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.

• 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.

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.

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.

• 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.

Hip replacement surgery is performed by an orthopedic surgeon to replace all or part of the hip joint with an artificial device known as a prosthesis. The prosthesis consists of three parts that include a cup that replaces the hip socket, a metal or ceramic ball that replaces the head of the femur, and a metal stem that is attached to the shaft of the bone to add stability.

Reasons for the surgery include severe pain and/or osteoarthritis, hip fractures or hip joint tumors.

Under general anesthesia, the surgeon will make an incision over the buttocks to expose the hip joint. The head of the femur is cut out and removed. The rest of the hip socket is cleaned out and removed of all bone and cartilage. The surgeon then places the new socket and ball in the area. The surgery usually takes two to three hours.

Most patients are discharged within ten days of having the surgery. Full recovery can take three to six months, depending on the type of surgery, the patient's overall health, and the type of rehabilitation.

As younger patients are having hip replacements, revision surgery is becoming more common as the wearing away of the joint surface becomes a problem after 15 to 20 years. The revision surgery can also be performed for fractures, partal dislocation, and infection.

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.

• 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

ACL meniscal repairs are typically performed using arthroscopic surgery where the physician uses a camera or arthroscope inserted in small incisions in the joint. The physician is able to insert instruments through the incisions to make repairs.

An orthopedic surgeon usually performs this type of surgery. Almost all surgeries are performed on an outpatient basis. The surgery can be performed under local, regional (specific area), or general anesthesia.

The surgery is performed on the medial (the middle part) or lateral (the side part) area of the knee. The surgery can be performed on both areas at the same time. Some procedures included in this surgery are:

• Meniscetomy – The removal of lateral or medial (or both) meniscus cartilage in the knee.
• Shaving – The partial removal or shaving of torn areas of the meniscus which also prepares the area for placement of a new ligament.

Knee replacement surgery is the placement of an artificial knee joint. The most common cause of knee pain is arthritis. It can be osteoarthritis, which normally occurs after the age of 50, rheumatoid arthritis (where too much synovial fluid is produced, overflowing the joint space), or post-traumatic arthritis following a knee injury.

Each artificial joint contains the following:

• Tibial Component – This replaces the end of the tibia (shinbone).
• Femoral Component – This replaces the end of the femur (thighbone).
• Patellar Component –This replaces the surface on the bottom of the patella (kneecap).

The knee can be attached by either cemented prosthesis, which is where the cement proxy attaches to the bone, or uncemented prosthesis, which is where there is a mesh on the surface that allows bone to grow into prosthesis.

The surgery is performed by an orthopedic surgeon using general or local anesthesia in a hospital setting. The surgeon begins by making an incision on the front of the knee to allow access to the joint. A tool is placed on the femur to keep proper alignment while the diseased bone is cut away from the end of the femur. The surgeon then prepares the top of the tibia bone by using another cutting tool. The undersurface of the kneecap is removed and the surgeon places the femoral component, the tibia component, and then the patellar component.

This procedure requires a hospital stay of several days.

Laparoscopic gallbladder removal (also known as laparoscopic cholecystectomy) is a procedure in which the gallbladder is removed using instruments inserted through small incisions in the abdomen. The procedure is performed in an operating room with the patient under general anesthesia. Most patients are released from the hospital the following day; some may even go home the same day.

Using a narrow tube-like instrument called a cannula, the surgeon enters the abdomen through small incisions made near the area of the navel. Inserted through the cannula is a tiny camera, which allows the surgeon to view the internal organs. The gallbladder is removed through the cannula, as well. If the surgeon finds one or more stones, he or she may remove them with a special scope, may choose to have them removed later through a second invasive procedure, or convert to an open procedure for the surgery.

A liver biopsy is a medical procedure to remove a small amount of tissue from the liver for examination. The biopsy helps diagnose a number of liver diseases or assess the stage (early, advanced) of liver disease. This is especially important in hepatitis C infection. The biopsy also helps detect infections, cancer, unexplained enlarged liver, or abnormal liver enzymes detected by blood tests.

The biopsy is performed in a hospital setting under local anesthesia. The physician will use a needle to remove a small piece of liver tissue, which is sent to the laboratory for evaluation. The patient usually will remain lying down for one or two additional hours, to ensure that there have been no complications. The patient is then released and sent home.

The surgeon can also explore the bile ducts during the liver biopsy for congenital abnormalities such as atresia, in which the bile may back up into the liver.

Lumpectomy is the surgical procedure in which a cancerous lump or tumor in the breast is removed. The procedure is recommended only for those patients with less than 25 percent of the breast involved.

