physiotherapist. Let’s have a look over the general surgical conditions.
Reasons for Surgery
Surgery is undertaken for the following reasons:
To remove a disease tissue- In case of an organ or the gland, the operation is referred to by thesuffix
–
ectomy. For example, haemoroidectomy is the removal of haemorroids, apneumonectomy is the removal of the lung, and a mastectomy is the removal of the mammarygland. The removal may be complete or it may be partial, as with a partial gastrectomy. Theremoval of the limb is known as amputation.
For Purposes of repair- In these cases the suffix
orraphy is applied, and so the repair of herniais a herniorraphy, the repair of the lacerated perineum is colporrhaphy. Sometime the repairhas suffix
plasty; for example reshaping a joint may be called an arthoplasty.
To produce an artificial opening- In such cases a suffix
otomy or
ostomy is applied. Anopening made in the stomach for the purpose of feeding or evacuating the stomach is agastrostomy or gastrotomy. An opening made in the transverse or sigmoid colon for theevacuation of the contents is called a colostomy, and an opening made in the trachea to assistbreathing is termed a tracheostomy.
For Inspection- If a speculum or some type of viewing apparatus is passed the suffix
oscopy isapplied. A cystoscopy is the inspection of the bladder, gastroscopy the inspection of thestomach; sigmoidoscopy is the inspection of the sigmoid colon. If an area is opened forinspection, the term
otomy is again used; for example a laparotomy is performed to inspectthe abdominal contents.
Preoperative Treatment
Ideally the patient is admitted to the hospital 24 hours or more before operation. This allowsthe patient to settle in and to meet those who will be responsible for the treatment. Any necessarychecks on the condition of the patient will be carried out, the operation site can be prepared,premedications given and sedatives administered as necessary.If any specialized treatment, tests or investigations are considered necessary, the patient willbe admitted several days or even weeks before the operation.
Types of Anesthesia
Many of the former operative risks and complications arose from the methods of anaesthetic used.Following methods are commonly used:
General anesthesia- This used for most major operations when it is necessary to render thepatient unconscious. The anesthetic may be administered by inhalation or intravenously. Unlikechloroform or ether which were used in the past, modern drugs, such as Pentothal, are easilybroken down and excreted from the body. This avoids much of the nausea and vomiting,common in former days, together with many post-operative risks.
This is often used for minor surgery and has the advantage of reducing the post-operative risksof chest complications which can follow inhalation anesthesia.
The anaesthetic is injected into the subarachnoid space surrounding the cauda equine.Anaesthetic of the perineal region and the legs can be achieved and this may be used for thecertain surgical procedures to the pelvis and legs.
Regional anaesthesia- Anaesthesia of the limb may be achieved by injecting an anaesthetic intothe nerve plexus. This method may be used if the patient is not fit enough to tolerate totolerate general anaesthesia.
Types of Incisions
These may be mastectomy incision, right sub costal (cholecystectomy), left sub costal incision(splenectomy), upper midline incision, lower midline incision, paramedian incision (laparotomy),inguinal incision (herniorraphy), oblique left iliac incision (colostomy), and appendectomy incision.
Post-Operative Treatment
The patient may be moved to recovery room where staff is specially trained to deal with immediatepost-operative complications and there is apparatus to deal with resuscitation, or he may be returnedto surgical ward depending upon the particular circumstances.Post operatively, the trachea must be kept patent and free from obstruction until the patient regainsconsciousness, and for this purpose an air tube is used.The patient is nursed flat in the bed in the side lying position until he regains consciousness.If the patient is in shock he may have a saline drip.Sedatives may be given to relieve pain but care must be taken in the type and amounts used as theycan depress respiratory activity and increase the risk of pulmonary complications.Normal micturation must be established as soon as possible, a catheter being passed if necessary toprevent retention and the possibility of bladder infection.After certain abdominal operations, it will be necessary to rest the stomach and gastrointestinal tract.The diet will be a fluid one administered intravenously, and the contents of stomach will be evacuatedby means of suction apparatus. The suction apparatus will have been inserted in the operation theatre,as will any drainage apparatus that may be required. In cases other than abdominal operation it isbetter to reestablish bowel action as soon as possible, and even if a fluid diet is required it will be given
for as short a time as required. It is essential to keep a careful watch on the patient’s chart as any
alteration in temperature, pulse rate or respiration may herald post-operative collapse, hemorrhage,infection or embolism.
Post-Operative Complications
Respiratory
Despite modern advances in anaesthesia, certain complications do still arise which can in part beattributed to anaesthesia. One of its effects is to dry and thicken the mucous secretions in therespiratory tract. The mucous then become difficult to dislodge and tends to remain in the airpassages. Plugs of mucous may form, and the bronchi or bronchioles are in danger of becomingblocked. Normally the cough reflex would be stimulated but this could be depressed by theadministration of analgesics or patient may try to stop coughing because it is painful.
Several chest conditions may arise:
1- Post Operative Atelectasis- This is due to the blockage of bronchus or bronchioles causingabsorption collapse of a segment of lobe of the lung. The basal lobes are most commonly affectedas the patient is nursed in the half lying position once he has regained consciousness. If the mainbronchus is occluded, the whole lung collapses but this is a rare occurrence. High abdominal,thoracic and mediastinal operations carry a higher risk of atelectasis than do lower abdominal andpelvic operations than do lower abdominal and pelvic operations because of the proximity of lungtissues to these regions. Atelectasis occurs between the first and third day after operation.2- Pneumonia or bronchopneumonia- If the mucous secretions are not removed, there is danger of infection with the development of one of these conditions, particularly in the elderly. Aspirationpneumonia may occur due to the inhalation of vomit although this is much less frequent withmodern anaesthesia.
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