Surgery - Treatment, Procedure And Side Effects

What Is Ulcerative Colitis?
Ulcerative colitis is a chronic, inflammatory condition of the colon and the rectum. It affects the mucosal lining of the large intestine (colon) and the rectum. The rectum is present just above the anus.
In this condition, patients have ulcers and abscesses in their colon and rectum.

Symptoms are seen periodically. The symptoms are severe pain in the abdomen, blood in stools and diarrhea. Anemia is seen due to decreased healthy red blood cells as a consequence of bleeding in stools.

When is surgery required?

• The colon has ruptured
• There is extensive bleeding
• The treatment results in severe side effects affecting the patient's health
• Drug therapy fails to provide results
• When it progresses to colon cancer
• Surgery for Ulcerative colitis

There are 2 types of surgeries:

1. Colectomy: Surgery performed to remove the entire colon
2. Proctocolectomy: Surgery is conducted to remove both the colon and rectum. It is considered as the standard treatment for ulcerative colitis.

Procedures for the surgery

1. Ileostomy: The entire colon and rectum are removed and the surgeon creates an opening or stoma in the abdominal wall particularly below the waist. Stoma allows waste from the intestines to exit the body. The tip of the lower small intestine is brought through the stoma. An external bag, or pouch, is attached to the stoma. This is called a permanent ileostomy. Stools pass through this opening and collect in the pouch. The pouch must be worn at all times. Before an ileostomy, the surgeon will perform a proctocolectomy. They will perform the ileostomy in the hospital, and the patient receives a general anesthesia.
2. Ileal Pouch Anal Anastomosis (IPAA): This is also called a J-pouch. This is a procedure that does not require a permanent stoma. The patient is still able to eliminate stool through the anus. A pouch is constructed at the end of the ileum and attached to the anus. This is called a J- pouch. As with the ileostomy, the patient will need a proctocolectomy before an IPAA. An IPAA is done in a hospital, and the patient will receive a general anesthesia.

Side-effects
Some people experience incontinence after the surgery. Medications may help control the function of the pouch.
Some women may become infertile after the procedure.

Recovery after Surgery
Both sets of the procedure will require a four-to-six-week recovery period.

1. Keep your diet healthy: A healthy diet is essential because good nutrition can help the body heal faster and help avoid post-operation health issues. Absorption of nutrients can be an issue after these surgeries, so eating well will help in maintaining the proper level of nutrients.
2. Keep yourself hydrated: Hydration is important for overall health, especially for the digestive health. Drinking six to eight glasses of water per day is recommended.
3. Manage your stress: Anxiety or emotional stress can cause stomach issues, which can aggravate the complaint.

Cartilage is a fine, rubbery elastic tissue that acts as cushion between the bones in the joint spaces. It is a connective tissue and enables the joints to move freely and smoothly. It acts as a shock absorber and reduces the friction between the joints. This cartilage could either be damaged as a result of injury or degeneration as part of normal ageing process. Either of this causes friction during joint movement, causing painful, stiff movements and in some cases, even swelling of the joint spaces.

There is also a covering around the joints known as synovium. When there is a cartilage damage, this synovium is irritated, leading to increased secretion of synovial fluid, which can cause swelling in joints. There is also reduction in the range of motion of the affected joint.

Most commonly affected joints include knees, hips, shoulders, elbows and ankles. Other than degeneration that happens with ageing, cartilage damage is mainly caused by injury or trauma including fall/impact, joint dislocation, infection, ligament tear, meniscus tear, and inflammation (gout, arthritis, etc.)

Read on to know some of the most common causes for cartilage damage and ways to manage it.

Causes:

Age and trauma are the main reasons for cartilage damage.

1. Direct blow: A heavy blow directly to any joint leads to damage (accident, sports injury, etc.).
2. Ageing: With constant wear and tear, joints that are under constant stress are prone for damage.
3. Obesity: This is also a common cause leading to chronic inflammation and breakdown of the joints.
4. Limited mobility: For whatever reasons (including sedentary lifestyle), lack of movement can cause cartilage damage.

