Hospital Surgery Guide

Cesarean Section (C-Section)

A Cesarean section (C-section) is a surgical procedure used to deliver a baby through an incision in the mother’s abdomen and uterus. It can be planned (elective) or done in an emergency when vaginal delivery is not safe.

1. Types of C-Section

A. Planned (Elective) C-Section

A planned C-section is scheduled in advance due to medical reasons, such as:

• The baby is in breech (feet-first) or transverse (sideways) position.
• The mother has had a previous C-section and does not want a vaginal birth (VBAC).
• The mother has placenta previa (placenta covering the cervix).
• The baby is too large (fetal macrosomia), increasing the risk of complications in vaginal birth.
• The mother has chronic health conditions, like heart disease, high blood pressure, or diabetes.

B. Emergency C-Section

An emergency C-section is done when sudden complications arise during labor, including:

• Fetal distress – When the baby’s heart rate drops or there’s a lack of oxygen.
• Prolonged labor (failure to progress) – When the cervix does not fully dilate, or contractions are not strong enough.
• Umbilical cord prolapse – When the umbilical cord slips into the birth canal before the baby, cutting off oxygen supply.
• Uterine rupture – A tear in the uterus, often in women with a previous C-section scar.

2. The C-Section Procedure

A. Preparation

• Anesthesia: Usually, spinal or epidural anesthesia is used, numbing the lower body while the mother remains awake. In some cases, general anesthesia may be required.
• Catheter and IV line: A catheter is placed in the bladder, and an IV is inserted for fluids and medication.
• Sterilization: The abdomen is cleaned with antiseptic to prevent infection.

B. Surgery Steps

1. Incision in the abdomen – A horizontal (bikini line) or vertical incision is made in the lower abdomen.
2. Incision in the uterus – A similar incision is made in the uterus.
3. Baby’s delivery – The doctor gently pulls out the baby, clears fluids from the nose and mouth, and clamps the umbilical cord.
4. Placenta removal – The placenta is detached and removed from the uterus.
5. Closing the incision – The uterus and abdomen are carefully stitched layer by layer.

C. Duration

• The procedure typically takes 30-60 minutes, with the baby being delivered within the first 10-15 minutes.

3. Recovery After a C-Section

A. Immediate Recovery (First 24 Hours)

• The mother is moved to a recovery room for monitoring.
• Pain management is given through IV or oral medication.
• Encouraged to move as soon as possible to prevent blood clots.

B. Hospital Stay

• Usually 2-4 days, depending on complications and healing.
• The mother starts eating solid food once her digestive system recovers from anesthesia.

C. Home Recovery (6-8 Weeks)

• Pain management: Painkillers may be prescribed.
• Avoid heavy lifting (more than 10 pounds) and intense activities.
• Keep the incision clean to prevent infection.
• Watch for complications such as excessive bleeding, fever, severe pain, or foul-smelling discharge.

4. Risks and Complications

A. Short-Term Risks

• Infections at the incision site or in the uterus.
• Blood clots in the legs or lungs.
• Excessive bleeding (hemorrhage).
• Reactions to anesthesia such as nausea or dizziness.
• Breathing problems for the baby, especially if born before 39 weeks.

B. Long-Term Risks

• Scarring and adhesions, which can cause pain or complications in future pregnancies.
• Higher risk of placenta previa or placenta accreta in future pregnancies.
• Risk of uterine rupture if attempting a vaginal birth after a C-section (VBAC).

5. Vaginal Birth After Cesarean (VBAC)

Many women who have had a C-section can still attempt a vaginal birth after cesarean (VBAC) in future pregnancies. However, it depends on factors like:

• The type of uterine incision in the previous C-section.
• The reason for the first C-section.
• The number of prior C-sections (more than two reduces the success rate).

6. C-Section and Future Pregnancies

Women who have had a C-section can:

• Attempt a VBAC if they meet the criteria.
• Plan for a repeat C-section if advised by their doctor.
• Be monitored closely for placenta-related issues in future pregnancies.

Pilonidal Sinus Surgery (PNS Surgery)

A Pilonidal Sinus (PNS) is a small tunnel or cavity that forms in the skin at the top of the buttocks, near the tailbone (sacrococcygeal region). It often contains hair, skin debris, and pus, leading to infection and abscess formation. PNS surgery is performed to remove the infected sinus and prevent recurrence.

1. Types of Pilonidal Sinus Surgery

A. Incision and Drainage (I&D) – For Acute Abscess

• This is an emergency procedure for infected pilonidal abscesses.
• The surgeon makes a small incision to drain pus and relieve pain.
• This is a temporary solution; definitive surgery is needed to prevent recurrence.

B. Excision and Healing by Secondary Intention

• The surgeon removes the sinus and leaves the wound open to heal naturally.
• Healing time: 4-12 weeks (requires regular dressing changes).
• Pros: Lower recurrence rate.
• Cons: Longer healing time, daily wound care required.

