Aortic aneurysm repair is performed when an aneurysm forms in the aortic artery. An aneurysm is an abnormal widening or ballooning of a portion of an artery, related to weakness in the wall of the blood vessel. The aorta is a large artery that stems from the heart and carries blood to the rest of the body.

Some common locations for aneurysms include:

• Abdominal aorta – the major artery from the heart that supplies blood to your abdomen, the pelvis, and legs.
• Thoracic aorta – the major artery from the heart that supplies blood through the chest.

Repairing an aortic aneurysm usually entails surgery, although a stent-graft repair procedure is also gaining popularity as it is minimally invasive and requires less recovery time. The most common procedures are as follows:

• Open Aorta Surgical Repair – The open aorta surgical repair involves placing clamps above and below the aneurysm to stop the blood flow to that part of the artery. Whether or not the surgery will involve the use of a heart-lung machine (cardio-pulmonary bypass) depends on the location of the aneurysm. If the aortic arch is involved, the surgeon may use a specialized technique known as circulatory arrest — a period without blood circulation while the patient is on life support. The surgeon replaces the weakened wall with a fabric tube called a graft. The surgeon may also use a prosthesis device.
  
• Graft-Stent Repair – This less-evasive procedure is used to repair thoracic aneurysms and does not require a chest incision. The surgeon inserts a tube where special catheters are introduced through the arteries at the groin. The physician then deploys a stent-graft or prosthesis at the site of the aneurysm which allows the flow of blood without putting pressure on the weakened wall.
  
• Endovascular Stent-Graft Repair – This less-invasive procedure is used for abdominal aneurysms. This procedure involves using long, thin tubes called catheters inserted in the patient's groin and guided through the blood vessels using live x-ray pictures. The physician then deploys a stent-graft or prosthesis at the site of the aneurysm which allows the flow of blood without putting pressure on the weakened wall. If this repair is unsuccessful, the surgeon may elect to perform an open repair.

A vascular and/or cardio-thoracic surgeon usually performs this surgery which requires a hospital stay, although the endovascular and graft-stent methods typically involve a shorter stay.

Alternative Names: Aortic aneurysm - thoracic; Syphilitic aneurysm; Aneurysm - thoracic aortic.

Appendectomy is the surgical removal of the appendix-a small process, or tube, located on the first part of the large intestine. If it becomes inflamed, infected or has ruptured, it can cause severe pain, and requires immediate medical treatment. An appendectomy can be performed through laparoscopic surgery or open surgery. Laparoscopic surgery involves a tiny camera inserted into a small incision in the abdomen by which the surgery is viewed. Traditional open surgery is always used in an emergency procedure to remove a ruptured appendix. Removal of the appendix may be likely if there is:

• Severe abdominal pain
• Fever
• Loss of appetite
• Nausea and vomiting

A ruptured appendix must be removed immediately, or it may leak into the abdominal space and cause peritonitis, a life-threatening condition. Both open and laparoscopic surgery are performed under general anesthesia, and require a hospital stay of 1-4 days. Recovery time is usually 1-3 weeks following surgery, but is shorter with laparoscopic surgery.

Back and Neck Surgery, also called spinal fusion, may be necessary when the vertebrae (small bony segments that make up the spine) become displaced, inflamed, or injured, and cause pain. Fusion surgery is performed to strengthen and limit motion of the spine until it can heal, and can involve metal rods and screws and/or bone grafts. Back and neck fusion may be needed to correct:

A developmental defect

A fracture

A degenerative disease, such as arthritis

Damage caused by infection or a tumor

Degeneration of the cushioning disk

An orthopedic surgeon usually performs this surgery, which requires a hospital stay. Recovery time will vary, and depends upon the patient, the extent of the injury, and the judgment and expertise of the physician.

Back surgery involves removal of all or part of a vertebra or disk in order to relieve pressure and pain on the nerves in the spine. A vertebra is one of 33 small bones making up the spine. Disks are the cushioning between the vertebrae that prevent the bones from coming into contact with each other.

A herniated disk is one that has ruptured or bulged from a tear in the disk covering. If the herniated disk presses on a nerve, surgery may be required to relieve the pressure and the pain associated with it.
Surgery may include:

Removal of part of a vertebra

Removal of a herniated disk

Incision of ligaments in the spinal cord to relieve pressure

Incision of nerves in the spinal cord

Removing damaged tissue on a vertebra

Back surgery is usually performed by an orthopedic surgeon, and is done under general anesthesia. It is an inpatient procedure, which means that it requires a hospital stay. The surgery will relieve pain and allow the back to heal. Recovery time is typically 1-3 months.

Bariatric surgery, or gastric bypass surgery, is surgery that can be used to achieve significant weight loss in individuals who are very obese (morbidly obese). A thumb-sized stomach pouch is created (using a stapling or banding technique) then the outlet of the pouch is connected directly to the intestine, essentially bypassing the lower stomach. After the surgery, the amount of calories your body can intake is reduced which leads to weight loss.

Different procedures used include:

• Vertical-banded Gastroplasty – The upper stomach near the esophagus is stapled to form a small pouch. The outlet from the pouch to the stomach is restricted by the use of a band made of special material. This band delays the emptying of food from the pouch, causing a fullness sensation.
• Short-limbed Roux-en-Y Gastroenterostomy – The surgeon will divide the stomach into a small upper section. The surgeon will staple off the small section from the larger section. Then, they will reconnect a section of the small intestine to this new pouch, bypassing the larger stomach area remaining and connecting the base to the remaining portion of the small intestine.
• Small Intestine Reconstruction – In this procedure, more of the small intestine is bypassed than with the short-limbed Roux-en-Y procedure.

All procedures are performed under general anesthesia. A hospital stay of two to four days is expected.

Bone marrow is a soft, fatty tissue inside the bones where blood cells (red blood cells, platelets, and white blood cells) are produced and developed. Bone marrow biopsies (collection of a small sample for examination) are used to evaluate blood disorders and diagnosis certain types of cancers. They can also be helpful in diagnosing fevers of unknown origins.

A bone marrow biopsy can be an aspiration, a needle biopsy, or both. A local anesthetic is applied to numb the skin and the tissue down to the surface of the bone. A special needle is then used to penetrate the outer shell of the bone. Once inside, the center part of needle is replaced by a syringe and the liquid is collected. For a biopsy, the center of the needle is not replaced and the needle cuts a core that is collected by the needle. The core is extracted and prepared for examination by a pathologist.

Since the area is very small, usually a bandage is applied and the patient is released.

Bone marrow is a soft, fatty tissue inside the bones where blood cells (red blood cells, platelets, and white blood cells) are produced and developed. A bone marrow transplant is a procedure to transplant healthy bone marrow into a patient whose bone marrow is not functioning properly (that is, diseased or damaged). Problems in bone marrow are often caused by chemotherapy or radiation treatment for cancer. Bone marrow transplant is also done to correct hereditary blood diseases.

The patient is given high doses of chemotherapy and/or radiation to destroy the diseased cells prior to the implantation or transplantation. The cells and/or marrow are then injected directly into the patient's vein. This procedure is done in the patient's hospital room and does not require an operating room.

The name of the procedure depends the source of the healthy bone marrow (or stem cells). The healthy bone marrow (or stem cells) may be taken from:

•  the patient prior to chemotherapy or radiation treatment (autograft or transplantation-autologous),

•  a donor who is not an identical twin (allograft or transplantion-allogenic), or

•  an identical twin (syngenetic or transplantation-syngenetic).

