Colectomy surgery usually requires other procedures to reattach the remaining
portions of your digestive system and permit waste to leave your body.

Why it's done

 Colectomy is used to treat and prevent diseases and conditions that affect the colon,
such as:
  Bleeding that can't be controlled. Severe bleeding from the colon may
require surgery to remove the affected portion of the colon. For instance, in
rare cases, pockets in the colon (diverticula) can cause bleeding that may
require surgery.
 Bowel obstruction. A blocked colon is an emergency that may require total
or partial colectomy, depending on the situation.
 Bowel perforation. A torn colon is also an emergency that may require
colectomy.
 Colon cancer. Early-stage cancers may require only a small section of the
colon to be removed during colectomy. Cancers at a later stage may require
more of the colon to be removed.
 Crohn's disease. If medications aren't helping you, removing the affected
part of your colon may offer temporary relief from signs and symptoms.
 Ulcerative colitis. Your doctor may recommend total colectomy if
medications aren't helping to control your signs and symptoms.
 Preventive surgery. If you have a very high risk of colon cancer due to the
formation of multiple precancerous colon polyps, you may choose to undergo
total colectomy to prevent cancer in the future. Colectomy may be an option
for people with inherited genetic conditions that increase colon cancer risk,
such as familial adenomatous polyposis or Lynch syndrome.

Risks
 Colectomy carries a risk of serious complications. Your risk of complications is based
on your general health, the type of colectomy you undergo and the approach your
surgeon uses to perform the operation. In general, complications of colectomy can
include:
 Bleeding
 Blood clots in the legs (deep vein thrombosis) and the lungs (pulmonary
embolism)
 Infection
 Injury to organs near your colon, such as the bladder and small intestines
 Tears in the sutures that reconnect the remaining parts of your digestive
system

How you prepare
 During the days leading up to your colon surgery, your doctor may ask that you:
 Stop taking certain medications. Certain medications can increase your risk
of complications during surgery, so your doctor will ask that you stop taking
those medications before your surgery.
  Fast before your surgery. Your doctor will give you specific instructions. You
may be asked to stop eating and drinking several hours to a day before your
procedure.
 Drink a solution that clears your bowels. Your doctor may prescribe a
laxative solution that you mix with water at home. You drink the solution
over several hours, following the directions. The solution causes diarrhea to
help empty your colon. Your doctor may also recommend enemas.
 Take antibiotics. In some cases, your doctor may prescribe antibiotics to
suppress the bacteria found naturally in your colon and prevent infection.
 Take a shower. Shower before going to the hospital for your surgery. This
may help reduce your risk of infection by cleaning germs from your skin. Your
doctor may recommend that you use a particular soap or antibacterial skin
wash.

After your colectomy

After surgery you'll be taken to a recovery room to be monitored as the anesthesia

wears off. Then your health care team will take you to your hospital room to
continue your recovery.
 You'll stay in the hospital until you regain bowel function. This may take a couple of
days to a week. You may not be able to eat solid foods at first. You might receive
liquid nutrition through a vein in your arm and then transition to drinking clear
liquids. As your intestines recover, you can eventually add solid foods.
 If your surgery involved a colostomy or ileostomy to attach your intestine to the
outside of your abdomen, you'll meet with an ostomy nurse who will show you how
to care for your stoma. The nurse will explain how to change the ostomy bag that
will collect waste.
 Once you leave the hospital, expect a couple of weeks of recovery at home. You may
feel weak at first, but eventually your strength will return. Ask your doctor when you
can expect to get back to your normal routine.

 CHOLECYSTECTOMY
 is the surgical removal of the gallbladder. It is the most common method for treating
symptomatic gallstones. Surgical options include the standard procedure,
called laparoscopiccholecystectomy, and an older more invasive procedure,
called open cholecystectomy.

Procedural Risks and Complications

 Laparoscopic cholecystectomy does not require the abdominal muscles to be cut,
resulting in less pain, quicker healing, improved cosmetic results, and fewer
complications such as infection and adhesions. Most patients can be discharged on
 the same or following day as the surgery, and most patients can return to any type
of occupation in about a week.
An uncommon but potentially serious complication is injury to the common bile
duct, which connects the gallbladder and liver. An injured bile duct can leak bile and
cause a painful and potentially dangerous infection. Many cases of minor injury to
the common bile duct can be managed non-surgically. Major injury to the bile duct,
however, is a very serious problem and may require corrective surgery. This surgery
should be performed by an experienced biliary surgeon
 Abdominal peritoneal adhesions, gangrenous gallbladders, and other problems that
obscure vision are discovered during about 5% of laparoscopic surgeries, forcing
surgeons to switch to the standard cholecystectomy for safe removal of the
gallbladder. Adhesions and gangrene, of course, can be quite serious, but converting
to open surgery does not equate to a complication.
One common complication of cholecystectomy is inadvertent injury to an anomalous
bile duct known as Ducts of Luschka, occurring in 33% of the population. It is non-
problematic until the gall bladder is removed, and the tiny supravesicular ducts may
be incompletely cauterized or remain unobserved, leading to biliary leak post
operatively. The patient will develop biliary peritonitis within 5 to 7 days following
surgery, and will require a temporary biliary stent. It is important that the clinician
recognize the possibility of bile peritonitis early and confirm diagnosis via HIDA
scan to lower morbidity rate. Aggressive pain management and antibiotic therapy
should be initiated as soon as diagnosed

 COLOSTOMY
A colostomy is a surgical procedure that brings a portion of the large intestine
through the abdominal wall to carry feces out of the body.

Surgery will result in one of three types of colostomies:

 End colostomy
 The functioning end of the intestine (the section of bowel that remains
connected to the upper gastrointestinal tract) is brought out onto the surface
of the abdomen, forming the stoma (artificial opening) by cuffing the
intestine back on itself and suturing the end to the skin. The surface of the
stoma is actually the lining of the intestine, usually appearing moist and pink.
The distal portion of bowel (now connected only to the rectum) may be
removed, or sutured closed and left in the abdomen. An end colostomy is
usually a permanent ostomy, resulting from trauma, cancer, or another
pathological condition.
 Double-barrel colostomy
 This involves the creation of two separate stomas on the abdominal wall. The
proximal (nearest) stoma is the functional end that is connected to the upper
 gastrointestinal tract and will drain stool; the distal stoma, connected to the
rectum and also called a mucous fistula, drains small amounts of mucus
material. This is most often a temporary colostomy performed to rest an area
of bowel, and to be later closed.
 Loop colostomy
 This surgery brings a loop of bowel through an incision in the abdominal wall.
The loop is held in place outside the abdomen by a plastic rod slipped
beneath it. An incision is made in the bowel to allow the passage of stool
through the loop colostomy. The supporting rod is removed approximately
seven to 10 days after surgery, when healing has occurred that will prevent
the loop of bowel from retracting into the abdomen. A loop colostomy is
most often performed for creation of a temporary stoma to divert stool away
from an area of intestine that has been blocked or ruptured.

Diagnosis/Preparation
 A number of diseases and injuries may require a colostomy. Among the diseases are
inflammatory bowel disease and colorectal cancer. Determining whether this surgery
is necessary is a decision the physician makes based on a number of factors,
including patient history, amount of pain, and the results of tests such
ascolonoscopy and lower G.I. (gastrointestinal) series. Due to lifestyle impact of the
surgery, the decision is made after careful consultation with the patient. However,
an immediate decision may be made in emergency situations involving injuries or
puncture wounds in the abdomen or intestinal perforations related to diverticulear
disease, ulcers, or life-threatening cancer.
As with any surgical procedure, the patient will be required to sign a consent form
after the procedure is explained thoroughly. Blood and urine studies, along with
various x rays and an electrocardiograph (EKG), may be ordered as the doctor deems
necessary. If possible, the patient should visit an enterostomal therapist, who will
mark an appropriate place on the abdomen for the stoma and offer preoperative
education on ostomy management
 In order to empty and cleanse the bowel, the patient may be placed on a low-residue
diet for several days prior to surgery. A liquid diet may be ordered for at least the
day before surgery, with nothing by mouth after midnight. A series of enemas and/or
oral preparations (GoLytely or Colyte) may be ordered to empty the bowel of stool.
Oral anti-infectives (neomycin, erythromycin, or kanamycin sulfate) may be ordered
to decrease bacteria in the intestine and help prevent postoperative infection. A
nasogastric tube is inserted from the nose to the stomach on the day of surgery or
during surgery to remove gastric secretions and prevent nausea and vomiting. A
urinary catheter (a thin plastic tube) may also be inserted to keep the bladder empty
during surgery, giving more space in the surgical field and decreasing chances of
accidental injury.
 Aftercare
 Postoperative care for the patient with a new colostomy, as with those who have
had any major surgery, involves monitoring of blood pressure, pulse, respirations,
and temperature. Breathing tends to be shallow because of the effect of anesthesia
and the patient's reluctance to breathe deeply and experience pain that is caused by
the abdominal incision. The patient is instructed how to support the operative site
during deep breathing and coughing, and given pain medication as necessary. Fluid
intake and output is measured, and the operative site is observed for color and
amount of wound drainage. The nasogastric tube will remain in place, attached to
low, intermittent suction until bowel activity resumes. For the first 24–48 hours after
surgery, the colostomy will drain bloody mucus.
 Fluids and electrolytes are infused intravenously until the patient's diet can gradually
be resumed, beginning with liquids. Usually within 72 hours, passage of gas and stool
through the stoma begins. Initially, the stool is liquid, gradually thickening as the
patient begins to take solid foods. The patient is usually out of bed in eight to 24
hours after surgery and discharged in two to four days.
A colostomy pouch will generally have been placed on the patient's abdomen around
the stoma during surgery. During the hospital stay, the patient and his or her
caregivers will be educated on how to care for the colostomy. Determination of
appropriate pouching supplies and a schedule of how often to change the pouch
should be established
 Regular assessment and meticulous care of the skin surrounding the stoma is
important to maintain an adequate surface on which to attach the pouch. Some
patients with colostomies are able to routinely irrigate the stoma, resulting in
regulation of bowel function; rather than needing to wear a pouch, these patients
may only need a dressing or cap over their stoma. Often, an enterostomal therapist
will visit the patient in the hospital or at home after discharge to help the patient
with stoma care.
Dietary counseling will be necessary for the patient to maintain normal bowel
function and to avoid constipation, impaction, and other discomforts

Risks
 Potential complications of colostomy surgery include:
 excessive bleeding
 surgical wound infection
 thrombophlebitis (inflammation and blood clot to veins in the legs)
 pneumonia
 pulmonary embolism (blood clot or air bubble in the lungs' blood supply)
 Psychological complications may result from colostomy surgery because of the fear
of the perceived social stigma attached to wearing a colostomy bag. Patients may
also be depressed and have feelings of low self-worth because of the change in their
lifestyle and their appearance. Some patients may feel ugly and sexually unattractive
and may worry that their spouse or significant other will no longer find them
appealing. Counseling and education regarding surgery and the inherent lifestyle
changes are often necessary.

 NISSEN FUNDOPLICATION
Nissen Fundoplication is typically performed in patients with serious
gastroesophageal reflux disease that does not respond to drug therapy.
Gastroesophageal reflux is classified as the symptoms produced by the inappropriate
movement of stomach contents back up into the esophagus. Nissen fundoplication is
the most common surgical approach in the correction of gastroesophageal reflux.
The laparoscopic method of Nissen fundoplication is becoming the standard form of
surgical correction.

Purpose
 Nissen fundoplication and laparoscopic fundoplication, has two essential purposes:
heartburn symptom relief and reduced backflow of stomach contents into the
esophagus.

Heartburn symptom relief

 Because Nissen fundoplication is considered surgery, it is usually considered as a
treatment option only when drug treatment is only partially effective or ineffective.
Nissen fundoplication is often used in patients with a particular anatomic
abnormality called hiatal hernia that causes significant gastroesophageal reflux. In
some cases, Nissen fundoplication is also used when the patient cannot or does not
want to take reflux medication. Surgery is also more likely to be considered when it
is obvious that the patient will need to take reflux drugs on a permanent basis.
Reflux drugs, like virtually all drugs, may produce side effects, especially when taken
over a period of years.
 One of the biggest problems in diagnosing and controlling gastroesophageal reflux
disease is that the severity of disease is not directly related to the presence or
intensity of symptoms. There is also no consistent relationship between the severity
of disease and the degree of tissue damage in the esophagus. When reflux occurs,
stomach acid comes into contact with the cells lining the esophagus. This contact can
produce a feeling of burning in the esophagus and is commonly called heartburn.
Some of the other symptoms associated with this condition include:
 chest pain
 swallowing problems
  changes in vocal qualities

Reduced reflux
 The reduction or elimination of reflux is as important, and sometimes more
important, than the elimination of symptoms. This necessity leads to one of the most
important points in gastroesophageal reflux disease. Long-term exposure to acid in
the esophagus tends to produce changes in the cells of the esophagus. These
changes are usually harmful and can result in very serious conditions, such as
Barrett's esophagus and cancer of the esophagus. Because of this, all persons with
gastroesophageal reflux disease symptoms need to be evaluated with a diagnostic
instrument called an endoscope. An endoscope is a long, flexible tube with a camera
on the end that is inserted down the throat and passed all the way down to te
esophageal/stomach region.

 TONSILLECTOMY
 Tonsillectomy is a surgical procedure to remove the tonsils. The tonsils are part of
the lymphatic system, which is responsible for fighting infection.
 A tonsillectomy is usually performed under general anesthesia, although adults may
occasionally receive a local anesthetic. The surgeon depresses the tongue in order to
see the throat, and removes the tonsils with an instrument resembling a scoop.
 Alternate methods for removing tonsils are being investigated, including lasers and
other electronic devices.

Purpose
 Tonsils are removed when a person, most often a child, has any of the following
conditions:
 obstruction
 sleep apnea (a condition in which an individual snores loudly and stops
breathing temporarily at intervals during sleep)
 inability to swallow properly because of enlarged tonsils
 a breathy voice or other speech abnormality due to enlarged tonsils
 recurrent or persistent abscesses or throat infections
 Physicians are not in complete agreement on the number of sore throats that
necessitate a tonsillectomy. Most would agree that four cases of strep throat in any
one year; six or more episodes of tonsillitis in one year; or five or more episodes of
tonsillitis per year for two years indicate that the tonsils should be removed.

Diagnosis/Preparation
 Tonsillectomy procedures are not performed as frequently today as they once were.
One reason for a more conservative approach is the risk involved when a person is
put under general anesthesia.
 In some cases, a tonsillectomy may need to be modified or postponed:
 Bleeding disorders must be adequately controlled prior to surgery.
 Acute tonsillitis should be successfully treated prior to surgery. Treatment
may postpone the surgery three to four weeks.

Aftercare
 Persons are turned on their side after the operation to prevent the possibility of
blood being drawn into the lungs (aspirated). Vital signs are monitored. Patients can
drink water and other non-irritating liquids when they are fully awake.
 Adults are usually warned to expect a very sore throat and some bleeding after the
operation. They are given antibiotics to prevent infection, and some receive pain-
relieving medications. For at least the first 24 hours, individuals are instructed to
drink fluids and eat soft, pureed foods.
 People are usually sent home the day of surgery. They are given instructions to call
their surgeon if there is bleeding or earache, or fever that lasts longer than three
days. They are told to expect a white scab to form in the throat between five and 10
days after surgery.

Risks
 There is a chance that children with previously normal speech will develop a nasal-
sounding voice. In addition, children younger than five years may be emotionally
upset by the hospital experience. There are risks associated with any surgical
procedure, including post-operative infection and bleeding.

 HEPATECTOMY
 Hepatectomy consists on the surgical resection of the liver. While the term is often
employed for the removal of the liver from a liver transplant recipient, this article
will focus on partial resections of hepatic tissue.

Indications
 Most hepatectomies are performed for the treatment of hepatic neoplasms, both
benign or malignant.
 Benign neoplasms include hepatocellular adenoma, hepatic hemangioma and focal
nodular hyperplasia.
 The most common malignant neoplasms (cancers) of the liver are metastases; those
arising from colorectal cancer are among the most common, and the most amenable
to surgical resection. The most common primary malignant tumour of the liver is
the hepatocellular carcinoma.
 Hepatectomy may also be the procedure of choice to treat
intrahepatic gallstones or parasitic cysts of the liver.

