This article is about the medical specialty. For other uses, see Surgery (disambiguation). Surgeons repairing a ruptured Achilles tendon on a man Surgery (from the Greek: χειρουργική cheirourgikē (composed of χείρ, "hand", and ἔργον, "work"), via Latin: chirurgiae, meaning "hand work") is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas.
The act of performing surgery may be called a "surgical procedure", "operation", or simply "surgery". In this context, the verb "operate" means to perform surgery. The adjective "surgical" means pertaining to surgery; e.g. surgical instruments or surgical nurse. The patient or subject on which the surgery is performed can be a person or an animal. A surgeon is a person who practices surgery and a surgeon's assistant is a person who practices surgical assistance.
A surgical team is made up of surgeon, surgeon's assistant, anesthesia provider, circulating nurse and surgical technologist. Surgery usually spans minutes to hours, but it is typically not an ongoing or periodic type of treatment. The term "surgery" can also refer to the place where surgery is performed, or simply the office of a physician, dentist, or veterinarian. Definitions Surgery is a technology consisting of a physical intervention on tissues.
As a general rule, a procedure is considered surgical when it involves cutting of a patient's tissues or closure of a previously sustained wound. Other procedures that do not necessarily fall under this rubric, such as angioplasty or endoscopy, may be considered surgery if they involve "common" surgical procedure or settings, such as use of a sterile environment, anesthesia, antiseptic conditions, typical surgical instruments, and suturing or stapling.
All forms of surgery are considered invasive procedures; so-called "noninvasive surgery" usually refers to an excision that does not penetrate the structure being excised (e.g. laser ablation of the cornea) or to a radiosurgical procedure (e.g. irradiation of a tumor). Types of surgery Surgical procedures are commonly categorized by urgency, type of procedure, body system involved, degree of invasiveness, and special instrumentation.
Based on timing: Elective surgery is done to correct a non-life-threatening condition, and is carried out at the patient's request, subject to the surgeon's and the surgical facility's availability. A semi-elective surgery is one that must be done to avoid permanent disability or death, but can be postponed for a short time. Emergency surgery is surgery which must be done promptly to save life, limb, or functional capacity.
Based on purpose: Exploratory surgery is performed to aid or confirm a diagnosis. Therapeutic surgery treats a previously diagnosed condition. Cosmetic surgery is done to subjectively improve the appearance of an otherwise normal structure. By type of procedure: Amputation involves cutting off a body part, usually a limb or digit; castration is also an example. Resection is the removal of all of an internal organ or body part, or a key part (lung lobe; liver quadrant) of such an organ or body part that has its own name or code designation.
Replantation involves reattaching a severed body part. Reconstructive surgery involves reconstruction of an injured, mutilated, or deformed part of the body. Excision is the cutting out or removal of only part of an organ, tissue, or other body part from the patient. Transplant surgery is the replacement of an organ or body part by insertion of another from different human (or animal) into the patient.
Removing an organ or body part from a live human or animal for use in transplant is also a type of surgery. By body part: When surgery is performed on one organ system or structure, it may be classed by the organ, organ system or tissue involved. Examples include cardiac surgery (performed on the heart), gastrointestinal surgery (performed within the digestive tract and its accessory organs), and orthopedic surgery (performed on bones or muscles).
By degree of invasiveness of surgical procedures: Minimally-invasive surgery involves smaller outer incision(s) to insert miniaturized instruments within a body cavity or structure, as in laparoscopic surgery or angioplasty. By contrast, an open surgical procedure such as a laparotomy requires a large incision to access the area of interest. By equipment used: Laser surgery involves use of a laser for cutting tissue instead of a scalpel or similar surgical instruments.
Microsurgery involves the use of an operating microscope for the surgeon to see small structures. Robotic surgery makes use of a surgical robot, such as the Da Vinci or the Zeus surgical systems, to control the instrumentation under the direction of the surgeon. Terminology See also: List of surgical procedures Excision surgery names often start with a name for the organ to be excised (cut out) and end in -ectomy.