Brain surgery is sometimes necessary to repair an injury, remove a tumor or lesion, or to stop bleeding or infection. Before surgery, an incision is made in the skull, and bone is removed to provide access to the brain. After surgery, the bone is replaced. This inpatient surgery is performed under general anesthesia by a neurosurgeon and requires a hospital stay. Brain surgery is performed in order to:

• Repair a fracture
• Remove a tumor or lesion
• Remove a blood clot
• Treat an area of infection
• Stop bleeding
• Implant electrodes to monitor seizures
• Treat an aneurysm (weakness in a blood vessel wall)

The patient may achieve partial recovery from brain surgery in one to four weeks; full recovery may take up to eight weeks, depending on patient health, the extent of the disease or injury, and the surgical procedures used by the physician.

Risks for any surgery are:

• Bleeding
• Infection

Additional risks of brain surgery are:

• Injury to brain tissue
• Injury to blood vessels
• Nerve or muscle paralysis or weekness
• Loss of mental functions (memory, speech, understanding)

Breast reconstruction surgery is performed when a breast has been removed due to cancer or other disease. Virtually any patient who loses their breast can have it rebuilt (with artificial implants and native tissue) through econstructive surgery, but there are risks associated with any surgery.

There are several different procedures that are associated with breast reconstruction. The first stage of reconstruction, the creation of the breast mound, is almost always performed in a hospital setting under general anesthesia. Follow-up surgery, however, may be performed at a hospital or an outpatient facility.

The surgery can take place immediately following the mastectomy or can be delayed.

Procedures include:

• Breast Prosthesis – This procedure involves inserting a breast implant.

• Nipple/Areola Reconstruction – This procedure involves either rebuilding the nipple or the areola (the circular area of darker pigmentation around the nipple). The nipple can be rebuilt using a skin flap or graft. The areola can be rebuilt using a graft or tattooing process.

• Breast Expander – A breast expander is used to stretch the skin. A surgeon inserts a balloon expander beneath the skin and the chest muscle. Periodically, the surgeon will inject a salt-water solution over a period of several weeks or months to stretch the skin. Once stretched, the surgeon can insert a more permanent implant. Some expanders can be left in place as the final implant.

• Flap Reconstruction – Flap reconstruction is the process of creating a skin flap using tissue from other areas of the body. Latissimus Dorsi Flap uses the tissue on the upper back. Free Flaps transplant non-essential donor tissue from one part of the body. Transverse Rectus Abdominis Myocutaneous (TRAM) Flaps use tissue from the lower abdominal wall.

Breast reduction surgery is performed to reduce the size of a patient's breasts. Many patients choose this operation to reduce back, neck and shoulder pain. Some choose this operation to make it easier to participate in sporting activities, to eliminate sleeping problems or poor posture resulting from large breasts, or to avoid unwanted attention and comments about large breasts.

Often called Reduction Mammoplasty, this surgery involves the removal of excess skin and fat from the breasts, reshaping of the breasts to form smaller breasts, and repositioning of the nipples.

The surgery is performed in a hospital setting under a general anesthesia and involves an overnight stay, sometimes longer.

A bunion is an enlargement of the joint at the base and the side of the big toe and consists of a bony growth. Most commonly seen in women, it is thought that wearing narrow pointed-toed shoes is the main cause. However, bunions are also known to be hereditary and are even found in societies where no footwear is ever worn, leading to the conclusion of inherited foot problems.

Surgical removal of a bunion is usually done while the patient is under general anesthesia and rarely requires a hospital stay. A podiatrist will make an incision along the bones of the big toe into the foot. The deformed joint and bones are repaired, and the bones are stabilized with a pin and/or cast.

Different procedures include:

• Keller Procedure – Distal soft tissue release
• McBride Procedure – Removal of the base of the proximal phalanx
• Mayo Procedure – Removal of the metatarsal head
• Removal of Joint with Implant - Removal of the total joint with implant placement
• Joplin Procedure – Transplantation of tendons
• Osteotomy – Surgical cutting of the joint
• Lapidus Procedure – Distal soft tissue rearrangement

Carotid surgery is a surgical procedure to remove the lining and fatty obstruction of a carotid artery that has been narrowed by atherosclerosis. Atherosclerosis is the narrowing of arteries usually due to the buildup of fatty tissue. The largest and most common clinical problems associated with atherosclerosis of a carotid artery are stroke or transient ischemic attack (TIA).

A carotid surgery restores normal blood flow to the brain, reducing stroke or TIA risk. Before surgery, the site of narrowing is located by means of an x-ray procedure called angiography.

Carotid surgery is a delicate procedure that may take several hours to perform. The procedure is performed in a hospital setting with general anesthesia. The artery is exposed, clamps are applied, an incision is made, and the diseased lining is removed along with the atherosclerotic material and any thrombus (blood clot) that has formed. The incision is closed with stitches. Most patients are able to leave the hospital within a day or two.

Carpal tunnel release is a surgery performed by an orthopedic and/or hand surgeon to relieve hand and wrist pain caused by the compression of the medial nerve at the wrist. The medial nerve and the tendons are located in one wall of the carpal tunnel. The other wall holds the bones of the wrist. Most conditions are caused by wrist fracture, rheumatoid arthritis, or overuse of the wrist.

The surgery is usually performed on an outpatient basis using either local or general anesthesia. The surgery can be performed two different ways:

• Using Endoscopy – The surgeon makes a small cut at the patient's wrist, reaches the carpal ligament using an endoscope, and makes repairs.

• Open Method – The surgeon makes a cut in the palm of the patient's hand and reaches the ligament by cutting through the underlying tissue and muscle.

The recovery time after the surgery depends on how damaged the nerve was before the surgery.

 

A cataract is the clouding of the eye's natural lens that lies between the iris and the pupil. Cataract surgery is performed to remove the clouded lens and replace the lens with a permanent implant. This implant is known as an intraocular lens implant (IOL). This surgery usually results in a return to normal vision. It is the most common surgery performed in the United States.

The surgery is usually performed on an outpatient basis by an ophthalmologist. The patient is given eye drops and sometimes medication to help the patient relax. A local anesthetic is applied to help make the operation painless.

The surgeon will make a small incision in the eye using an operating microscope. The lens is then removed or the surgeon will use a laser, ultrasound or other surgical solution to break up the lens for removal. The surgeon will then insert the lens implant (IOL) and close the incision. A patch is placed over the eye and after a short stay in the recovery area the patient is ready to go home.

A cesarean section, also called a C-section, is the delivery of the fetus through a surgical abdominal incision. A C-section is performed when a vaginal delivery is not safe for the mother or child. The most common reasons for a physician to perform a C-section are:

• Developmental abnormalities of the fetus
• Abnormal fetal heart rate
• Abnormal position of the fetus
• Extreme maternal illness
• Active genital herpes infection
• Maternal HIV infection
• Previous uterine surgery, including previous C-section
• Prolonged or arrested labor
• Placenta attached in abnormal location

Both regional and general anesthesia may be used. Regional anesthesia is most frequently used for labor and delivery. Regional anesthesia is when narcotics may be given by continuous infusion into the epidural space in the spine. General anesthesia is not recommended for routine deliveries, but is often the method used for an emergency cesarean section. Most mothers and infants recover well.