Technique
 Access is accomplished by laparotomy, typically by a bilateral subcostal ("chevron")
incision, possibly with midline extension (Calne or "Mercedes-Benz" incision).
 Hepatectomies may be anatomic, i.e. the lines of resection match the limits of one or
more functional segments of the liver as defined by the Couinaud classification
(cf. liver#Functional anatomy); or they may be non-anatomic, irregular or "wedge"
hepatectomies.
 Anatomic resections are generally preferred because of the smaller risk of bleeding
and biliary fistula; however, non-anatomic resections can be performed safely as
well in selected cases. For details on the variety of anatomic hepatectomies and the
specific nomenclature, cf. the International Hepato-Pancreatico-Biliary Association
(IHPBA) Terminology for Liver Resections

Complications
 Bleeding is the most feared technical complication and may be grounds for urgent
reoperation. Biliary fistula is also a possible complication, albeit one more amenable
to nonsurgical management. Pulmonary complications such
as atelectasis and pleural effusion are commonplace, and dangerous in patients with
underlying lung disease. Infection is relatively rare.
 Liver failure poses a significant hazard to patients with underlying hepatic disease;
this is a major deterrent in the surgical resection of hepatocellular carcinoma in
patients with cirrhosis. It is also a problem, to a lesser degree, in patients with
previous hepatectomies (e.g. repeat resections for reincident colorectal
cancer metastases).

 SPHINCTEROTOMY
 A sphincterotomy is a procedure performed to treat anal fissures. An anal fissure is a
split in the lining of the rectum, possibly resulting from a hard bowel movement.
Muscle spasms and subsequent bowel movements prevent healing. Fissures can be
encouraged to heal using topical medications and stool softeners, but severe or
recurring fissures may require a sphincterectomy.
 During a sphincterotomy, the outermost part of the anal sphincter is cut. This
weakens the muscle and relieves the muscle spasms which prevents healing. A
sphincterotomy may be performed in a hospital or clinic.

Details of the procedure

 What do I need to do before surgery?
 Please contact your insurance company to verify the coverage and determine
whether a referral is required. You will be asked to pre-register with the
appropriate hospital and provide demographic and insurance information.
This must be completed at least five to ten days before the date of surgery.
Your surgeon will give you specific instructions on how to prepare for your
surgery.
 What type of anesthesia will be used?
 You will have a pre-operative interview with an anesthesiologist, who will ask
you questions regarding your medical history. A Spincterotomy may be
performed using general or local anesthesia. With a general anesthetic, you
will be asleep during surgery. With a local anesthetic, you will be alert during
the surgery, and only the incision location will be anesthetized. Your surgeon
and anesthesiologist will determine the best option for you.
 What happens on the day of surgery?
 You will report to a pre-operative nursing unit, where you will change into a
gown. A nurse will review your chart and confirm that all paperwork is in
order. Before any medications are administered, your surgeon will verify your
name and the type of procedure you are having. You will then be taken to the
operating room. After the appropriate form of anesthesia is administered,
surgery will be performed.
 What happens during the surgery, how is the surgery performed?
 First, any skin tags associated with the fissure are removed. Then, an incision
is carefully made on the anal sphincter. This relaxes the sphincter and allows
stretching, so that less strain is placed on the fissure.
 What happens after the surgery, and how long will I be in the hospital?
 Once the surgery is completed, you will be taken to a post-operative or
recovery unit. Your length of stay will depend on the complexity of the
procedure. Most patients return home on the same day.
Your doctor will explain the procedure for post-operative care. This will involve
keeping the operated area clean and dry, eating a high fiber diet, drinking plenty of
fluids, and using stools softeners
 What are the risks associated with a sphincterotomy?
 As with any surgery, there are risks such as bleeding, infection, or an adverse
reaction to anesthesia. There is also the possibility of an abscess or fistula
formation, or the inability to control gas and bowel movements. Your doctor
will discuss these risks in detail.
 What should I watch out for?
 Be sure to call your doctor if any of the following symptoms appear:
• Bleeding
• Fever 
 • Redness, warmth, or swelling around the incision
• Drainage from the incision
 When can I return to work and resume normal activities?
Patients usually resume normal activities after one to two weeks. Full recovery may
take as long as two months. 

GENITOURINARY

 PYELOLITHOTOMY
The term pyelo means renal pelvis, and the term lithotomy means removal of stone.
Since the advent of extracorporeal shockwave lithotripsy (ESWL) and percutaneous
nephropyelolithotomy (PCN), pyelolithotomy is becoming an uncommon surgery in
most developing countries. However, before these newer technologies,
pyelolithotomy was the procedure of choice for stones within the renal pelvis,
including stones that demonstrated minimal invasion into calyces and infundibulum.

DIAGNOSIS
 The usual presenting symptom for renal calculi is radiating colicky flank pain, usually
associated with hematuria. Larger stones, however, may be relatively asymptomatic
or present with persistent infection and/or hematuria. The diagnosis of renal calculi
is generally made radiographically. Currently, the most common radiologic method
of diagnosis is via a KUB and intravenous pyelography, though some centers are
investigating the use of ultrasound and computed tomography.

INDICATIONS FOR SURGERY

 Although its use is limited because of this relative invasiveness, it sometimes has a
role to play, particularly when the stone burden is large or when problems with body
shape or habitus prevent percutaneous access to renal calculi or focusing on the
stone by ESWL.

Contraindications
 Pyelolithotomy is absolutely contraindicated in patients in a poor general medical
condition or those with severe kyphoscoliosis. Only consider this surgery when all
other options fail.
Relative contraindications include branched staghorn calculi with infundibular
stenosis and stones in the calices. These conditions may be approached using the
Boyce anatrophic nephrolithotomy or calycelectomy

Preoperative Details
 A plain x-ray film of the abdomen (KUB) is essential because kidney stones are
notorious for moving. Kidney position is always higher than visualized on the x-ray
 film; always incise above the site noted. Always assume more than one stone is
present in the renal pelvis. Make a bigger incision to gain better exposure. Be
prepared to take intraoperative x-ray films.

Intraoperative Details
 Recognize the left testicular vein or ovarian vein on the left side and on the right side
of the vena cava. Gonadal veins may be sacrificed with impunity if the need arises.
Always mobilize the entire kidney, both upper and lower poles. Be prepared to
extend the pyelotomy incision. The UPJ is not inviable; make sure it is not narrowed
when closing.
 If necessary, perform an extended pyelolithotomy to remove a larger stone. Always
use stone forceps to remove the stones, not regular forceps. When in doubt,
perform a nephroscopy or obtain an intraoperative x-ray film. When a caliceal stone
is present, incise the calyx and the infundibulum and then remove the stone with the
stone forceps. If several small stones are present, consider the use of a coagulum
pyelolithotomy.

Postoperative Details
 Pain is less severe if bupivacaine (Marcaine) is injected, but be absolutely sure that
the bupivacaine is not accidentally injected into a vessel because it can cause cardiac
arrhythmias.
 Drains may be removed in 24 hours if the drainage is less than 25 mL. Ureteral stents
can be removed after 2 weeks. If a ureteral catheter is used as a stent, it can be
removed after 5 days.

 NEPHRECTOMY
 A nephrectomy is a surgical procedure for the removal of a kidney or section of a
kidney.
 Nephrectomy may involve removing a small portion of the kidney or the entire
organ and surrounding tissues. In partial nephrectomy, only the diseased or infected
portion of the kidney is removed. Radical nephrectomy involves removing the entire
kidney, a section of the tube leading to the bladder (ureter), the gland that sits atop
the kidney (adrenal gland), and the fatty tissue surrounding the kidney. A simple
nephrectomy performed for living donor transplant purposes requires removal of
the kidney and a section of the attached ureter.

Purpose
Nephrectomy, or kidney removal, is performed on patients with severe kidney
damage from disease, injury, or congenital conditions. These include cancer of the
kidney (renal cell carcinoma); polycystic kidney disease (a disease in which cysts, or
 sac-like structures, displace healthy kidney tissue); and serious kidney infections. It is
also used to remove a healthy kidney from a donor for the purposes of kidney
transplantation 

Diagnosis/Preparation
 Prior to surgery, blood samples will be taken from the patient to type and
crossmatch in case transfusion is required during surgery. A catheter will also be
inserted into the patient's bladder. The surgical procedure will be described to the
patient, along with the possible risks.

Aftercare
 Nephrectomy patients may experience considerable discomfort in the area of the
incision. Patients may also experience numbness, caused by severed nerves, near or
on the incision. Pain relievers are administered following the surgical procedure and
during the recovery period on an as-needed basis. Although deep breathing and
coughing may be painful due to the proximity of the incision to the diaphragm,
breathing exercises are encouraged to prevent pneumonia. Patients should not drive
an automobile for a minimum of two weeks.

Risks
 Possible complications of a nephrectomy procedure include infection, bleeding
(hemorrhage), and post-operative pneumonia. There is also the risk of kidney failure
in a patient with impaired function or disease in the remaining kidney.

 NEPHROSTOMY
 A nephrostomy is a surgical procedure by which a tube, stent, or catheter is inserted
through the skin and into the kidney.
 First, the patient is given an anesthetic to numb the area where the catheter will be
inserted. The doctor then inserts a needle into the kidney. There are several imaging
technologies such as ultrasound and computed tomography (CT) that are used to
help the doctor guide the needle into the correct place.
 Next, a fine guide wire follows the needle. The catheter, which is about the same
diameter as IV (intravenous) tubing, follows the guide wire to its proper location. The
catheter is then connected to a bag outside the body that collects the urine. The
catheter and bag are secured so that the catheter will not pull out. The procedure
usually takes one to two hours.

PURPOSE
 The ureter is the fibromuscular tube that carries urine from the kidney to the
bladder. When this tube is blocked, urine backs up into the kidney. Serious,
 irreversible kidney damage can occur because of this backflow of urine. Infection is
also a common consequence in this stagnant urine.
 Nephrostomy is performed in several different circumstances:
 The ureter is blocked by a kidney stone.
 The ureter is blocked by a tumor.
 There is a hole in the ureter or bladder and urine is leaking into the body.
 As a diagnostic procedure to assess kidney anatomy.
 As a diagnostic procedure to assess kidney function.

Diagnosis/Preparation
 Either the day before or the day of the nephrostomy, blood samples are taken. Other
diagnostic tests done before the procedure may vary, depending on why the
nephrostomy is being done, but the patient may have a CT scan or ultrasound to
help the treating physician locate the blockage.
 Patients should not eat for eight hours before a nephrostomy. On the day of the
procedure, the patient will have an IV line placed in a vein in the arm. Through this
line, the patient will receive antibiotics to prevent infection, medication for pain, and
fluids. The IV line will remain in place after the procedure for at least several hours,
and often longer.
 People preparing for a nephrostomy should review with their doctor all the
medications they are taking. People taking anticoagulants (blood thinners such as
Coumadin) may need to stop their medication. People taking metformin
(Glucophage) may need to stop taking the medication for several days before and
after nephrostomy. Diabetics should discuss modifying their insulin dose because
fasting is required before the procedure.

Aftercare
 Outpatients are usually expected to stay in the clinic or hospital for eight to 12 hours
after the procedure to make sure the nephrostomy tube is functioning properly.
They should plan to have someone drive them home and stay with them for at least
the first 24 hours after the procedure. Inpatients may stay in the hospital several
days. Generally, people feel sore where the catheter is inserted for about a week to
10 days.
 Care of the nephrostomy tube is important. It is located on the patient's back, so it
may be necessary to have someone help with its care. The nephrostomy tube should
be kept dry and protected from water when taking showers. The skin around it
should be kept clean, and the dressing over the area changed frequently. It is the
main part of the urine drainage system, and it should be treated very carefully to
prevent bacteria and other germs from entering the system. If any germs get into
the tubing, they can easily cause a kidney infection. The drainage bag should not be
allowed to drag on the floor. If the bag should accidentally be cut or begin to leak, it
 must be changed immediately. It is not recommended to place the drainage bag in a
plastic bag if it leaks.

Risks
 A nephrostomy is an established and generally safe procedure. As with all
operations, there is always a risk of allergic reaction to anesthesia, bleeding, and
infection.
 Bruising at the catheter insertion site occurs in about half of people who have a
nephrostomy. This is a minor complication. Major complications include the
following:
 Injury to surrounding organs, including bowel perforation, splenic injury, and
liver injury
 infection, leading to septicemia
 significant loss of functioning kidney tissue (<1%)
 delayed bleeding, or hemorrhage (<0.5%)
 blocking of a kidney artery (<0.5%)

ENDOCRINE GLANDS

 THYROIDECTOMY

 is an operation that involves the surgical removal of all or part of the thyroid gland.

Surgeons often perform a thyroidectomy when a patient has thyroid cancer or some
other condition of the thyroid gland (such as hyperthyroidism). Other indications for
surgery include cosmetic (very enlarged thyroid), or symptomatic obstruction
(causing difficulties in swallowing or breathing). One of the complications of
"thyroidectomy" is voice change and patients are strongly advised to only be
operated on by surgeons who protect the voice by using electronic nerve
monitoring. Most thyroidectomies are now performed by minimally invasive surgery
using a cut in the neck of no more than 2.5 cms(1 inch).
 The thyroid produces several hormones, such as thyroxine (T4), triiodothyronine (T3)
and calcitonin.
 After the removal of a thyroid patients usually take prescribed oral synthetic thyroid
hormones to prevent the most serious manifestations of the
resultant hypothyroidism.

Less extreme variants of thyroidectomy include:

 "hemithyroidectomy" (or "unilateral lobectomy") -- removing only half of the thyroid
 "isthmectomy" -- removing the band of tissue (or isthmus) connecting the two lobes
of the thyroid

Indications
 Malignancy (see Thyroid neoplasm)
 Cosmetic reasons
 Goiter which is untreatable by medical methods
 Severe hyperthyroidism refractory to conservative treatment
 Orbitopathy in Graves' disease
 Removal and evaluation of a thyroid nodule whose FNAC results are unclear

Procedure
 Main steps of Thyroidectomy:
 Exposure - horizontal neck incision, +/- raising of flaps, +/- division of strap muscles
 Identification of essential structures - Recurrent and ext. branch of superior laryngeal
nerve, parathyroid glands
 Devascularization
 Superior thyroid artery
 Inferior thyroid artery while protecting the supply to the parathyroids
 Thyroid ima if present
 Resection
 Exploration of other pathology - e.g. contralateral lobe, lymph nodes
 Closure

Complications
 Hypothyroidism/Thyroid insufficiency in up to 50% of patients after ten years
 Thyrotoxic crisis/Thyroid storm
 Laryngeal nerve injury in about 1% of patients, in particular the recurrent laryngeal
nerve: Unilateral damage results in a hoarse voice. Bilateral damage presents as
laryngeal obstruction on removal of the tracheal tube and is a surgical emergency:
an emergency tracheostomy must be performed. Recurrent Laryngeal nerve injury
may occur during the ligature of the inferior thyroid artery.
 Hypoparathyroidism temporary (transient) in many patients, but permanent in about
1-4% of patients
 Anesthetic complications
 Infection
 Stitch granuloma
 Haemorrhage/Hematoma
 This may compress the airway, becoming life-threatening. A suture removal kit
should be kept at the bedside throughout the postoperative hospital stay.
 Surgical scar/keloid

 ADRENALECTOMY
 Adrenalectomy is an operation in which one or both adrenal glands are removed.
The adrenal glands are part of the endocrine system and are located just above the
kidneys.
 Adrenalectomy can be performed in two ways. In the "open" surgery, the surgeon
makes one large surgical cut to remove the gland. With the "laparoscopic"
technique, several small incisions are made. The surgeon will discuss which approach
is better for you.
 For the surgery, you will be placed under general anesthesia (unconscious and pain-
free).
 The adrenal gland is sent to a pathologist for examination under a microscope.

Why the Procedure is Performed

 The adrenal gland is removed when there is known cancer or a growth (mass) that
might be cancer.
 Sometimes a mass in the adrenal gland is removed because it releases a hormone
that can cause harmful side effects. One of the most common tumors is
a pheochromocytoma. This tumor can cause very high blood pressure.

Risks
 With any operation or anesthesia, there is a slight risk of:
 Blood clots in the legs that may travel to the lungs
 Breathing problems
 Damage to nearby organs in the body
 Heart attack or stroke
 Infection or bleeding
 Reactions to medicines
 Wound that breaks open or bulging tissue through the incision (incisional hernia)

Before the Procedure

 Your surgeon will give you instructions about your diet, including when you should
stop eating and drinking. Be sure to have a complete list of your medications so that
your surgeon and anesthesiologist can give you instructions about them.

Recovery
 As with any operation, there will be discomfort after surgery.
 Your health care provider will prescribe pain medications.
 You may need stool softeners to avoid constipation.
 Your surgeon will give you instructions about restricting your activities.
 Complete recovery from the procedure may take several weeks or longer, depending
on the type of surgical cuts you have.

