Introduction
- An extensive discussion of every surgical procedure is beyond the scope of this website
- For non-surgeons, the important considerations are the conditions and typical indications which suggest surgery is warranted
- Being able to manage minor complications is reasonable but recognition of major complications should be referred directly to the surgeon
- Advanced knowledge includes some familiarity with contraindications to surgery to prevent unnecessary referral
Purpose of surgery
- Repair e.g. laceration
- Reconstruct e.g. breast reconstruction, cleft lip
- Renew e.g. ulcer debridement
- Relieve [fluid/gas accumulations, obstruction] e.g. haemothorax, abscess
- Replace e.g. joint replacement, organ transplant
- Remove / Resect e.g. neoplasia
Typical surgical problems (by surgical sieve)
- Degenerative e.g. osteoarthritis > replace
- Neoplastic (benign and malignant) e.g. bowel cancer, melanoma > resect/remove
- Vascular e.g. peripheral vascular disease >. revascularise
- Congenital (malformations) e.g. cleft palate > repair/reconstruct
- Infection e.g. appendicitis > remove
- Traumatic e.g. femoral fracture > repair
Surgical Pathologies
Mucocutaneous and epithelial surfaces
- Traumatic disruption – Abrasions, penetrations, lacerations, incisions, degloving, burns
- Ulceration (e.g. loss of epithelial layer)
Swellings – solid and cystic
- Solid organs (e.g. liver, bone)
- Local compression
Traumatic – laceration, fracture, avulsion, amputation
Hollow organs (e.g. gallbladder, bowel) or external orifices (e.g. nose, vagina)
- Distension
- Rupture / Perforation e.g. perforated ulcer, ruptured aneurysm
- Obstruction – extra-luminal, luminal, intra-luminal
- Torsion e.g. testicular torsion
- Fistulas
Tissue planes
- Herniation (organ protrudes through tissue plane)
- Sinuses (blind ending sacs)
- Fistulas (abnormal connection between epithelialised surfaces e.g. hollow organ-hollow organ, hollow organ-skin)
- Ectopia (displacement or malposition of normal tissue)
- Metastases (distant spread of neoplastic tissue)
Vascular
- Ischaemic / Obstruction/ Torsion
- Distension / Rupture / haemorrhage
Cavity (e.g. intracranial, intrathoracic, intra-abdominal)
- Fluid accumulations – exudate, transudate, blood, digestive juice, lymphatic
- Gas accumulations
- Fibrosis / Obliteration
Conditions can be congenital, developmental or acquired
Treatment indications
- Organ / Physiological dysfunction with significant symptoms OR life/limb threatening pathology
Surgical vs Non-surgical treatment
Failure, non-candidate or unfeasible for:
- Medical treatment e.g. NSAIDS for disc prolapse
- Minimally invasive intervention e.g. cystoscopic removal of renal calculi
- Interventional radiology e.g. angiographic embolisation of bleeding
Treatment contra-indications
- High anaesthetic risk (see below)
- Extreme bleeding risk e.g. warfarinised [but can be reversed]
- High complication risk (see below) e.g. tumour encasement of IVC
- Technically not feasible e.g. diffuse coronary artery disease
- Incurable or irreversible disease e.g. metastatic cancer
- Poor life expectancy
Role of interventional radiology
- Vascular – ischaemia (angioplasty/stent), bleeding / tumour de-bulking (angioembolisation)
- Shunts / Stents – e.g. porto-systemic hepatic shunt, biliary stent
- Drainage – e.g. CT guided abscess drainage, nephtostomy for obstructed kidney
Surgical complications
Early / Mid
- Infection
- Bleeding / haemorrhage (+ embolisation in vascular procedures)
- Damage to proximal structures – nerves, vessels, ducts [e.g. uroma, biloma], organs
- Treatment failure
Late (complications of wound healing / disease recurrence)
- Chronic infection e.g. chronic osteomyelitis
- Impaired wound healing e.g. dehiscence, fracture non-union, hernias
- Abnormal passages / connections e.g. fistulas, sinuses
- Fibrosis / Scarring – e.g. obstructed viscus/adhesions
- Recurrence of disease e.g. hernias, malignancy
Anaesthetic complications
- Cardiac – ischaemia, infarction, arrhythmia
- Circulatory – hypotension
- Respiratory – infection, aspiration
- Airway damage / Dental damage
- Awareness