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General surgery is a branch of surgery focusing on the surgical procedures dedicated to the digestive tract, spleen, liver, pancreas and other supporting tissue of the gastrointestinal organs, breast tissue, glandular surgery, trauma surgery, vascular surgery and some skin conditions. Open general surgery involves accessing the target organs through a single or multiple wide incisions. This method offers the surgeon a direct view of the internal organs by exposing the deeper tissues. This is one of the oldest and a highly reliable method of performing surgical procedures.
Abdominal wall reconstruction involves restructuring of the abdominal wall in order to restore its anatomy and function. It is done to repair large hernia defects of the anterior wall. Abdominal wall is a vital structure for maintaining proper posture of the body, protection of intra abdominal organs and helps in functions like coughing, breathing, urination and defecation. Defects in the abdominal wall may be due to tumours, previous surgeries, or infection.
Abdominal wall reconstruction surgery is performed to repair any acquired or congenital defect in either of the internal layers of the abdominal wall (fascia). Mesh prosthesis, or muscle flaps along with mesh are usually used to repair and reinforce the weakened abdominal wall. Due to modern technology, minimal access techniques like laparoscopy have been widely used to successfully perform abdominal wall reconstruction surgery.
A gluteal abscess is a swelling located in or around the gluteal region, and is filled with pus and bacteria. The resultant lump is painful, often hard, and can be easily diagnosed due to the reddish appearance of the skin around the abscess.
The abscess is located and a slit is made over it using appropriate surgical tools. All the accumulated pus, inflammatory debris, and any accumulated blood is removed from within and the resultant wound is allowed to heal naturally. A course of antibiotic medicines and powders is prescribed to patients to prevent the recurrence of bacterial infection.
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A pilonidal abscess is the result of the accumulation of debris, dirt, pus, and often hair due to the formation of a pilonidal sinus. The abscess is located in the gluteal cleft and causes extreme discomfort to patients if they attempt to sit down and sometimes even while lying down.
During pilonidal abscess drainage, the skin and the sac enclosing the abscess are incised under the effect of anesthesia. All the debris and pus are removed and the area is cleaned with sterile gauze. The resulting wound is left open to heal naturally.
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Debridement is the removal of dead and devitalised tissue resulting due to trauma, abscess formation, ulceration, or as a result. The wound is cleaned and any dirt or debris that has accumulated within is removed.
Medicated powders or sprays are used to disinfect the wound and prevent infection. Depending on the nature and location of the wound, it may be left open or sutured and allowed to heal naturally. Some wounds like diabetic ulcers may require frequent debridement.
A hydrocele is a fluid filled scrotum that can cause considerable discomfort and pain to the patient. Surgery is one of the preferred treatment options for hydrocele.
The surgeon will incise the sack covering the hydrocele and drain out the fluid. The surgical wound is sutured and a drain may be kept in place to prevent further accumulation of fluids.
The pilonidal sinus is a hollow tract extending from within the gluteal region to the skin at the edge of the gluteal cleft. Z plasty is one of the surgical treatment options for the pilonidal sinus. The surgeon may locate the pilonidal sinus and assess its direction and extent using contrast dye studies. The sinus is laid open and the tissue debris, pus, and hair are removed. Triangular flaps of tissue are sutured over the sinus to close the hollow of the sinus. The resultant shape of the suture after stitching both flaps is in the shape of the letter ‘Z’. Therefore, the surgery is known as Z plasty.
Incision and drainage is a minor surgical procedure aimed at removing abscess or infected debris from within an abscess, cyst or a boil over the skin or from any internal tissue. Ultrasound, MRI or CT guided studies are used to locate any internal abscess if it is closer to the deeper organs. The sac of the abscess is surgically incised and all the pus is removed. A drain is kept in place till the abscess is devoid of any infected debris. The surgeon will remove the drain only after the abscess heals. The wound resulting due to incising the abscess wall is allowed to heal naturally.
Oesophagectomy is a surgical procedure performed to remove a certain diseased portion of the esophagus or the entire esophagus. Cancer of the esophagus is the most common indication for esophagectomy. The surgeon may use various approach routes like the neck, abdomen, or chest cavity to access the diseased esophagus during the surgery. Oesophagectomy may be performed using minimally invasive techniques like laparoscopy or by the open method.
After the diseased part of the esophagus is removed the remnant esophagus is sutured with the uppermost part of the stomach to maintain the continuity of the digestive tract. If the surgery is being performed for cancer treatment, the surgeon may remove surrounding lymph nodes to prevent the further spread of cancer. Sometimes portions of the small intestine or colon can be used to create neo esophagus.