 PAROTIDECTOMY
 is the removal of the parotid gland, a salivary gland near the ear.
 The parotid gland is the largest of the salivary glands. There are two parotid glands,
one on each side of the face, just below and to the front of the ear. A duct through
which saliva is secreted runs from each gland to the inside of the cheek.
 The main purpose of parotidectomy is to remove abnormal growths (neoplasms)
that occur in the parotid gland. Parotid gland neoplasms may be benign
(approximately 80%) or malignant. Tumors may spread from other areas of the body,
entering the parotid gland by way of the lymphatic system.

Procedure

 During surgery, two different areas of the parotid gland are identified: the superficial
lobe and the deep lobe. Superficial parotidectomy removes just the superficial lobe,
while total parotidectomy removes both lobes.
 The patient is first placed under general anesthesia to ensure that no pain is
experienced and that all muscles remain relaxed. An incision is made directly to the
front or back of the ear and down the jaw line. The skin is folded back to expose the
parotid gland. The various facial nerves are identified and protected during the
surgery so as to avoid permanent facial paralysis or numbness. A superficial or total
parotidectomy is then performed, depending on the type and location of the tumor.
If the tumor has spread to involve the facial nerve, the operation is expanded to
include parts of the bone behind the ear (mastoid) to remove as much tumor as
possible. Before the incision is closed, a drain is inserted into the area to collect any
leaking saliva, if a superficial parotidectomy was performed. The procedure typically
takes from two to five hours to complete, depending on the extent of surgery and
the skill of the surgeon.

Diagnosis/Preparation
 A complete physical examination and medical history is performed, as are diagnostic
tests to help the surgeon better plan for the surgery. Some tests that may be
performed include computed tomography (CT) scan, magnetic resonance
imaging (MRI), and fine-needle aspiration biopsy (using a thin needle to withdraw
fluid and cells from the growth).
 Aftercare
 After surgery, the patient will remain in the hospital for one to three days. The
incision site will be watched closely for signs of infection and heavy bleeding
(hemorrhage). The incision site should be kept clean and dry until it is completely
healed. If the patient has difficulty smiling, winking, or drinking fluids, the physician
should be contacted immediately. These are signs of facial nerve damage.

Risks
 There are a number of complications that are associated with parotidectomy. Facial
nerve paralysis after minor surgery should be minimal. After major surgery, a graft is
attempted to restore nerve function to facial muscles. Salivary fistulas can occur
when saliva collects in the incision site or drains through the incision. Recurrence of
cancer is the single most important consideration for patients who have undergone
parotidectomy. Long-term survival rates are largely dependent on the tumor type
and the stage of tumor development at the time of the operation.
 Other risks include hematoma (collection of blood under the skin) and infection. The
most common long-term complication of parotidectomy is redness and sweating in
the cheek, known as Frey's syndrome. Rarely, paralysis may extend throughout all
the branches of the facial nervous system.

 ADRENALECTOMY
 is an operation in which one or both adrenal glands are removed. The adrenal glands
are part of the endocrine system and are located just above the kidneys.
 Adrenalectomy can be performed in two ways. In the "open" surgery, the surgeon
makes one large surgical cut to remove the gland. With the "laparoscopic"
technique, several small incisions are made. The surgeon will discuss which approach
is better for you.

For the surgery, you will be placed under general anesthesia (unconscious and pain-
free).

The adrenal gland is sent to a pathologist for examination under a microscope.

Why the Procedure is Performed

 The adrenal gland is removed when there is known cancer or a growth (mass) that
might be cancer.

Sometimes a mass in the adrenal gland is removed because it releases a hormone

that can cause harmful side effects. One of the most common tumors is
a pheochromocytoma. This tumor can cause very high blood pressure.
 Risks
 With any operation or anesthesia, there is a slight risk of:
 Blood clots in the legs that may travel to the lungs
 Breathing problems
 Damage to nearby organs in the body
 Heart attack or stroke
 Infection or bleeding
 Reactions to medicines
 Wound that breaks open or bulging tissue through the incision
(incisional hernia)

Before the Procedure

 Your surgeon will give you instructions about your diet, including when you should
stop eating and drinking. Be sure to have a complete list of your medications so that
your surgeon and anesthesiologist can give you instructions about them.

Recovery
 As with any operation, there will be discomfort after surgery.
 Your health care provider will prescribe pain medications.
 You may need stool softeners to avoid constipation.
 Your surgeon will give you instructions about restricting your activities.
 Complete recovery from the procedure may take several weeks or longer, depending
on the type of surgical cuts you have.

 PARATHYROIDECTOMY
is the removal of one or more parathyroid glands. A person usually has four
parathyroid glands, although the exact number may vary from three to seven. The
glands are located in the neck, in front of the Adam's apple, and are closely linked to
the thyroid gland. The parathyroid glands regulate the balance of calcium in the
body.

Purpose
 Parathyroidectomy is usually performed to treat hyperparathyroidism (abnormal
over-functioning of the parathyroid glands).
 The operation begins when an anesthesiologist administers general anesthesia. The
surgeon makes an incision in the front of the neck where a tight-fitting necklace
would rest. All of the parathyroid glands are identified. The surgeon then identifies
the diseased gland or glands, and confirms the diagnosis by sending a piece of the
gland(s) to the pathology department for immediate microscopic examination. The
 diseased glands are then removed, and the incision is closed and covered with a
dressing.
 Parathyroidectomy patients usually stay overnight in the hospital after the
operation. Some patients remain hospitalized for one or two additional days.

Diagnosis/Preparation
 Prior to the operation, the diagnosis of hyperparathyroidism should be confirmed
using lab tests. Occasionally, physicians order computed tomography scans ( CT
scans ), ultrasound exams, or magnetic resonance imaging (MRI) tests to determine
the total number of parathyroid glands, and their location prior to the procedure.
 Parathyroidectomy should only be performed when other non-operative methods
have failed to control a person's hyperparathyroidism.
 Preparation is similar to other surgical procedures requiring general anesthetic. The
patient is not allowed any food or drink by mouth after midnight the night before
surgery. He or she should ask the physician for specific directions regarding
preparation for surgery, including food, drink, and medication intake.

Aftercare
 The incision should be watched for signs of infection. In general, no special wound
care is required.
 The calcium level is monitored during the first 48 hours after the operation by
obtaining frequent blood samples for laboratory analysis.
 Most individuals require only two or three days of hospitalization to recover from
the operation. They can usually resume most of their normal activities within one to
two weeks.

Risks
 The major risk of parathyroidectomy is injury to the recurrent laryngeal nerve (a
nerve that lies very near the parathyroid glands and serves the larynx or voice box).
If this nerve is injured, the voice may become hoarse or weak.
 Occasionally, too much parathyroid tissue is removed, and a person may develop
hypoparathyroidism (under-functioning of the parathyroid glands). If this occurs, he
or she will require daily calcium supplements.
 In some cases, the surgeon is unable to locate all of the parathyroid glands, and
cannot remove them in one procedure. A fifth or sixth gland may be located in an
aberrant place such as the chest (ectopic parathyroid). If this occurs, the
hyperparathyroidism may not be corrected with one operation, and a second
procedure may be required to find all of the patient's remaining parathyroid gland
tissue.
 ORTHOPEDIC

 AMPUTATION
 is the removal of a body extremity by trauma or surgery. As a surgical
measure, it is used to control pain or a disease process in the affected limb,
such as malignancy or gangrene. In some cases, it is carried out on individuals
as a preventative surgery for such problems. A special case is the congenital
amputation, a congenital disorder, where foetal limbs have been cut off by
constrictive bands. In some countries, amputation of the hands or feet is or
was used as a form of punishment for people who committed crimes.
Amputation has also been used as a tactic in war and acts of terrorism; it may
also occur as a war injury. 

Reasons for Amputation
 Circulatory disorders
 Diabetic foot infection or gangrene (the most common reason for non-
traumatic amputation)
 Sepsis with peripheral necrosis
 Neoplasm
 Cancerous bone or soft tissue tumors
(e.g. osteosarcoma, osteochondroma, fibrosarcoma, epithelioid
sarcoma, ewing's sarcoma, synovial sarcoma, sacrococcygeal teratoma)
 Melanoma

Reasons for Amputation

 Trauma
 Severe limb injuries in which the limb cannot be spared or attempts to spare
the limb have failed
 Traumatic amputation (Amputation occurs usually at scene of accident,
where the limb is partially or wholly severed). This would be the case of a
trapped limb with no other way to extract without harm to other parts of the
body.
 Amputation in utero (Amniotic band)
 Deformities
 Deformities of digits and/or limbs
 Extra digits and/or limbs (e.g. polydactyly)

 Infection
 Bone infection (osteomyelitis)
 Other
 Sometimes professional athletes may choose to have a non-essential digit
amputated to relieve chronic pain and impaired performance. Australian
Rules footballer Daniel Chickelected to have his left ring finger amputated as
chronic pain and injury was limiting his performance.[6] Rugby
union player Jone Tawake also had a finger removed.[7] NFL safetyRonnie
Lott had the tip of his little finger removed after it was damaged in the 1985
NFL season.

 TRAPEZIECTOMY
 involves removing a small bone (one of eight which form the wrist) called is situated
at the trapezium. This provides more space for the thumb to move so that the
arthritic bone surfaces are not rubbing together causing pain.

SURGERY
 The operation will usually involve you coming in hospital for a day. Your arm may be
numbed using a regional anaesthetic or a general anaesthetic may be used. A small
incision is made the thumb and the at the base of operation is carried out.
 After the surgery a bulky dressing is he thumb. During applied to protect tthis time it
is important to keep the hand elevated to help get rid of the swelling, and to move
the fingers to prevent them getting stiff.
 After two weeks the dressing and stitches are removed, and a lighter splint is made
which will allow you to use the hand for light activities yet still protecting the thumb.
Once the wound is healed it is safe to get the hand wet making sure that is it dried
well before reapplying the splint. At this stage you can moisturize and massage the
scar (E45/Nivea etc).
After 4 weeks you will be taught some exercises, which are to be done out of the
splint. as well as light activities. However the splint is to be worn for a total of 6
protection and at night for a total of 6 weeks

RECOVERY
 Recovery of full function can take a long time in some cases it can be 6 months or so
before you can carry out any heavy lifting. Driving is usually OK after 8 weeks but this
is dependant on whether you have regained movement and can drive pain free. You
will need to discuss returning to work with your physiotherapist or occupational
therapist, as it will obviously vary depending on your job.

 SYNOVECTOMY
 A synovectomy is a surgical procedure for those suffering from significant pain and
loss of function due to rheumatoid arthritis. This surgery is usually performed with
 an arthroscope, a thin, lighted tube attached to a television screen which is inserted
through a small incision in the affected area. This procedure, though not a cure, can
increase function and decrease pain.
A synovectomy removes inflamed joint tissue causing the pain and dysfunction, and
can decrease swelling and slow bone damage and erosion. Common areas for a
synovectomy are the knees, shoulders, wrists, elbows, fingers and hips. But, as with
any surgical procedure, it comes with its fair share of risks. Depending on the
severity and location, a local or general anesthesia is necessary. There is the
possibility of infection, bleeding into the joint area and possible loss of joint motion
post surgery

Diagnosis/Preparation
 Once diagnosed with RA, through a detailed medical history, blood tests, x-rays and
joint fluid analysis, conservative treatment options such as nonsteroidal anti-
inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs),
regular exercises and coping strategies, such as heat or cold application and
rethinking daily activity strategies, is recommended. If, after six to twelve months,
symptoms become worse, a synovectomy may be an option.

AFTER CARE
After a synovectomy, a brief time of immobilization is followed by movement,
typically through the use of a continuous passive motion machine (CPM). The use of
pain medications to deal with post-surgical pain, and physical therapy are the
recommended courses of action. Physical therapy consists of range of motion
exercises and general strengthening, essential to regaining function. Antibiotics also
may be used to ward off infection
 A synovectomy is most beneficial to joints with minimal damage and is a useful early
treatment option. But though it may only provide temporary relief of symptoms, if
left untreated, rheumatoid arthritis can lead to complete destruction of the joint. By
removing the inflamed tissue, a synovectomy can delay or stop the necessity of a
total joint replacement.

 ARTHROPLASTY
 is surgery performed to relieve pain and restore range of motion by realigning or rec
 Arthroplasty is performed under general (affecting the entire body) or regional
(numbing a specific area of the body, such as spinal block) anesthesia in a hospital,
by an orthopedic surgeon. Although many hospitals and medical centers perform
common types of joint surgery, orthopedic hospitals that specialize in joint surgery
tend to have higher success rates than less specialized centers.
 In joint resection, the surgeon makes an incision at the joint, then carefully removes
the minimum amount of bone necessary to allow free motion. The more bone that
 remains, the more stable the joint. Ligament attachments are preserved as much as
possible. In interpositional reconstruction, both bones of the joint are reshaped, and
a disk of material is placed between the bones to prevent their rubbing together.
Length of hospital stay depends on the joint affected; in the absence of
complications, a typical stay is only a few days.

PURPOSE
 The goal of arthroplasty is to restore the function of a stiffened synovial joint and
relieve pain. As a surgical procedure, it is usually performed when medical treatment
has not improved function in the affected joint. There are two types of arthroplastic
surgery: joint resection and interpositional reconstruction. Joint resection involves
removing a portion of the bone from a stiffened joint, increasing the space between
the bone and the socket to improve the range of motion. Scar tissue eventually fills
the gap, narrowing joint space again. Pain is relieved and motion is restored, but the
joint is less stable.

Diagnosis/Preparation
 Significant disabling pain, deformity, and reduced quality of life are the primary
indications for arthroscopic procedures. Patients at this stage of discomfort and
disability will most likely have already been diagnosed with a form of arthritis. Pain
and stiffness on weight-bearing joints are the major symptoms that patients report,
though some people experience night pain as well. Other symptoms may include
stiffness, swelling, and locking of the joint; and even the joint giving way, particularly
when the knees or hips are affected. To determine the extent of disabling, the
referring physician and/or the surgeon will likely ask about walking distance, sporting
ability, the need for walking aids, and the ability to perform self-care tasks such as
dressing and bathing.
 Besides evaluation of the joint itself and level of mobility, the clinical examination
will include evaluation of the patient's general health, the condition of the ligaments
and muscles around the affected joint, and also assessment of the patient's mental
outlook and social circumstances to help develop the most effective postoperative
rehabilitation plan. 
 Diagnostic testing will typically include:
 x rays of the affected joint (and other joints as well)to determine loss of joint
space and to differentiate between OA and RA
 imaging studies, such as computed tomography (Cat scans), magnetic
resonance (MRI), and bone densitometry to assess bone loss or bone
infection
 cardiac tests, such as electrocardiogram, to evaluate the heart and circulatory
system
 blood tests to rule out infection and possibly to confirm arthritis
  prior to arthroplasty, standard preoperative blood and urine tests are performed to
rule out such conditions as anemia and infection. If a patient has a history of
bleeding, the surgeon may ask that clotting tests be performed. The patient will
meet with the anesthesiologist to discuss any special conditions that may affect the
administration of anesthesia. Surgery will not be performed if infection is present
anywhere in the body or if the patient has certain heart or lung diseases. Smokers
will be asked to stop smoking. 
 Weight loss may also be recommended for overweight patients. If surgery involves
deep tissue and muscle, such as total hip arthroplasty, the surgeon may order units
of blood to be prepared in case transfusion is needed to replace blood lost during
the surgery. Healthy patients may be asked to donate their own blood, which will be
returned to them at the time of surgery (autologous transfusion). Certain pain
medications may have to be discontinued in the weeks just prior to surgery.

Aftercare
 Immediately after surgery, while still in the hospital, patients will be given pain
medications for the recovery period and antibiotics to prevent infection. When
patients are discharged after joint surgery, they must be careful not to overstress or
destabilize the joint, requiring rest at home for a period of weeks. Physical therapy
will begin immediately to improve strength and range of motion; it is the most
important aid to recovery and may continue for several months. Activity may be
resumed gradually, using devices if necessary, such as walkers or crutches, as
recommended by the physical therapist. Lifestyle changes may include the use of
special seating or sleeping surfaces, and employing home care assistance for help
with shopping, cooking, and household tasks.

Risks
 Joint resection and interpositional reconstruction do not always produce successful
results, especially in patients with rheumatoid arthritis, a chronic inflammatory
disease that may continue to narrow the joint space and accelerate the formation of
scar tissue. Repeat surgery or total joint replacement may be necessary. As with any
major surgery, there is always a risk of an allergic reaction to anesthesia, post-
operative infection, or the formation of blood clots (thrombophlebitis) that may
cause pain and swelling near the surgery site and travel through the veins to other
parts of the body. A joint that has undergone surgery is less stable than a healthy
joint and dislocation or loosening of the resected joint may occur, especially with
inappropriate physical activity.

