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Thyroid surgery is performed with the partial or complete removal of the thyroid gland when the patient is diagnosed with thyroid cancer, abnormal cyst formation, goitre, hyperthyroidism or painful thyroid nodules. There are 3 types of thyroid surgery which are performed – lobectomy (removal of part of the thyroid gland), subtotal thyroidectomy (characterized by the removal of the whole thyroid gland but presence of some of the thyroid tissues) and total thyroidectomy (removal of the whole thyroid gland and thyroid tissues).
The surgery is performed on the patient under general anaesthesia with a small cut over the skin and the subsequent compression of the tissues and muscles to expose the thyroid gland for operation. The factors on which recovery depends mainly include the age of the patient, the type of surgery performed and the extent to which the cancer has spread.
Here are the reasons because of which thyroid surgery is performed:
- Surgery might be performed if there is an abnormal enlargement of the thyroid gland, known as goitre, which obstructs common functions such as chewing foods, breathing and talking because of throat blockage.
- Surgery is a go-to respite for people suffering from hyperthyroidism as this disorder is impossible to diagnose by means of medications or radioactive iodine. Hyperthyroidism occurs because of a side-effect of another disorder called Grave’s Disease. This disease makes the antibodies attack the thyroid gland, as a result of which the gland tends to overproduce hormones.
- The most common reason for getting a thyroid surgery is the presence of abnormal cysts or nodule formation in the thyroid gland. While most of the nodules are usually non-malignant in nature, some of them can be cancerous. The benign nodules can also cause significant obstruction with normal bodily functions if they are not treated on time.
Like any other major surgery, thyroid surgery has its own share of risks, which are:
- Severe bleeding, infection and allergic reactions to local anaesthetics.
- Significant damage to the parathyroid glands (which are responsible for controlling the calcium level of the body) and the laryngeal nerves (situated adjacently to the vocal chords).
These risks can be prevented by prescribed dosage of supplements.
Cleft palate or palatoschisis is a common genetic abnormality that leads to a horde of problems and is presently a growing challenge to medicine practitioners. The major developmental stages affected due to this particular irregularity include feeding, speech development, dentition and maxillofacial growth which are rather important to the normal overall developmental pace of an individual. Even though the cleft palate deformity was defined centuries ago, no fixed management algorithm exists for patients suffering from the condition in the present day scenario.
Cleft palate may be successfully fixed using reconstructive surgery. Multiple specialists are involved in the reconstruction surgery including plastic surgeons, otolaryngologists, nutritionists, oromaxillofacial surgeons and speech pathologists. Some hospitals also consider psychological therapy for the patient and the family to help get through the emotional trauma and the issues faced due to developmental backlogs.
The treatment for cleft palate usually begins around 9 to 12 months of age. If left untreated, it may cause major deformities. It takes about some years before the whole procedure is completed although it depends on the type and severity of the deformity.
The process involves the administration of anaesthesia after which the palate repair closes the inner, middle and final layers and at the same time realigning of the palatal muscles in a technique called anintravelarveloplasty is conducted. This ensures that the muscles are adjusted in a normal position which facilitates the best functioning of the palate during feeding, swallowing and speaking. It is possible that the child might require more than one surgery to completely close the palate.
Some of the risks involved during the process include:
1. Abnormal reactions to the medications
3. Problems in breathing
4. Need for more surgery
Although complicated and time consuming, cleft palate must be given immediate attention to avoid serious developmental issues. The reconstruction surgery and therapy combined ensures a normal development for the child in the longer run, given the surgery was done at the correct time. The child would be required to remain at the hospital for about 5-7 days. Complete recovery takes a time period of 4 weeks. Keeping the wound of the surgery clean is of the utmost importance and it should not be strained.
Adverse respiratory events (AREs) are leading causes of post-operative morbidity and mortality. Anesthesia is the use of medicine to prevent or reduce the feeling of pain or sensation during surgery or other painful procedures (such as getting stitches). Giving as an injection or through inhaled gases or vapours, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.
Anesthesia can help control your breathing, blood pressure, blood flow, and heart rate. It may be used to:
- Relax you,
- Block pain,
- Make you sleepy or forgetful,
- Make you unconscious for your surgery.
Adverse Respiratory Events (ARE)
Adverse outcomes of such events are fatal and lead to Death & Brain Damage. Three mechanisms of injury are reported to account for highest adverse respiratory events:
Inadequate Ventilation: Insufficient Gas Exchange can produce the adverse outcome. Esophageal Intubation: Incubation between the two sides of the esophagus inadvertently.
Difficult tracheal intubation: Tracheal Intubation is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway. It is performed facilitate ventilation of lungs in severely ill, anesthetized patients.
