Surgery

Surgery: Overview

Deep down, every surgical patient has the same worry: How safe is surgery and anesthesia? The prospect of surgery and a hospital stay is discomforting for most people.  Asking questions and researching the specific type of surgery that one is about to undergo helps to alleviate fears.

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With better preoperative diagnostics, preoperative planning (including computerized surgical simulation), and intraoperative navigation (including augmented reality), the future is looking bright for patients.

History

The modern practice of medicine — in particular the field of surgery — has been undergoing a silent revolution since the beginning of the "information age" in the mid 1990s.  An explosion in new technologies combines the biological, physical, and information sciences into systems that enhance technological performance well beyond previous limitations.

The current trend is away from direct, hands-on surgical approaches, towards minimally-invasive and noninvasive "hands-off" procedures such as laparoscopic, catheter-based, robot-aided, and computer-aided surgery.  The technological developments occurring today hint at the even more amazing advancements that the future holds.

Expected Outcome; Side-Effects

Unfortunately, today's surgery patients are sicker than ever.  Some 5% of all surgical patients die within one year of surgery.  For those over 65, some 10% die within one year of a surgery.

Any form of invasive surgery carries certain risks.  Patients contemplating surgery should be advised of the possibility of experiencing complications, such as the following:

  • Damage to blood vessels
  • Secondary damage to organs
  • Hemorrhage (bleeding) during surgery (intraoperative) or after surgery (postoperative)
  • Incisional hernia (bulging of the internal organs beneath the surgical incision, caused by imperfect healing or damage to the overlying muscles)
  • Infection
  • Pneumothorax (unwanted air in the chest cavity).
  • Complications of Anesthesia

Anesthesia is just one area in which very impressive improvements in safety have been made.  Even as far back as 1999, the Institute of Medicine reported that mortality resulting from anesthesia had decreased from 1 death per 5,000 patients during the 1980s, down to 1 death per 200,000-300,000 patients.

On This Page

Surgery:

Surgery can help with the following:

Aging

Cataracts

It is a widely held belief that surgery to remove the diseased lens is the only effective treatment for cataracts.  In cases of marked vision impairment, cataract removal and lens implant may be the only alternative.  Cataract surgery is now a frequently performed operation in most parts of the world.  More than one million cataract procedures are performed every year, and in the majority of those cases, the diseased tissue is replaced with an artificial device known as an intraocular lens implant.

Allergy

Baggy or Droopy Eyes

The most common treatment for baggy eyes is called blepharoplasty, or simply eyelid surgery.

Autoimmune

Myasthenia Gravis

The thymus is thought to play an important role in the development of the disease by supplying helper T cells sensitized against thymic nicotinic receptors.  In most patients with myasthenia gravis, the thymus is enlarged, and 10-15% have thymomas.  Thymectomy is indicated if a thymoma is suspected.  In patients with generalized myasthenia without thymoma, thymectomy induces remission in 35% and improves symptoms in another 45%.

The thymus is the master gland of immunity, and removing this gland weakens the body's ability to fight infections and cancer.  The thymus normally shrinks and becomes less useful with age.  It would seem logical that thymectomy in a younger person could have greater negative long term consequences than thymectomy in an older person.

Circulation

Poor Circulation

Many severe blockages in the heart or elsewhere can now be cleared away without surgery, and surgery isn't for everyone: It is expensive and involves at least some degree of risk from infection, clotting, and other complications.  Also, those freshly opened arteries may well close up again with the passage of time.

When surgery is the only answer, there are two major options.  In a bypass operation, the surgeon grafts a segment taken from one of the patient's veins (or sometimes an artificial vessel) onto the clogged artery, giving blood a pathway around the blockage.  Alternatively, the surgeon can open the vessel and cut the plaque away (a procedure called endarterectomy).

Intermittent Claudication

Surgical options to restore blood supply, called "revascularization" procedures, are usually reserved for those with progressive or disabling symptoms.

Dental

Periodontal Disease - Gingivitis

Your periodontist may recommend periodontal surgery.  This is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired by non-surgical means.  Special deep cleaning procedures may prevent the need for surgery.

