FAQs on General Surgery

Ask your surgeon to explain the surgical procedure. For example, if something is going to be repaired or removed, find out why it is necessary to do so. Your surgeon can draw a picture or a diagram and explain to you the steps involved in the procedure.

There are many reasons to have surgery. Some operations can relieve or prevent pain. Others can reduce a symptom of a problem or improve some body function. Some surgeries are performed to diagnose a problem. Surgery also can save your life. Your surgeon will tell you the purpose of the procedure. Make sure you understand how the proposed operation fits in with the diagnosis of your medical condition.

Sometimes, surgery is not the only answer to a medical problem. Medicines or other non–surgical treatments, such as a change in diet or special exercises, might help you just as well or more. Ask your surgeon or primary care doctor about the benefits and risks of these other choices. You need to know as much as possible about these benefits and risks to make the best decision.

One alternative may be “ waiting an observation,” in which your doctor and you check to see if your problem gets better or worse. If it gets worse, you may need surgery right away. If it gets better, you may be able to postpone surgery, perhaps indefinitely.

Ask your surgeon what you will gain by having the operation. For example, a hip replacement may mean that you can walk again with ease.

Ask how long the benefits are likely to last. For some procedures, it is not unusual for the benefits to last for a short time only. There might be a need for a second operation at a later date. For other procedures, the benefits may last a lifetime.

When finding out about the benefits of the operation, be realistic. Sometimes patients expect too much and are disappointed with the outcome, or results. Ask your doctor if there is any published information about the outcomes of the procedure.

All operations carry some risk. This is why you need to weigh the benefits of the operation against the risks of complications or side effects. Complications can occur around the time of the operation. Complications are unplanned events, such as infection, too much bleeding, reaction to anesthesia, or accidental injury. Some people have an increased risk of complications because of other medical conditions.

In addition, there may be side effects after the operation. For the most part, side effects can be anticipated. For example, your surgeon knows that there will be swelling and some soreness at the site of the operation.

Ask your surgeon about the possible complications and side effects of the operation. There is almost always some pain with surgery. Ask how much there will be and what the doctors and nurses will do to reduce the pain. Controlling the pain will help you be more comfortable while you heal, get well faster, and improve the results of your operation.

Based on what you learn about the benefits and risks of the operation, you might decide not to have it. Ask your surgeon what you will gain—or lose—by not having the operation now. Could you be in more pain? Could your condition get worse? Could the problem go away?

Getting a second opinion from another doctor is a very good way to make sure having the operation is the best alternative for you. Many health insurance plans require patients to get a second opinion before they have certain non–emergency operations. If your plan does not require a second opinion, you may still ask to have one. Check with your insurance company to see if it will pay for a second opinion. If you get one, make sure to get your records from the first doctor so that the second one does not have to repeat tests.

Most surgeons practice at one or two local hospitals. Find out where your operation will be performed. Have many of the operations you are thinking about having been done in this hospital? Some operations have higher success rates if they are done in hospitals that do many of those procedures. Ask your doctor about the success rate at this hospital. If the hospital has a low success rate for the operation in question, you should ask to have it at another hospital. Until recently, most surgeries were performed on an inpatient basis and patients stayed in the hospital for one or more days. Today, a lot of surgeries are done on an outpatient basis in a doctor's office, a special surgical center, or a day surgery unit of a hospital. Outpatient surgery is less expensive because you do not have to pay for staying in a hospital room.

Ask whether your operation will be done in the hospital or in an outpatient setting. If your doctor recommends inpatient surgery for a procedure that is usually done as outpatient surgery, or just the opposite, recommends outpatient surgery that is usually done as inpatient surgery, ask why. You want to be in the right place for your operation.

Anesthesia is used so that surgery can be performed without unnecessary pain. Your surgeon can tell you whether the operation calls for local, regional, or general anesthesia, and why this form of anesthesia is recommended for your procedure.

Local anesthesia numbs only a part of your body for a short period of time, for example, a tooth and the surrounding gum. Not all procedures done with local anesthesia are painless.

Regional anesthesia numbs a larger portion of your body, for example, the lower part of your body for a few hours. In most cases, you will be awake with regional anesthesia.

General anesthesia numbs your entire body for the entire time of the surgery. You will be unconscious if you have general anesthesia.

Anesthesia is quite safe for most patients and is usually administered by a specialized physician (anesthesiologist) or nurse anesthetist. Both are highly skilled and have been specially trained to give anesthesia.