Other’s are as listed below:
- Airway Obstruction
- Inadequate inspired oxygen delivery
- Endobronchial Intubation
- Premature Extubation
Residual neuromuscular blockade is an important postoperative complication associated to the use of neuromuscular blocking drugs and is commonly observed in the post-anesthesia care unit (PACU) after non-depolarizing neuromuscular blocking agents (NMBAs) are administered intra-operatively. Incomplete neuromuscular recovery can be minimized with acceleromyography monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intra-operative acceleromyography use.
Reintubation is a serious adverse respiratory event and the consequences include increased cardiac and respiratory complications, prolonged length of stay at the PACU, intensive care unit (ICU) and hospital, prolonged mechanical ventilator support, higher costs, and increased mortality. Overweight and obesity have also been identified as risk factors for postoperative respiratory complications. Most adverse respiratory events are considered preventable with improved monitoring such as:
- Pulse Oximetry
- Combination of Both
Closed observation of the clinical factors and appropriate monitoring by well trained people are factors necessary to prevent adverse outcome.
Colorectal surgery deals with the disorders of the rectum, anus and colon. Another name of colon is ‘large intestine’. These three body parts form the last stages of the digestive process. When the human waste passes through the colon, its salt and water are extracted before it exits the body as human excreta.
- Swelling and inflammation of the veins in the anus (also called as Haemorrhoids)
- Anal fissures- unnatural cracks and fissures in the anal area
- Fistulas or the unnatural connections between the anus and other anorectal areas
- Conditions of constipation
- Incontinence in passing of faeces
- When the walls of the rectum protrude through the anus- also called as Rectal prolapse
- Birth defects such as imperforate anus
- Anal cancer- this condition is rare
- Colorectal cancer- cancer of colon and rectum
- Any injuries to the anus
- Removal of any objects inserted into the anus
Bowel habits after colorectal surgery
Many patients report cases of diarrhoea, leakage of stool or gas, urgency to use the toilet and a feeling of insufficient evacuation of faeces. Relax; these conditions are not going to last forever. Your rectum and anus are adjusting to new conditions after this surgery. These organs may take six to twelve months to adjust to new bowel habits.
Is there a need to take a laxative or stool softener?
There is no need to take laxatives after a colorectal surgery. Drink lots of water to make your stool softer and easy to pass. If there is a water deficiency in your body, then it may lead to your faeces becoming hard. In that case, take milk of magnesium, colace etc.
Activities post surgery
You can continue with your normal schedule after this surgical procedure. Carry on running, jogging, exercising, climbing up the stairs etc. even after your surgery. Gastroenterologists recommend that patients should desist from lifting loads weighing more than 10 pounds so that there are no post surgery complications.
Diet after colorectal surgery
Avoid spicy and heavy to digest meals after your surgery. Once the intestines begin working normally, you can continue having your spicy food. Chew your food well to aid its digestion.
Returning to work after colorectal surgery
Most people are back to their work after taking a break of 2-5 days. If the surgery is pretty detailed, you may have to take a break of up to a month. Patients undergoing laparoscopic surgery may have to take a rest of 2- 4 weeks before they report back to work. Take it easy before slipping into your regular schedule. If working hurts after your surgery, don’t do it.
The last stretch of the digestive system is the large intestine. Cancer of the large intestine is called colonic cancer. Like all cancers, in its initial phase, colonic cancer show up as a small benign lump of cells called adenomatous polyps. Gradually these polyps become cancerous.
What are the symptoms of colonic cancer?
Some common symptoms include-
• A break in the usual bowel routine like constipation or diarrhea
• In some cases, the consistency of the stool may change. This change lasts for more than a month.
• Bleeding during defecation or the presence of blood in stool
• Unexplained weight loss
Sometimes, not all the symptoms manifest themselves in the early phase of colon cancer. That is why, as soon as you experience even one of the symptoms, consult your doctor. If benign polyps are detected, doctors advise patients to undergo regular screening to keep tabs on the polyps.
What are the causes of colonic cancer
The exact cause of colonic cancer has not yet been identified. Healthy cells multiply following a particular code. When a cell’s DNA mutates abnormally, it becomes cancerous. The new cells that develop from it are also cancerous. This is how colonic cancer spreads. Cancerous cells even destroy healthy cells and tissues.
Is colonic cancer hereditary?
Gene mutations responsible for colonic cancer can be passed down along the blood line. These gene mutations do not make cancer inescapable but do raise the risk of cancer. In fact, very few cases of colonic cancer are actually hereditary.
The two common types of hereditary colonic cancer are-
Hereditary nonpolyposis colorectal cancer (HNPCC)- It is also called the Lynch Syndrome. This type of cancer develops by the time a person reaches the 50s.
Familial adenomatous polyposis (FAP)- people with this condition develop innumerable polyps along the lining of the colon and rectum and if left untreated progress to cancer.