Digestion

Heartburn / GERD / Acid Reflux

In most cases, heartburn can be relieved through diet and lifestyle changes alone, but some people may require medication or surgery.

Hormones

Hyperparathyroidism

Surgery to remove the enlarged gland (or glands) is the only treatment for the disorder and cures it in 95% of cases when performed by surgeons experienced with this condition.  About 1% of patients undergoing surgery have damage to the nerves controlling the vocal cords, which can affect speech.  Some 1-5% develop chronic low calcium levels, which may require treatment with calcium and/or vitamin D.  The complication rate is slightly higher for hyperplasia than it is for adenoma since more extensive surgery is needed.

Immunity

Chronic Fatigue / Fibromyalgia Syndrome

Some dentists report treating chronic fatigue and arthritic pain by removing infected bone in the third molar area.  These problems disappear in many patients after removing dental infections.

Infections

Appendicitis

Surgery is performed on the basis of a doctor's examination and the results of tests.  Many diseases can cause the same symptoms as appendicitis which is why surgeons find a normal appendix in some 3 out of 10 operations.  Surgical removal of the appendix (appendectomy) is the recommended treatment and is usually performed under general anesthesia.  In uncomplicated cases, a 2-3 day hospital stay is typical.

A 2002 study published in the journal Radiology found that among women who had a CT scan or ultrasound prior to having an appendectomy, a healthy appendix was removed just 7% of the time, compared with 28% of the time when no scan was done.

Boils, Abscesses, Carbuncles

Surgery may occasionally be needed, especially in cases of pilonidal cysts that recur, but also for hidradenitis suppurativa.  For pilonidal cysts, surgically removing the cyst lining is important.  The procedure is typically performed in the operating room.  For hidradenitis suppurativa, extensive involvement can require plastics surgical repair.

Middle Ear Infection

The insertion of tympanostomy tubes (plastic grommets punched through the ear drum) should be considered if more benign treatments fail.

Leukoplakia

The treatment of choice is removing the irritants that are causing leukoplakia.  If this doesn't work, or the lesions are precancerous, your dentist may decide to remove the leukoplakic patches using a scalpel, laser or cryoprobe (freezing probe.)

Metabolic

Meniere's Disease

If medical treatments fails to stop vertigo, hearing loss, ringing in the ear and pressure in the ear then there are several surgical options that may improve the condition.  The original surgical treatment (in the sixties) was total destruction of the inner ear which, though effective in almost all cases, resulted in total hearing loss (!) A second surgical option was introduced in the 1970s which cut the balance nerve to the brain, preserving hearing and relieving vertigo in 95% of cases.  However, because the procedure involves operating near to the brain, it is reserved for the most serious cases.

Musculo-Skeletal

Abdominal Hernia

Surgery will usually be required to repair the area.  It is important to get your hernia seen to by a doctor because if it is left untreated, the protruding organ may become strangulated (have its blood supply cut off), and infection and tissue death may occur as a result.  In babies, umbilical hernias frequently heal themselves within four years, making surgery unnecessary.

Ochronosis / Alkaptonuria

Arthroplasty of the hip and knee is often necessary.

Compartment Syndrome

Acute compartment syndrome is a surgical emergency requiring a fasciotomy: opening the skin and fascia covering the affected compartment, allowing room for the muscle to swell.  There is no effective non-surgical treatment.

In cases of chronic (exertional) compartment syndrome, if conservative treatment doesn't help, surgical intervention generally has a good success rate, with success being defined as the return to athletics without significant symptoms.  In the anterior (front) compartment of the leg, the success rate is over 85%; in the deep posterior (rear) compartment, the success rate is only around 70%.

Heberden's Nodes

In some cases, surgery may be required in order to correct or prevent joint deformity, relieve pain and improve movement.

Osteonecrosis of the Jaw

The only known treatment for NICO is jawbone curettage, in which the jawbone is opened, the infected area drilled out, and the bone biopsied to confirm the presence of inflammation or infection.  Often the bone cavity is packed with antibiotics such as terramycin.  A course of antibiotic treatment may be prescribed.  Jawbone curettage is not currently done routinely, and it is too early to say whether or not it will ever become generally accepted.