C. Excision with Primary Closure

• The sinus is removed and the wound is stitched closed.
• Healing time: 2-4 weeks (faster than secondary healing).
• Pros: Shorter recovery.
• Cons: Higher risk of infection and recurrence.

D. Flap Surgery (For Recurrent or Large Sinuses)

• A skin flap from nearby tissue is used to cover the wound after removing the sinus.
• Common techniques: Limberg flap, Karydakis flap.
• Pros: Lower recurrence rate, better wound healing.
• Cons: More complex surgery, longer hospital stay.

2. The PNS Surgery Procedure

A. Preparation

• The patient may need antibiotics if there is an active infection.
• Shaving the area to reduce hair accumulation.
• Anesthesia: Local, spinal, or general anesthesia depending on the procedure.

B. Surgical Steps

1. Incision – The surgeon makes a cut over the sinus.
2. Sinus removal – The infected tissue and tracts are completely excised.
3. Closure (or left open) – Depending on the method chosen.
4. Dressing applied – To keep the wound clean and promote healing.

C. Duration

• Surgery usually takes 30-60 minutes, depending on the technique.

3. Recovery After PNS Surgery

A. Hospital Stay

• 1 day for simple excision.
• 2-3 days for flap procedures.

B. Home Recovery (2-12 weeks, depending on surgery type)

• Pain management: Painkillers are prescribed.
• Wound care: Daily dressing changes, keeping the area clean.
• Avoid sitting for long periods and wear loose clothing.
• Hair removal (shaving or laser) to prevent recurrence.

4. Risks and Complications

A. Short-Term Risks

• Infection
• Bleeding or hematoma
• Pain and swelling

B. Long-Term Risks

• Recurrence of the sinus (especially if not properly removed).
• Delayed wound healing (if left open).
• Scar formation.

5. How to Prevent Recurrence?

• Maintain good hygiene.
• Shave or use laser hair removal in the sacrococcygeal area.
• Avoid prolonged sitting.
• Keep the area dry and clean.

Transurethral Lithotripsy (TUL)

Transurethral Lithotripsy (TUL) is a minimally invasive procedure used to break and remove kidney stones or ureteral stones through the urethra. It is performed using a ureteroscope (a thin, flexible tube with a camera) and a laser or pneumatic device to fragment the stones.

1. Types of TUL Procedures

A. Laser Lithotripsy (RIRS – Retrograde Intrarenal Surgery)

• A laser (Holmium:YAG laser) is used to break kidney or ureteral stones into fine dust.
• Suitable for small to medium-sized stones.
• Pros: High success rate, minimal trauma.
• Cons: Requires stent placement for a few days to prevent blockage.

B. Pneumatic Lithotripsy

• Uses high-pressure air pulses to break the stones into fragments.
• More effective for hard, large stones in the ureter.
• Pros: Fast stone fragmentation.
• Cons: May cause stone migration into the kidney.

2. The TUL Procedure

A. Preparation

• Preoperative tests: Urinalysis, kidney function tests, ultrasound, or CT scan.
• Antibiotics may be given to prevent infections.
• Fasting for 6-8 hours before surgery.

B. Surgical Steps

1. Anesthesia – Usually spinal or general anesthesia is used.
2. Insertion of the ureteroscope through the urethra into the bladder and ureter.
3. Stone fragmentation using a laser or pneumatic lithotripter.
4. Stone removal – Small fragments are either flushed out or extracted with a basket.
5. Stent placement – A DJ (double J) stent may be placed to allow urine flow and prevent swelling.

C. Duration

• 30-90 minutes, depending on stone size and location.

3. Recovery After TUL Surgery

A. Hospital Stay

• Same-day discharge or 24-hour stay, depending on recovery.

B. Home Recovery (1-2 Weeks)

• Mild burning sensation while urinating is normal.
• Drink plenty of water (2-3 liters daily) to flush out fragments.
• Pain management with prescribed medications.
• Avoid heavy lifting for at least 1 week.

4. Risks and Complications

A. Short-Term Risks

• Blood in urine (hematuria) (resolves in a few days).
• Urinary tract infection (UTI).
• Painful urination (dysuria).

B. Long-Term Risks

• Ureteral injury or stricture (narrowing).
• Stone recurrence if dietary and lifestyle changes are not followed.

5. DJ Stent Placement and Removal

• Purpose: Keeps the ureter open after surgery.
• Symptoms: Mild discomfort, urgency, and frequent urination.
• Removal: Usually after 1-2 weeks, done as an outpatient procedure.

6. How to Prevent Kidney Stones?

• Increase water intake (2-3 liters/day).
• Limit salt and oxalate-rich foods (spinach, nuts, tea).
• Maintain a balanced diet with adequate calcium intake.
• Regular follow-up with ultrasound or CT scan to check for new stones.