• If someone in the family has colonic cancer, then a person should consider cancer screening in her/his 30s.
• A diet comprising leafy vegetables, whole grains, fruits is ideal. Vitamins, minerals, anti-oxidants can help prevent colonic cancer.
• Smoking and alcohol consumption should be limited.
• 30 minutes worth of exercise at least four days a week is recommended. At the same time, keep an eye on your weight.
Surgery for colonic cancer:
In the more advanced stages, a doctor may recommend surgery to remove the cancer affected segment of the large intestine. The type of surgery depends on the stage when the cancer is detected. Surgery could be either an open surgery or a laparoscopic surgery.
• Local resection: in the early stages of colonic cancer, the surgeon uses a colonoscope to scrape away the cancerous cell from the lining of the large intestine.
• Hemi Colectomy: removing a part of the colon is called hemi colectomy. Either the left side of the transverse colon and the descending colon are removed (left hemi-colectomy) or the right transverse colon and the ascending colon are removed (right hemi-colectomy).
• Total Abdominal Colectomy: the entire large intestine is removed from the lowest part of the small intestine. The rectum and the anus remain in their places. The ends of the small intestine are sewn together.
The symptoms of colonic cancer should not be overlooked. Worldwide, colonic cancer is the second largest killer among men and women combined.
A tumor may be defined as an abnormal unwanted growth of tissue in any part of the body. This word need not immediately cause panic because the tumor may or may not cause a health threat.
There are three types of tumors:
- Benign tumor: This is a noncancerous type of tumor. In our body, new cells are formed while the old ones called dead ones are disposed by our immune system. When this disposal of cells does not occur, the remaining dead cells form a lump, which is called a benign tumor. They are not dangerous since, they do not contain harmful fluids and do not spread. A person suffering from a benign tumor in the brain may have frequent headaches.
- Pre-malignant tumor: It is an initial disorder, or an earlier symptom of cancer manifestation. The inclination of this medical condition is that it will progressively become precarious. This is so because it is capable of conquering neighboring tissues and spreading as well. Leukoplakia is a form of premalignant cancer. They evolve as thick white patches inside the cheeks or on gums below the tongue. These patches are very difficult to be scraped off from the mouth. They are caused mainly due to chewing tobacco and smoking, and ff left untreated can expand.
- Malignant tumor: These are the cancerous tumors, in which cells multiply abnormally and rapidly. They are unstable and travel along bloodstream, circulatory system and lymphatic system to other parts of the body. Sarcomas and carcinomas are the most common types of malignant tumors. While the former is related to connective tissues the latter is related to organs and glands.
The most common procedure to name the type of cancer is to refer to their site of origin. Adenocarcinoma, refers to cancer in the adenoid glands. Similarly, a benign tumor of fatty tissue is called lipoma, where as a malignant tumor in the same area is referred to as liposarcoma.
What is a biopsy? How does it relate to a tumor?
A Biopsy is a medical procedure practised by qualified medical practitioners. This procedure helps in identifying the type of tumor within a patient. It aids the doctor to conclude the type of treatment to be given to any patient. This procedure is a definite diagnosis to the identification of cancer. A Biopsy is the removal of a sample of the abnormal, unwanted tissue for laboratory examination. Biopsies are of different types, and they may be performed using ultrasound, CT scan or MRI depending on where the tumor is.
- Excisional biopsy: In this method the entire lump of excess tissue is removed.
- Incisional biopsy: Here a sample of the abnormal tissue is removed surgically.
- Needle aspiration biopsy: Here the sample is extracted with the help of a needle.
After extraction, the tissue layers are sent to pathological departments to check their composition, and cause of disease.
When an organ residing in a cavity such as the abdomen tries to push through the muscular layer it resides, it is called as hernia.
Though said to be genetic, hernias can be caused by things such as improper heavy lifting, incorrect posture, or chronic constipation and as a result of surgical complication or injury. Factors like obesity, pregnancy, smoking, chronic lung disease aggravate the severity of the hernia. It is believed that about 27% of all males and 3% of females can have a hernia during their lifetime.
Types of hernias:
Inguinal hernia - The groin is the most common area, where the abdomen pushes through a weak spot in the lower abdominal wall, causing a protrusion into the inguinal canal. More common in men than women.
Hiatal hernia - The abdomen has the diaphragm separating it from the thoracic cavity in the upper border. When it pushes through the diaphragm, a hernia is caused and there is almost always associated food reflux in these cases. Though the most common cause is associated old age, due to muscle weakness, there also are cases of congenital hiatal hernias.
Umbilical hernia - The abdomen finds a weak layer along its length and protrudes through the skin on the stomach. Most commonly seen in babies around the bellybutton, it gradually corrects itself on its own. Quiet rare in adults, seen during pregnancy and in chronic obese people.