Lumpectomies can include excisional biopsy procedures. Biopsies are obtained either by needle or tissue sampling using either a scalpel or vacuum-assisted devices while under the guidance of ultrasound, MRI or other stereotactic diagnostic imaging.

To perform the lumpectomy, the surgeon will make a small incision over or near the breast tumor and cut free the lump and at least one-half inch of healthy tissue surrounding the tumor. The surgeon will submit the tissue to the pathologist for evaluation, often while the patient is still on the operating table, and if the extra tissue does not contain any cancerous cells, the excision will be sufficient. If cells are present, the surgeon may perform another sampling or perform a partial mastectomy.

A lung biopsy is a medical procedure in which a small amount of lung tissue is removed and examined by a pathologist for any abnormalities. The procedure is used to diagnose certain lung conditions, such as pulmonary fibrosis (scarring of the lungs with fibrotic tissue), sarcoidosis (clumps of cells formed in various organs), and cancer.

There are four types of lung biopsies:

• Bronchoscope Biopsy – For this method, a lighted instrument called a bronchoscope is inserted through the mouth or nose and into the airway to remove a lung tissue sample. This method is used if an infectious disease is suspected, if the abnormal tissue is located next to the breathing tubes (bronchi), or before trying more invasive methods.

  This is an outpatient procedure done by a pulmonologist with a local anesthetic sprayed into the mouth.

• Needle Biopsy – For this method, a long needle is inserted through the chest wall to remove a sample of lung tissue. A CT scan, ultrasound or a fluoroscope is used to guide the needle to the desired area. This is the best method if the abnormality is located close to the chest wall.

  This outpatient procedure is done by a pulmonologist or a radiologist with a local anesthetic applied to the area where the needle will be inserted.

• Open Biopsy – For this method, a surgical incision is made between the ribs and a sample of lung tissue is taken. This surgical procedure is done when all other methods have not been successful or when a larger piece of tissue is needed.

  This surgical procedure is performed by a thoracic surgeon or a general surgeon under general anesthesia while the patient is in the hospital.

• Video-Assisted Thorascopic Surgery – For this method, a thorascope is passed through a small incision in the chest to remove a sample of lung tissue.

  This surgical procedure is performed by a thoracic surgeon or a general surgeon under general anesthesia while the patient is in the hospital.

• Simple or Total Mastectomy – Removal of the breast, its skin, the nipple, but no lymph nodes.
• Subcutaneous Mastectomy – Removal of entire breast but leaves nipple and areola (dark pigmented area around the nipple) in place.
• Radical Mastectomy – Removal of the entire breast, nipple/areolar region, the major and minor chest muscles, and the lymph nodes.
• Modified Radical Mastectomy – Removal of the entire breast, nipple/areolar region, and the axillary lymph nodes.

Mastectomies are performed by a surgeon while the patient is under general anesthesia. The surgeon makes an incision near the site of the tumor and removes the breast tissue, and makes another incision to remove the lymph nodes, if scheduled. Drains are inserted either in the breast or under the arm to collect any fluid during the healing process. The surgery time averages two to three hours, but can increase due to reconstruction of the breast. Most patients can leave the hospital in two to three days.

• Use forceps or a vacuum extractor. Forceps have rounded edges that fit around the fetus' head. A vacuum extractor consists of a small cup made of a rubberlike material that is connected to a vacuum. It is inserted into the vagina and uses suction to attach to the fetus's head.
• Perform an episiotomy. An episiotomy is an incision between the vaginal opening and the anus.

After delivery, the placenta will usually detach from the uterus and the woman can push out the placenta on her own. If the placenta is not delivered within 30 minutes the physician may insert a hand into the uterus, detach the placenta from the uterus and remove it.

Both regional and general anesthesia may be used. Regional anesthesia is the most frequently used for labor and delivery, and the narcotics are administered by continuous infusion into the epidural space. A physician may also use a Pudendal block, which involves injecting a local anesthetic through the vaginal wall. General anesthesia is not recommended for routine deliveries, but is often the method used for an emergency cesarean section.

The normal hospital stay for a vaginal delivery is 24-48 hours.

Open bladder surgery is performed to repair the bladder, to place incisions or insertions for drainage, to remove cysts, diverticulum, or tumors, or to remove the bladder completely.

Open bladder surgeries cover many different procedures.