Hernia Surgery (Abdominal Hernia Repair)

An abdominal hernia occurs when an organ or tissue pushes through a weak spot in the abdominal wall. Hernia surgery is performed to repair this weakness and prevent complications like strangulation (loss of blood supply to the trapped tissue).

1. Types of Hernia Surgery

A. Open Hernia Repair

• A single large incision is made over the hernia.
• The herniated tissue is pushed back, and the weakened area is repaired with sutures or a mesh.
• Pros: Simple and effective.
• Cons: Longer recovery time, more pain.

B. Laparoscopic Hernia Repair

• Minimally invasive approach using small incisions and a camera.
• A mesh is placed to reinforce the abdominal wall.
• Pros: Faster recovery, less pain, smaller scars.
• Cons: Requires general anesthesia, not suitable for all hernias.

2. The Hernia Surgery Procedure

A. Preparation

• Preoperative tests: Blood tests, ultrasound, or CT scan.
• Fasting for 6-8 hours before surgery.
• Stopping certain medications like blood thinners (if advised by the doctor).

B. Surgical Steps

1. Anesthesia – Local, spinal, or general anesthesia depending on the procedure.
2. Incision(s) made – A single large incision (open surgery) or small keyhole incisions (laparoscopy).
3. Hernia reduction – The protruding organ/tissue is pushed back.
4. Mesh placement (if needed) – A synthetic mesh is inserted to reinforce the abdominal wall.
5. Closure – The incision(s) are closed with sutures or surgical glue.

C. Duration

• 30-90 minutes, depending on the type of surgery and hernia size.

3. Recovery After Hernia Surgery

A. Hospital Stay

• Same-day discharge for laparoscopic surgery.
• 1-2 days for open surgery.

B. Home Recovery (2-6 Weeks)

• Pain management with prescribed medications.
• Avoid heavy lifting (more than 5 kg) for at least 6 weeks.
• Gradual return to normal activities within 2-4 weeks (laparoscopic) or 4-6 weeks (open surgery).
• Wear a supportive abdominal binder if advised by the doctor.

4. Risks and Complications

A. Short-Term Risks

• Infection at the surgical site.
• Bleeding or hematoma formation.
• Pain and swelling.

B. Long-Term Risks

• Hernia recurrence (higher in open repair without mesh).
• Chronic pain or nerve injury.
• Mesh complications (rare, but can cause infection or rejection).

5. How to Prevent Hernia Recurrence?

• Avoid heavy lifting for at least 6 weeks post-surgery.
• Maintain a healthy weight to reduce pressure on the abdominal wall.
• Strengthen core muscles gradually with light exercises.
• Treat chronic cough or constipation to prevent excessive straining.

Dilation and Curettage (D&C)

Dilation and Curettage (D&C) is a minor surgical procedure in which the cervix is dilated, and the uterine lining (endometrium) is scraped or suctioned to remove tissue. It is performed for both diagnostic and therapeutic purposes.

1. Types of D&C Procedures

A. Diagnostic D&C

• Used to collect a tissue sample from the uterus for biopsy.
• Helps diagnose abnormal bleeding, endometrial cancer, fibroids, or polyps.
• Often combined with hysteroscopy (a camera to visualize the uterus).

B. Therapeutic D&C

• Used to remove abnormal or unwanted tissue from the uterus.
• Indications:
  • Incomplete miscarriage (to remove retained pregnancy tissue).
  • Heavy or prolonged menstrual bleeding.
  • Endometrial hyperplasia (thickened uterine lining).
  • Molar pregnancy (abnormal pregnancy tissue growth).

2. The D&C Procedure

A. Preparation

• Preoperative tests: Pelvic ultrasound, blood tests.
• Fasting for 6-8 hours if under general anesthesia.
• Cervical softening: Medications like misoprostol may be given before surgery.

B. Surgical Steps

1. Anesthesia – Local, spinal, or general anesthesia based on patient needs.
2. Cervical dilation – The cervix is gently widened using dilators.
3. Tissue removal – A curette (small surgical instrument) or suction device is used to remove the uterine lining.
4. Closure and observation – The patient is monitored for a few hours for complications.

C. Duration

• 10-20 minutes (short procedure).

3. Recovery After D&C

A. Hospital Stay

• Usually an outpatient procedure (same-day discharge).
• 2-6 hours of observation post-surgery.

B. Home Recovery (1-2 Weeks)

• Mild cramping and spotting for a few days is normal.
• Pain management with mild painkillers (e.g., ibuprofen).
• Avoid tampons, douching, and sexual intercourse for at least 2 weeks to prevent infection.

4. Risks and Complications

A. Short-Term Risks

• Infection (fever, foul-smelling discharge).
• Heavy bleeding (rare).
• Perforation of the uterus (very rare but serious).

B. Long-Term Risks

• Asherman’s syndrome (scar tissue formation, leading to irregular periods or infertility).
• Hormonal imbalance (temporary menstrual irregularities).