Gastrostomy is a surgical procedure performed to create an artificial, surgically created opening into the stomach tissue. Gastrostomy aims to insert a feeding tube into the stomach. This allows direct passage of food into the stomach and allows bypassing the esophagus completely.
Children born with esophageal defects, patients who are unable to swallow food, and patients who have recently undergone esophageal surgery are ideal candidates for Gastrostomy. Only liquid foods can be administered through the G-tube. Patients need about a week to adjust to the G-tube feeding. Once the G-tube is no longer needed, the gastrostomy procedure can be reversed by suturing the stomach opening.It can be performed endoscopically as well
Gastrointestinal Stromal Tumor removal surgery is aimed at eliminating stomach cancer from its root and preventing its relapse. For open GIST removal surgery, the surgeon will need to make a single large incision over the abdominal skin. Open surgery is usually required for large tumors or if tumors are widespread along the stomach. The tumors along with some surrounding healthy portion of the stomach tissue are surgically excised during the surgery.
Stromal tumors of the gastrointestinal tract rarely spread to the surrounding lymph nodes, which is why this surgery is not usually associated with lymph node removal.
Gastrectomy is a surgical procedure performed to remove a portion of the stomach or the entire stomach. This procedure is performed in most cases for the treatment of gastric cancer. But other stomach disorders like recurrent gastric ulcers, gastric bleeding, the gastric polyp can also be eliminated with partial or subtotal gastrectomy.
Gastrectomy can be performed with the more old school open method or the relatively new and more advanced laparoscopic technique. Patients who undergo gastrectomy are restricted to a strict diet regimen for a few weeks following the surgery. Sleeve gastrectomy which involves partial removal of the stomach is helpful in weight reduction to treat obesity.
Gastrojejunostomy is a surgical procedure during which the stomach is attached to the jejunum and an artificial opening is created between the two. The surgeon will make a single, large incision on the abdominal skin to access the gastrointestinal tract. A surgical opening is created within the stomach tissue and jejunal tissue and both openings are connected. Gastrojejunostomy helps to bypass the duodenum, which allows the contents of the stomach to go to the jejunum directly. Patients undergoing treatment for chronic duodenal ulcers, duodenal cancer, or those who have undergone duodenum removal surgery. Patients who undergo gastrojejunostomy are put on a strict diet regimen for some days after the procedure.
Peptic perforation has the potential to transform into a medical emergency unless dealt with promptly. Open peptic perforation requires the surgeon to make an abdominal incision to locate and isolate the portion of the gastrointestinal tract where the peptic ulcer is located. A portion of the omentum (protective sheath encasing the digestive organs) is used to cover the gastric perforation. The surgeon also examines surrounding portions of the GI tract for any perforation before concluding the surgery. Patients are started with PPI agents (a class of antacid medicines) immediately to control their acid reflux (a major contributing factor for peptic ulcer formation).
Pylorus is the junction between the stomach and duodenum, and it is surrounded by a sphincter muscle. Pyloroplasty surgery helps to widen the pylorus by releasing the sphincter muscle and allowing easy passage of food from the stomach to the duodenum. Patients experiencing delayed emptying of the stomach, peptic ulcers of stomach or duodenum, or pyloric stenosis benefit from this procedure.
During open pyloroplasty, an incision is made on the abdominal skin to access the pylorus. The sphincter muscle is incised which will widen the pyloric opening.
The Ampulla of Vater is the union of the pancreatic duct with the common bile duct. The resultant junction eventually opens into the duodenum and acts as a passage for various digestive enzymes. Ampullectomy is indicated in the case of ampullary stenosis. The tumours along with the portion of the duct it is affecting are surgically excised. However, surgeons do not perform extensive tissue and lymph node removal during ampullectomy, making it a less invasive procedure.
Ampullectomy is preferred over other invasive surgeries like pancreatectomy or duodenectomy, as it helps to preserve the structural and functional integrity of the GI tract.
The gallbladder is an active participant in the process of digestion. It secretes its enzymes directly into the duodenum via a network of ducts. Cholecystoduodenostomy allows bypassing these ducts by connecting the gallbladder to the duodenum directly.
Fibrosed cystic or biliary ducts, gallstones blocking the cystic ducts or short gut syndrome are some indications for this surgery.
A large, single incision on the abdominal skin helps to access the duodenum and gallbladder. A duodenal anastomosis helps to form an anatomical connection between the duodenum and gallbladder, thereby retaining the functions of the digestive tract.