Your surgeon can tell you how you might feel and what you will be able to do or not do for the first few days, weeks, or months after surgery. Ask how long you will be in the hospital. Find out what kind of supplies, equipment, and any other help you will need when you go home. Knowing what to expect can help you cope better with recovery.

Ask when you can start regular exercise again and go back to work. You do not want to do anything that will slow down the recovery process. Lifting a 10–pound bag of potatoes may not seem to be “too much” a weak after your operation, but it could be. You should follow your surgeon's advice to make sure you recover fully as soon as possible.

For temporary relief, one could try limiting one’s activities, go on light duty, and avoid heavy work. Wearing a truss or binder, gives only temporary relief, and is only recommended for those unfit for surgery. The only treatment is surgery. There are many different surgical techniques, some of which are noted for minimal post–operative discomfort, faster recovery, and lasting relief. Briefly, there are 2 main ways of fixing a hernia – (1) the traditional method of a large open incision, (2) the laparoscopic method, with miniature incisions, tracers, a telescope and a camera. Discuss with your doctor. See other pages of this web–site, then come consult with us, especially if you have a complex or recurrent or bilateral inguinal hernia, or if you want to return to work quickly.

The hand pain in Rheumatoid Arthritis (RA) may originate from a large variety of causes, chief among which are the inflammation of the synovial membranes. In rheumatoid arthritis this tissue becomes inflamed and instead contributes to the destruction of the joint and its adjacent ligaments (which are the stays that effectively constrain the joint and render it stable but mobile). As the joints and ligaments decay, the joints may become unstable and deviate or adopt abnormal attitudes or positions, putting increasing strain on the remaining ligaments. Such inflamed and swollen joints are painful in their own right, and some pain may arise from the joint surfaces or from the capsule that surrounds the joint including the ligaments that bear abnormal strains. Surgery in this condition has several aims. Some feel that when the joints begin to deviate, corrective surgery to the ligaments and soft tissues (as opposed to bone) may allow realignment of the joint surfaces and prevent the erosion of those surfaces that comes from chronic malignant. This surgery was particularly appropriate for the metacarpophalangeal joints (at the junction between fingers and palm) which commonly deviate away from the thumb side of the hand, sometimes well before the joints themselves require replacement.

It should however be borne in mind that other causes of pain occur in rheumatoid arthritis in the hand, and important amongst these are nerve compression pains from swelling of adjacent joints or tendons, and subsequent compression of the nearby nerves. A good example of this is rheumatoid arthritis associated carpal tunnel syndrome. Any one suffering from rheumatoid arthritis with any new type of hand pain should be evaluated by a hand specialist or rheumatologist where possible, and regular checks by a rheumatologist or hand surgeon are sensible; in this condition. The individual indications for surgery for pain may then be discussed in detail.

The MCP (metacarpophalangeal)joints are the knuckle joints where the finger joins the palm. The PIP joints (proximal interphalangeal) are the middle joints of the fingers.

MCP replacement with prostheses is most commonly undertaken for advanced rheumatoid arthritic change with deviation and loss of function at these joints.

General anesthesia is commonly used to provide optimal operating conditions for the procedure and a pain–free state. Local anesthesia is added in the areas of the incisions to provide pain relief after the surgery. Any additional postoperative pain can be alleviated with small doses of intravenous, intramuscular or oral painkillers. Side effects from the anesthesia and surgery can include sleepiness, nausea or vomiting. Medication can be given to treat all of these conditions. As with the open method, urinating may be affected. You should be able to go home a few hours after your surgery is finished.

The main advantage of the laparoscopic technique is that it avoids painful incisions. Pain and discomfort are dramatically less than with the open technique. A secondary advantage is that both sides can be examined during a single surgery. Most patients are able to return to work within 72 hours and resume full or nearly full physical activity by one week.

You will need an escort to take you home after the surgery because you may still feel sleepy after the anesthetic. It is also a good idea to have someone with you for 12 to 24 hours to make sure that you can eat and drink normally. Side effects from the anesthesia and surgery include pain, muscle aches, abdominal swelled, stomach queasiness, nausea and/or vomiting, headache, somnolence or sleepiness, and sore throat (from the breathing tube). Mild pain and anti–nausea medications are given to all patients to help minimize this tendency and minor discomforts. All of these side effects will dissipate over the next few days.

Most patients need a few days to recover and get their strength back. Full activity in both open and laparoscopic procedures is encouraged after 48 hours, though the amount any patient can do is dependent on the type of procedure performed and individual responses to pain.