A cesarean section, also called a C-section, is the delivery of the fetus through a surgical abdominal incision. A Cesarean Section by Patient Choice is defined as a first-time, pre-planned C-section for which there is no medical necessity. Some reasons why a woman would choose a C-section as an alternative to vaginal birth are the fear of labor pain, fear of incontinence that is due to wear and tear on the pelvic muscles, fear of tearing that may happen during a vaginal delivery, or even apprehension about a friend or relative who's had a difficult vaginal birth.

This major surgery carries significant risks that need to be considered. For the mother, these risks are:

• Hemorrhage
• Pain
• Infection
• Placental implantation problems in future pregnancies

There are also risks to a child born by a C-section:

• Respiratory problems
• Accidental surgical cuts
• Breastfeeding difficulties
• Asthma

Both regional and general anesthesia may be used. Regional anesthesia is most frequently used for labor and delivery, and is administered by continuous infusion into the epidural space in the spine. General anesthesia is not recommended for routine deliveries, but is often the method used for an emergency cesarean section. The average hospital stay after a cesarean section is 2-4 days.

During colon resection surgery (bowel resection) the diseased part of the large intestine is removed and the two healthy ends are sewn back together (resected). This surgery is used to treat many conditions, such as bowel obstruction, diverticulitis, Crohn's Disease and colon cancer.

If the entire colon and rectum is removed, the procedure is called a proctocolectomy.

A bowel resection may be performed as a traditional open procedure or as a minimally invasive laparoscopic procedure. The surgery is performed in a hospital setting under general anesthesia and can involve a hospital stay of up to seven days.

•  Open Procedure – The surgeon makes one large incision in the abdomen.

•  Laparoscopic Surgery – The surgeon makes three or four small incisions in the abdomen and inserts tube-like instruments. The abdomen is filled with gas to help the surgeon view the abdominal cavity. A camera is inserted through one of the tubes allowing the surgeon to work inside your abdomen.

Some other procedures that can be performed with the colon resection are:

•  Colectomy – If it is necessary to allow the colon to heal before returning it to its normal digestive process, a temporary opening of the colon (large intestine) through the abdominal wall may be created. In this procedure, the end of the healthy bowel tissue is passed through the abdominal wall, and the edges are stitched to the skin of the abdominal wall. An adhesive drainage bag is placed around the opening. Depending on the situation, the colostomy is usually temporary and can be closed with another operation at a later date.

•  Ileostomy – The ileum is located at the lowest portion of the small intestine. Similar to the colectomy, the healthy end of the ileum is brought through the abdominal wall, and the edges are stitched to the skin of the abdominal wall and an adhesive drainage bag is placed around the opening. When a large portion of the bowel is removed and the colon is no longer functional, the colostomy is usually permanent.

•  Coloproctostomy – An artificial opening that is created between the colon and the rectum.

Cornea transplant surgery is performed when the damaged or diseased disc-shaped area of the cornea is replaced with a healthy similar-sized area of donor cornea. Some conditions that can cause the deterioration of the eye are keratoconus, bullous keratopathy, Fuch's dystrophy, and herpetic eye disease. Sometimes transplantation is necessary due to trauma or perforation to the cornea. Cornea transplants are one of the most frequently performed transplantation with over a 90-percent success rate.

The surgery is performed by an ophthalmologist in an outpatient setting using a local anesthetic. The surgery can be performed in tandem with cataract removal or intraocular lens (IOL) implantation.

After the patient is anesthetized, the surgeon sews a ring to the ocular surface to support the eye. The surgeon removes the cornea and the donor cornea is sewn into place with ultra-fine sutures. Post-operatively, the patient can expect gradual improvement of vision within six to twelve months. The surgeon will remove some of the sutures within a few weeks or months as the cornea heals.

Coronary angioplasty is a medical procedure in which a balloon catheter is used to open narrowed or blocked blood vessels of the heart (coronary arteries). Fat and cholesterol can accumulate inside arteries, forming deposits that narrowed the arteries enough that blood to the heart is hindered. This procedure can increase the blood flow to the heart, thus decreasing chest pain and enabling the patient to return to exercise.

The procedure is performed by a cardiologist and a team of specialized trained individuals at a hospital catheterization laboratory. The patient remains awake for the procedure (no anesthesia) but pain medicine may be given as needed.

Coronary angioplasty is performed by inserting a hollow needle into the femoral artery (an artery located in the groin near the thigh) . With the help of x-ray images, a guide wire is pushed through the needle into the artery, where it is advanced to a point just past the narrowing of the artery to be treated. Once the guide wire is in place, a balloon-tipped catheter is threaded over the guide wire and pushed along the artery until it reaches the area to be treated. The balloon at the tip of the catheter is then inflated and deflated several times to widen the narrowed part of the artery. When the procedure is complete, the balloon is deflated and the catheter is withdrawn.

The patient is monitored for 12-14 hours after the procedure with frequent vital sign checks. Most patients are released from the hospital within a day or two of the procedure.

Alternative Names: Balloon angioplasty; Coronary angioplasty; Coronary artery angioplasty; Cardiac angioplasty; PTCA; Percutaneous transluminal coronary angioplasty; Heart artery dilatation

Defibrillator implant surgery is performed to implant a device to help control a patient's heart rhythm. There are two types of devices, pacemakers and implantable cardioverter defibrillator (ICD). Both help treat arrhythmias–irregularities in your heart's natural heart rhythm. Almost everyone's heart skips a beat and most are considered harmless. Some patients, however, will need medication and/or a defibrillator implant.

• Pacemaker – This is a small battery-operated device (about the size of a matchbox). It usually has two parts: a pulse generator (which includes the battery and several electronic circuits), and leads, which are attached to the heart wall. You may have one or two leads, depending on the pacemaker.

• Implantable Cardioverter Defibrillator (ICD) – This implant is about the size of a pager (larger than a pacemaker). It too has two parts: the pulse generator (which includes the battery and several electronic circuits), and a lead wire, or wires, depending on the device implanted. The lead wire(s) are placed inside the heart or on its surface and attached to the ICD. ICD are typically used to control fast irregular heart rates.

Pacemaker surgery is performed under local anesthesia. It is implanted just near the collarbone. If the pacemaker has only one lead, the lead is placed inside the lower right chamber. If two leads are needed, the second lead is placed in the upper right chamber. The procedure takes about one to two hours.

ICD surgery is performed in a hospital under general anesthesia. The device is implanted beneath the skin near the collarbone. It can also be implanted at another location at or above the waistline. The surgeon will then test the device and this can take up to two hours. An overnight stay is recommended.

Dilatation and Curettage (D&C) is a procedure to scrape and collect tissue from inside the uterus. This procedure is used to help diagnose medical conditions using the tissue collected, to treat irregular or heavy menstrual bleeding, or to remove fetal or placental tissue following a miscarriage.

This procedure can be performed in a hospital or in a clinic setting using either local or general anesthesia.

The vaginal canal is held open by a speculum and the opening to the cervix is anesthetized. The cervix is then opened (dilated) using various rod sizes until the cervix is opened to the desired size. After the cervix is dilated, instruments can be inserted into the uterus and manipulated, depending on the nature of the procedure.

Ear tube placement, or tympanostomy, is a procedure to drain fluid that has built up behind a child's eardrums to restore the normal function of the ear. This surgery is performed by an otolaryngologist. The tubes ventilate the ears, which help prevent fluid from building up in the ear which can cause reoccurring ear infections, and help reduce hearing loss due to fluid trapped behind the eardrum.