Choledocoduodenostomy is the surgical anastomosis created to connect the common bile duct with the duodenum. Obstruction of the lower portion of common bile duct multiple stone formation in the hepatic duct and hyper dilatation of the biliary tubular network are common indications of choledocoduodenostomy. The surgeon carefully separates the healthy portion of the CBD or hepatic duct from the unhealthy portion and creates an artificial opening into the healthy portion. Another artificial opening is created into the duodenal wall, which is then anastomosed with the healthy CBD or hepatic duct.
Duodenal perforation is most likely to occur as a complication of neglected duodenal ulcers. The surgical management of duodenal perforation includes accessing the duodenum and inspecting it thoroughly for the extent of damage caused due to the perforation. An abdominal lavage performed during the surgery may help to remove any debris accumulated within the duodenum. A patch of omentum (protective sheath encasing the GI tract) is used to repair the perforated duodenal wall before concluding the surgery. Open duodenal perforation repair procedure requires the surgeon to make an incision over the abdominal skin to access and expose the damaged part of the duodenum adequately.
Duodenotomy is the surgical excision of a small portion of the duodenum which is diseased. The procedure is commonly performed to treat duodenal ulcer perforation that does not respond well to medical treatment. The ulcerated part of the duodenum is surgically incised along with some surrounding healthy portion of the duodenum. The edges of the excised portion are then sutured together to maintain the continuity of the duodenal wall.
Open duodenotomy involves a single incision over the abdominal skin and underlying abdominal wall. Patients are required to follow dietary and lifestyle restrictions for a few weeks after the surgery.
Bowel perforation may be a result of direct trauma to the abdomen with a sharp object, severe bowel ulcer, uncontrolled inflammatory disorders of the bowel, cancer or severe allergic response to certain drugs. The duration and type of surgery required will depend on the extent and nature of the bowel perforation. Open surgery allows the surgeon to explore the GI tract well and detect the exact nature of the bowel damage. Parts of the bowel may be excised and the remnant healthy portions are surgically connected to maintain the continuity of the digestive tract. Lavage may be helpful to clear any degenerated tissue or inflammatory debris accumulated within the bowels. Sometimes, bowel perforation repair may be combined with a colostomy procedure, to facilitate the emptying of faecal matter into a bag and bypassing the lower GI tract completely to facilitate healing.
Small bowel enterotomy involves creating a full-thickness incision of any part of the small intestine. During the procedure, the surgeon will create a large incision on the abdominal skin and abdominal wall to isolate the part of the intestine that is to be operated upon. Enterotomy may be done to retrieve tissue for intestinal biopsy, to remove a foreign body or a tumour that may be obstructing the intestinal lumen, or to remove a diseased portion of the intestinal wall. All the layers of the intestinal wall are sutured to close the previously made surgical incision.
An enterocutaneous fistula (ECF) is an abnormal opening between the intestinal lumen and the overlying skin. An ECF may develop as a result of a perforated intestinal ulcer, severe inflammatory degeneration of the intestinal wall or as a complication of a failed intestinal surgery.
The surgeon will adequately expose the fistula and the portion of the intestine it is originating from during the surgery. Some portion of the length of the intestine around the fistula is also examined to check for any damage. The fistula is surgically excised along with the portion of the intestine it is attached to. Healthy edges of the intestine are sutured together to conclude the surgery.
Ladd’s bands are adhesive fibrous tissue bands that may extend from the retroperitoneum to the caecum when the latter is not positioned normally in the abdominal cavity. Due to the abnormal positioning of the caecum, the bands tend to compress the duodenum, thereby obstructing normal intestinal activity. During open Ladd’s band excision, the surgeon will use a large abdominal skin incision to isolate these bands and make surgical cuts on them. The normal position of the caecum is also restored and the cuts made on the bands relieve the obstruction over the duodenum.
Meckel’s diverticulum is an abnormal pouch formation in the walls of the small intestine that develops congenitally. Nausea, vomiting, abdominal pain, bloodstained stools or vomit are the diagnostic features of Meckel’s diverticulum. During open surgical excision of Meckel’s diverticulum, the pouch-like structure is cut and removed along with the surrounding damaged portion of the intestines if any. The resultant healthy edges of the intestine are carefully sutured to prevent further complications. Meckel’s diverticulum surgery is often performed during childhood if the condition is diagnosed early.
An ileostomy is a surgical procedure during which a surgical opening is made in the wall of the ileum, which is sutured with the abdominal wall. A bag is attached to the ileal opening during surgery to facilitate the expulsion of faecal matter, by bypassing the colon in the process. An ileostomy is indicated in case of colonic obstruction, cancer of the colon or rectum, Hirschsprung disease or any other health conditions which obstruct the lower part of the bowel. Ileostomy formation may be temporary or permanent depending on the patient’s health and the disease for which it is indicated.
