Surgery - Treatment, Procedure And Side Effects

When the appendix (present at the junction of the small intestine and the large intestine) becomes swollen, it is called appendicitis. It can be acute or chronic and is a common cause of abdominal pain. It can happen at any age but it usually occurs between the ages of 10 and 30.

The appendix is an organ whose function is not yet known. It is believed that the appendix helps in recovering from diarrhoea and infections of the small or large intestine. However, the body can function normally without the appendix.

Symptoms of appendicitis

When the appendix inflames, bacteria start to multiply and this leads to the formation of pus inside the appendix. The build-up bacteria are accompanied by the following symptoms-

• Pain in the abdomen
• Nausea and vomiting
• Diarrhoea

Appendicitis requires immediate medical intervention. If it bursts, it expels poisonous pus into the abdominal cavity and it can be life-threatening.

Surgery for appendicitis (Appendicectomy)-

In most cases, surgery is the only permanent cure for appendicitis. Appendicitis often causes an abscess. Your doctor will recommend a course of antibiotics and then drain the abscess through your skin. After the treatment for infection, the doctor will prepare you for surgery.

Appendicectomy can be a laparoscopic surgery or an open surgery. If you are already taking some over-the-counter medicines, or are pregnant or if you are allergic to some medicines, you must inform your doctor before the surgery. On the day of the surgery, the doctor will ask you to not drink any water for seven or eight hours prior to the operation.

• If the surgery is laparoscopic, the surgeon makes three minute incisions in the abdomen. Then a camera (which displays images of the inside of the abdomen) and surgical instruments are inserted through the three holes into the abdomen. With the help of these, the surgeon extracts the appendix. A laparoscopic surgery is more advantageous than an open surgery because laparoscopic surgery reduces the risk of infection, causes less pain after surgery.

• When an appendix bursts, you will need immediate surgery. And for this, a surgeon will opt for an open surgery. In case of an open surgery, an incision is made in the lower right side of the abdomen. Then the appendix is removed and the wound is closed with stitches. Since it is an open surgery, the surgeon gets the opportunity to clear up your abdominal cavity if the appendix had burst. An open surgery is the most preferred type of surgery when it comes to a ruptured appendix.

The benefit of the surgery lies in the fact that you will never again get appendicitis. Moreover, a surgery can prevent the complications that arise from appendicitis.

Recovery after an appendicectomy-

• If the surgery is laparoscopic, you will be discharged from the hospital within a day.

• If the surgery followed a burst appendix, you may be required to stay in the hospital for around a week. The doctor will recommend bed rest for at least three weeks and you will be able to get back to work in a month.

If you have appendicitis, you will continuously have to endure pain in your abdomen. The situation becomes grave when your inflamed appendix bursts. Doctors advise people with appendicitis to undergo surgery so that the eventuality of a burst appendix does not arise.

Adenoids are tonsils located behind the nose which affect a fair percentage of the population, especially children. Despite a difference in location, adenoids are essentially like tonsils in their characteristic properties which cause a host of issues. These adenoids get reduced in size as a person ages though it is not abnormal for children to have enormous adenoids.

Problems Caused By Adenoids:
The greatest issue concerning adenoids is that the symptoms are often confused with that of allergies or sinusitis which makes it difficult to treat. Since adenoids cause a restriction in airflow in the nasal passage, it may lead to nasal obstruction, congestion, and even nasal sounding speech. A reduction in the normal mucus flow in the throat leads to rhinitis, snotty nose, and allergy-like symptoms. One may also suffer from ear pain and clog of the ear due to the physical blockage of the Eustachian tube in the ears. The location of the adenoids plays a vital role in determining the symptoms that one will be suffering from.

Treating adenoids with endoscopic adenoidectomy:
The issue can be treated efficiently with adenoidectomy, which is a surgical procedure. In endoscopic adenoidectomy, the adenoid tissue is located with the help of a nasal telescope called the endoscope. This offers better control over the situation and performing the surgery with utmost precision. And it is essential to bear in mind that several million adenoidectomies had been performed all across the globe for many years with satisfactory results.

In the recent times, a new tool known as the debrider is available. The combined benefits of the endoscope and the debrider can offer better results and a more comprehensive procedure. This invariably brings about a hike in the cost and those patients who can afford the costing of such an assisted surgery should go for it for better results. Most of the ENT surgeons have easy access to such instruments and can easily operate successful removal of the adenoid tissue.

The effectiveness of endoscopic adenoidectomy:
Nasal endoscopic adenoidectomy helps in easy assessment of the size of the adenoids and enhances the accuracy of the adenoidectomy. This treatment option is particularly useful for treating children who have small oral cavities. And typically, the assessment and the subsequent excision of the adenoids in the affected patients are often tough. With the help of the nasal endoscope, the curette can be precisely inserted at the superior border of the adenoid so that the main bulk of the adenoid tissue can be trans-orally removed.