Procedures involving cutting into an organ or tissue end in -otomy. A surgical procedure cutting through the abdominal wall to gain access to the abdominal cavity is a laparotomy. Minimally invasive procedures involving small incisions through which an endoscope is inserted end in -oscopy. For example, such surgery in the abdominal cavity is called laparoscopy. Procedures for formation of a permanent or semi-permanent opening called a stoma in the body end in -ostomy.
Reconstruction, plastic or cosmetic surgery of a body part starts with a name for the body part to be reconstructed and ends in -oplasty. Rhino is used as a prefix for "nose", therefore a rhinoplasty is reconstructive or cosmetic surgery for the nose. Repair of damaged or congenital abnormal structure ends in -rraphy. Reoperation (return to the operating room) refers to a return to the operating theater after an initial surgery is performed to re-address an aspect of patient care best treated surgically.
Reasons for reoperation include persistent bleeding after surgery, development of or persistence of infection. Description of surgical procedure Location At a hospital, modern surgery is often performed in an operating theater using surgical instruments, an operating table for the patient, and other equipment. Among United States hospitalizations for nonmaternal and nonneonatal conditions in 2012, more than one-fourth of stays and half of hospital costs involved stays that included operating room (OR) procedures.
 The environment and procedures used in surgery are governed by the principles of aseptic technique: the strict separation of "sterile" (free of microorganisms) things from "unsterile" or "contaminated" things. All surgical instruments must be sterilized, and an instrument must be replaced or re-sterilized if it becomes contaminated (i.e. handled in an unsterile manner, or allowed to touch an unsterile surface).
Operating room staff must wear sterile attire (scrubs, a scrub cap, a sterile surgical gown, sterile latex or non-latex polymer gloves and a surgical mask), and they must scrub hands and arms with an approved disinfectant agent before each procedure. Preoperative care Main article: Preoperative care Prior to surgery, the patient is given a medical examination, receives certain pre-operative tests, and their physical status is rated according to the ASA physical status classification system.
If these results are satisfactory, the patient signs a consent form and is given a surgical clearance. If the procedure is expected to result in significant blood loss, an autologous blood donation may be made some weeks prior to surgery. If the surgery involves the digestive system, the patient may be instructed to perform a bowel prep by drinking a solution of polyethylene glycol the night before the procedure.
Patients are also instructed to abstain from food or drink (an NPO order after midnight on the night before the procedure), to minimize the effect of stomach contents on pre-operative medications and reduce the risk of aspiration if the patient vomits during or after the procedure. Some medical systems have a practice of routinely performing chest x-rays before surgery. The premise behind this practice is that the physician might discover some unknown medical condition which would complicate the surgery, and that upon discovering this with the chest x-ray, the physician would adapt the surgery practice accordingly.
 In fact, medical specialty professional organizations recommend against routine pre-operative chest x-rays for patients who have an unremarkable medical history and presented with a physical exam which did not indicate a chest x-ray. Routine x-ray examination is more likely to result in problems like misdiagnosis, overtreatment, or other negative outcomes than it is to result in a benefit to the patient.
 Likewise, other tests including complete blood count, prothrombin time, partial thromboplastin time, basic metabolic panel, and urinalysis should not be done unless the results of these tests can help evaluate surgical risk. Staging for surgery In the pre-operative holding area, the patient changes out of his or her street clothes and is asked to confirm the details of his or her surgery. A set of vital signs are recorded, a peripheral IV line is placed, and pre-operative medications (antibiotics, sedatives, etc.
) are given. When the patient enters the operating room, the skin surface to be operated on, called the operating field, is cleaned and prepared by applying an antiseptic such as chlorhexidine gluconate or povidone-iodine to reduce the possibility of infection. If hair is present at the surgical site, it is clipped off prior to prep application. The patient is assisted by an anesthesiologist or resident to make a specific surgical position, then sterile drapes are used to cover the surgical site or at least a wide area surrounding the operating field; the drapes are clipped to a pair of poles near the head of the bed to form an "ether screen", which separates the anesthetist/anesthesiologist's working area (unsterile) from the surgical site (sterile).