Ileostomy closure is a surgical procedure that involves closing the surgical hole created into the ileal wall, and removing the bag attached to the hole that collects the faecal matter. Ileostomy closure is indicated only when the health condition for which ileostomy formation was indicated is completely treated.
The ileal opening is surgically closed and the ileum is repositioned to its former anatomical location. If any portion of the intestine requires to be resected, the remnant healthy intestine is surgically connected. The part of the abdominal wall that was surgically excised to attach the ileostomy bag is also closed to prevent further complications.
An ileostomy is a complex procedure involving the creation of an artificial opening into the ileal wall which will allow passage of faecal matter directly out of the body without passing through the colon and rectum. The procedure may fail at times causing a leak of mucus or faecal matter from the stoma (an opening created in the ileal wall), or an infection may develop around the stoma.
In such cases, Ileostomy Redo surgery is performed, during which the bag attached to collect the faecal matter is removed, the pouch created from the loop of the ileum is examined and reformed. The new structure is then again connected with the bag externally after checking its integrity.
Mesenteric torsion occurs when a loop of the intestine rotates around the mesentery (a membrane that attaches the intestines to the abdominal wall). The resultant torsion occludes the blood supply to a large part of the intestine and may be a cause of gangrene of that part of the intestine.
Surgery is required to reverse the torsion and to resect the gangrenous portion of the intestine. The remaining healthy intestine is surgically connected to maintain the structural integrity of the GI tract. Exploratory laparotomy may be needed if there is a suspicion of widespread bowel gangrene.
Mesenteric cysts are usually benign and may remain undetected for years before symptoms develop. In some cases, they are diagnosed accidentally during unrelated radio studies. Cyst excision is performed if patients start developing abdominal pain, digestive troubles or other symptoms of discomfort. Trauma or infection may precipitate mesenteric cyst formation.
The surgeon will explore the mesentery to locate the size, dimension and number of cysts. The Cyst is resected along with the affected portion of the bowels if any. Surgeons may obtain tissue from the cyst for biopsy if they suspect malignancy.
Mesenteric lymph nodes excision biopsy may be needed if there is suspicion of malignancy or chronic Cancer of the bowels may spread to the mesenteric lymph nodes infection like tuberculosis. The affected as well some of the surrounding healthy lymph nodes are isolated, excised and sent for biopsy. Tissue is obtained from the lymph nodes for biopsy. Mesenteric lymph node excision biopsy is often performed as an accompanying procedure during bowel surgery for cancer.
Abdominal adhesions are a common complication of extensive or repeated abdominal surgery. They result due to scar tissue formation and tend to bind intestinal loops together, thereby hampering their normal functioning. During open abdominal adhesiolysis, the surgeon exposes the abdominal cavity adequately with the help of a large incision of the abdominal wall. The adhesions may also be located through a diagnostic laparoscopy. The adhesive bands are surgically excised and any scar tissue debris is also removed during surgery.
Small bowel and mesenteric pexy involve using a mesh to support the loops of the intestine that have a tendency to develop intussusception or volvulus. A mesh is used to prevent the intestines from twisting and obstructing the flow of digested food through their lumen. The surgery is usually performed for patients who are not suitable candidates for extensive abdominal surgery or intestinal resection. The mesh pexy method is also ideal for patients who require a stoma bag, but it keeps collapsing often.
The intestine is a large single tube that is responsible for the digestion of food and assimilation of nutrients. There are severalÂ
Strictures are concentric fibrosis of bowel lumen resulting in narrowing of intestinal passage.There are various causes which will lead to stricture formation in intestine like tuberculosis, crohn’s disease etc. In such a case patients will present with obstruction due to narrowed lumen. Strictureplasty surgery helps to loosen these contractions by surgically incising the concentric stricture. The surgeon takes adequate precaution to widen the strictures just enough to continue normal digestion.
Anterior resection is the surgical procedure performed to remove the entire rectum or a part of it that is affected by cancer. The healthy part of the rectum is anastomosed with the colon. Patients who require anterior resection usually do not always require a colostomy bag, as they resume normal bowel movements soon after surgery.
While Anterior Resection is mostly performed as a treatment for rectal cancer, some cases of diverticulitis also respond well to this surgery.
Total Colectomy is the surgical resection of the ascending, transverse and descending colon and the sigmoid colon. Colonic cancer is the commonest indication for total colectomy. Crohn’s disease, Inflammatory Bowel Disease, recurrent intestinal ulcers or polyps are also treated with total colectomy.
Total colectomy is always associated with ileorectal anastomosis during which the terminal edge of the ileum and the proximal portion of the rectum are surgically connected.