Diagnosis:

The presenting symptoms of a person with any affected joint would be pain, discomfort and stiffness with movement. In addition to history and physical examination, MRI and arthroscopy can be used to confirm the diagnosis.

Treatment:

Start with a conservative approach and gradually switch to more advanced treatments. Conservative approach includes a combination of pain killers, steroid injections, and exercise (at a clinic or at home). If these do not work, the following surgical options are available:

1. Debridement: The affected cartilage is smoothened and the loose edges are removed to prevent rubbing and irritation. It is done using a shaver.
2. Marrow Stimulation: Using the marrow cells, more cartilage production is stimulated. Using tiny drills, holes are drilled to form a blood clot, which triggers formation of new cartilage.
3. Mosaicplasty: In areas of localized damage, healthy cartilage from an unaffected area is placed.
4. Autologous Chondrocyte Implantation: Cartilage that is grown in a lab for one to three months are placed into the knee or affected joint to allow for healthy tissue growth.  

Movement of the human body is possible through various joints which work in coordination to allow for smooth painless movement. However, with age, these muscles and tendons undergo wear and tear which gradually leads to tender swollen joints and painful movement.

The knee is the largest human joint and most of the body movements (walking, running, squatting, sitting, etc.) are only possible because of the flexible knee cap. Whether with age or with injury or trauma, if the knee is affected, then total knee replacement (TKR) would be required.

Indications: With a success rate of almost 98%, knee replacement almost seems magical for arthritis patients.

Wear and tear of the knee leading to arthritis. This causes all knee movements to be painful, which can be especially distressing at night.
Injury or trauma where the knee joint is damaged beyond repair.

What to expect during surgery?

1. Once it is decided that surgery is required, the doctor will brief you on what to expect before, during, and after the surgery.
2. The operation is done under combined signal epidural anaesthesia, so 3 days admission is required in the hospital.
3. The damaged portion of the knee is removed and this is replaced with an implant which is made up of titanium and cobalt chromium.
4. Hospital stay can vary from 3 to 5 days depending on overall condition of the person.
5. Most patients will be able to do basic movement on the very next day of the surgery.
6. Ice pack and painkillers can be applied to control swelling.
7. The pain will be completely gone within 15 days.
8. In the beginning, walking with the support of parallel bars is advised (walker). This can be followed by the use of cane for the first few days to avoid overload and damage to the knees.
9. Most people can walk the next day, though it is advisable to use a cane for the first few weeks so that knee can strengthen to support the load.
10. Regular postoperative visits should be scheduled for up to 2 months after surgery.
11. In addition, it is extremely important to draw up an exercise regimen and follow it to sustain and improve mobility.
12. In the absence of regular exercise, there could be stiffness of the joint which can set in and further aggravate the situation
13. Driving is permissible only after the doctor's advice.

Let your doctor know before going for any surgical procedure (including dental work) as people with TKR should have antibiotic coverage before any procedure.

What is gallstone surgery?

It is a surgical removal of the gallstone from the gallbladder. It is also known as cholelithotomy.

What are the Statistics of the surgery?
Approximately 90% of patients who seek treatment undergo a surgery to remove the stones and the gallbladder.

What is the role of gallstone surgery?
Gallstones which are asymptomatic generally don’t need surgical removal. Treatment depends on the size and location of the gallstones. Surgery to remove the entire gallbladder with all its stones is usually the best treatment, and it is done in patients who can tolerate the procedure.