The tubes are placed through the ear canal in an operating room under general anesthesia. A tiny hole is made in the eardrum, and fluid is suctioned. A tiny tube is then inserted into the hole, allowing air to enter the middle ear. The procedure is a short one, and the patient is allowed to go home after a brief recovery period.

The tubes usually will fall out of the ear within one to two years as the eardrum grows.

Gastrectomy is the surgical removal of all or part of the stomach and reconnection with the small intestine. This surgery used to treat stomach cancer, noncancerous polyps, gastric ulcers, or a hole in the stomach wall. The surgery is performed under general anesthesia and usually involves a hospital stay of seven to ten days. If combined with other procedures, the stay can be lengthy.

Procedures used can include:

• Esophagectomy – An esophagectomy is the partial or complete removal of the esophagus (the tube from the mouth to the stomach) and the top part of the stomach. An esophagectomy is performed using one of two methods. Transhiatal Esophagectomy is performed with surgical incisions at the upper abdomen and the neck area. The second method, Transthoracic Esophagectomy is also known as the Ivor Lewis procedure and is performed with an upper abdominal incision and an incision into the chest area.
• Esophagoenterostomy – In this procedure, a connection is made between the esophagus and the small intestine following a gastrectomy.
• Roux-en-Y Reconstruction – In this procedure a small pouch is formed and connected to the intestine.
• Gastroduodenostomy – In this procedure, a connection is made between the stomach and duodenum (the first portion of the small intestine).
• Gastrojejunostomy – In this procedure, a connection is made between the stomach and the jejunum (the portion of the small intestine that extends from the duodenum to the ileum).
• Vagotomy – In this procedure the vagus nerve is cut to reduce acid secretion in the stomach. The vagus nerve has branches that go to different parts of the stomach.
• Pancreatectomy – This procedure involves the total or partial surgical removal of the pancreas.
• Whipple Procedure – Also known as a pancreaticoduodenectomy , this procedure is the removal of the duodenum with all or part of the pancreas.

Gastroesophageal reflux surgery is used to correct gastroesophageal reflux disease (GERD). GERD is a condition in which partially digested food or liquid travels from the stomach back up into the esophagus (the tube from the mouth to the stomach). At the lower end of the esophagus, there is a small ring of muscle called the lower esophageal sphincter (LES). The LES is a one-way valve that normally closes after swallowing to prevent back-up of the stomach juices. If the LES is not functioning properly, stomach acid or partially digested material will flow back in to the esophagus often inflaming the esophagus and causing heartburn and other symptoms.

Some procedures used are:

• Upper Gastrointestinal Endoscopy – For this procedure, the physician inserts an endoscope through the mouth where it travels down to the stomach, allowing the physician to view the esophagus, stomach and duodenum (upper gastrointestinal tract). Tissue samples can be obtained, polyps can be removed and bleeding can be treated. Thermal therapy can also be administered where electrodes are placed at multiple sites and the heat is used to create lesions that help strengthen the lower esophagus sphincter (LES). This procedure is done on an outpatient basis with local anesthesia for the throat and medication to relax the patient.
• Esophagogastric Fundoplasty – This surgery reinforces the valve between the esophagus and stomach by wrapping the upper portion of the stomach around the lowest portion of the esophagus, much like the way a bun wraps around a hot dog. This allows for increased pressure within the lower esophageal sphincter (LES), allowing the LES to strengthen and lengthen. This procedure can be performed both laparoscopic (using small incisions to enter the abdomen) or open (through a large incision to the patient's abdomen). This procedure is done on an inpatient basis under general anesthesia.

Aortic aneurysm repair is performed when an aneurysm forms in the aortic artery. An aneurysm is an abnormal widening or ballooning of a portion of an artery, related to weakness in the wall of the blood vessel. The aorta is a large artery that stems from the heart and carries blood to the rest of the body.

Some common locations for aneurysms include:

• Abdominal aorta – the major artery from the heart that supplies blood to your abdomen, the pelvis, and legs.
• Thoracic aorta – the major artery from the heart that supplies blood through the chest.

Repairing an aortic aneurysm usually entails surgery, although a stent-graft repair procedure is also gaining popularity as it is minimally invasive and requires less recovery time. The most common procedures are as follows:

• Open Aorta Surgical Repair – The open aorta surgical repair involves placing clamps above and below the aneurysm to stop the blood flow to that part of the artery. Whether or not the surgery will involve the use of a heart-lung machine (cardio-pulmonary bypass) depends on the location of the aneurysm. If the aortic arch is involved, the surgeon may use a specialized technique known as circulatory arrest — a period without blood circulation while the patient is on life support. The surgeon replaces the weakened wall with a fabric tube called a graft. The surgeon may also use a prosthesis device.
  
• Graft-Stent Repair – This less-evasive procedure is used to repair thoracic aneurysms and does not require a chest incision. The surgeon inserts a tube where special catheters are introduced through the arteries at the groin. The physician then deploys a stent-graft or prosthesis at the site of the aneurysm which allows the flow of blood without putting pressure on the weakened wall.
  
• Endovascular Stent-Graft Repair – This less-invasive procedure is used for abdominal aneurysms. This procedure involves using long, thin tubes called catheters inserted in the patient's groin and guided through the blood vessels using live x-ray pictures. The physician then deploys a stent-graft or prosthesis at the site of the aneurysm which allows the flow of blood without putting pressure on the weakened wall. If this repair is unsuccessful, the surgeon may elect to perform an open repair.

A vascular and/or cardio-thoracic surgeon usually performs this surgery which requires a hospital stay, although the endovascular and graft-stent methods typically involve a shorter stay.

Alternative Names: Aortic aneurysm - thoracic; Syphilitic aneurysm; Aneurysm - thoracic aortic.

Back and Neck Surgery, also called spinal fusion, may be necessary when the vertebrae (small bony segments that make up the spine) become displaced, inflamed, or injured, and cause pain. Fusion surgery is performed to strengthen and limit motion of the spine until it can heal, and can involve metal rods and screws and/or bone grafts. Back and neck fusion may be needed to correct:

A developmental defect

A fracture

A degenerative disease, such as arthritis

Damage caused by infection or a tumor

Degeneration of the cushioning disk

An orthopedic surgeon usually performs this surgery, which requires a hospital stay. Recovery time will vary, and depends upon the patient, the extent of the injury, and the judgment and expertise of the physician.

Back surgery involves removal of all or part of a vertebra or disk in order to relieve pressure and pain on the nerves in the spine. A vertebra is one of 33 small bones making up the spine. Disks are the cushioning between the vertebrae that prevent the bones from coming into contact with each other.

A herniated disk is one that has ruptured or bulged from a tear in the disk covering. If the herniated disk presses on a nerve, surgery may be required to relieve the pressure and the pain associated with it.
Surgery may include:

Removal of part of a vertebra

Removal of a herniated disk

Incision of ligaments in the spinal cord to relieve pressure

Incision of nerves in the spinal cord

Removing damaged tissue on a vertebra

Back surgery is usually performed by an orthopedic surgeon, and is done under general anesthesia. It is an inpatient procedure, which means that it requires a hospital stay. The surgery will relieve pain and allow the back to heal. Recovery time is typically 1-3 months.