Colonic anastomosis is a mandatory follow up surgery required for patients who have had a part of their colon removed. The surgery is most commonly indicated in patients being operated on for the treatment of colonic cancer.
The affected portion of the colon is surgically resected and the remnant healthy edges of the colon are brought closer together and sutured. This process is mandatory to continue the structural integrity of the lower portion of the bowels.
Colo-rectal anastomosis is a surgical procedure aimed at surgically attaching the colon to the healthy portion of the rectum that remains untouched after partial removal of the rectum. The procedure is most often indicated in patients who have undergone removal of a partial portion of the rectum that is affected by cancer.
After removing the cancerous part of the rectum, there remains a length of the healthy rectum that is anatomically not situated close to the distal parts of the colon. The healthy edges of the rectum are brought closer to the colon and both ends are sutured together to facilitate normal passage of faecal matter from the colon to the rectum.
A colostomy closure involves reverting the structural changes that were made in the lower bowels to create a ‘stoma’ for excreting the faecal matter out of the body and bypassing the terminal portion of the GI tract completely. The colostomy bag is removed, the stoma is detached from the skin and the opening made within the colonic wall is sutured. The colon is repositioned to its former site before concluding the surgery. Anastomosis of the colon with the ileum above or rectum below may be performed during the colostomy closure if indicated.
Patients can resume their normal bowel habits after colostomy closure. Only those patients who require temporary colostomy may undergo a closure procedure.
Colostomy formation is a surgery during which an opening is made into the walls of a segment of the colon. The surgeon then relocates this segment upward and stitches it to the edges of the skin which are also left open. The resultant ‘stoma’ is covered with a colostomy bag during the surgery. The purpose of this surgery is to collect faecal matter, to prevent its passage through any diseased portion of the colon, rectum or anal canal. Cancer of the lower bowel is the commonest indication for colostomy formation, the other being severe inflammatory conditions, bleeding from the colon, lower bowel fistula or congenital lower bowel defects. The edges of the stoma have to be kept clean to prevent infection.
A hemicolectomy is the partial resection of the colon. Colon cancer, widespread inflammation of the colon, recurrent colonic bleeding or ulcers, recurrent colon polyps are common indications for hemicolectomy. To perform this procedure, the surgeon will make an incision over the abdominal skin and the abdominal wall. The diseased portion of the colon is removed, and the remaining healthy edges of the colon are sutured to one another. Sometimes, hemicolectomy may involve suturing the remaining colon to the ileum above or the distally located rectum. Patients may require a temporary colostomy before they undergo hemicolectomy. This procedure can also be done laparoscopically with a smaller incision.
Ileoanal anastomosis involves connecting the distal end of the ileum to the proximal end of the anal canal surgically. The surgery is performed for patients who undergo total colectomy with the removal of the sigmoid colon and the entire rectum. Widespread colon cancer or IBD inflammation of the colon are the commonest causes for total colectomy.
For ileoanal anastomosis, the surgeon will mobilize and remove all the segments of the colon and the rectum. After ensuring that the ileum and anal canal are healthy, the two are brought closer to suture them together. This allows continuing the structural integrity of the GI tract.
Proctocolectomy is a surgical procedure during which the terminal portion of the colon is surgically resected along with the entire rectum or a part of it. The surgery is most commonly indicated as a treatment for cancer of the terminal part of the colon, that has spread to has the potential to spread to the rectum. The remnant colon is anastomosed with the terminal part of the rectum (if it has been retained during surgery), or with the anal canal.
The surgeon makes a large skin incision followed by an incision over the lower portion of the abdominal wall to access the colon during the surgery.
An ileoanal pouch is a structure created using the loops of the ileum, to replicate the rectum in case of total proctocolectomy. The resultant J pouch is surgically attached to the anal canal to facilitate normal passage of faecal matter from the newly constructed ‘rectum’ to the anus.
While the newly formed J pouch heals, patients require an ileostomy, during which an artificial opening is created in the ileal walls and is sutured to the abdominal skin. The resultant stoma expels the faecal matter into a bag attached externally, thereby bypassing the anal canal. The temporary ileostomy is removed and the openings are sutured after the patient recovers and can pass stool via the normal passage.
Sometimes the stoma formation may be erroneous or the stoma may get infected, in which case the colonic opening may need to be closed and another may be created to form a new stoma. The formation of a new stoma and reattaching the colostomy bag is known as revision colostomy.