• Ureteroncystostomy – This procedure involves the surgical fusion of a single or duplicated ureter to the bladder. This procedure may also include a bladder flap or extensive tailoring to help prevent reflex.
• Cystotomy – This is a surgical incision into the bladder which can be used to insert radioactive material, a stent or ureteral catheter, or a drain, remove a bladder stone, or to perform cryosurgery (freezing tissue in order to destroy it).
• Excision and Cystotomy – These procedures involve removing bladder cysts, lesions, diverticulum and tumors.
• Partial Cystectomy – This procedure involves the partially removing the bladder and can include reimplanting the ureters into the bladder.
• Complete Cystectomy – This procedure involves completely removing the bladder and can include fusion to the small and/or large intestines to create a "neobladder."
• Cystoplasty or Cystouterthroplasty – This procedure involves plastic or reconstructive surgery on the urinary bladder or ureter(s).
• Cystorrhaphy – This procedure is the suturing of the bladder to repair a wound.
• Closure – These procedures are repairs done on the bladder, vagina, or vaginal fistulas.

Most procedures are done in a hospital setting under general anesthesia.

Ovary removal surgery (also known as oophorectomy or ovariectomy), is the surgical removal of one or both ovaries. The surgery is performed to remove ovaries affected by cancer, to remove the source of estrogen that may stimulate some cancers, to remove large ovarian cysts, or to treat endometriosis.

The surgery is performed under general anesthesia and can be either open or laparoscopic surgery.

• Open Surgery – The surgeon makes a horizontal or vertical abdominal incision and the abdominal muscles are pulled apart, allowing the surgeon a better view of the abdominal cavity and the ovaries. The surgeon then removes the ovaries and often, the fallopian tubes. If cancer is not present, the patient may be started on hormone therapy ease the symptoms of menopause. The patient is usually discharged from the hospital in two to five days.
• Laparoscopic Surgery – A tube containing a tiny lens is inserted through a small incision made in the navel. Other instruments are inserted through another small incision made in the pubic area. The ovary is disected into smaller pieces and removed through the small incision at the top of the vagina. If cancer is not present, the patient may be started on hormone therapy to ease the symptoms of menopause. The recovery time is normally shorter than that for the open procedure.

If a patient has a heartbeat that is too fast, too slow, or frequently irregular, blood is not pumped efficiently around the body and the body's cells do not get enough oxygen and nourishment. In this situation, a physician may recommend that an artificial pacemaker be implanted in the body to ensure that the heart beats more regularly.

A pacemaker is a small, battery-operated device implanted just under the skin near the collarbone to help the heart beat regularly at an appropriate rate. Pacemakers are about the size of a matchbox and are used to treat heart arrhythmias — irregularities in your heart's natural heart rhythm. Almost everyone's heart skips a beat sometimes, and that is generally considered harmless. Some people, however, will need medication and/or a pacemaker.

A pacemaker usually has two parts: a pulse generator (which includes the battery and several electronic circuits); and a lead(s), (which is attached to the heart wall).

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. An overnight stay is usually recommended.

Prostate removal surgery (also known as Prostatectomy) is the removal of all or part of the prostate. The prostate gland is an organ at the base of the bladder in men, surrounding the urethra. When the gland becomes enlarged, the prostate can compress the urethra, causing problems with urination.

The removal of the prostate gland can be done in different ways, depending on the size of the prostate and the cause of the enlargement. The most common prostate removal surgical procedures are:

• Transurethral Resection of the Prostate (TURP)- is the most common treatment for benign hyperplasia (prostate gland overgrowth). The procedure is performed using either a general or a spinal anesthesia. A tubelike instrument called a cystoscope is inserted into the penis through the urethra. A cutting instrument is then inserted through the cystoscope to remove the prostate gland piece by piece. Any blood vessels are cauterized during the surgery to stop the bleeding. A catheter will be placed following surgery to help the bladder drain and is usually removed within one to three days. The hospitalization time is approximately one to five days.

• Open Prostatectomy – Using general or spinal anesthesia, an incision is made in the lower abdomen between the navel and the penis. The gland is then removed through this incision. Catheters inserted following surgery will remain in place from five days to a few weeks until the bladder has healed. The hospitalization time is longer than five days. This surgical procedure is also known as suprapubic or retropublic prostactomy.

• Transurethral Incision of the Prostate (TUIP) – is a procedure that is recommended for men with only slightly enlarged prostates. In this procedure, under general or spinal anesthesia, the surgeon will use an instrument inserted into the penis through the urethra that generates an electric current or laser beam to make incisions in the prostate where the prostate meets the bladder. This relaxes the opening to the bladder, allowing for greater flow out of the bladder. A catheter is inserted in the bladder following surgery and is left in for one to three days. This procedure can be done in a hospital setting with a short stay of one to three days, or in an outpatient setting.

• Reduce or increase the size of the nose
• Change the shape
• Narrow the opening of the nostrils
• Correct a birth defect
• Relieve breathing problems
• Correct an injury.