5. When to Seek Medical Help?

• Severe pain or heavy bleeding (soaking >1 pad per hour).
• Fever or chills (signs of infection).
• Foul-smelling vaginal discharge.

Evacuation Curettage (D&E – Dilation and Evacuation)

Evacuation Curettage (Dilation and Evacuation – D&E) is a surgical procedure used to remove pregnancy tissue from the uterus after a missed miscarriage, fetal demise, or elective termination. It is performed after the first trimester (usually after 12-14 weeks of pregnancy) when a standard D&C (Dilation and Curettage) is not sufficient.

1. Indications for Evacuation Curettage (D&E)

• Missed miscarriage (fetal demise, but no natural expulsion).
• Incomplete miscarriage (retained pregnancy tissue causing bleeding or infection).
• Molar pregnancy (abnormal growth of placental tissue).
• Elective termination of pregnancy (for medical or personal reasons).
• Severe fetal anomalies incompatible with life.

2. The D&E Procedure

A. Preparation

• Preoperative tests: Ultrasound, blood tests (hemoglobin, clotting factors).
• Cervical softening:
  • Medications (Misoprostol) may be given a few hours before the procedure.
  • Laminaria sticks (natural dilators) may be inserted a day before for gradual dilation.
• Fasting for 6-8 hours before surgery (if under general anesthesia).
• Antibiotics to reduce the risk of infection.

B. Surgical Steps

1. Anesthesia – General or spinal anesthesia is used.
2. Cervical dilation – Gradual widening of the cervix.
3. Evacuation of the uterus – A combination of suction and surgical instruments (curette, forceps) is used to remove pregnancy tissue.
4. Final check – Ultrasound may be used to ensure complete evacuation.
5. Uterine contraction medication – Drugs like oxytocin may be given to help the uterus shrink.

C. Duration

• 15-30 minutes depending on the gestational age and method used.

3. Recovery After D&E

A. Hospital Stay

• Same-day discharge after a few hours of monitoring.
• In some cases, overnight observation may be needed.

B. Home Recovery (1-2 Weeks)

• Mild cramping and bleeding for a few days (similar to a heavy period).
• Pain management with ibuprofen or prescribed painkillers.
• Avoid tampons, douching, and sexual intercourse for at least 2 weeks.
• Emotional recovery: Hormonal changes may cause mood swings, and psychological support may be needed.

4. Risks and Complications

A. Short-Term Risks

• Infection (signs: fever, foul-smelling discharge).
• Heavy bleeding (rare but possible).
• Uterine perforation (very rare, but a serious complication).

B. Long-Term Risks

• Asherman’s syndrome (scar tissue formation leading to menstrual irregularities or infertility).
• Future pregnancy complications (slightly increased risk of preterm birth in some cases).

5. When to Seek Medical Help?

• Heavy bleeding (soaking >1 pad per hour).
• Severe abdominal pain that doesn’t improve with medication.
• Fever or chills (possible infection).
• Prolonged or foul-smelling vaginal discharge.

6. Future Fertility and Pregnancy After D&E

• Menstrual cycles return within 4-6 weeks.
• Ovulation may occur within 2-3 weeks after the procedure.
• Pregnancy is possible after the first period, but doctors may recommend waiting 3-6 months for the uterus to fully heal.
• Emotional support and counseling may help with psychological recovery.

Laparoscopic Cholecystectomy

Laparoscopic Cholecystectomy is a minimally invasive surgery to remove the gallbladder, usually due to gallstones (cholelithiasis) or gallbladder inflammation (cholecystitis). This procedure is the gold standard for treating symptomatic gallbladder disease and offers faster recovery, less pain, and smaller scars compared to open surgery.

1. Indications for Laparoscopic Cholecystectomy

• Symptomatic gallstones (pain, bloating, nausea).
• Acute or chronic cholecystitis (gallbladder inflammation).
• Gallbladder polyps (especially if >1 cm, due to cancer risk).
• Biliary dyskinesia (poor gallbladder function).
• Pancreatitis caused by gallstones.

2. The Laparoscopic Cholecystectomy Procedure

A. Preparation

• Preoperative tests: Blood tests, ultrasound, sometimes an MRI or MRCP (Magnetic Resonance Cholangiopancreatography).
• Fasting for 6-8 hours before surgery.
• Stopping blood thinners (if prescribed by the doctor).
• Antibiotics may be given before surgery to prevent infection.

B. Surgical Steps

1. Anesthesia – General anesthesia is used.
2. Trocar insertion – 4 small incisions are made in the abdomen, and carbon dioxide gas is used to inflate the abdominal cavity.
3. Gallbladder dissection – The gallbladder is carefully separated from the liver and bile ducts.
4. Cystic duct and artery clipping – Clips are placed to seal the duct and artery before removal.
5. Gallbladder removal – It is extracted through one of the small incisions.
6. Final check and closure – The surgeon ensures there is no bleeding, removes the gas, and closes the incisions with sutures or surgical glue.