 Anesthesia is administered to prevent pain from an incision, tissue manipulation and suturing. Based on the procedure, anesthesia may be provided locally or as general anesthesia. Spinal anesthesia may be used when the surgical site is too large or deep for a local block, but general anesthesia may not be desirable. With local and spinal anesthesia, the surgical site is anesthetized, but the patient can remain conscious or minimally sedated.
In contrast, general anesthesia renders the patient unconscious and paralyzed during surgery. The patient is intubated and is placed on a mechanical ventilator, and anesthesia is produced by a combination of injected and inhaled agents. Choice of surgical method and anesthetic technique aims to reduce the risk of complications, shorten the time needed for recovery and minimise the surgical stress response.
Surgery An incision is made to access the surgical site. Blood vessels may be clamped or cauterized to prevent bleeding, and retractors may be used to expose the site or keep the incision open. The approach to the surgical site may involve several layers of incision and dissection, as in abdominal surgery, where the incision must traverse skin, subcutaneous tissue, three layers of muscle and then the peritoneum.
In certain cases, bone may be cut to further access the interior of the body; for example, cutting the skull for brain surgery or cutting the sternum for thoracic (chest) surgery to open up the rib cage. Whilst in surgery aseptic technique is used to prevent infection or further spreading of the disease. The surgeons' and assistants' hands, wrists and forearms are washed thoroughly for at least 4 minutes to prevent germs getting into the operative field, then sterile gloves are placed onto their hands.
An antiseptic solution is applied to the area of the patient's body that will be operated on.Sterile drapes are placed around the operative site. Surgical masks are worn by the surgical team to avoid germs on droplets of liquid from their mouths and noses from contaminating the operative site. Work to correct the problem in body then proceeds. This work may involve: excision – cutting out an organ, tumor, or other tissue.
resection – partial removal of an organ or other bodily structure. reconnection of organs, tissues, etc., particularly if severed. Resection of organs such as intestines involves reconnection. Internal suturing or stapling may be used. Surgical connection between blood vessels or other tubular or hollow structures such as loops of intestine is called anastomosis. Reduction – the movement or realignment of a body part to its normal position.
e.g. Reduction of a broken nose involves the physical manipulation of the bone or cartilage from their displaced state back to their original position to restore normal airflow and aesthetics. ligation – tying off blood vessels, ducts, or "tubes". grafts – may be severed pieces of tissue cut from the same (or different) body or flaps of tissue still partly connected to the body but resewn for rearranging or restructuring of the area of the body in question.
Although grafting is often used in cosmetic surgery, it is also used in other surgery. Grafts may be taken from one area of the patient's body and inserted to another area of the body. An example is bypass surgery, where clogged blood vessels are bypassed with a graft from another part of the body. Alternatively, grafts may be from other persons, cadavers, or animals. insertion of prosthetic parts when needed.
Pins or screws to set and hold bones may be used. Sections of bone may be replaced with prosthetic rods or other parts. Sometime a plate is inserted to replace a damaged area of skull. Artificial hip replacement has become more common. Heart pacemakers or valves may be inserted. Many other types of prostheses are used. creation of a stoma, a permanent or semi-permanent opening in the body in transplant surgery, the donor organ (taken out of the donor's body) is inserted into the recipient's body and reconnected to the recipient in all necessary ways (blood vessels, ducts, etc.
). arthrodesis – surgical connection of adjacent bones so the bones can grow together into one. Spinal fusion is an example of adjacent vertebrae connected allowing them to grow together into one piece. modifying the digestive tract in bariatric surgery for weight loss. repair of a fistula, hernia, or prolapse other procedures, including: clearing clogged ducts, blood or other vessels removal of calculi (stones) draining of accumulated fluids debridement- removal of dead, damaged, or diseased tissue Blood or blood expanders may be administered to compensate for blood lost during surgery.
