Shoulder surgery involves the repair or reconstruction of bones, tendons or muscles that help the shoulder rotate smoothly and properly. Shoulder surgery is usually performed to restore movement, stability, function and comfort following an injury.

Depending on the extent of damage, repairing the shoulder could involve:

• Repairing a torn rotator cuff (the tendons and muscles that help the shoulder rotate properly)
• Repairing a broken collarbone (clavicle) with pins, plates, or wires
• Replacing the shoulder joint with an artificial implant
• Cutting of tendons to lengthen a muscle
• Repair of scapula using synthetic material
• Muscle transfer

An orthopedic surgeon usually performs this type of surgery as either open surgery (larger incision to expose the joint) or arthroscopic surgery (where the physician uses a camera or arthroscope inserted in small incisions in the joint). Shoulder surgery is done under general anesthesia. Recovery time can be from one to six months, depending on the procedure and severity of injury. For many patients of shoulder surgery, physical therapy may help them regain range of motion and strength.

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.

Thyroidectomy is the surgical removal of all or part of the thyroid gland. A thyroidectomy can be used to correct conditions such as hypothyroidism (low thyroid function), hyperthyroidism (overactive thyroid function), thyroid cancer, and nontoxic goiter.

The surgery is performed while the patient is under general anesthesia. An incision is made through the skin in the low collar area of the neck. Incisions can also be made near the sternum (breastbone). The muscles in the area are spread aside to reveal the thyroid gland. All or part of the gland will be cut free from the surrounding tissues and removed. The surgeon will then use stitches to bring the neck muscles back together and the outer incision will be closed. A suction catheter is inserted near the incision to help drain any accumulating fluid. The catheter is removed within 24 hours, and most patients leave the hospital in one or two days after the surgery.

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).

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.

 

Tubal ligation is a surgery where a woman's fallopian tubes are cut and sealed. It is commonly known as “tying one's tubes.” Tubal ligation permanently sterilizes a woman by preventing an egg from traveling from the ovary down to the uterus, so that the male sperm cannot make contact with the egg. If the sperm and the egg cannot make contact, fertilization cannot take place and pregnancy cannot occur.

Tubal ligations can be performed in a hospital or an outpatient setting under general anesthesia. It can be performed at any time when the patient is not pregnant. Often, tubal ligations are performed following childbirth in a hospital setting.

During this procedure, the physician makes one or two small incisions in the abdomen (usually below the navel) and a laparoscope (a tiny camera) is inserted. Using surgical instruments, the fallopian tubes are sealed shut with either cautery (burned), or a small clip placed on the tube. (Cautery heals naturally without stitches and has a minimum of blood loss.) The skin incision(s) is then stitched closed. The patient can return home a few hours after the procedure. Most patients recover fully within a week.

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.