The sigmoid colon is the terminal part of the colon that connects with the rectum. Total removal of sigmoid colon may be indicated as a treatment for sigmoid cancer/sigmoid volvulus. The surgical abdominal procedure involved to remove the sigmoid colon is known as sigmoidectomy. A large skin incision is used to access and mobilize the sigmoid colon and isolated and removed. As part of the surgery, the terminal part of the descending colon is anastomosed with the rectum to allow normal passage of stool. Â
An appendicular abscess is a rare occurrence that results due to the aggregation of pus and inflammatory debris around the appendix. It is a painful condition that may be coupled with the perforation of an inflamed appendix.
The surgeon makes a single incision over the abdominal skin to access the inflamed and infected appendix. The abscess is located and all the pus and other debris are drained from within. A catheter may be inserted and retained for a few days to ensure the complete removal of all the infected pus. Removal of the damaged appendix is at a later date once the pus is drained and infection settles.
Carcinoid is a slow-growing cancerous tumour that has a tendency to develop within the digestive tract. Carcinoid resection involves the removal of the cancerous tumour and in some cases the segment of the intestine where the carcinoid has developed.
The surgeon may also inspect the other loops of the intestine during the surgery to look for any undetected carcinoids. Anastomosis surgery is also performed to suture the healthy remnants of the intestines together if a loop of the diseased intestine is removed during surgery.
Omentum is a layer of fatty tissue covering the stomach, intestines and some peritoneal and pelvic organs. The omentum is rich in lymph and blood supply making it an easy route for the spread of cancer. Omenctectomy is a surgical procedure during which the entire omentum or a part of it is removed to prevent further metastasis of cancer to other peritoneal organs. The omental layer is carefully separated with care being taken to avoid injury to any healthy organs. Surgeons may even use a portion of the tissue obtained from the excised omentum for biopsy. Ovarian cancer is one of the common indications for performing omentectomy.
Liver transplant is a life-saving surgery for patients who have sustained form permanent damage to the structure and function of their liver. After a series of blood tests and physical examinations a living or deceased donor is finalized whose liver will suit the patient. A part of the donor’s liver is surgically transplanted into the patient’s body. The neighboring vessels, nerves and muscles are surgically attached to the new liver tissue. The transplanted healthy liver uses its own cells to gradually regenerate the entire liver tissue.
Abdominal packing is often performed as an emergency surgical procedure to control bleeding due to injury to any abdominal organ. A laparotomy is performed by cutting the abdominal wall to gain access to the site of injury. Abdominal packs like surgical gauze, bandages or swabs are kept in place to apply pressure on the bleeding blood vessel. The surgeon may even use sutures to control the abdominal bleeding. Abdominal packing may be indicated in case of direct trauma to the abdominal wall or accidental intra-op rupture of blood vessels.
A triple bypass involves creating an alternate route for the flow of bile so that the pancreas is bypassed and the bile enters the digestive tract via the duodenum. The surgeon will consider a triple bypass in case of pancreatic cancer that has affected a major portion of the pancreatic tissue. Partial removal of pancreas becomes difficult in such cases and the bile duct is obstructed. The surgeon then connects the healthy part of the bile duct to the duodenum to allow normal flow of bile.
Reversal of Hartmann’s procedure involves closing a colostomy that was previously formed after colo-rectal anastomosis. The procedure is quite complicated since restructuring of important organs is involved. The colostomy bag is removed and the colon is relocated to its former position. The incision made on the colonic wall is closed and the skin incision is sutured. The colorectal anastomosis is examined to check for any leakages before concluding the surgery.
Jejunostomy is a surgical procedure during which an incision is made in the abdominal wall to approach the jejunum. A surgical opening is then created into the wall of the jejunum and a tube is passed inside. This is one of the ways of administering nutrition to patients who may not be able to digest food when eaten the normal way. Jejunostomy is performed in patients who have undergone or are going to undergo major upper bowel surgery for duodenal or gastric ulcers, cancer or torsion of the bowel, or serious afflictions of the gallbladder or liver. Patients who undergo jejunostomy may only be administered liquids through the jejunostomy tube.
Coloanal anastomosis is a surgical technique of suturing the terminal portion of the sigmoid colon with the anal canal. Coloanal anastomosis is performed as a follow-up procedure for surgical excision of the rectum, to maintain the structural integrity of the GI tract.
Patients who undergo the procedure are most likely being treated for cancer, bleeding ulcers or widespread inflammation of the rectum. A temporary colostomy may be required till the newly formed coloanal anastomosis heals.
Rectopexy is a surgical technique during which the prolapsed rectum that has protruded into the anal canal is relocated to its original position. A mesh and surgical sutures may be used to keep the rectum in place and prevent it from prolapsing again.