Organ Health

Retinopathy

Proliferative retinopathy is treatable in many cases by laser beam (photocoagulation), which stops the fragile blood vessels from leaking and helps prevent blindness or lessen any losses in vision.  The high-energy light from a laser is aimed at the weakened blood vessels in the eye, destroying them.  Scars will remain where the laser treatment was performed.  For that reason, laser treatment cannot be performed everywhere.  For example, laser photocoagulation at the fovea would destroy the area for sharp vision.  Larger area treatment (panretinal photocoagulation) may be performed in the periphery of the retina in the hope that it will decrease neovascularization.  Prompt treatment of proliferative retinopathy may reduce the risk of severe vision loss by 50%.

Kidney Stones (Urolithiasis)

Surgical intervention – cystoscope or open surgery – may be required if other physical intervention, such as shockwave therapy (F-SWL) to break up stone(s) is unsuccessful.

Gallbladder Disease

Gallbladder removal for stones and disease is called a cholecystectomy.  The first such operation for symptomatic gallbladder disease was performed in 1882.  It is preformed by cutting a 4 to 8 inch hole in the right upper quadrant of the abdomen.  The gallbladder is directly visualized and removed by the surgeon.  Laparoscopy cholecystectomy was introduced in 1987.  This technique is done using a small scope through which the gallbladder is removed.  Small incisions, leaving barely visible scars, are made and the patient has a much quicker recovery than with open surgery.

Rheumatic Heart Disease

Surgery to replace the damaged valve may be necessary in some cases.

Glaucoma

In all forms of glaucoma, if the pressure cannot be controlled with medicines and eye drops, or if the side-effects are unacceptable, the drainage from the front part of the eye can be increased surgically.  This can be done either by using a laser to create a hole in the iris or by using microsurgery to cut out part of the iris.  Usually both eyes are treated.

Enlarged Spleen

A severely ruptured spleen is usually surgically removed.  The human body usually adapts well to life without a spleen, so surgically removing a diseased or damaged spleen is possible without causing serious harm to the patient.  In some cases, it is possible to remove only the diseased or damaged parts of the spleen, allowing the remaining healthy portions to keep functioning as normal.

Pain

Low Back Pain

Some dentists report treating chronic low back pain patients by removing infected bone in the third molar area.  Chronic fatigue and arthritic pain disappear in many patients with these conditions after removing dental infections.

Reproductive

Endometriosis

Laser techniques to destroy endometrial tissue are currently popular in conventional medicine as is removing the uterus, ovaries (and perhaps appendix) thus stopping the menstrual cycle altogether.

Peyronie's Disease

If the bend in the penis is so severe that intercourse is impossible, surgery may be recommended.  The scarring plaque that causes the bend may need to be removed or cut to straighten the penis, but this usually affects the quality of erections.  A penile implant may be inserted to improve erections.

Peyronie's disease often occurs in a mild form that heals without treatment in 6-15 months.  It is not clear why this occurs without intervention.  However, once a plaque has calcified, it is unlikely to resolve and surgery is the only solution.  Because the cause of Peyronie's disease is still unknown and all of its symptoms may lessen or disappear in some individuals, many experts recommend that a man wait 1 to 2 years before considering surgery.

Respiratory

Problems Associated With Snoring

Several surgical procedures are available for treating chronic snoring.  These include:

  • Uvulopalatopharyngoplasty (UPPP) – removing excess throat tissues (e.g. tonsils, parts of the soft palate) to expand the airway.
  • Laser-assisted uvulopalatoplasty (LAUP) – removing part of the uvula and palate with a surgical laser.
  • Palatal stiffening – a minimally-invasive surgical technique where a laser or a cauterizer is used to produce scar tissue in the soft palate in order to stop the vibrations that produce snoring.
  • Radiofrequency ablation – another technique which uses scarring to shrink the uvula and/or soft palate.  A needle electrode is used to shrink and scar the mouth and throat tissues.