Once the procedure is complete, sutures or staples are used to close the incision. Once the incision is closed, the anesthetic agents are stopped or reversed, and the patient is taken off ventilation and extubated (if general anesthesia was administered). Post-operative care After completion of surgery, the patient is transferred to the post anesthesia care unit and closely monitored. When the patient is judged to have recovered from the anesthesia, he/she is either transferred to a surgical ward elsewhere in the hospital or discharged home.
During the post-operative period, the patient's general function is assessed, the outcome of the procedure is assessed, and the surgical site is checked for signs of infection. There are several risk factors associated with postoperative complications, such as immune deficienty and obesity. Obesity has long been considered a risk factor for adverse post-surgical outcomes. It has been linked to many disorders such as obesity hypoventilation syndrome, atelectasis and pulmonary embolism, adverse cardiovascular effects, and wound healing complications.
 If removable skin closures are used, they are removed after 7 to 10 days post-operatively, or after healing of the incision is well under way. It is not uncommon for surgical drains (see Drain (surgery)) to be required to remove blood or fluid from the surgical wound during recovery. Mostly these drains stay in until the volume tapers off, then they are removed. These drains can become clogged, leading to abscess.
Postoperative therapy may include adjuvant treatment such as chemotherapy, radiation therapy, or administration of medication such as anti-rejection medication for transplants. Other follow-up studies or rehabilitation may be prescribed during and after the recovery period. The use of topical antibiotics on surgical wounds to reduce infection rates has been questioned. Antibiotic ointments are likely to irritate the skin, slow healing, and could increase risk of developing contact dermatitis and antibiotic resistance.
 It has been also been suggested that topical antibiotics should only be used when a person shows signs of infection and not as a preventative. A systematic review published by Cochrane (organisation) in 2016, though, concluded that topical antibiotics applied over certain types of surgical wounds reduce the risk of surgical site infections, when compared to no treatment or use of Antiseptics.
 The review also did not find conclusive evidence to suggest that topical antibiotics increased the risk of local skin reactions or antibiotic resistance. Through a retrospective analysis of national administrative data, the association between mortality and day of elective surgical procedure suggests a higher risk in procedures carried out later in the working week and on weekends. The odds of death were 44% and 82% higher respectively when comparing procedures on a Friday to a weekend procedure.
This “weekday effect” has been postulated to be from several factors including poorer availability of services on a weekend, and also, decrease number and level of experience over a weekend. Epidemiology USA in 2011, of the 38.6 million hospital stays in U.S. hospitals, 29% included at least one operating room procedure. These stays accounted for 48% of the total $387 billion in hospital costs.
 The overall number of procedures remained stable from 2001 to 2011. In 2011, over 15 million operating room procedures were performed in U.S. hospitals. Data from 2003 to 2011 showed that U.S. hospital costs were highest for the surgical service line; the surgical service line costs were $17,600 in 2003 and projected to be $22,500 in 2013. For hospital stays in 2012 in the United States, private insurance had the highest percentage of surgical expenditure.
 in 2012, mean hospital costs in the United States were highest for surgical stays. Special populations Elderly people Older adults have widely varying physical health. Frail elderly people are at significant risk of post-surgical complications and the need for extended care. Assessment of older patients before elective surgery can accurately predict the patients' recovery trajectories. One frailty scale uses five items: unintentional weight loss, muscle weakness, exhaustion, low physical activity, and slowed walking speed.
A healthy person scores 0; a very frail person scores 5. Compared to non-frail elderly people, people with intermediate frailty scores (2 or 3) are twice as likely to have post-surgical complications, spend 50% more time in the hospital, and are three times as likely to be discharged to a skilled nursing facility instead of to their own homes. Frail elderly patients (score of 4 or 5) have even worse outcomes, with the risk of being discharged to a nursing home rising to twenty times the rate for non-frail elderly people.