 BUNIONECTOMY
 A bunionectomy is a surgical procedure to excise, or remove, a bunion. A bunion is
an enlargement of the joint at the base of the big toe and is comprised of bone and
 soft tissue. It is usually a result of inflammation and irritation from poorly fitting
(narrow and tight) shoes in conjunction with an overly mobile first metatarsal joint
and over-pronation of the foot. Over time, a painful lump appears at the side of the
joint, while the big toe appears to buckle and move sideway towards the second toe.
New bone growth can occur in response to the inflammatory process, and a bone
spur may develop.
 Therefore, the development of a bunion may involve soft tissue as well as a hard
bone spur. The intense pain makes walking and other activities extremely difficult.
Since the involved joint is a significant structure in providing weight-bearing stability,
walking on the foot while trying to avoid putting pressure on the painful area can
create an unstable gait.

 Purpose
 A bunionectomy is performed when conservative means of addressing the problem,
including properly fitting, wide-toed shoes, a padded cushion against the joint,
orthotics, and anti-inflammatory medication, are unsuccessful. As the big toe moves
sideways, it can push the second toe sideways as well. This can result in extreme
deformity of the foot, and the patient may complain not only of significant pain, but
of an inability to find shoes that fit.

Diagnosis/Preparation
 Intense pain at the first joint of the big toe is what most commonly brings the patient
to the doctor. Loss of toe mobility may also have occurred. Severe deformity of the
foot may also make it almost impossible for the patient to fit the affected foot into a
shoe. The condition may be in either foot or in both. In addition, there may be a
crackling sound in the joint when it moves. Diagnosis of a bunion is based on
a physical examination , a detailed history of the patient's symptoms and their
development over time, and x rays to determine the degree of deformity. Other foot
disorders such as gout must be ruled out.
 The patient history should include factors that increase the pain, the patient's level
of physical activity, occupation, amount of time spent on his or her feet, the type of
shoe most frequently worn, other health conditions such as diabetes that can affect
the body's ability to heal, a thorough medication history, including home remedies,
and any allergies to food, medications, or environmental aspects. The physical exam
should include an assessment while standing and walking to judge the degree to
which stability and gait have been affected, as well as an assessment while seated or
lying down to measure range of motion and anatomical integrity. 
 An examination of the foot itself will check for the presence of unusual calluses,
which indicate abnormal patterns of friction. Circulation in the affected foot will be
noted by checking the skin color and temperature. A neurological assessment will
also be conducted.
 Conservative measures are usually the first line of treatment and target dealing with
the acute phase of the condition, as well as attempting to stop the progression of the
condition to a more serious form.

 Measures may include:

 rest and elevation of the affected foot
 eliminating any additional pressure on the tender area, perhaps by using soft
slippers instead of shoes
 soaking the foot in warm water to improve blood flow
 use of anti-inflammatory oral medication
 an injection of a steroidal medication into the area surrounding the joint
 systematic use of an orthotic, either an over-the-counter product or one
specifically molded to the foot
 the use of a cushioned padding against the joint when wearing a shoe

If these measures prove unsuccessful, or if the condition has worsened to

significant foot deformity and altered gait, then a bunionectomy is considered. The
doctor may use the term hallux valgus when referring to the bunion. Hallux means
big toe and valgus means bent outward. In discussing the surgical option, it is
important for the patient to clearly understand the degree of improvement that is
realistic following surgery.
 X rays to determine the exact angle of displacement of the big toe and
potential involvement of the second toe will be taken. The angles of the two
toes in relation to each other will be noted to determine the severity of the
condition. Studies in both a standing as well as a seated or lying down
position will be considered. These will guide the surgeon at the time of the
surgery as well. In addition, blood tests, an EKG, and a chest x-ray will most
likely be ordered to be sure that no other medical condition has gone
undiagnosed that could affect the success of the surgery and the patient's
recovery.

 Aftercare
 Recovery from a bunionectomy takes place both at the surgical center as well as in
the patient's home. Immediate post-surgical care is provided in the surgical recovery
area. The patient's foot will be monitored for bleeding and excessive swelling; some
swelling is considered normal. The patient will need to stay for a few hours in the
recovery area before being discharged. This allows time for the anesthesia to wear
off. The patient will be monitored for nausea and vomiting, potential aftereffects of
the anesthesia, and will be given something light to eat, such as crackers and juice or
ginger ale, to see how the food is tolerated.
  The patient will be monitored for nausea and vomiting, potential aftereffects of the
anesthesia, and will be given something light to eat, such as crackers and juice or
ginger ale, to see how the food is tolerated. Hospital policy usually requires that the
patient have someone drive them home, as there is a safety concern after having
undergone anesthesia. In addition, the patient will most likely be on pain medication
that could cause drowsiness and impaired thinking.
 It is important to contact the surgeon if any of the following occur after discharge
from the surgical center:
 fever
 chills
 constant or increased pain at the surgical site
 redness and a warmth to the touch in the area around the dressing
 swelling in the calf above the operated foot
 the dressing has become wet and falls off
 the dressing is bloody

 While the patient can expect to return to normal activities within six to eight weeks
after the surgery, the foot is at increased risk for swelling for several months. When
the patient can expect to bear weight on the operated foot will depend on the
extent of the surgery. The milder the deformity, the less tissue is removed and the
sooner the return to normal activity level. During the sixto-eight-week recovery
period, a special shoe, boot, or cast may be worn to accommodate the surgical
bandage and to help provide stability to the foot.

Risks
 All surgical procedures involve some degree of risk. The most likely problems to
occur in a bunionectomy are infection, pain, nerve damage to the operated foot, and
the possibility that the bunion will recur. Sharing all pertinent past and present
medical history with the surgical team helps to lower the chance of a complication.
In addition to the risk of the surgery itself, anesthesia also has risks. It is important to
share with the anesthesia team the list of all the vitamins, herbs, and supplements,
over-the-counter medications, and prescription medications that the patient is
taking.

CARDIO

 CORONARY ARTERY BYPASS SURGERY

is a surgical procedure performed to relieve angina and reduce the risk of death
from coronary artery disease. Arteries or veins from elsewhere in the patient's body
are grafted to the coronary arteries to bypassatherosclerotic narrowings and
 improve the blood supply to the coronary circulation supplying
the myocardium (heart muscle). This surgery is usually performed with the heart
stopped, necessitating the usage of cardiopulmonary bypass; techniques are
available to perform CABG on a beating heart, so-called "off-pump" surgery.
Indications for CABG
 Several alternative treatments for coronary artery disease exist. They include:
 Medical management (anti-anginal medications
plus statins, antihypertensives, smoking cessation, tight blood sugar control
in diabetics)
 Percutaneous coronary intervention (PCI)
 Both PCI and CABG are more effective than medical management at relieving
symptoms e.g. angina, dyspnea, fatigue). CABG is superior to PCI for some
patients with multivessel

Procedure (Simplified
1. The patient is brought to the operating room and moved on to the operating table.
2. An anaesthetist places a variety of intravenous lines and injects a painkilling agent
(usually Phentanyl) followed within minutes by an induction agent (usually propofol)
to render the patient unconscious.
3. An endotracheal tube is inserted and secured by the anaesthetist or assistant
(e.g. respiratory therapist or nurse anaesthetist) and mechanical ventilation is
started. General anaesthesia is maintained by a continuous very slow injection
of Propofol.
4. The chest is opened via a median sternotomy and the heart is examined by the
surgeon.
5. The bypass grafts are harvested - frequent conduits are the internal thoracic
arteries, radial arteries and saphenous veins. When harvesting is done, the patient is
given heparin to prevent the blood from clotting.
6. In the case of "off-pump" surgery, the surgeon places devices to stabilize the heart.
7. If the case is "on-pump", the surgeon sutures cannulae into the heart and instructs
the perfusionist to start cardiopulmonary bypass (CPB). Once CPB is established, the
surgeon places the aortic cross-clamp across the aorta and instructs the perfusionist
to deliver cardioplegia (a special Potassium-mixture, cooled) to stop the heart and
slow its metabolism. Usually the patient's machine-circulated blood is cooled to
around 84°F (29°C)
8. One end of each graft is sewn on to the coronary arteries beyond the blockages and
the other end is attached to the aorta.
9. The heart is restarted; or in "off-pump" surgery, the stabilizing devices are removed.
In some cases, the aorta is partially occluded by a C-shaped clamp, the heart is restarted
and suturing of the grafts to the aorta is done in this partially occluded section of the
aorta while the heart is beating.
 10. Protamine is given to reverse the effects of heparin.
11. The sternum is wired together and the incisions are sutured closed.
12. The patient is moved to the intensive care unit (ICU) to recover. After awakening and
stabilizing in the ICU
(approximately 1 day), the person is transferred to the cardiac surgeryward until ready to go
home (approximately 4 days).

Complications

 CABG associated
 Postperfusion syndrome (pumphead), a transient neurocognitive impairment
associated with cardiopulmonary bypass. Some research shows the incidence
is initially decreased byoff-pump coronary artery bypass, but with no
difference beyond three months after surgery. A neurocognitive decline over
time has been demonstrated in people with coronary artery disease
regardless of treatment (OPCAB, conventional CABG or medical
management). However, recent research suggests that the cognitive decline
is not caused by CABG but is rather a consequence of vascular disease.
 Nonunion of the sternum; internal thoracic artery harvesting devascularizes
the sternum increasing risk.
 Myocardial infarction due to embolism, hypoperfusion, or graft failure.
 Late graft stenosis, particularly of saphenous vein grafts due
to atherosclerosis causing recurrent angina or myocardial infarction.
 Acute renal failure due to embolism or hypoperfusion.
 Stroke, secondary to embolism or hypoperfusion.
 Vasoplegic syndrome, secondary to cardiopulmonary bypass and hypothermia

 General surgical
 Infection at incision sites or sepsis.
 Deep vein thrombosis (DVT)
 Anesthetic complications such as malignant hyperthermia.
 Keloid scarring
 Chronic pain at incision sites
 Chronic stress related illnesses
 Death

 ANGIOPLASTY
 Angioplasty is a term describing a procedure used to widen vessels narrowed by
stenoses or occlusions. There are various types of angioplasty. The specific names of
these procedures are derived from the type of equipment used and the path of entry
to the blood vessel. For example, percutaneous transluminal angioplasty (PTA)
 means that the vessel is entered through the skin (percutaneous) and that the
catheter is moved into the blood vessel of interest through the same vessel or one
that communicates with it (transluminal). In the case of an angioplasty involving the
coronary arteries, the point of entry might be the femoral artery in the groin, with
the catheter/guidewire system passed through the aorta to the heart and the origin
of the coronary arteries at the base of the aorta just outside the aortic valve.

PURPOSE
 An angioplasty is done to reopen a partially blocked blood vessel so that blood can
flow through it again at a normal rate. In patients with an occlusive vascular disease
such as atherosclerosis, the flow of blood to other organs or remote parts of the
body is limited by the narrowing of the vessel's lumen due to fatty deposits or
patches known as plaque. Once the vessel has been widened, an adequate blood
flow is restored. The vessel may narrow again over time at the same location,
however, and the procedure may need to be repeated.

Risks

 There is a danger of puncturing the vessel with the guidewire during an angioplasty,
although the risk is very small. Patients must be monitored for hematoma or
hemorrhage at the puncture site. There is also a small risk of heart attack, stroke,
and, although unlikely, death—all related to vessel spasm (transient vessel
narrowing from irritation by the catheter), or from emboli (as plaque can be
dislodged by the catheter or and travel to the heart or brain). Abrupt closure of the
coronary artery occurs in about 4% of patients.
 Recurrence of stenosis is an additional potential complication. The risk of recurrence
is highest in the first six months after angioplasty, with rates as high as 35% reported
in some studies.
 The length of the patient's hospital stay following an angioplasty depends on his or
her overall condition, the occurrence of complications, and the availability of home
care .

Health care team roles

 Physicians often have specially trained assistants for vascular procedures. These
assistants may be nurses, surgical technicians, or x ray specialists. Cardiac
catheterization laboratories will include someone specially trained in monitoring EKG
equipment and vital signs. Either a nurse, nurse anesthetist, or anesthesiologist will
administer sedation or anesthesia for the procedure.

 HEART TRANSPLANTTATION
 Heart transplantation, also called cardiac transplantation, is the replacement of a
patient's diseased or injured heart with a healthy donor heart.

Patients with end-stage heart disease unresponsive to medical treatment may be

considered for heart transplantation. Potential candidates must have a complete
medical examination before they can be put on the transplant waiting list. Many
types of tests are done, including blood tests, x rays, and tests of heart, lung, and
other organ function. The results of these tests indicate to doctors how serious the
heart disease is and whether or not a patient is healthy enough to survive
the transplant surgery

PURPOSE
 Heart transplantation is performed on patients with end-stage heart failure or some
other life-threatening heart disease. Before a doctor recommends heart
transplantation for a patient, all other possible treatments for his or her disease
must have been attempted. The purpose of heart transplantation is to extend and
improve the life of a person who would otherwise die from heart failure. Most
patients who have received a new heart were so sick before transplantation that
they could not live a normal life. Replacing a patient's diseased heart with a healthy,
functioning donor heart often allows the recipient to return to normal daily
activities.

Diagnosis/Preparation
 Before patients are put on the transplant waiting list, their blood type is determined
so a compatible donor heart can be found. The heart must come from a person with
the same blood type as the patient, unless it is blood type O negative. A blood type O
negative heart is a universal donor and is suitable for any patient regardless of blood
type.
 A panel reactive antibodies (PRA) test is also done before heart transplantation. This
test tells doctors whether or not the patient is at high risk for having a hyperacute
reaction against a donor heart. A hyperacute reaction is a strong immune response
against the new heart that happens within minutes to hours after the new heart is
transplanted.
 If the PRA shows that a patient has a high risk for this kind of reaction, then a
crossmatch is done between a patient and a donor heart before transplant surgery.
A crossmatch checks how close the match is between the patient's tissue type and
the tissue type of the donor heart. Most people are not high risk, and a crossmatch
usually is not done before the transplant because the surgery must be done as
quickly as possible after a donor heart is found.
 While waiting for heart transplantation, patients are given treatment to keep the
heart as healthy as possible. They are regularly checked to make sure the heart is
 pumping enough blood. Intravenous medications may be used to improve cardiac
output. If these drugs are not effective, an intra-aortic balloon pump or ventricular-
assist device can maintain cardiac output until a donor heart becomes available.

Aftercare
 Immediately following surgery, patients are monitored closely in the intensive care
unit (ICU) of the hospital for 24–72 hours. Most patients need to receive oxygen for
four to 24 hours following surgery. Continuous cardiac monitoring is used to
diagnose and treat donor heart function. Renal, liver, brain, and pulmonary functions
are carefully monitored during this time.
 Heart transplant patients start taking immunosuppressive drugs before or during
surgery to prevent immune rejection of the heart. High doses of immunosuppressive
drugs are given at this time, because rejection is most likely to happen within the
first few months after the surgery
 A few months after surgery, lower doses of immunosuppressive drugs usually are
given, and then must be taken for the rest of the patient's life.
 For six to eight weeks after the transplant surgery, patients usually come back to the
transplant center twice a week for physical examinations and medical tests, which
check for any signs of infection, rejection of the new heart, or other complications.
 In addition to physical examination , the following tests may be done during these
visits:
 laboratory tests to check for infection
 chest x ray to check for early signs of lung infection
 electrocardiogram (ECG) to check heart function
 echocardiogram to check the function of the ventricles in the heart
 blood tests to check liver and kidney function
 complete blood counts (CBC) to check the numbers of blood cells
 taking of a small tissue sample from the donor heart (endomyocardial biopsy)
to check for signs of rejection
 During the physical examination, the blood pressure is checked and the heart sounds
are listened to with a stethoscope to determine if the heart is beating properly and
pumping enough blood. Kidney and liver functions are checked because these organs
may lose function if the heart is being rejected.
 An endomyocardial biopsy is the removal of a small sample of the heart muscle. This
is done by cardiac catheterization . The heart muscle tissue is examined under a
microscope for signs that the heart is being rejected. Endomyocardial biopsy is
usually done weekly for the first four to eight weeks after transplant surgery, and
then at longer intervals after that.