Bariatric surgery, or gastric bypass surgery, is surgery that can be used to achieve significant weight loss in individuals who are very obese (morbidly obese). A thumb-sized stomach pouch is created (using a stapling or banding technique) then the outlet of the pouch is connected directly to the intestine, essentially bypassing the lower stomach. After the surgery, the amount of calories your body can intake is reduced which leads to weight loss.

Different procedures used include:

• Vertical-banded Gastroplasty – The upper stomach near the esophagus is stapled to form a small pouch. The outlet from the pouch to the stomach is restricted by the use of a band made of special material. This band delays the emptying of food from the pouch, causing a fullness sensation.
• Short-limbed Roux-en-Y Gastroenterostomy – The surgeon will divide the stomach into a small upper section. The surgeon will staple off the small section from the larger section. Then, they will reconnect a section of the small intestine to this new pouch, bypassing the larger stomach area remaining and connecting the base to the remaining portion of the small intestine.
• Small Intestine Reconstruction – In this procedure, more of the small intestine is bypassed than with the short-limbed Roux-en-Y procedure.

All procedures are performed under general anesthesia. A hospital stay of two to four days is expected.

Bone marrow is a soft, fatty tissue inside the bones where blood cells (red blood cells, platelets, and white blood cells) are produced and developed. A bone marrow transplant is a procedure to transplant healthy bone marrow into a patient whose bone marrow is not functioning properly (that is, diseased or damaged). Problems in bone marrow are often caused by chemotherapy or radiation treatment for cancer. Bone marrow transplant is also done to correct hereditary blood diseases.

The patient is given high doses of chemotherapy and/or radiation to destroy the diseased cells prior to the implantation or transplantation. The cells and/or marrow are then injected directly into the patient's vein. This procedure is done in the patient's hospital room and does not require an operating room.

The name of the procedure depends the source of the healthy bone marrow (or stem cells). The healthy bone marrow (or stem cells) may be taken from:

•  the patient prior to chemotherapy or radiation treatment (autograft or transplantation-autologous),

•  a donor who is not an identical twin (allograft or transplantion-allogenic), or

•  an identical twin (syngenetic or transplantation-syngenetic).

Brain surgery is sometimes necessary to repair an injury, remove a tumor or lesion, or to stop bleeding or infection. Before surgery, an incision is made in the skull, and bone is removed to provide access to the brain. After surgery, the bone is replaced. This inpatient surgery is performed under general anesthesia by a neurosurgeon and requires a hospital stay. Brain surgery is performed in order to:

• Repair a fracture
• Remove a tumor or lesion
• Remove a blood clot
• Treat an area of infection
• Stop bleeding
• Implant electrodes to monitor seizures
• Treat an aneurysm (weakness in a blood vessel wall)

The patient may achieve partial recovery from brain surgery in one to four weeks; full recovery may take up to eight weeks, depending on patient health, the extent of the disease or injury, and the surgical procedures used by the physician.

Risks for any surgery are:

• Bleeding
• Infection

Additional risks of brain surgery are:

• Injury to brain tissue
• Injury to blood vessels
• Nerve or muscle paralysis or weekness
• Loss of mental functions (memory, speech, understanding)

Breast reconstruction surgery is performed when a breast has been removed due to cancer or other disease. Virtually any patient who loses their breast can have it rebuilt (with artificial implants and native tissue) through econstructive surgery, but there are risks associated with any surgery.

There are several different procedures that are associated with breast reconstruction. The first stage of reconstruction, the creation of the breast mound, is almost always performed in a hospital setting under general anesthesia. Follow-up surgery, however, may be performed at a hospital or an outpatient facility.

The surgery can take place immediately following the mastectomy or can be delayed.

Procedures include:

• Breast Prosthesis – This procedure involves inserting a breast implant.

• Nipple/Areola Reconstruction – This procedure involves either rebuilding the nipple or the areola (the circular area of darker pigmentation around the nipple). The nipple can be rebuilt using a skin flap or graft. The areola can be rebuilt using a graft or tattooing process.

• Breast Expander – A breast expander is used to stretch the skin. A surgeon inserts a balloon expander beneath the skin and the chest muscle. Periodically, the surgeon will inject a salt-water solution over a period of several weeks or months to stretch the skin. Once stretched, the surgeon can insert a more permanent implant. Some expanders can be left in place as the final implant.

• Flap Reconstruction – Flap reconstruction is the process of creating a skin flap using tissue from other areas of the body. Latissimus Dorsi Flap uses the tissue on the upper back. Free Flaps transplant non-essential donor tissue from one part of the body. Transverse Rectus Abdominis Myocutaneous (TRAM) Flaps use tissue from the lower abdominal wall.

Breast reduction surgery is performed to reduce the size of a patient's breasts. Many patients choose this operation to reduce back, neck and shoulder pain. Some choose this operation to make it easier to participate in sporting activities, to eliminate sleeping problems or poor posture resulting from large breasts, or to avoid unwanted attention and comments about large breasts.

Often called Reduction Mammoplasty, this surgery involves the removal of excess skin and fat from the breasts, reshaping of the breasts to form smaller breasts, and repositioning of the nipples.

The surgery is performed in a hospital setting under a general anesthesia and involves an overnight stay, sometimes longer.

A bunion is an enlargement of the joint at the base and the side of the big toe and consists of a bony growth. Most commonly seen in women, it is thought that wearing narrow pointed-toed shoes is the main cause. However, bunions are also known to be hereditary and are even found in societies where no footwear is ever worn, leading to the conclusion of inherited foot problems.

Surgical removal of a bunion is usually done while the patient is under general anesthesia and rarely requires a hospital stay. A podiatrist will make an incision along the bones of the big toe into the foot. The deformed joint and bones are repaired, and the bones are stabilized with a pin and/or cast.

Different procedures include:

• Keller Procedure – Distal soft tissue release
• McBride Procedure – Removal of the base of the proximal phalanx
• Mayo Procedure – Removal of the metatarsal head
• Removal of Joint with Implant - Removal of the total joint with implant placement
• Joplin Procedure – Transplantation of tendons
• Osteotomy – Surgical cutting of the joint
• Lapidus Procedure – Distal soft tissue rearrangement

Carotid surgery is a surgical procedure to remove the lining and fatty obstruction of a carotid artery that has been narrowed by atherosclerosis. Atherosclerosis is the narrowing of arteries usually due to the buildup of fatty tissue. The largest and most common clinical problems associated with atherosclerosis of a carotid artery are stroke or transient ischemic attack (TIA).

A carotid surgery restores normal blood flow to the brain, reducing stroke or TIA risk. Before surgery, the site of narrowing is located by means of an x-ray procedure called angiography.

Carotid surgery is a delicate procedure that may take several hours to perform. The procedure is performed in a hospital setting with general anesthesia. The artery is exposed, clamps are applied, an incision is made, and the diseased lining is removed along with the atherosclerotic material and any thrombus (blood clot) that has formed. The incision is closed with stitches. Most patients are able to leave the hospital within a day or two.

Carpal tunnel release is a surgery performed by an orthopedic and/or hand surgeon to relieve hand and wrist pain caused by the compression of the medial nerve at the wrist. The medial nerve and the tendons are located in one wall of the carpal tunnel. The other wall holds the bones of the wrist. Most conditions are caused by wrist fracture, rheumatoid arthritis, or overuse of the wrist.

The surgery is usually performed on an outpatient basis using either local or general anesthesia. The surgery can be performed two different ways:

• Using Endoscopy – The surgeon makes a small cut at the patient's wrist, reaches the carpal ligament using an endoscope, and makes repairs.