Patients who require rectopexy are advised to limit their physical activity for a few weeks after surgery, to avoid overstraining of the abdominal muscles.
Perineal resection is a surgical procedure during which the terminal portion of the colon is surgically excised along with the entire rectum and the entire anal canal. The procedure is indicated most commonly as a treatment for cancer of the lower part of the GI tract.
Since the entire rectum and anal canal are removed during surgery, a permanent colostomy is required to expel the faecal matter outside the patient’s body. For this, a surgical opening. Though the rectum and abdominal wall to remove rectum anal canal and part of colon.
Rectosigmoidectomy is the surgical excision of the entire rectum and the entire sigmoid colon or a part of them. Diverticulum, recurrent bleeding ulcers, recurrent polyps or widespread inflammatory disorders of the rectum and sigmoid colon are common indications for rectosigmoidectomy.
The healthy part of the descending colon is sutured with the anal canal to allow normal passage of faecal matter out of the body. But a colostomy is needed till the newly formed colo-anal anastomosis heals. An opening made into the colonic wall is connected to a similar opening made over the abdominal skin to form a stoma. A colostomy bag is attached to the stoma to collect the faecal matter.
Haemorrhoidectomy is the surgical removal of the swollen hemorrhoidal veins that often protrude out of the anal opening while straining to pass stool.
During a haemorrhoidectomy, the surgeon will locate the swollen veins and excise them completely. New veins are laid down within the walls of the rectum to replace the older damaged veins. It takes 3-4 weeks after the surgery for patients to completely recover. A strict diet regimen is given to the patients to prevent the recurrence of haemorrhoids.
Banding is one of the fastest and most preferred treatment options for the management of haemorrhoids (also known as piles). The swollen veins are located and bands are tied at their base. This obstructs the flow of blood through the veins, which eventually dry up and shrink. Banding is a painless treatment method for haemorrhoids and also ensures faster recovery than patients who undergo haemorrhoid removal surgery.
A sentinel tag or an anal skin tag is a lump or lesion of the skin that develops often in patients diagnosed with haemorrhoids. While it is not a painful condition, a skin tag may develop sensitivity in the form of itching. The surgeon uses a local numbing agent over the skin tags before removing them to avoid any pain and discomfort.
Antibiotics are prescribed after the skin tag removal procedure is completed, to avoid infection.
Thrombosis is a complication of piles that involves the formation of a blood clot within swollen haemorrhoidal veins. The blood flow within the haemorrhoids get obstructed and may cause pain and bleeding.
During surgery, the thrombosed veins are either excised completely or banding may be done to shrink the thrombosed veins. Thrombosed veins need immediate surgical intervention since they are very painful and have the tendency to develop ulceration and further health complications.
Stapling is a treatment option for haemorrhoids that involves placing sutures above the swollen haemorrhoids. A tool known as a stapler inserted within the anal canal pulls the haemorrhoidal tissue back within the anal canal. Tightening of the sutures causes the blood supply of the haemorrhoids to be cut off completely.
Surgeons usually resort to stapling as a treatment for advanced haemorrhoids that do not respond to medication. Other procedures for haemorrhoids treatment include banding, infrared coagulation (Laser Hemorrhoidectomy), Sclerotherapy.
An anal fistula is an abnormal track that forms between the walls of the anal canal and the overlying skin. Recurrent anal abscess formation or inflammation of the anal canal are likely to cause an anal fistula. To repair the fistula the surgeon first determines the exact location of the fistula and its internal structure. Endoanal ultrasound and MR fistullogram helps in better localisation of complex tracts.
The fistula is opened and all the accumulated pus is removed. Any remaining tissue debris is also removed and the fistula is sealed. New healthy tissue cells form over a period of time and natural healing occurs.
The anal sphincter is a group of concentric muscles that contracts and relaxes to allow passage of faecal matter via the anal canal. Anal fissures are very painful and develop die formation of cracks or tears within the walls of the anal canal.
If they do not respond to medical treatment, the surgeon may opt for anal sphincterotomy. During the surgery, the anal sphincter muscles are incised enough to allow them to relax. Relaxation of the sphincter muscles allows the tears in the anal wall to repair, thereby promoting healing of the anal fissure.
Graciloplasty is a surgical procedure performed to treat anal incontinence due to recurrent fistula formation. The sphincter muscles of the anal canal are damaged due to which it becomes difficult to maintain voluntary control over the passage of stool.
The surgeon will use a flap of the Gracilis muscle and suture it over the anal canal to act in place of the anal sphincter. An electrode will provide the required stimulus to control contraction and relaxation of the new ‘sphincter’ to prevent fecal leakage.