Risks
 The most common and dangerous complications of heart transplant surgery are
organ rejection and infection. Immunosuppressive drugs are given to prevent
rejection of the heart. Most heart transplant patients have a rejection episode soon
after transplantation. Rapid diagnosis ensures quick treatment, and when the
response is quick, drug therapy is most successful. Rejection is treated with
combinations of immunosuppressive drugs given in higher doses than
immunosuppressive maintenance. Most of these rejection situations are successfully
treated.
 Infection can result from the surgery, but most infections are a side effect of the
immunosuppressive drugs. Immunosuppressive drugs keep the immune system from
attacking the foreign cells of the donor heart. However, the suppressed immune cells
are then unable to adequately fight bacteria, viruses, and other microorganisms.
 Microorganisms that normally do not affect persons with healthy immune systems
can cause dangerous infections in transplant patients taking immunosuppressive
drugs.
 Patients are given antibiotics during surgery to prevent bacterial infection. They may
also be given an antiviral drug to prevent virus infections. Patients who develop
infections may need to have their immunosuppressive drugs changed or the dose
adjusted. Infections are treated with antibiotics or other drugs, depending on the
type of infection.
 Other complications that can happen immediately after surgery are:
 bleeding
 pressure on the heart caused by fluid in the space surrounding the heart
(pericardial tamponade)
 irregular heart beats
 reduced cardiac output
 increased amount of blood in the circulatory system
 decreased amount of blood in the circulatory system
 About half of all heart transplant patients develop coronary artery disease one to
five years after the transplant. The coronary arteries supply blood to the heart.
Patients with this problem develop chest pains called angina. Other names for this
complication are coronary allograft vascular disease and chronic rejection.

NEURO
 Diskectomy
 Diskectomy is surgery to remove all or part of a cushion that helps protect your
spinal column. These cushions, called disks, separate your spinal bones (vertebrae).
 When one of the disks herniates (moves out of place), the soft gel inside pushes
through the wall of the disk. The disk may then place pressure on the spinal cord and
nerves that are coming out of your spinal column.
 Why the Procedure is Performed
 Diskectomy is done when a herniated disk makes you have:
 Leg pain or numbness that is very bad or is not going away, making it hard to
do daily tasks
 Weakness in muscles of your lower leg or buttocks
 An inability to control bowel movements or urination

Risks
 Risks for any anesthesia are:
 Reactions to medications
 Breathing problems
 Risks for any surgery include are:
 Bleeding
 Infection
 Risks for this surgery are:
 Damage to the nerves that come out of the spine, causing weakness or pain
that does not go away.
 Your back pain does not get better or comes back again later.
 Because of the small surgical cut used in a microdiskectomy, the doctor may
miss some disk fragments. This could cause you to continue having pain after
surgery.

Before the Procedure

 During the days before the surgery:
 Prepare your home for when you come back from the hospital.
 If you are a smoker, you need to stop. Your recovery will be slower and
possibly not as good if you continue to smoke. Ask your doctor for help.
 Two weeks before surgery, you may be asked to stop taking drugs that make
it harder for your blood to clot. These include aspirin, ibuprofen (Advil,
Motrin), naproxen (Aleve, Naprosyn), and other drugs like these.
 If you have diabetes, heart disease, or other medical problems, your surgeon
will ask you to see your regular doctor.
 Talk with your doctor if you have been drinking a lot of alcohol.
 Ask your doctor which drugs you should still take on the day of the surgery.
 Always let your doctor know about any cold, flu, fever, herpes breakout, or
other illnesses you may have.
 You may want to visit the physical therapist to learn some exercises to do
before surgery and to practice using crutches.

On the day of the surgery

 You will usually be asked not to drink or eat anything for 6 to 12 hours before the
procedure.
 Take your drugs your doctor told you to take with a small sip of water.
 Bring your cane, walker, or wheelchair if you have one already. Also bring shoes with
flat, nonskid soles.
 Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
 Your doctor or nurse will ask you to get up and walk around as soon as your
anesthesia wears off. Most people go home the day of surgery. Do NOT drive
yourself home.

 CAROTID ENDARTERECTOMY
 Carotid endarterectomy (CEA) is a surgical procedure that is performed to remove
deposits of fat, called plaque, from the carotid arteries in the neck. These two main
arteries, one on each side of the neck, deliver blood and oxygen to the brain. Plaque
builds up in large- and medium-sized arteries as people get older, more in some
people than others depending on lifestyle and hereditary factors. This build up is a
vascular disease called atherosclerosis, or hardening of the arteries. When this
happens in either one or both of the carotid arteries, they can become narrowed, a
condition called stenosis. During a carotid endarterectomy, a surgeon removes the
fatty deposits to correct the narrowing and to allow blood and oxygen to flow freely
to the brain.

Purpose
 Carotid endarterectomy is a protective procedure intended to reduce the risk of
stroke, a vascular condition also known as a cardiovascular accident (CVA). In studies
conducted by the National Institute of Neurological Disorders and Stroke (NINDS),
endarterectomy has proven to be especially protective for people who have already
had a stroke, and for people who are at high risk for stroke or who have already
been diagnosed with significant stenosis (between 50% and 70% blockage).

Diagnosis
 The presence and degree of stenosis in the carotid artery must be determined
before a doctor decides that carotid endarterectomy is necessary. Carotid stenosis
can sometimes be detected in a routine checkup, especially when a detailed history
reveals to the doctor that the patient has experienced symptoms of TIA or stroke.
The doctor will use a stethoscope to listen to blood flow in the carotid artery and
may hear an abnormal rushing sound called a "bruit" (pronounced "brew-ee") that
will indicate narrowing in the artery. The absence of sound, however, does not mean
there is no risk. More extensive testing will most likely have to be done to determine
 the degree of stenosis and the potential of risk for the patient. These tests may
include:

 These tests may include:

 Ultrasound imaging with Doppler—a painless, noninvasive imaging test that
measures sound waves directed into the body and returned to the ultrasound
machine as echoes. Usually these echoes are visualized as an image on a
screen; Doppler captures the sound as the echoes bounce off of moving
blood in the carotid artery, giving some indication of the amount of blockage
as the ultrasound probe moves up and down the arteries on each side of the
neck.
 Computed tomography (CT) or computer-assisted tomography (CAT scan)—a
series of cross-sectional x rays of the head and brain that can rule out other
causes for the symptoms but cannot detect carotid artery stenosis.
 Oculoplethysmography (OPG)—a procedure that measures the pulsing of
arteries behind the eye, which can show carotid artery blockage.
 Arteriography and digital subtraction angiography (DSA)—special x-ray
procedures using dye in the patient's vascular system. These tests are
invasive and can actually cause a stroke, but they do indicate more exactly
what degree of stenosis is present. The doctor will have to weigh the extent
of risk and how much the patient will benefit from the tests.
 Magnetic resonance angiography (MRA)—an imaging test that does not use
dyes or x rays and relies on special computer software and powerful
magnetic fields to create a highly detailed image of the inside of the brain's
arteries.

Preparation
 If carotid ultrasonography or arteriography procedures were not performed earlier
to diagnose carotid stenosis, these tests will be performed before surgery to
evaluate the amount of plaque and the extent and location of narrowing in the
patient's carotid arteries. Other blood vessels in the body are also evaluated. If other
arteries show significant signs of artherosclerosis or damage, the patient's risk for
surgery may be too great, and the procedure will not be performed. Aspirin therapy
or other clot-prevention medication may be prescribed before surgery. Any
underlying medical condition such as high blood pressure or heart disease will be
treated prior to carotid endarterectomy to help achieve the best result from the
 surgery. Upon admission to the hospital , routine blood and urine tests will be
performed.

Aftercare
 A person who has had carotid endarterectomy will be monitored in a
hospital recovery room immediately after the surgery and will then go to
an intensive care unit at least overnight to be observed for any sign of
complications. The total hospital stay may be two to three days. When the patient
returns home, activities can be resumed gradually, as long as they are not strenuous.
During recuperation, the patient's neck may ache slightly. The doctor may
recommend against turning the head often or too quickly during recovery.
 The most important thing people can do after endarterectomy is to follow their
doctor's guidelines for stroke prevention, which will reduce the progression of
artherosclerosis and avoid repeat narrowing of the carotid artery. Repeat stenosis
(restenosis) has been shown to occur frequently in people who do not make the
necessary changes in lifestyle such as in diet, exercise , and quitting smoking or
excessive use of alcohol. The benefits of the surgery may only be temporary if
underlying disease such as artherosclerosis high blood pressure, or diabetes, is not
also treated.

Risks
 Serious risks are associated with carotid endarterectomy. They involve complications
that can arise during or following the surgery, as well as underlying conditions that
led to blockage of the patient's arteries in the first place. Stroke is the most serious
postoperative risk. If it occurs within 12 to 24 hours after surgery, the cause is
usually an embolism, which is a clot or tissue from the endarterectomy site.
 Other major complications that can occur are:
 heart attack or other heart problems
 death
 breathing difficulties
 high blood pressure
 nerve injury, which can cause problems with vocal cords, saliva management,
and tongue movement
 bleeding within the brain
 restenosis, the continuing buildup of plaque, which can occur from five
months to 13 years after surgery
 The risks of carotid endarterectomy surgery depend upon age, overall health, and
the skill and experience levels of the surgeons treating the patient. The likelihood of
complications is lower when the surgeon performing the procedure has
acknowledged skills and experience. According to the Stroke Council of the American
Heart Association, surgery is best performed by a surgeon who has only had
 complications occur in less than 3% of patients. Hospitals, too, should be able to
show that fewer than 3% of their patients undergoing endarterectomy have had
complications. These recommendations are based not only on skill levels, but also on
the ability to accurately weigh the stroke risks for each patient against the potential
risk of complication because of age, hereditary factors, and the presence of
underlying conditions or diseases.

HEMISPHERECTOMY
 Hemispherectomy is a surgical treatment for epilepsy in which one of the two
cerebral hemispheres, which together make up the majority of the brain, is
removed.
 Hemispherectomy may be "anatomic" or "functional." In an anatomic
hemispherectomy, a hemisphere is removed, while in a functional
hemispherectomy, some tissue is left in place, but its connections to other brain
centers are cut so that it no longer functions.

Purpose
 Hemispherectomy is used to treat epilepsy when it cannot be sufficiently controlled
by medications.
 The cerebral cortex is the wrinkled outer portion of the brain. It is divided into left
and right hemispheres, which communicate with each other through a bundle of
nerve fibers called the corpus callosum, located at the base of the hemispheres.
 The seizures of epilepsy are due to unregulated electrical activity in the brain. This
activity often begins in a discrete brain region called the focus of the seizure, and
then spreads to other regions. Removing or disconnecting the focus from the rest of
the brain can reduce seizure frequency and intensity.
 In some people with epilepsy, there is no single focus. If there are multiple focal
points within one hemisphere, or if the focus is undefined but restricted to one
hemisphere, hemispherectomy may be indicated for treatment.
 Removing an entire hemisphere of the brain is an effective treatment. The
hemisphere that is removed is usually quite damaged by the effects of multiple
seizures, and the other side of the brain has already assumed many of the functions
of the damaged side.
 In addition, the brain has many "redundant systems," which allow healthy regions to
make up for the loss of the damaged side.
 Children who are candidates for hemispherectomy usually have significant
impairments due to their epilepsy, including partial or complete paralysis and partial
or complete loss of sensation on the side of the body opposite to the affected brain
region.
Diagnosis/Preparation
 The candidate for hemispherectomy has epilepsy untreatable by medications, with
seizure focal points that are numerous or ill defined, but localized to one
hemisphere. Such patients may have one of a wide variety of disorders that have
caused seizures, including:
 neonatal brain injury
 Rasmussen disease
 Hemimegalencephaly
 Sturge-Weber syndrome
 The candidate for any type of epilepsy surgery will have had a wide range of tests
prior to surgery. These include electroencephalography (EEG), in which electrodes
are placed on the scalp, on the brain surface, or within the brain to record electrical
activity. EEG is used to attempt to locate the focal point(s) of the seizure activity.
 Several neuroimaging procedures are used to obtain images of the brain. These may
reveal structural abnormalities that the neurosurgeon must be aware of. These
procedures will include magnetic resonance imaging (MRI), x rays, computed
tomography (CT) scans, or positron emission tomography (PET)imaging.
 Neuropsychological tests may be done to provide a baseline against which the
results of the surgery are measured. A Wada test may also be performed, in which a
drug is injected into the artery leading to one half of the brain, putting it to sleep.
This allows the neurologist to determine where in the brain language and other
functions are localized, and may also be useful for predicting the result of the
surgery.

Aftercare
 Immediately after the operation, the patient may be on a mechanical ventilator for
up to 24 hours. Patients remain in the hospital for at least one week. Physical and
occupational therapy are part of the rehabilitation program to improve strength and
motor function.

Risks
 Hemorrhage during or after surgery is a risk for hemispherectomy. Disseminated
intravascular coagulation, or blood clotting within the circulatory system, is a risk
that may be managed with anticoagulant drugs. "Aseptic meningitis," an
inflammation of the brain's covering without infection, may occur. Hydrocephalus, or
increased fluid pressure within the remaining brain, may occur in 20–30% of
patients. Death from surgery is a risk that has decreased as surgical techniques have
improved, but it still occurs in approximately 2% of patients.
 The patient will lose any remaining sensation or muscle control in the extremities on
the side opposite the removed hemisphere. However, upper arm and thigh
 movements may be retained, allowing adapted function with these parts of the
body.

EENT
YAG CAPSULOTOMY
 The modern technique of cataract surgery involves removing the cloudy contents of
the eye's natural lens, while leaving the clear outer membrane (called the capsule) to
hold the new intraocular lens in place.
 This capsule has cells on it which will, in some cases, continue to produce lens fibers.
These fibers cannot be laid down in an organized manner and will form little beads
or "pearls" on the lens capsule, forming a secondary membrane. When these pearls
accumulate in the pupil, they cause a blurring of vision similar to that which one
experiences with a cataract.  This occurs approximately 30-40% of the time and can
appear at any time after surgery, even as much as five or more years later.
Although the blurred vision produced by this membrane can be quite significant,
fortunately, there is a very easy way of clearing the pupil of this cloudy capsule.
During the procedure, called YAG Laser Capsulotomy , a special laser
(YttriumAluminum Garnet) is used There is absolutely no pain involved in this
procedure and patients can resume their normal activities immediately. The patient
will usually notice an improvement as soon as the pupil, which is dilated, goes back
to its normal size.

The Procedure
 Is completely painless.
 Does not involve any anesthesia.
 Does not require any preoperative tests.
 Does not need an operating room.
 Takes less than 5 minutes.
 Does not have any postoperative restrictions.

Two infrequent, but serious complications to consider

 1. People who have a YAG Laser Capsulotomy have a slightly higher risk of
developing a retinal detachment in the future. The rate is approximately 0.5-1.0%,
but can be considerably higher in people who were significantly nearsighted before
their cataract surgery.
 2. Even more rarely (one out of 400-500 cases), the intraocular lens can dislocate
through the opening in the capsule, requiring surgical repositioning or replacement.

 MASTIODECTOMY
 A mastoidectomy is performed to remove infected mastoid air cells resulting from
ear infections, such as mastoiditis or chronic otitis, or by inflammatory disease of the
middle ear (cholesteatoma). The mastoid air cells are open spaces containing air that
are located throughout the mastoid bone, the prominent bone located behind the
ear that projects from the temporal bone of the skull. The air cells are connected to
a cavity in the upper part of the bone, which is in turn connected to the middle ear.
Aggressive infections in the middle ear can thus sometimes spread through the
mastoid bone. When antibiotics can't clear this infection, it may be necessary to
remove the infected area by surgery. The primary goal of the surgery is to
completely remove infection so as to produce an infection-free ear.
Mastoidectomies are also performed sometimes to repair paralyzed facial nerves.
 A mastoidectomy is performed with the patient fully asleep under general
anesthesia. There are several different types of mastoidectomy procedures,
depending on the amount of infection present:
 Simple (or closed) mastoidectomy. The operation is performed through the
ear or through a cut (incision) behind the ear. The surgeon opens the mastoid
bone and removes the infected air cells. The eardrum is incised to drain the
middle ear. Topical antibiotics are then placed in the ear.
 Radical mastoidectomy. The procedure removes the most bone and is usually
performed for extensive spread of a cholesteatoma. The eardrum and middle
ear structures may be completely removed. Usually the stapes, the "stirrup"
shaped bone, is spared if possible to help preserve some hearing.
 Modified radical mastoidectomy. In this procedure, some middle ear bones
are left in place and the eardrum is rebuilt by tympanoplasty.
 After surgery, the wound is stitched up around a drainage tube and a dressing is
applied.

Diagnosis/Preparation
 The treating physician gives the patient a thorough ear, nose, and throat
examination and uses detailed diagnostic tests, including an audiogram and imaging
studies of the mastoid bone using x rays or CT scans to evaluate the patient for
surgery.
 The patient is prepared for surgery by shaving the hair behind the ear on the mastoid
bone. Mild soap and a water solution are commonly used to cleanse the outer ear
and surrounding skin.