What are the indications for gallstone surgery?
Indications for gallstone surgery are as follows:

• Stone lodged in the pancreatic duct
• If the stone is causing severe pain, vomiting
• Chronically obliterated cystic duct due to gallstone
• Nonfunctioning gallbladder due to obstruction
• Calculi greater than 3 cm in diameter
• Acute infection of gallbladder (acute cholecystitis) due to gallbladder obstruction
• Chronic infection of gallbladder due to gallbladder obstruction

How is the surgery performed?
The following surgeries are done in patients who are found to have cholelithiasis and choledocholithiasis:

1. Extracorporeal shock wave lithotripsy: A special machine which generates sound waves is used to break the stone. It is only done in the people who are having a small, and soft stone. This procedure doesn’t require any anesthesia, and repeated shock wave therapy is required for complete removal.
2. Laparoscopic cholecystectomy: It is a procedure where a laparoscope (a small, thin tube) is put inside the body through a tiny incision made just below the umbilicus, and another probe is inserted to remove the stone.
3. Open gallbladder surgery: It is done to remove the gallbladder when it is infected, or inflamed, or has large gallstones, or when complications are found during laparoscopic surgery.
4. Percutaneous cholecystostomy guided by computed tomography (CT), or ultrasonography (USG) to remove the gallbladder.
   • Contact dissolution of gallstone can be done where direct catheter of a chemical solvent is introduced by the percutaneous way. It is best for cholesterol stone and, is best at removing any size of the stone.
   • Endoscopic retrograde cholangiopancreatoscopy (ERCP) is used to remove the stones which are in bile duct through the mouth, throat, esophagus, stomach, duodenum, and biliary system without any surgical incisions.

What are the complications of surgery?
Following are the most common complications of surgery:

• Bile leakage leading to biliary peritonitis
• Infection of gallbladder due to improper aseptic precautions
• Abscess formation around the gallbladder, or over adjacent structures
• Death due to rapidly spreading peritonitis causing septicemia
• Raised liver enzymes, jaundice, and severe pain

In case you have a concern or query you can always consult an expert & get answers to your questions!

Of all the joints in the body, the knees probably see the maximum wear and tear. In cases of severe osteoarthritis, or injuries which destroy the knee joint, a total knee replacement surgery may be advised. This procedure involves the replacement of diseased cartilage and bone in the knees with artificial materials.

In cases of osteoarthritis and other such degenerative conditions, this procedure is performed only when the adjacent joints such as the hips are strong and healthy. Before the procedure, you may be advised to discontinue any blood thinning and anti-inflammatory medication. Your doctor will also conduct blood and urine tests to check for signs of anaemia, abnormal metabolism and infections. You may also be asked to lose weight if you are on the heavier side to reduce the pressure on your knees.

A total knee replacement surgery is usually performed under general anaesthesia. The lower end of the femur bone or thigh bone and the upper end of the tibia or calf bone are removed and replaced with a metal shell and plastic piece respectively. In some cases, a plastic ‘button’ may also be placed on the surface of the knee cap. If the posterior cruciate ligament in intact it is left as is or it is replaced by a polyethene post to stabilise the joint and prevent the calf from slipping backwards.

In most cases, a patient is discharged after 3-5 days of hospitalisation following the surgery. Post-surgery, it takes about a month for the patient to experience notable improvements. For optimal results, total knee surgery must be followed by physiotherapy and regular exercise. This helps prevent scarring and keeps the muscles strong enough to maintain joint stability. Exercising can also reduce recovery time. However, not all exercises are advisable. Avoid running, jumping, climbing stairs and contact sports which have a high risk of knee injury. Swimming is highly encouraged as it boosts endurance and muscle strength without putting any pressure on the joint.

In some cases, a second surgery may be required in cases of total knee replacement to fix fractures, loosening or complications of the artificial joint. As with any other surgical procedure, a total knee replacement surgery also has risks. Some of these are:

1. Formation of blood clots that can cause shortness of breath, chest pain and shock
2. Urinary tract infection
3. Nausea and vomiting
4. Knee pain and stiffness
5. Nerve damage
6. Internal bleeding in the knee
7. Increased risk of infections

In case you have a concern or query you can always consult an expert & get answers to your questions!