Tumors, Benign

Thymoma

Surgery is the main treatment for thymoma.  When the tumor is non-invasive, completely removing it will cure the condition in most people.  If the tumor is invasive, surgery may be more difficult and radiotherapy is usually given after surgery, to treat any remaining tumor and reduce the risk of the tumor coming back.

Cysts

A very large cyst that causes significant symptoms can be surgically removed, or drained by inserting a needle or catheter into the cavity.

Sebaceous cysts are usually ignored unless they become bothersome or infected.  An infected cyst can form into a very painful abscess for which surgical incision and drainage is usually necessary for pain relief.  Excision of the cyst and the surrounding sac may be necessary to prevent recurrence.  Sebaceous cysts may disappear spontaneously, or remain in place without causing any problems.

Tendency To Develop Polyps

Since there is no way of knowing whether a polyp will become malignant, total removal of the polyp is the best treatment.  If polyps are detected during a colonoscopy, they can usually be removed painlessly using the colonoscope.  A wire loop is placed around the polyp and then a electrical current is passed through the wire, to separate the polyp from the bowel.  If the polyp is very large it may require more than one treatment for complete removal.  If the polyp cannot be removed with these methods then surgery may be required.

Fibroids

A new procedure called Uterine Artery Embolization is considered to be less invasive than other procedures and enjoys a high success rate.  It involves cutting off the blood supply to the fibroid by placing a catheter into the uterine arteries and injecting small particles.  This blocks the blood flow and causes the fibroid to degenerate, leaving the remainder of the organ intact.  Often this is a better approach than a hysterectomy.

Tumors, Malignant

Kidney Cancer

Surgery (to remove cancerous tissue) is usually required to treat Renal Cell Carcinoma (RCC).  Without it, most patients' chances for survival are poor.  Several surgical options are available to the patient and physician; which is most appropriate depends on the patient's condition and the cancer's stage.  The most common form of surgery for RCC, radical nephrectomy involves removal of the entire kidney, often along with the attached adrenal gland, surrounding fatty tissues and nearby lymph nodes (regional lymphadenectomy), depending upon how far the cancer has spread.  It may be possible to remove only the cancerous tissue and part of the kidney if the tumor is small and confined to the very top or bottom of the kidney.  A partial nephrectomy may be the procedure of choice for patients with RCC in both kidneys and for those who have only one functioning kidney.  In additional to the standard risks of surgery, possible failure of the remaining kidney is something that should be considered.

Prostate Cancer

Surgery is the main treatment for most prostate cancer.  The most common technique is a "radical prostatectomy", which involves removing the prostate gland, seminal vesicles and nearby lymph nodes.  It is a major operation, so it is most suitable for otherwise healthy men (usually, those under 70) whose cancer appears not to have spread.  About 80% of men who have this operation are still alive after 10 years.  Possible side-effects of the procedure include some urinary incontinence, sterility and erectile dysfunction (impotence), although modern surgical techniques can minimize the risks of this to some extent.  It is important to remember that it is very hard through surgery alone to remove every single cancer cell: a radical prostatectomy is no guarantee that one will remain free from cancer.

Stomach Cancer

The only way to cure stomach cancer is to find it early and remove the tumor through surgery.  If it has not spread outside the stomach, then an operation to remove either the whole stomach or just the affected part of it may be done.  In advanced cases, surgery will not cure the cancer but may be needed to treat symptoms such as vomiting, pain or bleeding.

Thyroid Cancer

Surgery is the main treatment for thyroid cancer.  In most cases, doctors will remove the entire thyroid gland.

Bile Duct Cancer

The optimal and only definitive treatment is the complete surgical removal of the tumor, which is not often possible.  Unfortunately, by the time symptoms develop, the cancer has usually spread throughout the bile ducts and into the liver, meaning that the tumor cannot be entirely removed.

Uro-Genital

Vulvodynia / Vestibulitis

Surgical treatment may include removal of painful areas such as the vulvar (bartholin's) glands, decompression surgery of the pudendal nerve to free the nerve and its branches up (from compressions due to blood vessels and veins, damaged tissue, and ligamental grip), and/or laser therapy to destroy underlying vulvar blood vessels.

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