Aftercare
 The drainage tube inserted during surgery is typically removed a day or two later.
 Painkillers are usually needed for the first day or two after the operation. The patient
should drink fluids freely. After the stitches are removed, the bulky mastoid dressing
 can be replaced with a smaller dressing if the ear is still draining. The patient is given
antibiotics for several days.
 The patient should inform the physician if any of the following symptoms occur:
 bright red blood on the dressing
 stiff neck or disorientation (These may be signs of meningitis.)
 facial paralysis, drooping mouth, or problems swallowing

Risks
 Complications do not often occur, but they may include:
 persistent ear discharge
 infections, including meningitis or brain abscesses
 hearing loss
 facial nerve injury (This is a rare complication.)
 temporary dizziness
 temporary loss of taste on the side of the tongue

 TURBINOPLASTY
 There are three turbinates in each nasal passage. Each one protrudes from the
sidewall of the nose. Turbinates are shaped like a scroll, and act to warm, humidify
and filter air before it passes on to your throat. Throughout the day, the turbinates
periodically change size in a pattern known as the nasal cycle. Turbinoplasty is the
operation performed to reduce the size of the turbinate. Usually, only the inferior
turbinates need correction.

How is an Inferior Turbinoplasty Performed?

 Various procedures have been designed for turbinoplasty. A small inside incision may
be placed and the turbinate bone can be removed with special instruments.
Alternatively, the bone can be crushed in order to convince the turbinate not to stick
too far into the nasal sidewall. The fleshy cover of the bone can be reduced by
excision or with the help of heat. In general, the goal is a gentle reduction in size, not
a removal of the turbinate. Turbinoplasty is usually performed under conscious
sedation (twilight sleep) or general anesthesia.

Recovery after Turbinate Surgery

 Most patients are able to return to work after 1 week, sometimes even earlier.
Because turbinoplasty is rarely performed on its own, the other nasal procedures
may determine recovery.

 TRABECULECTOMY
 Trabeculectomy is a surgical procedure that removes part of the trabeculum in the
eye to relieve pressure caused by glaucoma.

PURPOSE
Glaucoma is a disease that injures the optic nerve, causing progressive vision loss.
Glaucoma is a major cause of blindness in the United States. If caught early,
glaucoma-related blindness is easily prevented. However, because it does not
produce symptoms until late in its cycle, periodic tests for the disease are necessary.

Diagnosis/Preparation
 The procedure is fully explained and any alternative methods to control intraocular
pressure are discussed. Antiglaucoma drugs are prescribed before surgery. Added
pressure on the eye caused from coughing or sneezing should be avoided.
 Several eye drops are applied immediately before surgery. The eye is sterilized, and
the patient draped. A speculum is inserted to keep the eyelids apart during surgery.

Aftercare
 Eye drops, and perhaps patching, will be needed until the eye is healed. Driving
should be restricted until the ophthalmologist grants permission. The patient may
experience blurred vision. Severe eye pain, light sensitivity, and vision loss should be
reported to the physician.
 Antibiotic and anti-inflammatory eye drops must be used for at least six weeks after
surgery. Additional medicines may be prescribed to reduce scarring.

Risks
 Infection and bleeding are risks of any surgery. Scarring can cause the drainage to
stop. One-third of trabeculectomy patients will develop cataracts.

 SEPTOPLASTY
Septoplasty is a surgical procedure to correct the shape of the septum of the nose.
The goal of this procedure is to correct defects or deformities of the septum. The
nasal septum is the separation between the two nostrils. In adults, the septum is
composed partly of cartilage and partly of bone. Septal deviations are either
congenital (present from birth) or develop as a result of an injury. Most people with
deviated septa do not develop symptoms. It is typically only the most severely
deformed septa that produce significant symptoms and require surgical intervention.
However, many septoplasties are performed during rhinoplastyprocedures, which
are most often performed for cosmetic purposes.

Purpose
 Septoplasty is performed to correct a crooked (deviated) or dislocated septum, often
as part of plastic surgery of the nose (rhinoplasty). The nasal septum has three
functions: to support the nose, to regulate air flow, and to support the mucous
membranes (mucosa) of the nose. Septoplasty is done to correct the shape of the
nose caused by a deformed septum or correct deregulated airflow caused by a
deviated septum. Septoplasty is often needed when the patient is having an
operation to reduce the size of the nose (reductive rhinoplasty), because this
operation usually reduces the amount of breathing space in the nose.

Diagnosis/Preparation
 During surgery, the patient's own cartilage that has been removed can be reused to
provide support for the nose if needed. External septum supports are not usually
needed. Splints may be needed occasionally to support cartilage when extensive
cutting has been done. External splints can be used to support the cartilage for the
first few days of healing. Tefla gauze is inserted in the nostril to support the flaps and
cartilage and to absorb any bleeding or mucus.
 The primary conditions that may suggest a need for septoplasty include:
 nasal air passage obstruction
 nasal septal deformity
 headaches caused by septal spurs
 chronic and uncontrolled nosebleeds
 chronic sinusitis associated with a deviated septum
 obstructive sleep apnea
 polypectomy (polyp removal)
 tumor excision
 turbinate surgery
 ethmoidectomy (removal of all or part of a small bone on the upper part of
the nasal cavity)

Aftercare
 Patients who receive septoplasty are usually sent home from the hospital later the
same day or in the morning after the surgery. All dressings inside the nose are
usually removed before the patient leaves. Aftercare includes a list of detailed
instructions for the patient that focus on preventing trauma to the nose.
 The head needs to be elevated while resting during the first 24-48 hours after
surgery. Patients will have to breathe through the mouth while the nasal packing is
still in place. A small amount of bloody discharge is normal but excessive bleeding
should be reported to the physician immediately. Antibiotics are usually not
prescribed unless the packing is left in place more than 24 hours. Most patients do
not suffer significant amounts of pain, but those who do have severe pain are
sometimes given narcotic pain relievers. Patients are often advised to place an ice
 pack on the nose to enhance comfort during the recovery period. Patients who have
splint placement usually return seven to 10 days after the surgery for examination
and splint removal.

Risks
 The risks from septoplasty are similar to those from other operations on the face:
postoperative pain with some bleeding, swelling, bruising, or discoloration. A few
patients may have allergic reactions to the anesthetics. The operation in itself,
however, is relatively low-risk in that it does not involve major blood vessels or vital
organs. Infection is unlikely if proper surgical technique is observed. One of the
extremely rare but serious complications of septoplasty is cerebrospinal fluid leak.
This complication can be treated with proper nasal packing, bed rest, and antibiotic
use. Follow-up surgery may be necessary if the nasal obstruction relapses.

 POLYPECTOMY
NASAL POLYPECTOMY
 If you would like to know about polypectomy surgery, the reasons for polypectomy
and the benefits of polypectomy, the following information will help you.
 
 Before you agree to have your nasal polypectomy operation, it is important to know
all you can about this nose surgery. The information here is a guide to common
medical practice. Each hospital and doctor will have slightly different ways of doing
things, so you should follow their guidance where it is different from the information
given here. Because all patients, conditions and treatments vary it cannot cover
everything. Use this information when making your nose surgery choices with your
doctors. You should mention any worries you have. Remember that you can ask for
more information at any time.

What is the problem?

 You have nasal polyps. Your nose probably feels blocked. The polyps can block
odours from reaching the part of your nose which responds to scent resulting in
some loss of your sense of smell.

What are nasal polyps?

 A polyp is a growth. They are usually benign, meaning not harmful. Polyps appear as
soft swellings, which hang down like small grapes. Polyps come in many shapes and
sizes.
 Nasal polyps come from the mucous membranes, which line your sinuses. Your
sinuses are hollow spaces in the bones of your face and skull. These spaces connect
with the inside of your nose through tiny holes and passages. Polyps can come
through these openings into the inside of your nose and block your nasal passages.
 What has gone wrong?
 Polyps usually start in the sinuses at the top of your nose between your eyes. As they
grow they can block the inside of your nose and other sinuses. They can cause
discharge or infection and reduce your sense of smell. The cause of polyps is
unknown, but they may occur in people with respiratory allergies, such as hay fever
and in asthmatics.

The aims
 The aim of a nasal polypectomy operation is to remove the polyps from the inside of
your nose. You will have a full general anaesthetic and be completely asleep for the
operation.

The benefits
 Removing the polyps will relieve your blocked nose. Blocked sinuses will then have a
better chance to clear. If you have a reduced sense of smell, this should improve but
it may not always return to normal.
 In some people polyps grow back again. This may be within a year or even several
years later. We cannot predict whether you will have more polyps; only time will tell.

GONIOTOMY
 A goniotomy is a surgical procedure primarily used to treat congenital glaucoma, first
described in 1938. It is caused by a developmental arrest of some of the structures
within the anterior (front) segment of the eye. These structures include the iris and
the ciliary body, which produces the aqueous fluid needed to maintain the integrity
of the eye. These structures do not develop normally in the eyes of patients with
isolated congenital glaucoma. Instead, they overlap and block the trabecular
meshwork, which is the primary drainage system for the aqueous fluid. As a result of
this blockage, the trabecular meshwork itself becomes thicker and the drainage
holes within the meshwork are narrowed. These changes lead to an excess of fluid in
the eye, which can cause pressure that can damage the internal structures of the eye
and cause glaucoma.

Purpose
 The purpose of a goniotomy is to clear the obstruction to aqueous outflow from the
eye, which in turn lowers the intraocular pressure (IOP). Lowering the IOP helps to
stabilize the enlargement of the cornea and the distension and stretching of the eye
that often occur in congenital glaucoma. The size of the eye, however, will not return
to normal. Most importantly, once the aqueous outflow improves, damage to the
 optic nerve is halted or reversed. The patient's visual acuity may improve after
surgery.
 Goniotomies are commonly performed to treat the following eye disorders:
 Congenital glaucomas.
 Aniridia. Aniridia is a condition in which the patient lacks a visible iris. A
goniotomy is performed as a preventive measure, as 50%–75% of patients
with aniridia will develop glaucoma.
 Uveitic glaucoma associated with juvenile rheumatoid arthritis.
 Maternal rubella syndrome.
 JOAG.

Diagnosis
 The clinical signs of congenital and infantile glaucoma may be detected within a few
months after birth. They include an enlarged eye, called buphthalmos; corneal
swelling; decreased vision; tearing; sensitivity to light; and blepharospasm, or
uncontrolled twitching of the eyes. These signs, however, are usually absent in JOAG.
As a result, glaucoma in the older child may go undetected until the child loses
vision.

Preparation
 Once the diagnosis of glaucoma is confirmed, goniotomy is often the first line of
treatment. If goniotomy is determined to be the best procedure and there is a lot of
corneal haze, the surgeon may treat the patient for several days pre-operatively with
azetozolamide to lower the IOP and increase the clarity of the cornea. Or, he may
elect to perform another procedure called a trabeculotomy, which is the preferred
surgery if the corneal diameter is greater than 14 mm. The patient is given antibiotics
for several days before surgery.
 Obtaining the family's informed consent is another important part of preparing for a
goniotomy. The surgeon tells the family that the child will need general anesthesia,
and that several postoperative visits with anesthesia or sedation will be necessary
after the goniotomy.

Aftercare
 The patient will continue to be given antibiotics, corticosteroids, and miotics for one
to two weeks after surgery. If the surgeon believes that the procedure was not
successful, then he or she may give the patient acetazolamide by mouth in addition
to these medications for up to 10 days to lower the IOP.
 The patient will be anesthetized again three to six weeks after surgery for a
reevaluation of the anterior chamber of the eye. This examination is repeated every
three months for the first year; every six months during the second year; and once a
year thereafter. Once the child is older, usually three to four years old, the physician
 can perform the follow-up examination in his or her office without anesthesia or
sedation. Since a visual field test is difficult or impossible to do on an infant or young
child, the doctor measures the cornea to assess progression of the disease.
 An increase in corneal diameter indicates that the glaucoma is getting worse. Visual
field testing will be performed when the child is old enough to understand it. A visual
field test can establish the extent of vision loss that has occurred because of
glaucoma.
 An important aspect of managing glaucoma patients after surgery is assessing the
degree of nearsightness and astigmatism, both of which result from the stretching of
the eye caused by increased intraocular pressure. If the child needs eyeglasses, they
should be given as early in life as possible to decrease the probability of amblyopia.
Amblyopia is a condition in which the vision cannot be corrected completely, even
with glasses, and is common for pediatric glaucoma patients.
 Although almost 80% of children with congenital glaucoma can have their vision
corrected to 20/50 or better, patching of an eye and vision therapy is often required
to achieve this level of correction.
 About 10% of goniotomy patients will experience a recurrence of the glaucoma or
have it develop in the unaffected eye. As a result, the patient will need periodic eye
examinations for the rest of his/her life. If glaucoma does recur later in life, then
either medical or surgical treatment is instituted depending on the cause.

Risks
 Since goniotomy is performed under general anesthesia, there is some risk of a
reaction to the anesthetic. The most common risk of general anesthesia in infants is
cardiorespiratory arrest. This complication is not life-threatening, however, and
occurs in fewer than 2% of goniotomies.
 A hyphema (bleeding and formation of a blood clot in the anterior chamber) is the
most common complication of a goniotomy. In most cases, however, the blood clots
resolve within a few days.
 If the cornea is not clear during surgery, the surgeon may accidentally sever the iris
from the ciliary body or separate the ciliary body from the sclera of the eye. Both of
these complications can lead to hypotony, a condition in which the integrity of the
eye is compromised because of insufficient intraocular fluid.
 Other complications of goniotomy are cataract formation; inflammation in the
anterior chamber; scarring of the cornea; subluxation or dislocation of the lens; and
retinal detachment. The risk of damage to the lens is greater when the patient is
aniridic.
 The intraocular pressure may increase in spite of, or due to complications of the
procedure, and the goniotomy may have to be repeated. If the goniotomy is not
successful after two or three attempts, the surgeon will perform a trabeculotomy.
IRIDECTOMY
 An iridectomy is a procedure in eye surgery in which the surgeon removes a small,
full-thickness piece of the iris, which is the colored circular membrane behind the
cornea of the eye. An iridectomy is also known as a corectomy. In recent years,
lasers have also been used to perform iridectomies.

Purpose
 Today, an iridectomy is most often performed to treat closed-angle glaucoma or
melanoma of the iris. An iridectomy performed to treat glaucoma is sometimes
called a peripheral iridectomy, because it removes a portion of the periphery or root
of the iris.
 In some cases, an iridectomy is performed prior to cataract surgery in order to make
it easier to remove the lens of the eye. This procedure is referred to as a preparatory
iridectomy.

Diagnosis/Preparation
 Closed-angle glaucoma
 Closed-angle glaucoma may be diagnosed in the course of a routine eye
examination or during emergency treatment for symptoms of an acute
attack. A doctor who is performing a standard eye examination may notice
that the patient's eye has a shallow anterior chamber or a narrow angle
between the iris and the cornea. He or she may perform one or both of the
following tests to evaluate the patient's risk of developing closed-angle
glaucoma. One test, called tonometry, measures the amount of fluid pressure
in the eye.
 It is a painless procedure that involves blowing a puff of pressurized air toward the
patient's eye as the patient sits near a lamp and measuring the changes in the light
reflections on the patient's corneas. Other methods of tonometry involve the
application of a local anesthetic to the outside of the eye and touching the cornea
briefly with an instrument that measures the fluid pressure directly. The second test,
gonioscopy, involves the use of a special mirrored contact lens to evaluate the
anatomy of the angle between the iris and the cornea. The doctor numbs the outside
of the eye with a local anesthetic and touches the outside of the cornea with the
gonioscopic lens. He or she can use a slit lamp to magnify what appears on the lens.
Patients with subacute, intermittent, or chronic closed-angle glaucoma can then be
treated before they develop acute symptoms.
 If the patient is having a sudden attack of closed-angle glaucoma, he or she will feel
intense pain, and is likely to be seen on an emergency basis with the following
symptoms:
 nausea and vomiting
 severe pain in or above the eye
  visual disturbances that include seeing halos around lights and hazy or foggy
vision
 headache
 redness and watering in the affected eye
 a dilated pupil that does not close normally in bright light
 These symptoms are produced by the sharp rise in intraocular pressure (IOP) that
occurs when the angle is completely blocked. This increase can occur in a matter of
hours and cause permanent loss of vision in as little as two to five days. An acute
attack of closed-angle glaucoma is a medical emergency requiring immediate
treatment . Emergency treatment includes application of eye drops to reduce the
pressure in the eye quickly, other eye drops to shrink the size of the pupil, and
acetazolamide or a similar medication to stop the production of aqueous humor. In
severe cases, the patient may be given drugs intravenously to lower the intraocular
pressure. After the pressure has been relieved with medications, the eye will require
surgical treatment.
 Melanoma of the iris
 Melanoma of the iris is usually discovered in the course of a routine eye
examination because it will be visible to the ophthalmologist as he or she
looks through the pupil in the center of the iris. A melanoma on the iris may
look like a dark spot or ring, or it may resemble tapioca. The doctor can
perform a gonioscopy, and use specialized imaging studies to rule out other
possible eye disorders. An ultrasound study can be made by using a small
probe placed on the eye that directs sound waves in the direction of the
tumor.
 Another test is called fluorescein angiography , which involves injecting a fluorescent
dye into a vein in the patient's arm. As the dye circulates throughout the body, it is
carried to the blood vessels in the back of the eye. These blood vessels can be
photographed through the pupil.
 In a minority of patients, melanoma of the iris is discovered because the patient is
experiencing eye pain resulting from a rise in IOP caused by tumor growth.