According to the experts, nasal endoscopic-guided transoral adenoidectomy is a feasible alternative to the conventional adenoidectomy. Moreover, this technique offers the advantage of using commonly available ENT instruments. Hence, it might be recommended for the right candidates, and is known to offer satisfactory results.

Liver surgery or reception is actually a very serious operation that should always be done by some skilled or experienced surgeons. Due to the fact that the person with liver cancer also has some other issues besides cancer that is why surgeons need to remove enough for the liver so that all of the cancer can be removed and still has to leave a decent amount and so that the liver functions properly. Liver plays an important part in the clotting of blood and also the factors that a lot of blood passed through it and the fact that after the rejection of liver there is usually lot of bleeding so that is a primary concern.

Possible Side-effects of Risks involving Liver Resection
Surgery or liver resection is a very important operation so it is necessary that you are healthy enough to go for the surgery and the doctor is sure of the benefits compared to the risks as every surgery bears risks of its own. This surgery is no different as it also has some risks such as:

1. Blood clots in the lungs
2. There is action may cause some damage to the surrounding organs
3. Pneumonia is always common risk
4. Although bleeding is a risk with any surgery, the stake can be much higher in this case. This is due to the fact that huge amount of blood passes through the liver. As liver helps in the clotting of blood this surgery can affect this also.
5. People who are getting liver transplant have specially a concern in the form of infection as they need to take proper medicines to repress the immune system. People who are taking medicines can be affected with serious infections and in some cases medicines also cause there own side effects.
6. In Spite of having proper medicines to repress the new system there is always a possibility that the body Would Still reject a new liver.

What to expect after the surgery
It will take your time to do your regular day to day activities as your bowel movements will still not function properly. Eventually you can resume your regular lifestyle once you leave the hospital. You should definitely about yourself from lifting heavy things for several weeks and you should definitely follow the instructions given by your doctor.

Feeling weakness is pretty much normal and the duration of time to heal from an operation varies from one person to another. People undergoing laparoscopic hepatectomy is likely to go home sooner than the person undergoing open hepatectomy.

A liver transplant surgery is a procedure by the virtue of which the doctors remove the liver in that cases where it becomes non-functional or does not function appropriately. In this process, the malfunctioning liver is substituted with the healthy liver obtained from a living donor.

Liver transplant surgery has been performed in the medicine for more than 30 years and it has been observed that this surgery is successful and the patients who undergo liver transplant are able to live healthy lives.
Liver transplant is usually performed in the cases where the liver failure could not be treated by other alternative medical treatments available and cancerous conditions. There can be either acute liver failure or chronic liver failure. The Liver transplantation is more often performed in order to treat the chronic ailments.

In Adults

1. In the cases of adults, one of the major causes of getting liver transplantation done is liver cirrhosis. Cirrhosis is a medical condition where there is a gradual deterioration of liver and severe chronic illness may lead to malfunctioning of the liver.
2. The blood flow across the liver can be blocked due to the dominance of the scar tissue over healthy tissue.
3. There can also be other reasons for cirrhosis which include the attack of viruses like hepatitis B and C, the alcoholic liver disease due to excess intake of alcohol, increase in the fat proportion in the liver, Autoimmune disorders of liver or you can say, hereditary diseases such as hemochromatosis and Wilson’s disease.
4. When the alcohol intake increases rapidly, then the patients do need a liver transplant but if the person controls the intake of alcohol, then improvements can be observed significantly and the patients may even survive for a long time even without getting the transplant done. But in certain cases, even after abstaining from alcohol, the damage is untreatable and healthy liver tissue cannot be restored, in such cases, liver transplant becomes a compulsion.

In children

1. In the case of children, biliary atresia is the most prominent reason for the liver transplant surgery. It is a very rare condition wherein the bile duct that connect the liver and the small intestine is either blocked or absent in newborn babies. Hence, the function of bile ducts, i.e. removal of bile juice from the liver gets hampered and obstructed bile leads to cirrhosis. The digestion of the food could not be carried out properly.
2. There can be several other reasons for liver transplantation such as the cancer in the liver or benign tumors that can be present in the liver. When a patient suffers from liver cirrhosis, the chances of acquiring the primary cancer increase by multiple times. The likelihood increases furthermore in those patients who have liver disorders along with hepatitis B. Mostly, after liver transplant surgery, patients are able to live their life normally, but if the cancer starts spreading to other body parts from the liver, then liver transplantation is not the solution.

Bariatric surgery is unlike other surgeries, as its effects are not instant but gradual and are seen over the months. Like any other surgery, it is not without complication. But again unlike all other surgeries, the complication rate can be negligible if a strict protocol is followed. Moreover, the factors like technology advancements, development in the field of advanced laparoscopy, enhanced skillset of the bariatric surgeon, dedicated management of bariatric and metabolic surgeries by bariatric surgeons, play a vital role in the reduction of complication rate which eventually results in safe surgery.