You will need to make an appointment with your surgeon for 1 week after the surgery to follow–up and check on your healing. There are 2 choices today for the repair of an inguinalhernia. Namely laparoscopic or Open Laparoscopic Repair.

With the minimally invasive approach the surgery is performed through 3 small incisions. A balloon is placed beneath the abdominal muscles and the hernia is reduced into the space created. A mesh patch is then placed over the defect and tacked to the surrounding ligaments and muscles with titanium tacks. Pro's include limited postoperative pain and early return to work in as few as 3–4 days. Early return to full activities by 2 weeks. 5 year results reveal recurrence rate around 2% must be performed using a general anesthetic

A hernia is a weakness, or defect, in the lining of the abdominal muscles. This can be something you are born with or something that develops with time due to continued straining on the muscle lining from lifting, coughing, sneezing, etc. Eventually there will be a large enough defect to allow abdominal contents, such as fat, fluid or intestine, to enter into the opening. This will result in a visible bulge in the skin in the area involved. For most people this is the inguinal, or groin region. Other areas are the belly button, abdominal midline, or previous surgical scar, in addition to some other rare locations.

Hernia repair can now be performed with the aid of a small camera called a Laparoscope. This allows the surgeon to use small incisions to place the instruments and mesh needed to repair a hernia. The first incision is made below the belly button. A balloon is then placed beneath he abdominal muscles and inflated to create a working space. Two additional 1/2 inch incisions are made below the belly button. After the hernia sac is returned below the muscles a mesh patch is placed over the hernia defect and tacked to the surrounding ligaments and muscle with titanium tacks. The incisions are then closed with a single dissolvable suture.

The advantage of laparoscopic repair is the quicker recovery. Most patients return to work between 1 – 2 weeks depending on the amount of lifting required. No heavy lifting greater than 20 pounds is advised for the first 2 weeks. You may resume normal activities the same day, including walking up stairs, and may shower the following day. Driving should wait until there is minimal discomfort, usually 4 – 5 days.

Anyone with an inguinal or groin type hernia can be repaired with the laparoscopic technique unless there has been previous surgery in the middle of the lower abdomen, the patient is unable to tolerate a general anesthetic due to medical illness, or the hernia is too large (such as those that remain in the scrotum). A patient with a previous hernia repair, or a hernia on both sides is an excellent candidates for this procedure.

A general anesthetic is used to allow complete relaxation of the abdominal muscles. This results in nausea for some patients as the main side effect. The anesthesiologist will discuss other risks with you at the time of the procedure.

As with any surgery we always worry about the risk of bleeding or infection where the surgery was performed (less than 1%). Additionally, with hernia surgery there is a risk of injury to the spermatic cord which carries the blood supply and sperm tube, which could result in sterility if injured on both sides or can cause changes in the testicles such as pain, swelling or shrinkage (less than 1%). The patch which is placed is artificial and can become infected requiring treatment with antibiotics or even removal. There is an approximately 1% recurrence rate in the immediate postoperative period with the 5 year results about 2%.

With the open or traditional approach an incision is made in the groin over the site of the bulge. The muscle layers are divided to reach the neck of the hernia which is then reduced into the abdomen. The muscle layers are then reap–proximated and a patch material is placed over the repair to help prevent a recurrence.

Pro's include known long term results with a recurrence rate approximately 2–5% may be performed with a local, spinal or general anesthetic. Con's include increased discomfort in immediate postoperative period Time off of work approximately 2–4 weeks.

The groin area is the most common site of a hernia (80%), hernias in this area are called inguinal hernias. But hernias can occur below the groin area (femoral), at the belly button (umbilical), in the abdominal area and at sites of prior surgery (incisional).

Men, women, and children of any age can get hernias. They can occur because you were born with a natural weakness in the abdominal wall, or from a weakness acquired with age. Contributing factors include previous surgery in the abdominal area, excessive weight gain, pregnancy, constipation, infection, malignancy, or trauma. Strenuous physical activity including heavy lifting may also be a contributing factor.

Hernias don’t go away. All defects, even ones that show no symptoms (“Asymptomatic”), should be surgically corrected since the risks of surgery are much less than the risks to you of not fixing the hernia. Once you develop symptoms, surgical repair is mandatory. Small asymptomatic hernias can sometimes be pushed back into place by your doctor, but surgery is the only way to really fix a hernia.
Surgical repair of hernias
There are two main ways to surgically fix a hernia: open repair and minimally invasive laparoscopic repair.