Preparation for treatment

 Patients scheduled for a laser iridotomy or iridectomy are not required to fast or
make other special preparations before the procedure. They may, however, be given
a sedative to help them relax. Patients scheduled for a conventional iridectomy are
asked to avoid eating or drinking for about eight hours before the procedure.

Aftercare
 Short-term aftercare following laser iridectomy or iridotomy is minimal. Patients are
asked to make arrangements for someone to drive them home after surgery, but can
 usually go to work the next day and resume other activities with no restrictions. They
should not need any medication stronger than aspirin for discomfort.
 Short-term aftercare following a surgical iridectomy includes wearing a patch over
the affected eye for several days and using eye drops to minimize the risk of
infection. The surgeon may also prescribe medication for discomfort. It will take
about six weeks for vision to return to normal.
 Long-term aftercare following an iridectomy for closed-angle glaucoma usually
involves taking medications to help control the fluid pressure in the eye and seeing
the ophthalmologist for periodic checkups.
 Aftercare for melanoma of the iris includes eye checkups to be certain that the
tumor has not recurred. In addition, patients are advised to reduce their exposure to
sunlight and other sources of ultraviolet light.
Risks
 The risks of a laser iridotomy or iridectomy include the following:
 irritation in the eye for two to three days after the procedure
 bleeding
 scarring
 failure to relieve fluid pressure in the eye
 The risks of a conventional iridectomy include:
 infection
 bleeding
 scarring in the area of the incision
 failure to relieve fluid pressure
 formation of a cataract
 The risks of an iridectomy for melanoma of the iris include glaucoma resulting from
the formation of new blood vessels near the angle, cataract formation, and
recurrence of the tumor. In the event of a recurrence, the standard treatment is
enucleation, or surgical removal of the entire eye.

RESPI
 LOBECTOMY
 A lobectomy is the removal of a lobe, or section, of the lung.
 To perform a lobectomy, the surgeon makes an incision ( thoracotomy ) between
the ribs to expose the lung while the patient is under general anesthesia. The chest
cavity is examined and the diseased lung tissue is removed. A drainage tube (chest
tube) is then inserted to drain air, fluid, and blood out of the chest cavity. The ribs
and chest incision are then closed.

PURPOSE
 Lobectomies are performed to prevent the spread of cancer to other parts of the
lung or other parts of the body, as well as to treat patients with such noncancerous
diseases as chronic obstructive pulmonary disease (COPD). COPD includes
emphysema and chronic bronchitis, which cause airway obstruction.

Lung surgery may be recommended for the following reasons:

 presence of tumors
 small areas of long-term infection (such as highly localized pulmonary tuberculosis or
mycobacterial infection)
 lung cancer
 abscesses
 permanently enlarged (dilated) airways (bronchiectasis)
 permanently dilated section of lung (lobar emphysema)
 injuries associated with lung collapse (atelectasis, pneumothorax, or hemothorax)
 a permanently collapsed lung (atelectasis)

Preparation
 Patients should not take aspirin or ibuprofen for seven to 10 days before surgery.
Patients should also consult their physician about discontinuing any blood-thinning
medications such as Coumadin (warfarin). The night before surgery, patients should
not eat or drink anything after midnight.

Aftercare
 If no complications arise, the patient is transferred from the surgical intensive care
unit (ICU) to a regular hospital room within one to two days. Patients may need to
be hospitalized for seven to 10 days after a lobectomy. A tube in the chest to drain
fluid will probably be required, as well as a mechanical ventilator to help the patient
breathe. The chest tube normally remains in place until the lung has fully re-
expanded. Oxygen may also be required, either on a temporary or permanent basis.
A respiratory therapist will visit the patient to teach him or her deep breathing
exercises. It is important for the patient to perform these exercises in order to re-
expand the lung and lower the risk of pneumonia or other infections. The patient will
be given medications to control postoperative pain. The typical recovery period for a
lobectomy is one to three months following surgery.

Risks
 The specific risks of a lobectomy vary depending on the specific reason for the
procedure and the general state of the patient's health; they should be discussed
with the surgeon. In general, the risks for any surgery requiring a general anesthetic
include reactions to medications and breathing problems. As previously mentioned,
patients having part of a lung removed may have difficulty breathing and may
 require the use of oxygen. Excessive bleeding, wound infections, and pneumonia are
possible complications of a lobectomy. The chest will hurt for some time after
surgery, as the surgeon must cut through the patient's ribs to expose the lung.
Patients with COPD may experience shortness of breath after surgery.

 TRACHEOTOMY
A tracheotomy is a surgical procedure that opens up the windpipe (trachea). It is
performed in emergency situations, in the operating room , or at bedside of critically
ill patients. The term tracheostomy is sometimes used interchangeably with
tracheotomy. Strictly speaking, however, tracheostomy usually refers to the opening
itself while a tracheotomy is the actual operation

Purpose
 A tracheotomy is performed if enough air is not getting to the lungs, if the person
cannot breathe without help, or is having problems with mucus and other secretions
getting into the windpipe because of difficulty swallowing. There are many reasons
why air cannot get to the lungs. The windpipe may be blocked by a swelling; by a
severe injury to the neck, nose, or mouth; by a large foreign object; by paralysis of
the throat muscles; or by a tumor. The patient may be in a coma, or need a
ventilator to pump air into the lungs for a long period of time.

Emergency tracheotomy
 There are two different procedures that are called tracheotomies. The first is done
only in emergency situations and can be performed quite rapidly. The emergency
room physician or surgeon makes a cut in a thin part of the voice box (larynx) called
the cricothyroid membrane. A tube is inserted and connected to an oxygen bag. This
emergency procedure is sometimes called a cricothyroidotomy .

Surgical tracheotomy
 The second type of tracheotomy takes more time and is usually done in an operating
room. The surgeon first makes a cut (incision) in the skin of the neck that lies over
the trachea. This incision is in the lower part of the neck between the Adam's apple
and top of the breastbone. The neck muscles are separated and the thyroid gland,
which overlies the trachea, is usually cut down the middle. The surgeon identifies the
rings of cartilage that make up the trachea and cuts into the tough walls. A metal or
plastic tube, called a tracheotomy tube, is inserted through the opening. This tube
acts like a windpipe and allows the person to breathe. Oxygen or a mechanical
ventilator may be hooked up to the tube to bring oxygen to the lungs. A dressing is
placed around the opening. Tape or stitches (sutures) are used to hold the tube in
place.
 After a nonemergency tracheotomy, the patient usually stays in the hospital for
three to five days, unless there is a complicating condition. It takes about two weeks
to recover fully from the surgery.

Diagnosis/Preparation

 Emergency tracheotomy
 In the emergency tracheotomy, there is no time to explain the procedure or
the need for it to the patient. The patient is placed on his or her back with
face upward (supine), with a rolled-up towel between the shoulders. This
positioning of the patient makes it easier for the doctor to feel and see the
structures in the throat. A local anesthetic is injected across the cricothyroid
membrane.
Nonemergency tracheotomy
 In a nonemergency tracheotomy, there is time for the doctor to discuss the surgery
with the patient, to explain what will happen and why it is needed. The patient is
then put under general anesthesia. The neck area and chest are then disinfected and
surgical drapes are placed over the area, setting up a sterile surgical field.

Aftercare

 Postoperative care
 A chest x ray is often taken, especially in children, to check whether the tube
has become displaced or if complications have occurred. The doctor may
prescribe antibiotics to reduce the risk of infection. If the patient can breathe
without a ventilator, the room is humidified; otherwise, if the tracheotomy
tube is to remain in place, the air entering the tube from a ventilator is
humidified. During the hospital stay, the patient and his or her family
members will learn how to care for the tracheotomy tube, including
suctioning and clearing it. Secretions are removed by passing a smaller tube
(catheter) into the tracheotomy tube.
 It takes most patients several days to adjust to breathing through the
tracheotomy tube. At first, it will be hard even to make sounds. If the tube
allows some air to escape and pass over the vocal cords, then the patient
may be able to speak by holding a finger over the tube. Special tracheostomy
tubes are also available that facilitate speech.
 The tube will be removed if the tracheotomy is temporary. Then the wound
will heal quickly and only a small scar may remain. If the tracheotomy is
permanent, the hole stays open and, if it is no longer needed, it will be
surgically closed.
 Home care
 After the patient is discharged, he or she will need help at home to manage the
tracheotomy tube. Warm compresses can be used to relieve pain at the incision site.
The patient is advised to keep the area dry. It is recommended that the patient wear
a loose scarf over the opening when going outside. He or she should also avoid
contact with water, food particles, and powdery substances that could enter the
opening and cause serious breathing problems. The doctor may prescribe pain
medication and antibiotics to minimize the risk of infections. If the tube is to be kept
in place permanently, the patient can be referred to a speech therapist in order to
learn to speak with the tube in place. The tracheotomy tube may be replaced four to
10 days after surgery.
 Patients are encouraged to go about most of their normal activities once they leave
the hospital. Vigorous activity is restricted for about six weeks. If the tracheotomy is
permanent, further surgery may be needed to widen the opening, which narrows
with time.

Risks

 Immediate risks
 There are several short-term risks associated with tracheotomies. Severe
bleeding is one possible complication. The voice box or esophagus may be
damaged during surgery. Air may become trapped in the surrounding tissues
or the lung may collapse. The tracheotomy tube can be blocked by blood
clots, mucus, or the pressure of the airway walls. Blockages can be prevented
by suctioning, humidifying the air, and selecting the appropriate tracheotomy
tube. Serious infections are rare.

 Long-term risks
 Over time, other complications may develop following a tracheotomy. The
windpipe itself may become damaged for a number of reasons, including
pressure from the tube, infectious bacteria that forms scar tissue, or friction
from a tube that moves too much. Sometimes the opening does not close on
its own after the tube is removed. This risk is higher in tracheotomies with
tubes remaining in place for 16 weeks or longer. In these cases, the wound is
surgically closed. Increased secretions may occur in patients with
tracheostomies, which require more frequent suctioning.

 High-risk groups

 The risks associated with tracheotomies are higher in the following groups of
patients:
  children, especially newborns and infants
 smokers
 alcoholics
 obese adults
 persons over 60
 persons with chronic diseases or respiratory infections
 persons taking muscle relaxants , sleeping medications, tranquilizers,

REPAIR

 CHEILOPLASTY
 Cleft lip repair (cheiloplasty) is surgical procedure to correct a groove-like defect in
the lip.

Developmental anatomy
 Important structures of the embryo's mouth form at four to seven weeks of
gestation. Development during this period entails migration and fusion of
mesenchymal cells with facial structures. If this migration and fusion is interrupted
(usually by a combination of genetic and environmental factors), a cleft can develop
along the lip. The type of clefting varies with the embryonic stage when its
development occurred.
 There are several types of cleft lip, ranging from a small groove on the border of the
upper lip to a larger deformity that extends into the floor of the nostril and part of
the maxilla (upper jawbone).
 Unilateral cleft lip results from failure of the maxillary prominence on the affected
side to fuse with medial nasal prominences. The result is called a persistant labial
groove. The cells of the lip become stretched and the tissues in the persistent groove
break down, resulting in a lip that is divided into medial (middle) and lateral (side)
portions. In some cases, a bridge of tissue (simart band) joins together the two
incomplete lip portions.
 Bilateral cleft lip occurs in a fashion similar to the unilateral cleft. Patients with
bilateral cleft lip may have varying degrees of deformity on each side of the defect.
An anatomical structure (intermaxillary segment) projects to the front and hangs
unattached. Defects associated with bilateral cleft lip are particularly problematic
due to discontinuity of the muscle fibers of the orbicularis oris (primary muscle of
the lip.) This deformity can result in closure of the mouth and pursing of the lip.
 PURPOSE
 A cleft lip does not join together (fuse) properly during embryonic development.
Surgical repair corrects the defect, preventing future problems with breathing,
speaking, and eating, and improving the person's physical appearance.

Surgical procedure
 Cleft lip repair can be initiated at any age, but optimal results occur when the first
operation is performed between two and six months of age. Surgery is usually
scheduled during the third month of life.
 While the patient is under general anesthesia, the anatomical landmarks and
incisions are carefully demarcated with methylene blue ink. An endotracheal tube
prevents aspiration of blood. The surgical field is injected with a local anesthestic to
provide further numbing and blood vessel constriction (to limit bleeding).
Myringotomy (incisions in one or both eardrums) is performed, and myringotomy
tubes are inserted to permit fluid drainage

Diagnosis/Preparation
 Facial clefting has a wide range of clinical presentations, ranging from a simple
microform cleft to the complete bilateral cleft involving the lip, palate, and nose. A
comprehensive physical examination is performed immediately after birth, and the
defect is usually evident by visual inspection and examination of the facial structures.
 Care must be taken to diagnose other physical problems associated with a genetic
syndrome. Weight, nutrition, growth, and development should be assessed and
closely monitored.
 Presurgical tests include a variety of procedures, such as hemoglobin studies. It is
important for the pateint's parents and physician to discuss the operation prior to
surgery.

Aftercare
 The postoperative focus is on ensuring proper nutrition, as well as lip care and
monitoring the activity level. Breast milk or full-strength formula is encouraged
immediately after surgery or shortly thereafter. Lip care for patients with sutures
should include gentle cleansing of suture lines with cotton swabs and diluted
hydrogen peroxide. Liberal application of topical antibiotic ointment several times a
day for 10 days is recommended. There will be some scar contracture, redness, and
firmness of the area for four to six weeks after surgery. Parents should gently
massage the area, and avoid sunlight until the scar heals.
 The patient's activities may be limited. Some surgeons use elbow immobilizers to
minimize the risk of accidental injury to the lip. Immobilizers should be removed
 several times a day in a supervised setting, allowing the child to move the restricted
limb(s).
 Interaction between the orthodontist and surgeon as part of the treatment team
begins in the neonatal period, and continues through the phases of mixed dentition.

Risks
 There may be excessive scarring and contraction of the lips. Two types of scars,
hypertrophic or keloid, may develop. Hypertrophic scars appear as raised and red
areas that usually flatten, fade in color, and soften within a few months. Keloids form
as a result of the accelerated growth of tissue in response to the surgery or trauma
to the area. The keloid can cause itching and a burning sensation. Scratching must be
avoided because it can lead to healing problems. Some patients require minimal
revision surgery, but in most cases, the initial redness and contracture is part of the
normal healing process.
 TYMPANOPLASTY
Tympanoplasty, also called eardrum repair, refers to surgery performed to
reconstruct a perforated tympanic membrane (eardrum) or the small bones of the
middle ear. Eardrum perforation may result from chronic infection or, less
commonly, from trauma to the eardrum.

PURPOSE
The tympanic membrane of the ear is a three-layer structure. The outer and inner
layers consist of epithelium cells. Perforations occur as a result of defects in the
middle layer, which contains elastic collagen fibers. Small perforations usually heal
spontaneously. However, if the defect is relatively large, or if there is a poor blood
supply or an infection during the healing process, spontaneous repair may be
hindered. Eardrums may also be perforated as a result of trauma, such as an object
in the ear, a slap on the ear, or an explosion
 The purpose of tympanoplasty is to repair the perforated eardrum, and sometimes
the middle ear bones (ossicles) that consist of the incus, malleus, and stapes.
Tympanic membrane grafting may be required. If needed, grafts are usually taken
from a vein or fascia (muscle sheath) tissue on the lobe of the ear. Synthetic
materials may be used if patients have had previous surgeries and have limited graft
availability.

Diagnosis/Preparation
 The examining physician performs a complete physical with diagnostic testing of the
ear, which includes an audiogram and history of the hearing loss, as well as any
vertigo or facial weakness. A microscopic exam is also performed. Otoscopy is used
to assess the mobility of the tympanic membrane and the malleus. A fistula test can
 be performed if there is a history of dizziness or a marginal perforation of the
eardrum.
 Preparation for surgery depends upon the type of tympanoplasty. For all procedures,
however; blood and urine studies, and hearing tests are conducted prior to surgery.