• Open Method – The surgeon makes a cut in the palm of the patient's hand and reaches the ligament by cutting through the underlying tissue and muscle.

The recovery time after the surgery depends on how damaged the nerve was before the surgery.

 

A cataract is the clouding of the eye's natural lens that lies between the iris and the pupil. Cataract surgery is performed to remove the clouded lens and replace the lens with a permanent implant. This implant is known as an intraocular lens implant (IOL). This surgery usually results in a return to normal vision. It is the most common surgery performed in the United States.

The surgery is usually performed on an outpatient basis by an ophthalmologist. The patient is given eye drops and sometimes medication to help the patient relax. A local anesthetic is applied to help make the operation painless.

The surgeon will make a small incision in the eye using an operating microscope. The lens is then removed or the surgeon will use a laser, ultrasound or other surgical solution to break up the lens for removal. The surgeon will then insert the lens implant (IOL) and close the incision. A patch is placed over the eye and after a short stay in the recovery area the patient is ready to go home.

A cesarean section, also called a C-section, is the delivery of the fetus through a surgical abdominal incision. A C-section is performed when a vaginal delivery is not safe for the mother or child. The most common reasons for a physician to perform a C-section are:

• Developmental abnormalities of the fetus
• Abnormal fetal heart rate
• Abnormal position of the fetus
• Extreme maternal illness
• Active genital herpes infection
• Maternal HIV infection
• Previous uterine surgery, including previous C-section
• Prolonged or arrested labor
• Placenta attached in abnormal location

Both regional and general anesthesia may be used. Regional anesthesia is most frequently used for labor and delivery. Regional anesthesia is when narcotics may be given by continuous infusion into the epidural space in the spine. General anesthesia is not recommended for routine deliveries, but is often the method used for an emergency cesarean section. Most mothers and infants recover well.

A cesarean section, also called a C-section, is the delivery of the fetus through a surgical abdominal incision. A Cesarean Section by Patient Choice is defined as a first-time, pre-planned C-section for which there is no medical necessity. Some reasons why a woman would choose a C-section as an alternative to vaginal birth are the fear of labor pain, fear of incontinence that is due to wear and tear on the pelvic muscles, fear of tearing that may happen during a vaginal delivery, or even apprehension about a friend or relative who's had a difficult vaginal birth.

This major surgery carries significant risks that need to be considered. For the mother, these risks are:

• Hemorrhage
• Pain
• Infection
• Placental implantation problems in future pregnancies

There are also risks to a child born by a C-section:

• Respiratory problems
• Accidental surgical cuts
• Breastfeeding difficulties
• Asthma

Both regional and general anesthesia may be used. Regional anesthesia is most frequently used for labor and delivery, and is administered by continuous infusion into the epidural space in the spine. General anesthesia is not recommended for routine deliveries, but is often the method used for an emergency cesarean section. The average hospital stay after a cesarean section is 2-4 days.

During colon resection surgery (bowel resection) the diseased part of the large intestine is removed and the two healthy ends are sewn back together (resected). This surgery is used to treat many conditions, such as bowel obstruction, diverticulitis, Crohn's Disease and colon cancer.

If the entire colon and rectum is removed, the procedure is called a proctocolectomy.

A bowel resection may be performed as a traditional open procedure or as a minimally invasive laparoscopic procedure. The surgery is performed in a hospital setting under general anesthesia and can involve a hospital stay of up to seven days.

•  Open Procedure – The surgeon makes one large incision in the abdomen.

•  Laparoscopic Surgery – The surgeon makes three or four small incisions in the abdomen and inserts tube-like instruments. The abdomen is filled with gas to help the surgeon view the abdominal cavity. A camera is inserted through one of the tubes allowing the surgeon to work inside your abdomen.

Some other procedures that can be performed with the colon resection are:

•  Colectomy – If it is necessary to allow the colon to heal before returning it to its normal digestive process, a temporary opening of the colon (large intestine) through the abdominal wall may be created. In this procedure, the end of the healthy bowel tissue is passed through the abdominal wall, and the edges are stitched to the skin of the abdominal wall. An adhesive drainage bag is placed around the opening. Depending on the situation, the colostomy is usually temporary and can be closed with another operation at a later date.

•  Ileostomy – The ileum is located at the lowest portion of the small intestine. Similar to the colectomy, the healthy end of the ileum is brought through the abdominal wall, and the edges are stitched to the skin of the abdominal wall and an adhesive drainage bag is placed around the opening. When a large portion of the bowel is removed and the colon is no longer functional, the colostomy is usually permanent.

•  Coloproctostomy – An artificial opening that is created between the colon and the rectum.

Cornea transplant surgery is performed when the damaged or diseased disc-shaped area of the cornea is replaced with a healthy similar-sized area of donor cornea. Some conditions that can cause the deterioration of the eye are keratoconus, bullous keratopathy, Fuch's dystrophy, and herpetic eye disease. Sometimes transplantation is necessary due to trauma or perforation to the cornea. Cornea transplants are one of the most frequently performed transplantation with over a 90-percent success rate.

The surgery is performed by an ophthalmologist in an outpatient setting using a local anesthetic. The surgery can be performed in tandem with cataract removal or intraocular lens (IOL) implantation.

After the patient is anesthetized, the surgeon sews a ring to the ocular surface to support the eye. The surgeon removes the cornea and the donor cornea is sewn into place with ultra-fine sutures. Post-operatively, the patient can expect gradual improvement of vision within six to twelve months. The surgeon will remove some of the sutures within a few weeks or months as the cornea heals.

Coronary angioplasty is a medical procedure in which a balloon catheter is used to open narrowed or blocked blood vessels of the heart (coronary arteries). Fat and cholesterol can accumulate inside arteries, forming deposits that narrowed the arteries enough that blood to the heart is hindered. This procedure can increase the blood flow to the heart, thus decreasing chest pain and enabling the patient to return to exercise.

The procedure is performed by a cardiologist and a team of specialized trained individuals at a hospital catheterization laboratory. The patient remains awake for the procedure (no anesthesia) but pain medicine may be given as needed.

Coronary angioplasty is performed by inserting a hollow needle into the femoral artery (an artery located in the groin near the thigh) . With the help of x-ray images, a guide wire is pushed through the needle into the artery, where it is advanced to a point just past the narrowing of the artery to be treated. Once the guide wire is in place, a balloon-tipped catheter is threaded over the guide wire and pushed along the artery until it reaches the area to be treated. The balloon at the tip of the catheter is then inflated and deflated several times to widen the narrowed part of the artery. When the procedure is complete, the balloon is deflated and the catheter is withdrawn.

The patient is monitored for 12-14 hours after the procedure with frequent vital sign checks. Most patients are released from the hospital within a day or two of the procedure.

Alternative Names: Balloon angioplasty; Coronary angioplasty; Coronary artery angioplasty; Cardiac angioplasty; PTCA; Percutaneous transluminal coronary angioplasty; Heart artery dilatation

Defibrillator implant surgery is performed to implant a device to help control a patient's heart rhythm. There are two types of devices, pacemakers and implantable cardioverter defibrillator (ICD). Both help treat arrhythmias–irregularities in your heart's natural heart rhythm. Almost everyone's heart skips a beat and most are considered harmless. Some patients, however, will need medication and/or a defibrillator implant.