As the procedure is done laparoscopically, the pain is just for a day and is minimally managed by analgesics.

The fear of increasing incidence of incisional hernias while operating an obese patient is so negligible or nil, as the procedure is performed through tiny key holes and all precautions are taken to suture the sheath through which the ports are put to perform the surgery.

Reduced hospital stay and early resuming to work is one of the biggest benefits of this laparoscopic bariatric procedure.

Sometimes, problems that may be faced are:- 

1. Post-operative bleeding: Normally, this a nearly bloodless surgery involving 5 to 10ml loss of blood. However bleeding from the staple edges is known, but this can be managed well by the surgeon, by choosing the right size of the cartridge as well the right technique of application of the cartridge.

2. Dehydration: We are normally accustomed to drinking water at long intervals (a few hours) as we can consume nearly 200 to 400ml at one go. Following bariatric surgery, gulping or drinking water in one go is not possible in the first 2 to 4 weeks, due to reduced capacity of the gastric pouch. Hence, care needs to be taken to drink small quantities of water at frequent intervals to avoid dehydration. This is possible only if the patient is counselled about this prior to surgery and is fully aware of this. Also, the patient needs to be given good and clear post operative instructions regarding the quantity and frequency of liquid consumption, not forgetting the type of liquids. Coffee taken frequently could be another cause for dehydration. Family members and colleagues and friends at work play a major role in reminding tthe patient about consuming water frequently. Special care needs to be taken in people who are not accustomed to consuming adequate quantities of water prior to surgery as a general habit.

3. Vomiting/Fullness/ Discomfort/Indigestion: Following bariatric surgery, soft food is introduced in the diet in the third week, after the first 2 weeks of taking liquids. Due to the reduced capacity of the gastric pouch, the morsel size is significantly reduced and one has to chew the morsel well and eat slowly, giving a gap of 40 to 50 seconds between the morsels. This prevents distension or overdistension of the gastric pouch and thus avoids vomiting. This again requires good counselling prior to the surgery and on the follow up visit too before stating soft food. There is a subjective difference when we say small morsels and we cannot reach a standardization as the morsels size of each individual varies prior to the surgery itself. The best way to avoid this confusion is to make the person have the first soft food meal before you where in you can physically show the way food is expected to be eaten. However, by mistake, there is a chance that one can have a regular sized morsel as over years one is used to eating in that manner. If this happens, the person will vomit , and this will be a reminder to gauge the morsel size the next time the person eats. Following the vomiting, there could be a burning sensation in the stomach which will subside afer taking an antacid. If one follows the instructions of small morsel size, chewing properly and eating slowly, there is no chance that there will be vomiting. Another reason for vomiting could be keeping the stomach empty for a longer duration or having sicy food on an empty stomach. Avoid nuts, seeds, fried foods and processed foods. Very rarely vomiting could be due to reduced size of the joint between the gastric pouch and the small intestine. This could require an Endoscopy and necessary treatment.

4. Vitamin and mineral deficiency: It is seen that many of the obese patients are seen to have vitamin B12, vitamin D, iron and protein deficiencies in their blood tests that are done prior to surgery. With the significant reduction in the amount of food consumed after bariatric surgery, the existing deficiencies are bound to increase. Hence, it is necessary to do these tests, before surgery and rectify the deficit prior to the surgery.     

5. Gall bladder stones: Significant weight loss which is consistant over a short duration could lead to the formation of gall bladder stones, be it with or with out surgery in a small percentage of patients. To avoid this there are two schools of thought, one is have a prophylactic removal of the gall bladder along with the bariatric surgery and another is to put the patient on ursodeoxycholic acid (a tablet) for the first few months after surgery during which there is significant weight loss.

6. Skin sagging: In the morbidly obese, when the skin is overstretched beyond a certain point, it tends to sag once significant weight is lost. This sagging is influenced by a number of factors like age of the patient, the BMI, pre existing sagging, pre-existing muscle tone and protein supplements taken during weight loss and exercises done during the weight loss period. Skin sagging is less if the age is less than 45, BMI less than 45, good protein intake during weight loss and good toning exercises done during the weight loss period.

7. Hairfall: Significant weight loss either by diet and exercise, aerobics, bariatric surgery, will entail hair loss. But this can be minimised to a greater extent by ensuring good protein intake during the weight loss period and adequate supplements in terms of vitamins and minerals.

8. Dumping syndrome: With a reduced size of the stomach, the food moves from the stomach into the smaller intestine much faster. This causes the pancreas to release excessive amount of insulin, leading to very low blood sugar levels , producing various symptoms like abdominal cramps, bloating, diarrhoea, sweating, dizziness, nausea, weakness, and anxiety. This is managed by eating less amount of sugars and fats and spacing out the meals through the day, having four to five small meals compared to  2 to 3 large meals. Having a high protein diet and avoiding liquids during meals is also an option.