C. Duration

• 30-90 minutes, depending on difficulty and patient anatomy.

3. Recovery After Laparoscopic Cholecystectomy

A. Hospital Stay

• Same-day discharge or 1-night hospital stay in most cases.

B. Home Recovery (1-2 Weeks)

• Mild pain and bloating for a few days due to gas used in surgery.
• Light activity is encouraged after 24 hours, but avoid heavy lifting for 2-4 weeks.
• Low-fat diet for a few weeks to help digestion.
• Return to work within 1-2 weeks (if non-strenuous).

4. Risks and Complications

A. Short-Term Risks

• Infection (redness, swelling, fever).
• Bile leakage (rare but possible if clips fail).
• Bleeding (very rare).

B. Long-Term Risks

• Bile duct injury (serious but rare complication).
• Post-cholecystectomy syndrome (mild digestive issues like bloating or diarrhea, usually temporary).

5. Diet and Lifestyle After Gallbladder Removal

• First few weeks:
  • Eat small, frequent meals.
  • Low-fat diet (avoid fried or greasy foods).
  • Increase fiber gradually to prevent diarrhea.
• Long-term:
  • Most people can eat normally after 1-2 months.
  • If persistent digestive issues occur, dietary adjustments may be needed.

6. When to Seek Medical Help?

• Severe abdominal pain or persistent nausea/vomiting.
• Yellowing of skin or eyes (jaundice).
• High fever or pus-like discharge from incisions.

DJ Stent Removal Surgery

A DJ (Double J) stent is a tube placed in the ureter to help drain urine from the kidney to the bladder when there is a blockage, such as from kidney stones, strictures, or post-surgery healing. DJ stent removal is the procedure used to remove this stent after it has served its purpose.

1. Indications for DJ Stent Removal

• Post-kidney stone treatment (to help drain the kidney while healing).
• Stricture management (to relieve ureteral blockages or narrowing).
• Surgical healing (after surgeries involving the urinary tract, such as kidney transplant or ureteral reimplantation).
• Infection prevention (to prevent urine retention and reduce the risk of infection).

2. The DJ Stent Removal Procedure

A. Preparation

• Preoperative tests: Ultrasound or X-ray to confirm stent placement and kidney condition.
• Fasting for 6-8 hours before surgery (if general anesthesia is used).
• Cystoscopy preparation: The procedure is typically done using cystoscopy, a procedure that allows the surgeon to view the bladder and urethra.
• Local or general anesthesia may be used depending on the complexity of the procedure and patient preferences.

B. Surgical Steps

1. Anesthesia – General anesthesia or local anesthesia with sedation is typically used.
2. Cystoscopy – A small flexible tube with a camera (cystoscope) is inserted into the bladder through the urethra.
3. Stent retrieval – The DJ stent is carefully removed using specialized instruments. The stent usually has string-like threads that allow the surgeon to pull it out.
4. Post-removal check – The surgeon will check for any signs of irritation, infection, or damage to the ureter.
5. Final observations – After stent removal, the surgeon may perform a small imaging test (e.g., X-ray) to ensure everything is functioning properly.

C. Duration

• 10-30 minutes, depending on stent location and complexity of the case.

3. Recovery After DJ Stent Removal

A. Hospital Stay

• Outpatient procedure: In most cases, the patient can go home on the same day.
• Minimal to no hospital stay is required unless there are complications.

B. Home Recovery (1-2 Days)

• Mild discomfort or irritation in the bladder or urethra due to the stent removal.
• Urinary frequency or burning sensation may occur temporarily.
• Drinking plenty of water is recommended to help flush out any residual irritants.
• Over-the-counter pain relief (e.g., ibuprofen) can be used for mild discomfort.

4. Risks and Complications

A. Short-Term Risks

• Urinary tract infection (UTI): As the stent is removed, the risk of infection may temporarily increase.
• Mild bleeding: Small amounts of blood in the urine are common but should subside in a day or two.
• Irritation or discomfort: Bladder or urethral irritation is common right after stent removal.

B. Long-Term Risks

• Infection: Any residual infection may cause pain or fever.
• Blockage or re-stenosis: In rare cases, the area where the stent was removed can become blocked again, leading to a need for another stent.
• Injury to the ureter: Rarely, the procedure can result in mild injury to the ureter, which may require further treatment.

5. When to Seek Medical Help?

• Severe pain or persistent discomfort that does not improve with over-the-counter painkillers.
• Fever or chills (possible infection).
• Excessive bleeding or blood clots in the urine that do not resolve in a few days.
• Urinary retention or difficulty urinating.

Kyphoplasty

Kyphoplasty is a minimally invasive surgical procedure used to treat vertebral compression fractures (VCFs), commonly caused by osteoporosis, spinal tumors, or trauma. The procedure involves the insertion of a balloon into the fractured vertebra to restore its shape, followed by the injection of bone cement to stabilize the fracture and relieve pain.