Children Surgery on children requires considerations which are not common in adult surgery. Children and adolescents are still developing physically and mentally making it difficult for them to make informed decisions and give consent for surgical treatments. Bariatric surgery in youth is among the controversial topics related to surgery in children. See also: Pediatric surgery and Pediatric plastic surgery Vulnerable populations Doctors perform surgery with the consent of the patient.
Some patients are able to give better informed consent than others. Populations such as incarcerated persons, people living with dementia, the mentally incompetent, persons subject to coercion, and other people who are not able to make decisions with the same authority as a typical patient have special needs when making decisions about their personal healthcare, including surgery. In low- and middle-income countries In 2014, the Lancet Commission on Global Surgery was launched to examine the case for surgery as an integral component of global health care and to provide recommendations regarding the delivery of surgical and anesthesia services in low and middle income countries.
 Amongst the conclusions in this study, two primary conclusions were reached: Five billion people worldwide lack access to safe, timely, and affordable surgical and anesthesia care. Areas in which especially large proportions of the population lack access include Sub-Saharan Africa, the Indian Subcontinent, Central Asia and, to a lesser extent, Russia and China. Of the estimated 312.9 million surgical procedures undertaken worldwide in 2012, only 6.
3% were done in countries comprising the poorest 37.3% of the world's population. An additional 143 million surgical procedures are needed each year to prevent unnecessary death and disability. Globally, there are few studies comparing outcomes from surgery across different income level countries, although evidence suggests significantly poorer outcomes from surgery performed in lower income settings.
One major prospective study of 10,745 adult patients undergoing emergency abdominal surgery from 357 centres in 58 high-, middle-, and low-income countries found that mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. In this study the overall global mortality rate was 1·6 per cent at 24 hours (high 1·1 per cent, middle 1·9 per cent, low 3·4 per cent; P < 0·001), increasing to 5·4 per cent by 30 days (high 4·5 per cent, middle 6·0 per cent, low 8·6 per cent; P < 0·001).
Of the 578 patients who died, 404 (69·9 per cent) did so between 24 h and 30 days following surgery (high 74·2 per cent, middle 68·8 per cent, low 60·5 per cent). Patient safety factors were suggested to play an important role, with use of the WHO Surgical Safety Checklist associated with reduced mortality at 30 days. Taking a similar approach, a unique global study of 1,409 children undergoing emergency abdominal surgery from 253 centres in 43 countries showed that adjusted mortality in children following surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed in these settings.
Internationally, the most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries.
 Human rights Access to surgical care is increasingly recognized as an integral aspect of healthcare, and therefore is evolving into a normative derivation of human right to health. The ICESCR Article 12.1 and 12.2 define the human right to health as “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health” In the August 2000, the UN Committee on Economic, Social and Cultural Rights (CESCR) interpreted this to mean “right to the enjoyment of a variety of facilities, goods, services, and conditions necessary for the realization of the highest attainable health”.
 Surgical care can be thereby viewed as a positive right- an entitlement to protective healthcare. Woven through the International Human and Health Rights literature is the right to be free from surgical disease. The 1966 ICESCR Article 12.2a described the need for “provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child” which was subsequently interpreted to mean “requiring measures to improve… emergency obstetric services”.
 Article 12.2d of the ICESCR stipulates the need for “the creation of conditions which would assure to all medical service and medical attention in the event of sickness”, and is interpreted in the 2000 comment to include timely access to “basic preventative, curative services… for appropriate treatment of injury and disability.”. Obstetric care shares close ties with reproductive rights, which includes access to reproductive health.
 Surgeons and public health advocates, such as Kelly McQueen, have described surgery as “Integral to the right to health”. This is reflected in the establishment of the WHO Global Initiative for Emergency and Essential Surgical Care in 2005, the 2013 formation of the Lancet Commission for Global Surgery, the 2015 World Bank Publication of Volume 1 of its Disease Control Priorities “Essential Surgery”, and the 2015 World Health Assembly 68.