Incisional hernia is a result of abnormal protrusion of the intestinal loops through a part of the abdominal wall weakened due to previous abdominal surgery. The hernia may present as a bulge that the patients experience at the site of their previous surgery. It may be a painful condition and can cause general discomfort to the patient.
The surgeon incises the abdominal wall again to locate the hernia. The intestines are pushed back to their normal position. The weakened spot of the abdominal wall is kept in place with sutures and often a mesh to prevent recurrence of the hernia.
Epigastric hernia involves the protrusion of fat through a weak spot in the abdominal wall at the epigastrium. The patient may feel a bulge or heaviness or discomfort just below the sternum.
During epigastric hernia repair surgery, the abdominal wall is incised and the fat protruding through the abdominal wall is removed. The weak spot of the abdominal wall is fortified with sutures and a mesh to prevent recurrence of the condition.
A femoral hernia is the protrusion of the abdominal contents through a weak part of the abdominal wall near the groin. The femoral canal is naturally present close to the groin and houses important blood vessels and nerves. The abdominal organs often protrude into the femoral canal.
The surgeon will access the femoral canal and push back the protruded organs and tissue inside. The abdominal wall is reinforced using sutures and often mesh. The surgery is performed after putting the patient under general anesthesia.
Inguinal hernia is the abnormal protrusion of the abdominal organs or loops of intestines via a weak spot of the abdominal wall into the groin area. The condition is often precipitated due to a congenital weakness of the abdominal wall.
During surgery, the surgeon will access the Incisional canal via incision. The herniated abdominal contents are pushed back to their normal position. The abdominal wall is strengthened with surgical sutures and a mesh.
Hernia involves the protrusion of intestinal loops or abdominal organs via weakened abdominal wall. If the condition remains undiagnosed or neglected the intestinal loops may twist around themselves or get compressed due to pressure from surrounding organs and get obstructed.
Surgical repair involves manual sorting of the entangled intestines to release the obstruction. The intestines are then repositioned within the abdominal cavity. The weakened abdominal wall is fixed with sutures and sometimes a mesh also.
A paraumbilical hernia occurs when the abdominal wall has a weakness along the midline. The abdominal contents protrude through the weakness and may form a bulge around the umbilical region. If the herniation occurs just above the level of the belly button, the condition is known as a paraumbilical hernia. At times, the abdominal contents protrude through the area of the abdominal wall where the umbilical cord is attached during fetal life. This condition is known as umbilical hernia.
The surgical treatment remains the same for all the above-mentioned types of hernia. To repair the hernia, the surgeon will access the abdominal wall skin incision. The protruded contents are relocated to their normal position. A mesh and strong sutures help to reinforce the abdominal wall and prevent recurrence of the hernia.
A strangulated hernia is a complication of a case of a hernia that has been poorly treated or neglected. The complication occurs when the herniated contents of the abdominal cavity are compressed to a degree that it occludes their blood supply.
The condition is a medical emergency and required immediate surgical aid. The abdominal skin over the herniated organs is incised. The pressure over the hernia is released and the organs are inspected for signs of necrosis or gangrene. If the herniated contents have suffered irreversible damage, they may be surgically excised, and the healthy loops of the intestine are surgically connected.
The inguinal region is anatomically close to the patient’s groins. For dissection of inguinal lymph nodes, the doctor will make a skin incision along the lower part of the abdominal akin and the abdominal wall.
The entire target group of lymph nodes is carefully separated from the surrounding healthy tissue using surgical tools and is removed. Inguinal lymph node dissection may be indicated when a group of inguinal lymph nodes develop recurrent and severe inflammation, or when they are suspected to be affected by cancer of penis or lower limb. Inguinal lymph node dissection may also be performed as a preventive surgery to stop the spread of cancer from any neighbouring affected organs.
Lymph node dissection involves the removal of an entire group of lymph nodes; whereas lymph node excision typically involves removing a single lymph node. Inguinal lymph node excision is often done to obtain tissue to be sent for biopsy to confirm the presence of cancer.
The surgery is not as extensive as lymph node dissection since a lesser area of the internal organs is to be explored. The surgeon will remove the entire target lymph node and send the complete tissue or a part of it for pathological examination.
An inguinal abscess is a collection of pus and bacterial debris located along the groin or upper thigh. The abscess presents as a red, hard, and painful swelling along with fever. During inguinal abscess surgery, the surgeon will incise the overlying skin and soft tissue and carefully cut the sac of the abscess.
The pus and bacterial debris are drained completely and the surgeon inspects the hollow cavity for any pus loculi. The drained abscess is allowed to heal naturally or can be closed by secondary intention once the infection subsides.
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