• Pacemaker – This is a small battery-operated device (about the size of a matchbox). It usually has two parts: a pulse generator (which includes the battery and several electronic circuits), and leads, which are attached to the heart wall. You may have one or two leads, depending on the pacemaker.

• Implantable Cardioverter Defibrillator (ICD) – This implant is about the size of a pager (larger than a pacemaker). It too has two parts: the pulse generator (which includes the battery and several electronic circuits), and a lead wire, or wires, depending on the device implanted. The lead wire(s) are placed inside the heart or on its surface and attached to the ICD. ICD are typically used to control fast irregular heart rates.

Pacemaker surgery is performed under local anesthesia. It is implanted just near the collarbone. If the pacemaker has only one lead, the lead is placed inside the lower right chamber. If two leads are needed, the second lead is placed in the upper right chamber. The procedure takes about one to two hours.

ICD surgery is performed in a hospital under general anesthesia. The device is implanted beneath the skin near the collarbone. It can also be implanted at another location at or above the waistline. The surgeon will then test the device and this can take up to two hours. An overnight stay is recommended.

Dilatation and Curettage (D&C) is a procedure to scrape and collect tissue from inside the uterus. This procedure is used to help diagnose medical conditions using the tissue collected, to treat irregular or heavy menstrual bleeding, or to remove fetal or placental tissue following a miscarriage.

This procedure can be performed in a hospital or in a clinic setting using either local or general anesthesia.

The vaginal canal is held open by a speculum and the opening to the cervix is anesthetized. The cervix is then opened (dilated) using various rod sizes until the cervix is opened to the desired size. After the cervix is dilated, instruments can be inserted into the uterus and manipulated, depending on the nature of the procedure.

Ear tube placement, or tympanostomy, is a procedure to drain fluid that has built up behind a child's eardrums to restore the normal function of the ear. This surgery is performed by an otolaryngologist. The tubes ventilate the ears, which help prevent fluid from building up in the ear which can cause reoccurring ear infections, and help reduce hearing loss due to fluid trapped behind the eardrum.

The tubes are placed through the ear canal in an operating room under general anesthesia. A tiny hole is made in the eardrum, and fluid is suctioned. A tiny tube is then inserted into the hole, allowing air to enter the middle ear. The procedure is a short one, and the patient is allowed to go home after a brief recovery period.

The tubes usually will fall out of the ear within one to two years as the eardrum grows.

Gastrectomy is the surgical removal of all or part of the stomach and reconnection with the small intestine. This surgery used to treat stomach cancer, noncancerous polyps, gastric ulcers, or a hole in the stomach wall. The surgery is performed under general anesthesia and usually involves a hospital stay of seven to ten days. If combined with other procedures, the stay can be lengthy.

Procedures used can include:

• Esophagectomy – An esophagectomy is the partial or complete removal of the esophagus (the tube from the mouth to the stomach) and the top part of the stomach. An esophagectomy is performed using one of two methods. Transhiatal Esophagectomy is performed with surgical incisions at the upper abdomen and the neck area. The second method, Transthoracic Esophagectomy is also known as the Ivor Lewis procedure and is performed with an upper abdominal incision and an incision into the chest area.
• Esophagoenterostomy – In this procedure, a connection is made between the esophagus and the small intestine following a gastrectomy.
• Roux-en-Y Reconstruction – In this procedure a small pouch is formed and connected to the intestine.
• Gastroduodenostomy – In this procedure, a connection is made between the stomach and duodenum (the first portion of the small intestine).
• Gastrojejunostomy – In this procedure, a connection is made between the stomach and the jejunum (the portion of the small intestine that extends from the duodenum to the ileum).
• Vagotomy – In this procedure the vagus nerve is cut to reduce acid secretion in the stomach. The vagus nerve has branches that go to different parts of the stomach.
• Pancreatectomy – This procedure involves the total or partial surgical removal of the pancreas.
• Whipple Procedure – Also known as a pancreaticoduodenectomy , this procedure is the removal of the duodenum with all or part of the pancreas.

Gastroesophageal reflux surgery is used to correct gastroesophageal reflux disease (GERD). GERD is a condition in which partially digested food or liquid travels from the stomach back up into the esophagus (the tube from the mouth to the stomach). At the lower end of the esophagus, there is a small ring of muscle called the lower esophageal sphincter (LES). The LES is a one-way valve that normally closes after swallowing to prevent back-up of the stomach juices. If the LES is not functioning properly, stomach acid or partially digested material will flow back in to the esophagus often inflaming the esophagus and causing heartburn and other symptoms.

Some procedures used are:

• Upper Gastrointestinal Endoscopy – For this procedure, the physician inserts an endoscope through the mouth where it travels down to the stomach, allowing the physician to view the esophagus, stomach and duodenum (upper gastrointestinal tract). Tissue samples can be obtained, polyps can be removed and bleeding can be treated. Thermal therapy can also be administered where electrodes are placed at multiple sites and the heat is used to create lesions that help strengthen the lower esophagus sphincter (LES). This procedure is done on an outpatient basis with local anesthesia for the throat and medication to relax the patient.
• Esophagogastric Fundoplasty – This surgery reinforces the valve between the esophagus and stomach by wrapping the upper portion of the stomach around the lowest portion of the esophagus, much like the way a bun wraps around a hot dog. This allows for increased pressure within the lower esophageal sphincter (LES), allowing the LES to strengthen and lengthen. This procedure can be performed both laparoscopic (using small incisions to enter the abdomen) or open (through a large incision to the patient's abdomen). This procedure is done on an inpatient basis under general anesthesia.

Heart bypass surgery or coronary artery bypass grafting (CABG) is a surgical procedure in which a section of a coronary artery, which has been partially or completely blocked, is bypassed by transplanting a healthy section of blood vessel around the diseased area. The conduit to route blood around the obstructed area may be an artery or a vein. There is some information that arteries may have a better long-term patency rate (chance of staying open for years) than veins. The arteries and veins used for the bypass procedure are taken from the patient's own body; they may be harvested from within the chest, the arms or the legs.

This procedure is performed in a hospital under general anesthesia.

Coronary artery bypass is performed by a cardiothoracic surgeon who makes an incision in the patient's chest to expose the patient's heart. Incisions may also be made in the legs or the arms to obtain a vein or artery for the bypass. The patient is connected to a heart-lung machine that takes over the function of the heart and lungs while the surgeon works on the heart. An opening is made in the diseased artery or arteries above and below the blockage. A section of artery or vein is then sewn to the points above and below the blockage in the affected artery, effectively providing a detour around the obstruction. At the conclusion of the bypass procedure the heart-lung machine is disconnected, allowing blood to flow back through the heart, and the incision is closed.

Most bypass operations are performed by dividing the breastbone to provide access to the heart. Some bypass operations are now performed through "limited" incisions made either between the ribs or partially through the breastbone, with or without the use of the heart-lung machine.

Most patients experience some discomfort at the incision site for a few days but most preoperative angina will resolve.

Alternative Names
Bypass surgery - heart; CABG; Coronary artery bypass graft

Heart transplantation is surgery to remove a damaged or diseased heart and replace it with a healthy donor heart. Finding a donor heart can be difficult and often requires time on a waitlist. The heart is donated by a person who has been declared brain-dead but who remains on life support. The donor heart must match as closely as possible to your tissue type to reduce the chance that your body will reject the new heart.