1. Indications for Kyphoplasty

• Osteoporotic vertebral compression fractures (most common cause, especially in older adults).
• Spinal tumors (such as metastases).
• Traumatic fractures (from accidents or falls).
• Severe back pain that does not improve with conservative treatments like pain medications, physical therapy, or bracing.
• Spinal deformities caused by compression fractures (e.g., kyphosis or “dowager’s hump”).

2. The Kyphoplasty Procedure

A. Preparation

• Preoperative tests: Imaging studies like X-rays, CT scans, or MRI to assess the location and severity of the fracture.
• Fasting for 6-8 hours before surgery if general anesthesia is used.
• Medication adjustments (if the patient is on blood thinners or other medications).
• IV line will be placed for fluids and medications during the procedure.

B. Surgical Steps

1. Anesthesia – Local anesthesia or general anesthesia, depending on the extent of the fracture and patient’s preference.
2. Incision – A small (1-2 cm) incision is made in the skin near the affected vertebra.
3. Balloon insertion – A thin tube (catheter) with a deflated balloon at the tip is inserted into the fractured vertebra.
4. Balloon inflation – The balloon is inflated to restore the vertebra to its normal height and shape, creating space for the bone cement.
5. Cement injection – Once the balloon is deflated and removed, medical-grade bone cement (usually polymethyl methacrylate) is injected into the vertebra to stabilize it and prevent further collapse.
6. Final check and closure – The doctor will check for proper cement placement and remove the catheter. The incision is closed with sutures or adhesive strips.

C. Duration

• 1-2 hours, depending on the number of vertebrae treated and the complexity of the case.

3. Recovery After Kyphoplasty

A. Hospital Stay

• Outpatient procedure in most cases, meaning the patient can go home the same day after a few hours of observation.
• Shorter hospital stays may be required if the procedure was complex or if the patient has other health concerns.

B. Home Recovery (1-2 Weeks)

• Mild discomfort or soreness at the incision site for a few days.
• Pain relief from the fracture usually starts to improve within 1-2 days after the procedure.
• Light activity is encouraged, but avoid heavy lifting or bending for a few weeks.
• Walking and gentle movements are typically recommended to prevent stiffness.

4. Risks and Complications

A. Short-Term Risks

• Infection (at the incision site or in the bone).
• Bleeding from the small incision or around the treated vertebra.
• Injury to the surrounding spinal structures, such as the spinal cord, nerve roots, or blood vessels (rare).
• Leakage of cement from the vertebra into the surrounding tissues or spinal canal (rare but serious).

B. Long-Term Risks

• Adjacent vertebral fractures (new fractures in neighboring vertebrae due to altered biomechanics after kyphoplasty).
• Cement hardening complications or complications from the cement expanding into unintended areas.
• Non-union or insufficient cement placement, requiring a second procedure.

5. When to Seek Medical Help?

• Severe pain or new back pain that worsens after the procedure.
• Swelling, redness, or fever (possible infection).
• Difficulty breathing or chest pain (signs of a pulmonary embolism, though rare).
• Numbness, weakness, or loss of bowel or bladder control (suggesting nerve injury).

6. Post-Procedure Care and Lifestyle Changes

• Physical therapy: Most patients will be advised to participate in rehabilitation or physical therapy to strengthen the back and improve mobility.
• Calcium and vitamin D supplements may be recommended to support bone health.
• Bone-strengthening medications (bisphosphonates or other treatments for osteoporosis) may be prescribed to reduce the risk of future fractures.
• Fall prevention strategies: Patients should focus on reducing fall risks at home to avoid further fractures.

Mastectomy

A mastectomy is a surgical procedure to remove one or both breasts, typically performed to treat or prevent breast cancer. There are different types of mastectomies, depending on the extent of tissue removed and the reason for the surgery. This procedure is a key part of breast cancer treatment and can also be done for prevention in high-risk individuals.

1. Indications for Mastectomy

• Breast cancer (treatment for invasive or non-invasive cancer).
• Prevention of breast cancer (prophylactic mastectomy for women with a high risk, such as those with the BRCA1 or BRCA2 gene mutations).
• Breast cancer recurrence (if cancer returns after a lumpectomy or other treatments).
• Severe or symptomatic fibrocystic breast disease (rarely, mastectomy may be considered).
• Large tumors that cannot be removed effectively with a lumpectomy.

2. Types of Mastectomy

A. Simple (Total) Mastectomy

• Removal of the entire breast, including the breast tissue, skin, and nipple-areola complex, but without removal of lymph nodes.
• Often performed when cancer is confined to one part of the breast and does not involve the lymph nodes.

B. Modified Radical Mastectomy

• Removal of the entire breast, including the nipple, skin, and most of the lymph nodes under the arm (axillary lymph nodes).
• This is a common approach if cancer has spread to the lymph nodes.