Open Surgical Repair of Hernia
This type of repair involves making a cut (incision) over the hernia, carefully dissecting through the body tissues and closing the area of weakness. Usually a mesh (composed of gortex, teflon or other material) is sewn into place over or under the weakened area to make it stronger and to prevent recurrence. After the repair, the incision is closed and covered with bandages and tape.

Local anesthesia (lidocaine, mepivacaine) is commonly used to prevent you from feeling pain during the procedure. In addition, the anesthesiologist gives a mixture of short–acting sedating medications to provide comfort. Occasionally spinal or general anesthesia may be required for larger hernias or more complicated cases. Postoperative pain may be managed with a combination of intravenous, intramuscular and oral painkillers. You may have some trouble urinating for the first 12–24 hours following the procedure.

The main disadvantage of the open technique is that it can cause considerable pain. You may not be able to return to work for a week or longer and full activity may not be possible for up to six weeks. Swelling and black and blue discoloration of the wound site is common. Repairs of repeat inguinal hernias, and two sided repairs, are much more painful and have a much longer recovery period.

By far the commonest replacement joint is made from Silicone rubber and was designed by Dr. Al Swanson from Grand Rapids Michigan. It is beautifully simple, acting as a flexible hinge. Because of its structure it does not accurately replicate the biomechanics of the joint it replaces, and so full function is never restored. In addition it is made of a friable material and for this reason it is subject to attritional wear. Most surgeons therefore use it almost exclusively in the low demand low load hands of rheumatoid patients where it can be very successful indeed.

In addition the joint has no inherent lateral stability, which is not a problem in the MCP because the adjacent joints bolster it, but in the PIP it can pose problems resisting lateral stress.

Many of us believe that the ideal range of motion after an MCP joint replacement is about 30 to 40 degrees, compared with 90 degrees in the unaffected hand. Many other designs have been tried and continue to be developed but none have achieved the wide acceptance of the Swanson Implant.

The hand pain in rheumatoid arthritis (RA) may originate from a large variety of causes, chief amongst which are the inflammation of the synovial membranes. Synovium is specialized tissue that allows gliding to occur and which secretes the lubricant and nutrient synovial fluid essential to normal joint function and the function of some tendons. In rheumatoid arthritis this tissue becomes inflamed and instead contributes to the destruction of the joint and its adjacent ligaments (which are the stays that effectively constrain the joint and render it stable but mobile). As the joints and ligaments decay, so the joints may become unstable and deviate or adopt abnormal attitudes or positions, putting increasing strain on the remaining ligaments. Such inflamed and swollen joints are painful in their own right, and some pain may arise from the joint surfaces or from the capsule that surrounds the joint including the ligaments that bear abnormal strains.

Surgery in this condition has several aims. Some believe that in particular circumstances there is a place for “Prophylactic” or preventative surgery in which the destructive diseased synovium is removed to prevent its adverse effect on adjacent tissues. Further, some feel that when the joints begin to deviate, corrective surgery to the ligaments and soft tissues (as opposed to bone) may allow realignment of the joint surfaces and prevent the erosion of those surfaces that come from chronic malalignment. This surgery was particularly appropriate for the metacarpophalangeal joints (at the junction between fingers and palm) which commonly deviate away from the thumb side of the hand, sometimes well before the joints themselves require replacement.

It should however be borne in mind that other causes of pain occur in rheumatoid arthritis in the hand, and important amongst these are nerve compression pains from swelling of adjacent joints or tendons, and subsequent compression of the nearby nerves. A good example of this is rheumatoid arthritis associated carpal tunnel syndrome. Any one suffering from rheumatoid arthritis with any new type of hand pain should be evaluated by a hand specialist or rheumatologist where possible, and regular checks by a rheumatologist or hand surgeon are sensible; in this condition. The individual indications for surgery for pain may then be discussed in detail.

Supernumery digits
I recently underwent surgery for the removal of what was diagnosed as “Rudimentary extra digits”..What exactly causes this abnormality: is it common?...

The condition you describe is of extra digits on the little finger side of the hand, or ulnar border. Often known as supernumery digits, these are commonly found in the site you describe and are often removed at or just after birth by ligation with a thread. This is not a method one recommend’s because it leaves a small bobble of skin and can (rarely) cause dangerous undetected bleeding when the digit separates. The digits are usually attached by a slight stalk, rather than truly articulating with the rest of the skeleton: hence the ease of removal. Many people who have had them treated this way are unaware they have had extra digits.

The condition can have a hereditary element, and is more prevalent amongst African Americans, but affects all races. Search for it in reference libraries under polydactyly, post–axial polydactyly or ulnar border polydactyly.

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