Rhinoplasty may be performed under local or general anesthesia, depending on the extent of the procedure. Surgery is usually performed by a plastic surgeon in an office-based facility, an outpatient surgery center, or hospital. Patients are up and about within two days, and can usually return to work after a week. Complete recovery may take several weeks.

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.

Splenectomy is the surgical removal of a diseased or damaged spleen. A splenectomy can also be performed as a treatment for some blood disorders and some cancers. A complete splenectomy removes the entire spleen, while a partial splenectomy removes only a part of the spleen. A splenectomy can be performed in conjunction with another partial organ removal, such as the pancreas.

The spleen is in the uppermost area of the left side of the abdomen, just under the diaphragm. In healthy people, the spleen plays a role in immunity against bacterial infections and acts as a reservoir for blood.

During a splenectomy the artery to the spleen is tied to prevent blood loss, and surgeon detaches the ligaments and removes the spleen. A splenectomy can be performed as either open or laparoscopic surgery.

• In the open procedure, the surgeon makes an incision in the abdomen, under general anesthesia. This is performed in a hospital setting only and involves a hospital stay.

• The laparoscopic method is also performed in the hospital under general anesthesia but involves a shorter stay. The surgeon makes several small incisions in the abdomen, and using a tiny camera and instruments inserted through one of the openings, performs the removal of the spleen.

• 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.

Hip replacement surgery is performed by an orthopedic surgeon to replace all or part of the hip joint with an artificial device known as a prosthesis. The prosthesis consists of three parts that include a cup that replaces the hip socket, a metal or ceramic ball that replaces the head of the femur, and a metal stem that is attached to the shaft of the bone to add stability.

Reasons for the surgery include severe pain and/or osteoarthritis, hip fractures or hip joint tumors.

Under general anesthesia, the surgeon will make an incision over the buttocks to expose the hip joint. The head of the femur is cut out and removed. The rest of the hip socket is cleaned out and removed of all bone and cartilage. The surgeon then places the new socket and ball in the area. The surgery usually takes two to three hours.

Most patients are discharged within ten days of having the surgery. Full recovery can take three to six months, depending on the type of surgery, the patient's overall health, and the type of rehabilitation.

As younger patients are having hip replacements, revision surgery is becoming more common as the wearing away of the joint surface becomes a problem after 15 to 20 years. The revision surgery can also be performed for fractures, partal dislocation, and infection.

• 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.

A vaginal hysterectomy is a surgical procedure in which the uterus is removed through the vagina. As part of the hysterectomy, the fallopian tubes and cervix may also be removed.

Hysterectomies are performed for uterine fibroids (benign tumors in the womb), abnormal uterine bleeding, endometriosis (the formation of cells outside of the uterus) and uterine prolapse, which involves the loosening of support muscles and tissue in the pelvic area. A hysterectomy can also be performed to treat cancer of the uterus.

In a vaginal hysterectomy, the uterus is removed through the vagina. A laparoscopic-assisted vaginal hysterectomy is performed with the help of a tiny lens that allows the surgeon to inspect the abdomen while performing surgery through small incisions.

Types of vaginal hysterectomies include:

• Partial Hysterectomy – The surgeon removes only the uterus and the fallopian tubes. The cervix is left intact to help support the vagina.
• Radical Hysterectomy – This involves the removal of the uterus and the cervix and tissue surrounding the cervix and some removal of the upper vagina. This procedure is usually performed for early cervical cancer.

All hysterectomies are performed in a hospital setting and involve a stay of a few days.

A vasectomy is a surgical procedure to tie the vas deferens of a man to cause sterility by preventing the sperm from leaving the testes. The vas deferens is located in the testicle as a small tube that carries the sperm to the semen. The procedure is recommended for adult men who are certain that they wish to prevent future pregnancies (permanent sterilization). There will still be a fluid ejaculate, but no sperm will be in the fluid, so the man cannot impregnate his partner.

Vasectomies are performed by an urologist in the office using a local anesthetic. There are two types of vasectomies:

• Conventional or Traditional – The surgeon uses a scalpel to make one or two incisions in the skin of the scrotum to expose the vas deferens in each testicle. The vas deferens is then lifted, cut and tied and returned to the scrotal sac and the incisions are closed with a few sutures.
• No Scalpel Vasectomy – The surgeon will locate the vas deferens in the scrotum manually, and will hold the tube in place with the use of a small clamp. A tiny puncture is made in the skin to form an opening for the vas deferens to be lifted, cut and tied, and put back into place. A suture can be used but most incisions are so small that none are needed.

Soreness is common, along with swelling and discomfort in the first few days. Most can return to normal activities within a week.