C. Radical Mastectomy

• Removal of the entire breast, lymph nodes, and chest muscles (pectoralis major and minor).
• This type of mastectomy is rarely performed today and is only used for extensive cancer.

D. Skin-Sparing Mastectomy

• Removal of the breast tissue, but the skin is preserved.
• Often used in conjunction with breast reconstruction surgery for cosmetic reasons.

E. Nipple-Sparing Mastectomy

• Removal of the breast tissue while preserving the skin and nipple-areola complex.
• This is generally an option for women with early-stage breast cancer and no involvement of the nipple.

3. The Mastectomy Procedure

A. Preparation

• Preoperative tests: Blood tests, mammograms, or ultrasound to assess the cancer and the extent of spread.
• Fasting for 6-8 hours before surgery if general anesthesia is required.
• Lymph node evaluation (sentinel lymph node biopsy or axillary lymph node dissection) may be performed to check for cancer spread.
• Anesthesia: General anesthesia is typically used.
• Pre-surgical counseling: Discussion about potential need for breast reconstruction, prosthetics, and the emotional impact of the surgery.

B. Surgical Steps

1. Anesthesia – General anesthesia is administered for the procedure.
2. Incision – The surgeon makes an incision around the breast to remove the tissue, preserving the skin and nipple where possible.
3. Tissue removal – Depending on the type of mastectomy, the surgeon removes breast tissue, skin, and/or nipple-areola complex.
4. Lymph node removal – Axillary lymph nodes may be removed to check for signs of cancer spread.
5. Breast reconstruction (optional) – Reconstruction may be done immediately after mastectomy or at a later time using tissue from other parts of the body or implants.
6. Final closure – The incision is closed with sutures, and drains may be placed to remove fluid from the surgical site.

C. Duration

• 2-4 hours, depending on the extent of surgery (type of mastectomy and if reconstruction is performed).

4. Recovery After Mastectomy

A. Hospital Stay

• 1-2 days for a simple mastectomy, 3-4 days if lymph node removal or reconstruction is performed.
• Patients may need additional observation for pain management and monitoring drains.

B. Home Recovery (4-6 Weeks)

• Pain and discomfort are common, with some swelling, bruising, and tightness around the surgery area.
• Drain care: Drains are typically removed after a few days or weeks, depending on the fluid accumulation.
• Rest and limited movement are recommended in the first few weeks to avoid stress on the surgical site.
• Gentle arm exercises and physical therapy may be prescribed to regain range of motion, especially if lymph nodes were removed.
• Avoid lifting heavy objects for several weeks to promote healing.

5. Risks and Complications

A. Short-Term Risks

• Infection at the incision site or surrounding tissues.
• Bleeding or hematoma formation (rare).
• Seroma (fluid collection around the surgical site).
• Blood clots (especially in the legs or lungs).

B. Long-Term Risks

• Lymphedema (swelling in the arm or chest due to lymph node removal).
• Changes in sensation (numbness or tingling around the surgical site or in the arm, particularly if lymph nodes were removed).
• Scarring and cosmetic changes (depending on whether reconstruction is performed).
• Psychological impact (body image concerns, emotional adjustment to breast loss).

6. Emotional and Psychological Support

• Counseling or support groups are highly recommended to address emotional recovery, especially for those undergoing a mastectomy due to cancer.
• Breast reconstruction or the use of breast prosthetics can help in regaining body confidence.
• Partner and family support are crucial in the emotional healing process.

7. When to Seek Medical Help?

• Signs of infection: Redness, warmth, pus, or fever.
• Excessive swelling or pain that does not improve with pain medication.
• Unusual drainage or leakage from the surgical site.
• Persistent or worsening arm swelling (possible sign of lymphedema).

8. Future Considerations and Lifestyle Changes

• Follow-up appointments for monitoring breast health, potential recurrence, and managing lymphedema.
• Hormonal therapy or chemotherapy may be part of the treatment plan depending on cancer stage and type.
• Diet and exercise are important for maintaining overall health and managing potential side effects of cancer treatments.

Hysterectomy

A hysterectomy is a surgical procedure to remove the uterus. It is commonly performed to treat various medical conditions, including fibroids, endometriosis, uterine cancer, or prolapsed uterus. The procedure can be done for both medical and preventive reasons.

1. Indications for Hysterectomy

• Uterine fibroids: Benign tumors that cause heavy bleeding, pain, or other complications.
• Endometriosis: A condition where tissue similar to the uterine lining grows outside the uterus, causing pain and infertility.
• Uterine cancer: Cancer affecting the uterus, such as endometrial cancer.
• Chronic pelvic pain: Pain that cannot be relieved by other treatments.
• Uterine prolapse: When the uterus drops into the vaginal canal due to weakened pelvic muscles.
• Abnormal bleeding: Heavy or irregular bleeding that doesn’t respond to other treatments.
• Infections or complications: Severe infections or other complications that affect the uterus.