Aftercare
 Generally, the patient can return home within two to three hours. Antibiotics are
given, along with a mild pain reliever. After 10 days, the packing is removed and the
ear is evaluated to see if the graft was successful. Water is kept away from the ear,
and nose blowing is discouraged. If there are allegies or a cold, antibiotics and a
decongestant are usually prescribed. Most patients can return to work after five or
six days, or two to three weeks if they perform heavy physical labor. After three
weeks, all packing is completely removed under the operating microscope. It is then
determined whether or not the graft has fully taken.
 Post-operative care is also designed to keep the patient comfortable. Infection is
generally prevented by soaking the ear canal with antibiotics. To heal, the graft must
be kept free from infection, and must not experience shearing forces or excessive
tension. Activities that change the tympanic pressure are forbidden, such as sneezing
with the mouth shut, using a straw to drink, or heavy nose blowing. A complete
hearing test is performed four to six weeks after the operation.

Risks
 Possible complications include failure of the graft to heal, causing recurrent eardrum
perforation; narrowing (stenosis) of the ear canal; scarring or adhesions in the
middle ear; perilymph fistula and hearing loss; erosion or extrusion of the prosthesis;
dislocation of the prosthesis; and facial nerve injury. Other problems such as
recurrence of cholesteatoma, may or may not result from the surgery.
 Tinnitus (noises in the ear), particularly echo-type noises, may be present as a result
of the perforation itself. Usually, with improvement in hearing and closure of the
eardrum, the tinnitus resolves. In some cases, however, it may worsen after the
operation. It is rare for the tinnitus to be permanent after surgery.

 PYLOROPLASTY
Pyloroplasty is a surgical procedure in which the pylorus valve at the lower portion of
the stomach is cut and resutured, relaxing and widening its muscular opening
(pyloric sphincter) into the duodenum (first part of the small intestine). Pyloroplasty
is a treatment for patients at high risk for gastric or peptic ulcer disease (PUD).

Purpose
 Pyloroplasty surgery enlarges the opening through which stomach contents are
emptied into the intestine, allowing the stomach to empty more quickly. A
 pyloroplasty is performed to treat the complications of PUD or when medical
treatment has not been able to control PUD in high-risk patients.

Diagnosis
 Diagnosis begins with an accurate history of prior illnesses and existing medical
conditions as well as a family history of ulcers or other gastrointestinal (stomach and
intestines) disorders. A complete history and comprehensive diagnostic testing may
include:
 location, frequency, duration, and severity of pain
 vomiting and description of gastric material
 bowel habits and description of stool
 all medications, including over-the-counter products
 appetite, typical diet, and weight changes
 family and social stressors
 alcohol consumption and smoking habits
 heart rate, pulse, and blood pressure
 chest examination and x ray, if necessary
 palpation (touch) of the abdomen
 rectal examination and stool testing
 pelvic examination in sexually active females
 examination of testicles and inguinal (groin) area in males
 testing for the presence of Helicobacter pylori
 complete blood count and blood chemistry profile
 urinalysis
 imaging studies of gastrointestinal system (x ray, other types of scans)
 biopsy of stomach lining using a tube-like telescopic instrument (endoscope)

Preparation
 Before surgery, standard preoperative blood and urine tests will be performed and
various x rays may be ordered. The patient will not be permitted to eat or drink
anything after midnight the night before the procedure. When the patient is
admitted to the hospital, cleansing enemas may be ordered to empty the intestine. If
nausea or vomiting are present, a suction tube may be used to empty the stomach.

Aftercare
 The patient will spend several hours in a recovery area after surgery where blood
pressure, pulse, respiration, and temperature will be monitored. The patient's
breathing may be shallower than normal because of the effect of anesthesia and the
patient's reluctance to breathe deeply and experience pain at the site of the surgical
incision. The patient will be shown how to support the site while breathing deeply or
coughing, and will be given pain medication as needed. Fluid intake and output will
 be measured. The operative site will be observed for any sign of redness, swelling, or
wound drainage. Intravenous fluids are usually given for 24–48 hours until the
patient is gradually permitted to eat a special light diet and as bowel activity
resumes. About eight hours after surgery, the patient may be allowed to walk a little,
increasing movement gradually over the next few days. The average hospital stay,
dependent upon the patient's overall recovery status and any underlying conditions,
ranges from six to eight days.

Risks
 Potential complications of this abdominal surgery include excessive bleeding,
surgical wound infection, incisional hernia, recurrence of gastric ulcer, chronic
diarrhea, and malnutrition. After the surgery, the surgeon should be informed of an
increase in pain, and of any swelling, redness, drainage, or bleeding in the surgical
area. The development of headache, muscle aches, dizziness, fever, abdominal pain
or swelling, constipation, nausea or vomiting, rectal bleeding, or black stools should
also be reported.

 HERRNIORRAPHY
 A herniorrhaphy is a surgical procedure used to treat medical problems stemming
from a hernia condition. It is a specific surgical strategy where the hernia is repaired
through a series of incisions and sutures.Herniorrhaphy is a medical term that
combines the Ancient Greek words hernia and raphere, the latter meaning
to suture or to make a seam. A herniorrhaphy procedure may also be known
as hernioplasty or hernia repair, although hernioplasty denotes the use of a material
foreign to the patient's body to help treat the hernia.
 Herniorrhaphy (Hernioplasty, Hernia repair) is a surgical procedure for
correcting hernia. A hernia is a bulging of internal organs or tissues, which protrude
through an abnormal opening in the muscle wall. Hernias can occur in
the abdomen, groin, and at the site of a previous surgery.
 An operation in which the hernia sac is removed without any repair of the inguinal
canal is described as a 'herniotomy'.
 Hernia refers to any protrusion of tissues or internal organs through an area of
muscle in the body. Most often, a hernia can be found in the areas of the stomach
or abdomen. It is a highly common medical problem that may be the result of
genetic disposition or of strenuous activities such as heavy lifting.

Techniques
 Groups 1 and 2: open "tension" repair
 A workable technique of repairing hernia was first described by Bassini in the
1880s the Bassini technique was a "tension" repair, in which the edges of the
defect are sewn back together without any reinforcement or prosthesis. In
 the Bassini technique, the conjoint tendon (formed by the distal ends of
the transversus abdominis muscle and the internal oblique muscle) is
approximated to the inguinal ligament and closed.

 Group 3: open "tension-free" repair

 Almost all repairs done today are open "tension-free" repairs that involve the
placement of a synthetic mesh to strengthen the inguinal region; some
popular techniques include the Lichtenstein repair (flat mesh patch placed on
top of the defect), Plug and Patch (mesh plug placed in the defect and
covered by a Lichtenstein-type patch), Kugel (mesh device placed behind the
defect), and Prolene Hernia System (2-layer mesh device placed over and
behind the defect). This operation is called a 'hernioplasty'. The meshes used
are typically made from polypropylene orpolyester, although some
companies market Teflon meshes and partially absorbable meshes.
 Group 4: laparoscopic repair
 In recent years, as in other areas of surgery, laparoscopic repair of inguinal
hernia has emerged as an option. "Lap" repairs (sometimes called "keyhole"
surgery or minimally invasive surgery) are also tension-free, although the
mesh is placed within the pre-peritoneal space behind the defect as opposed
to in or over it. Advantages of lap over the open method include a faster
recovery time and a lower post-operative pain score.
 Like the open method, laparoscopic surgery may involve local or general
anesthesia, depending on the size and related factors of the hernia. Lap is
usually more expensive as it requires more Operating Room time than open
repair, but a shorter hospitalization period.

 RHINOPLASTY
 The term rhinoplasty means "nose molding" or "nose forming." It refers to a
procedure in plastic surgery in which the structure of the nose is changed. The
change can be made by adding or removing bone or cartilage, grafting tissue from
another part of the body, or implanting synthetic material to alter the shape of the
nose.
Purpose
 Rhinoplasty is most often performed for cosmetic reasons. A nose that is too large,
crooked, misshapen, malformed at birth, or deformed by an injury can be given a
more pleasing appearance. If breathing is impaired due to the form of the nose or to
an injury, it can often be improved with rhinoplasty.
 The quality of the skin plays a major role in the outcome of rhinoplasty. Persons with
extremely thick skin may not see a significant change in the underlying bone
structure after surgery. On the other hand, thin skin provides almost no cushion to
hide many minor bone irregularities or imperfections.
 Rhinoplasty should not be performed until the pubertal growth spurt is complete,
ages 14–15 for girls and older for boys.
 During the initial consultation, the candidate and surgeon will determine what
changes can be made in the shape of the nose. Most doctors take photographs
during that consult. The surgeon will also explain the techniques and anesthesia
options available to the candidate.

Aftercare
 Patients usually feel fine immediately after surgery. As a precaution, most surgery
centers do not allow patients to drive themselves home after an operation.
 The first day after surgery, there will be some swelling of the face. Persons should
stay in bed with their heads elevated for at least a day. The nose may hurt and a
headache is common. The surgeon will prescribe medication to relieve these
conditions. Swelling and bruising around the eyes will increase for a few days, but
will begin to diminish after about the third day. Slight bleeding and stuffiness are
normal, and vary according to the extent of the surgery performed. Most people are
walking in two days, and back to work or school in a week. No strenuous activities
are allowed for two to three weeks.
 Patients are given a list of postoperative instructions, which include requirements for
hygiene, exercise , eating, and follow-up visits to the doctor. Patients should not
blow their noses for the first week to avoid disruption of healing. It is extremely
important to keep the surgical dressing dry. Dressings, splints, and stitches are
removed in one to two weeks. Patients should avoid excessive sun or sunburn.
Risks
 Any type of surgery carries a degree of risk. There is always the possibility of
unexpected events such as an infection or a reaction to the anesthesia.
 When the nose is reshaped or repaired from inside, the scars are not visible. If the
surgeon needs to make the incision on the outside of the nose, there will be some
slight scarring. In addition, tiny blood vessels may burst, leaving small red spots on
the skin. These spots are barely visible, but may be permanent.

 ABDOMINOPLASTY
Also known as a tummy tuck, abdominoplasty is a surgical procedure in which excess
skin and fat in the abdominal area is removed and the abdominal muscles are
tightened
PURPOSE
 Abdominoplasty is a cosmetic procedure that treats loose or sagging abdominal skin,
leading to a protruding abdomen that typically occurs after significant weight loss.
Good candidates for abdominoplasty are individuals in good health who have one or
more of the above conditions and who have tried to address these issues with diet
and exercise with little or no results.
 Women who have had multiple pregnancies often seek abdominoplasty as a means
of ridding themselves of loose abdominal skin. While in many cases diet and exercise
are sufficient in reducing abdominal fat and loose skin after pregnancy, in some
women these conditions may persist. Abdominoplasty is not recommended for
women who wish to have further pregnancies, as the beneficial effects of the
surgery may be undone.
Contraindications
 Certain patients should not undergo abdominoplasty. Poor candidates for the
surgery include:
 Women who wish to have subsequent pregnancies.
 Individuals who wish to lose a large amount of weight following surgery.
 Patients with unrealistic expectations (those who think the surgery will give
them a "perfect" figure).
 Those who are unable to deal with the post-surgical scars.
 Patients who have had previous abdominal surgery.
 Heavy smokers.

Diagnosis/Preparation
 There are a number of steps that the patient and plastic surgeon must take before
an abdominoplasty may be performed. The surgeon will generally schedule an initial
consultation, during which a physical examination will be performed. The surgeon
will assess a number of factors that may impact the success of the surgery. These
include:
 the patient's general health
 the size and shape of the abdomen and torso
 the location of abdominal fat deposits
 the patient's skin elasticity
 what medications the patient may be taking
 It is important that the patient come prepared to ask questions of the surgeon
during the initial consultation. The surgeon will describe the procedure, where it will
be performed, associated risks, the method of anesthesia and pain relief, any
additional procedures that may be performed, and post-surgical care. The patient
may also meet with a staff member to discuss how much the procedure will cost and
what options for payment are available.
 The patient will also receive instructions on how to prepare for abdominoplasty.
Certain medications should be avoided for several weeks before and after the
surgery; for example, medications containing aspirin may interfere with the blood's
ability to clot. Because tobacco can interfere with blood circulation and wound
healing, smokers are recommended to quit for several weeks before and after the
procedure. A medicated antibacterial soap may be prescribed prior to surgery to
decrease levels of bacteria on the skin around the incision site.
 Aftercare
 The patient may remain in the hospital or surgical facility overnight, or return home
the day of surgery after spending several hours recovering from the procedure and
anesthesia. Before leaving the facility, the patient will receive the following
instructions on post-surgical care:
 For the first several days after surgery, it is recommended that the patient
remain flexed at the hips (i.e., avoid straightening the torso) to prevent
unnecessary tension on the surgical site.
 Walking as soon as possible after the procedure is recommended to improve
recovery time and prevent blood clots in the legs.
 Mild exercise that does not cause pain to the surgical site is recommended to
improve muscle tone and decrease swelling.
 The patient should not shower until any drains are removed from the surgical
site; sponge baths are permitted.
 Work may be resumed in two to four weeks, depending on the level of
physical activity required.
 Surgical drains will be removed within one week after abdominoplasty, and stitches
from one to two weeks after surgery. Swelling, bruising, and pain in the abdominal
area are to be expected and may last from two to six weeks. Recovery will be faster,
however, in the patient who is in good health with relatively strong abdominal
muscles. The incisions will remain a noticeable red or pink for several months, but
will begin to fade by nine months to a year after the procedure. Because of their
location, scars should be easily hidden under clothing, including bathing suits.

Risks
 There are a number of complications that may arise during or after abdominoplasty.
Complications are more often seen among patients who smoke, are overweight, are
unfit, have diabetes or other health problems, or have scarring from previous
abdominal surgery. Risks inherent to the use of general anesthesia include nausea,
vomiting, sore throat, fatigue, headache, and muscle soreness; more rarely, blood
pressure problems, allergic reaction, heart attack, or stroke may occur.
 Risks associated with the procedure include:
 bleeding
 wound infection
 delayed wound healing
 skin or fat necrosis (death)
 hematoma (collection of blood in a tissue)
 seroma (collection of serum in a tissue)
 blood clots
 pulmonary embolism (a blood clot that travels to the lungs)
  numbness to the abdominal region or thighs (due to damage to nerves during
surgery)

 BLEPHAROPLASTY
 Blepharoplasty is a cosmetic surgical procedure that removes fat deposits, excess
tissue, or muscle from the eyelids to improve the appearance of the eyes.

PURPOSE
 The primary use of blepharoplasty is for improving the cosmetic appearance of the
eyes. In some older persons, however, sagging and excess skin surrounding the eyes
can be so extensive that it limits the range of vision. In those cases, blepharoplasty
serves a more functional purpose.
 Blepharoplasty can be performed on the upper or lower eyelid. It can involve the
removal of excess skin and fat deposits and the tightening of selected muscles
surrounding the eyelids. The goal is to provide a more youthful appearance and/or
improve eyesight.

Diagnosis/Preparation
 Before performing blepharoplasty, the surgeon will assess whether a person is a
good candidate for the treatment. A thorough medical history is important. The
surgeon will want to know about any history of thyroid disease, hypertension, or eye
problems, which may increase the risk of complications.
 Prior to surgery, surgeons and their candidates meet to discuss the procedure, clarify
the results that can be achieved, and discuss potential problems that might occur.
Having realistic expectations is important in any cosmetic procedure. People will
learn, for example, that although blepharoplasty can improve the appearance of the
eyelid, other procedures, such as a chemical peel, will be necessary to reduce the
appearance of wrinkles around the eye. Some surgeons prescribe vitamin C and
vitamin K for 10 days prior to surgery in the belief that this helps the healing process.
Candidates are also told to stop smoking in the weeks before and after the
procedure, and to refrain from using alcohol or aspirin .

Aftercare
 An antibiotic ointment is applied to the line of stitches each day for several days
after surgery. Patients also take an antibiotic several times a day to prevent
infection. Ice-cold compresses are applied to the eyes continuously for the first day
following surgery, and several times a day for the next week or so, to reduce
swelling. Some swelling and discoloration around the eyes is expected with the
procedure. Persons should avoid aspirin or alcoholic beverages for one week and
should limit their activities, including bending, straining, and lifting. The stitches are
removed a few days after surgery. People can generally return to their usual
activities within a week to 10 days.

Risks
As with any surgical procedure, blepharoplasty can lead to infection and scarring.
Good care of the wound following surgery can minimize these risks. In cases where
too much skin is removed from the eyelids, people may experience difficulty closing
their eyes. Dry eye syndrome may develop, requiring the use of artificial tears to
lubricate the eye. In a rare complication, called retrobulbar hematoma, a pocket of
blood forms behind the eyeball