For the surgery, a patient is put under general anesthesia and the patient’s blood is circulated through a heart-lung bypass machine to keep the blood oxygen-rich and circulating through the body. An incision is made through the breast bone. The diseased heart is removed and the donor heart is attached in its place. The heart-lung machine is disconnected so that blood can flow through the transplanted heart. The incision is closed.

Heart transplantation usually requires 7 to 21 days in the hospital, with the first 24 to 48 hours in an intensive care unit. The recovery period is about six months and often requires regular check-ups with blood tests and x-rays. All transplant recipients need lifelong treatment with immunosuppressant medications to prevent rejection of the transplanted heart.

Heart valve repair surgery is performed to repair malfunctioning heart valves. Examples of these can be valves that are blocked, narrowed or leaking. There are four valves in your heart. The mitral and aortic valves are the most commonly repaired, followed by the tricuspid valve.

Some procedures performed are:

• Valvuloplasty – This is plastic surgery repair of the valves and can be performed with cardiopulmonary bypass, occlusion (where the blood flow is temporarily interrupted by clamps) and dilation (stretching of the ventricle while on bypass).

• Valvotomy – This is a surgical incision into the stenosed cardiac valve to relieve obstruction. This can be performed with the patient being on occlusion (blood flow temporarily interrupted by clamps) and on a bypass. It can involve the placement of a prosthetic device that can replace the diseased area.
• Valvectomy – This is a surgical procedure in which a catheter is inserted to open a blocked or restricted valve and is performed while the patient is on bypass.

• Commissurotomy – This is a procedure where a surgical incision is made at the place where two cardiac valves form a connection.

All procedures are performed in a hospital setting by a cardiac surgeon under general anesthesia.

Alternative Names: Valve replacement; Valve repair; Heart valve prosthesis.

A heart valve surgery involves replacement or repair of disease heart valves. Surgery may be recommended for:

• Narrowing of the heart valve (stenosis)
• Leaking of the heart valve (regurgitation)
• Prolape (when the mitral valve flaps do not close properly).

Heart valve surgery is performed under general anesthesia by a cardiac surgeon. During the surgery your blood is routed to a heart-lung bypass machine that keeps the blood circulating during heart surgery. Replacement heart valves can be either natural (human or animal donors), or artificial (metal). After surgery the patient is usually placed in an intensive care unit for 2-3 days. The average hospital stay is 1-2 weeks and recovery time can take several weeks to several months.

Hemorrhoid surgery (also called hemorrhoidectomy) is the surgical removal of hemorrhoids. Hemorrhoids are swollen or enlarged veins located inside (internal) or outside (external) the anus. They are usually caused by straining when constipated or during pregnancy. The surgery can remove large internal hemorrhoids that do not respond to nonsurgical treatment and large external hemorrhoids.

The surgery is performed in a surgery center under general or spinal anesthesia. The surgeon will make an incision in the tissue surrounding the hemorrhoid. The surgeon then ties off the swollen vein in the hemorrhoid to prevent bleeding and removes the hemorrhoid. The surgeon can remove the hemorrhoid with a knife (scalpel), a laser, or a cautery pencil. The area of the surgery is then either sewn closed or can be left open with gauze covering the wound.

Most patients can be released after the anesthetic wears off and the patient is able to urinate, although an overnight stay is not uncommon.

Hernia repair (or Herniorrhaphy) involves surgery to correct an abnormal protrusion of an organ through the wall of the area that normally holds the organ. This can happen when the outer layers of the abdominal wall weaken, bulge or rip. There are four types of hernias:

• Inguinal Hernia – The most common type of hernia; it occurs in the groin area.
• Umbilical Hernia – This is a hernia that develops through the navel.
• Incisional Hernia – This is a hernia that protrudes through a past surgical or operation site.
• Hiatal Hernia – This is a hernia that forms when the upper portion of the stomach slides into the chest cavity through the normal opening created by the esophagus.

If the protrusion can be pushed back into place, the hernia is referred to as reducible. If it cannot be, the hernia is referred to as irreducible, incarcerated or imprisoned. A strangulated hernia occurs when the blood supply to the tissue is cut off, causing worsening pain.

Most hernia repairs can be done on an outpatient basis. There are two methods used:

• Conventional Method – An incision is made over the site of the hernia. The surgeon returns the tissue to the abdominal cavity and removes the sac that has formed. The surgeon then sews strong surrounding muscle over the area.
• Laparoscopic Method – The surgeon inserts a scope through a small incision in the abdomen that the surgeon will use to view the contents of the abdomen with the use of a camera. The surgeon then makes repairs using instruments inserted into another small incision in the abdomen.

Both surgeries are performed using general anesthesia.

Urinary incontinence is the accidental leakage of urine. The condition can range from occasional leakage to an inability to hold any urine. The two main types of urinary incontinence are:

• Stress Incontinence – Occurs with an activity that can put stress on the bladder, such as coughing, sneezing, exercise, or laughing.
• Urge Incontinence – Involves a strong sudden urge to urinate followed immediately by bladder contraction and involuntary loss of bladder control.

Urinary incontinence is most common among the elderly. Additionally, women are more likely to experience urinary incontinence due to the stress placed on the urinary tract by childbirth. Men can experience urinary incontinence due to prostate problems. Nerve problems and diseases such as diabetes and stroke can affect urinary incontinence in both sexes.

There are several surgical options for both men and women.

• Sling – For the male, the surgeon creates support for the urethra by wrapping a strip of material around the urethra and attaching the ends of the material to the pelvic bone. For female patients, the surgeon fashions a piece of material or muscle into a sling that lifts the urethra back into a normal position.
• Artificial Sphincter – This implanted device for men has three parts: a cuff that fits around the urethra, a small balloon reservoir placed in the abdomen, and a pump placed in the scrotum. The patient squeezes the pump when he wants to urinate, which deflates the cuff and allows the urine to flow. When the bladder is empty, the cuff automatically refills to keep the urethra tightly closed.
• Retropubic Suspension – This surgery for women lifts the sagging bladder neck and urethra by attaching their supporting tissues to the pubic bone.

All surgeries are performed using general anesthesia in a hospital setting. Stays in the hospital can average one to two days but could be more depending on the type of surgery and whether or not an abdominal incision is involved.

Kidney transplantation is surgery to treat kidney failure or end-stage renal disease. The kidney is an organ responsible for cleansing the blood. Damage to the kidneys can occur because of other diseases, such as diabetes, lupus, sickle cell anemia, gout, or rheumatoid arthritis.

A kidney transplant involves placing a healthy donor kidney into the body where it can perform all the functions that a failing kidney cannot. Kidney transplants are one of the most common transplant operations in the United States. People with chronic kidney disease can receive lifesaving dialysis until a donated kidney becomes available. A donated kidney may come from a living related donor, a living unrelated donor, or a deceased donor.

The donor kidney must match as closely as possible to your tissue type to reduce the chance that your body will reject the new kidney. A healthy donated kidney can be transported in cool salt water to preserve the organ for up to 48 hours. This allows time for tests to match the donor’s and recipient’s blood type before the operation.

For the surgery, a patient is put under general anesthesia. An incision is made in the lower abdomen area. The donor kidney is placed in the lower abdomen where it is surgically connected to nearby blood vessels and the bladder.

The donor kidney should begin to function immediately and patients typically remain in the hospital for about a week. The recovery period is usually three to six weeks and requires regular check-ups with blood tests during the first year. All transplant recipients need lifelong treatment with immunosuppressant medications to prevent rejection of the transplanted kidney.