2. Types of Hysterectomy

A. Total Hysterectomy

• Removal of the entire uterus, including the cervix.
• Most common type of hysterectomy.

B. Subtotal (Supracervical) Hysterectomy

• Removal of the uterus but leaving the cervix intact.
• Often recommended for patients who don’t have cancer or other issues with the cervix.

C. Radical Hysterectomy

• Removal of the entire uterus, cervix, upper vagina, and lymph nodes.
• Typically performed in cases of uterine cancer or other malignancies.

D. Laparoscopic or Minimally Invasive Hysterectomy

• Performed using small incisions and a camera (laparoscope).
• Minimally invasive option with faster recovery, less pain, and smaller scars.

E. Abdominal Hysterectomy

• The uterus is removed through a larger incision in the abdomen.
• This method is typically used for larger fibroids or cancer treatment.

F. Vaginal Hysterectomy

• Removal of the uterus through the vagina, leaving no visible scar.
• Preferred in some cases due to less post-operative pain and quicker recovery.

3. The Hysterectomy Procedure

A. Preparation

• Preoperative tests: Blood tests, imaging (e.g., ultrasound, CT scan) to evaluate the size of the uterus, and any abnormalities.
• Fasting for 6-8 hours before surgery if general anesthesia is used.
• Anesthesia: General anesthesia or spinal anesthesia may be used depending on the surgical method.
• Pre-surgical counseling: Discussion of possible side effects, such as early menopause or hormone therapy needs.
• Medication: Medications to manage bleeding or pain, and prevent infection.

B. Surgical Steps

1. Anesthesia – The patient is put under general or regional anesthesia.
2. Incision – Depending on the type of hysterectomy, a small incision (for laparoscopic) or a larger incision (for abdominal hysterectomy) is made.
3. Uterus removal – The surgeon carefully removes the uterus and any additional organs or tissues, depending on the type of surgery.
4. Closure – After removing the uterus, the incision is closed with sutures, and a drain may be placed to remove any fluid or blood.
5. Post-operative monitoring – The patient is closely monitored in the recovery room.

C. Duration

• 1-3 hours, depending on the method used and whether additional procedures (like lymph node removal) are needed.

4. Recovery After Hysterectomy

A. Hospital Stay

• 1-2 days for laparoscopic or vaginal hysterectomy.
• 2-4 days for abdominal hysterectomy, especially if there were complications or a larger incision was made.

B. Home Recovery (4-6 Weeks)

• Rest: Patients are encouraged to rest during the first few weeks and gradually return to normal activity.
• Pain management: Pain relief is typically provided with medications.
• No heavy lifting: Patients should avoid lifting heavy objects for 6-8 weeks to allow proper healing.
• Diet and hydration: A balanced diet and plenty of water are important to aid recovery.
• Incision care: Keep the incision site clean and dry, and follow care instructions from the surgeon.
• Gentle walking: Walking and light activities can help improve circulation and prevent blood clots.

5. Risks and Complications

A. Short-Term Risks

• Infection: At the incision site, urinary tract, or internally.
• Bleeding: Some bleeding is normal immediately after surgery. However, excessive bleeding may require medical attention.
• Blood clots: Particularly in the legs or lungs.
• Damage to surrounding organs: Rarely, the bladder, intestines, or ureters may be injured during surgery.

B. Long-Term Risks

• Early menopause: If the ovaries are removed during the procedure, it can lead to surgical menopause.
• Hormonal changes: If the ovaries are removed, hormone replacement therapy may be needed.
• Pelvic organ prolapse: In rare cases, other pelvic organs may drop after the uterus is removed.
• Sexual health: Some women may experience changes in libido or vaginal dryness, particularly if the ovaries are removed.
• Psychological effects: Emotional adjustment to the changes in body image or hormonal shifts.

6. When to Seek Medical Help?

• Severe pain that is not relieved by prescribed medication.
• Fever or signs of infection such as redness, swelling, or pus around the incision.
• Excessive bleeding (heavier than a normal period or clots larger than a golf ball).
• Urinary or bowel issues (inability to urinate or pass stools).
• Shortness of breath or chest pain (signs of a blood clot).

7. Emotional and Psychological Support

• Counseling: Many women benefit from counseling or support groups to address the emotional impact of losing their uterus.
• Hormone therapy: Women who undergo menopause after a hysterectomy may need hormone replacement therapy (HRT) to manage symptoms.
• Body image: Support from family, friends, and mental health professionals can help adjust to changes in body image and fertility.

8. Lifestyle Changes and Follow-Up Care

• Follow-up appointments: Regular check-ups to monitor recovery, hormonal health, and to screen for any long-term effects.
• Exercise: A gradual return to physical activity can improve strength and circulation, but heavy lifting should be avoided for several weeks.
• Dietary adjustments: A balanced diet and weight management are important, especially if hormonal changes affect metabolism.
• Pelvic floor health: Pelvic floor exercises may be recommended to maintain bladder and bowel control.