Incisional - These are post-surgical, and happen when the organ protrudes through the weakened wall due to surgery. The abdomen is again the most common area and the hernia can happen either onto the external surface or internally, when they are called ventral hernias.
These are the most frequent types, though hernia affects other organs like the spine, brain, appendix, etc.
Treatment - This includes a combination of constant monitoring followed by a decision to do surgical treatment. Hiatal hernias and umbilical hernias can be monitored for a while before deciding on surgery. Inguinal hernias may require surgery earlier in the stage. Post-surgery, a mesh is placed to hold back the tissue in its corrected place. The umbilical hernia in children could be self-limiting. If it does not get auto-corrected in the first year of life, that also would qualify for a surgical treatment.
Dependent on each patient, hernias need to be managed under medical supervision.
There are many kinds of conditions and symptoms that require different kinds of surgery for treatment as well as diagnostic management. One such procedure is called a laparoscopy or the laparoscopic surgery. This is a surgical diagnostic management procedure that is known to be a low risk process with minimal invasion and suitable for various types of ailments.
Read on to know everything about laparoscopic surgeries.
- Definition: A laparoscopic surgery is one where small incisions are made and an instrument called a laparoscope is used in order to take a look at the organs in the abdominal region. This tool is a long tube shaped one that comes with its own high intensity light and a high resolution camera that can easily move along the walls of the organs while the camera sends back imagery that will be displayed on a video screen in front of the doctor. This avoids the need for an open surgery and helps the doctors in getting samples for a biopsy on an outpatient basis.
- Need for Laparoscopy: This procedure is performed when the patient complains of persistent pain that is also sharp and shooting, in the abdomen region and surrounding areas like the pelvic cavity. This non-invasive method helps in diagnosis where other imaging methods like an ultrasound and CT or MRI scans would have failed to give a conclusive reason for the pain and suffering of the patient. When these tests do not supply enough reason for proper diagnosis, then the doctors usually resort to this kind of procedure.
- The Organs it can be used for: The laparoscopic surgery can be used for many organs including the appendix as well as the gall bladder, the pelvic region and the reproductive organs, the small and large intestines, the spleen, the stomach, the liver and the pancreas.
- What all can it Detect: The laparoscopic surgery can help in detecting a number of issues including any abnormal growth or mass that may be a tumour. It can also point at the presence of any disease in the liver, as well as the proper functioning of certain treatments. Also, it can show the amount of fluid that may or may not be present in the abdominal cavity and the extent of cancer's progression in the body.
- Risks: There are a few side effects or risks of this method including fever, chills, swelling, bleeding or redness of the site where the incision was made for the surgery, and shortness of breath. All these symptoms must be reported to the doctor immediately as they may point at the presence of an infection. Also, there is a risk of organ damage in this procedure.
The word 'surgery' is often dreaded by most patients. Be it an invasive oral surgery or a keyhole gallbladder surgery, it does not evoke a ready "yes" in most patients. There are too many patients who are ready to be on long-term medications if they could avoid the surgery and its complications. While there could be swelling, bruising, tingling, and many other symptoms, the one feared by most is the postoperative pain. What happens after the effect of the anesthetic wears off can leave many patients in a very anxious and fearful state. The trick is to prepare oneself - not just for the surgery but for the after effects.
Before the surgery, a detailed discussion with the doctor on the following is very important:
- Complete list of medications including supplements so that the medications used during and after surgery to avoid any potential drug interactions
- Type and severity of the pain - This will help you anticipate and be prepared for the pain after the surgery.
- Pain tolerance/threshold - Letting your doctor know your tolerance levels can help them prescribe an appropriate pain killer
After the surgery, the following are some ways to cope with the pain:
- Pain killers - Don't wait for the anesthesia effect to completely wear out. Take the pain killer much before the pain starts so that the onset of pain is delayed or nullified. For severe cases, opioids may be used to manage immediate postoperative pain. However, in most cases, non-steroidal anti-inflammatories like ibuprofen are used. They may also be used up to a few days after surgery to ease the pain and inflammation, depending on the type of surgery.
- Topical creams/lotions - In cases involving skin incisions, these help reduce the pain in the skin along the incision.
- Compression stockings - In addition to reducing blood clot, they also reduce pain in the legs.
- Physiotherapy - If there is a joint involved, doing physiotherapy after surgery is extremely beneficial. In addition to reducing pain, they also help improve mobility.
- Sleep - Sufficient sleep (more than you normally would) promotes healing and helps your ability to cope with the pain.
- Heating pads and ice packs - If these are your regular remedies for pain, feel free to use them even in postsurgical pains.
- Reduce Stress - This will help you cope better with the pain and heal faster.
A given patient and a given surgery are a unique combination. No two patients will react the same way to a particular surgery. Postsurgical pain can be managed very effectively with a little planning.