15 passing of the Resolution for Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage. The Lancet Commission for Global Surgery outlined the need for access to “available, affordable, timely and safe” surgical and anesthesia care; dimensions paralleled in ICESCR General Comment No. 14, which similarly outlines need for available, accessible, affordable and timely healthcare.
 History Main articles: History of surgery, Prehistoric medicine, and History of general anesthesia Plates vi & vii of the Edwin Smith Papyrus, an Egyptian surgical treatise Ancient Egypt Surgical treatments date back to the prehistoric era. The oldest for which there is evidence is trepanation, in which a hole is drilled or scraped into the skull, thus exposing the dura mater in order to treat health problems related to intracranial pressure and other diseases.
Prehistoric surgical techniques are seen in Ancient Egypt, where a mandible dated to approximately 2650 BC shows two perforations just below the root of the first molar, indicating the draining of an abscessed tooth. Surgical texts from ancient Egypt date back about 3500 years ago. Surgical operations were performed by priests, specialized in medical treatments similar to today, and used sutures to close wounds.
 Infections were treated with honey. India and China Sushruta, the author of Sushruta Samhita, one of the oldest texts on surgery Remains from the early Harappan periods of the Indus Valley Civilization (c. 3300 BC) show evidence of teeth having been drilled dating back 9,000 years.Susruta was an ancient Indian surgeon commonly credited as the author of the treatise Sushruta Samhita.
He is dubbed as the "founding father of surgery" and his period is usually placed between the period of 1200–600 BC. One of the earliest known mention of the name is from the Bower Manuscript where Sushruta is listed as one of the ten sages residing in the Himalayas. Texts also suggest that he learned surgery at Kasi from Lord Dhanvantari, the god of medicine in Hindu mythology. It is one of the oldest known surgical texts and it describes in detail the examination, diagnosis, treatment, and prognosis of numerous ailments, as well as procedures on performing various forms of cosmetic surgery, plastic surgery and rhinoplasty.
 Instruments resembling surgical tools have also been found in the archaeological sites of Bronze Age China dating from the Shang Dynasty, along with seeds likely used for herbalism. Ancient Greece Hippocrates stated in the oath (c. 400 BC) that general physicians must never practice surgery and that surgical procedures are to be conducted by specialists In ancient Greece, temples dedicated to the healer-god Asclepius, known as Asclepieia (Greek: Ασκληπιεία, sing.
Asclepieion Ασκληπιείον), functioned as centers of medical advice, prognosis, and healing. In the Asclepieion of Epidaurus, some of the surgical cures listed, such as the opening of an abdominal abscess or the removal of traumatic foreign material, are realistic enough to have taken place. The Greek Galen was one of the greatest surgeons of the ancient world and performed many audacious operations—including brain and eye surgery—that were not tried again for almost two millennia.
In the Middle East, surgery was developed to a high degree in the Islamic world. Abulcasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi), an Andalusian-Arab physician and scientist who practised in the Zahra suburb of Córdoba, wrote medical texts that influenced European surgical procedures. Early modern Europe Ambroise Paré (c. 1510–1590), father of modern military surgery. 12th century medieval eye surgery in Italy In Europe, the demand grew for surgeons to formally study for many years before practicing; universities such as Montpellier, Padua and Bologna were particularly renowned.
In the 12th century, Rogerius Salernitanus composed his Chirurgia, laying the foundation for modern Western surgical manuals. Barber-surgeons generally had a bad reputation that was not to improve until the development of academic surgery as a specialty of medicine, rather than an accessory field. Basic surgical principles for asepsis etc., are known as Halsteads principles. There were some important advances to the art of surgery during this period.
The professor of anatomy at the University of Padua, Andreas Vesalius, was a pivotal figure in the Renaissance transition from classical medicine and anatomy based on the works of Galen, to an empirical approach of 'hands-on' dissection. In his anatomic treatis, De humani corporis fabrica, he exposed the many anatomical errors in Galen and advocated that all surgeons should train by engaging in practical dissections themselves.
The second figure of importance in this era was Ambroise Paré (sometimes spelled "Ambrose"), a French army surgeon from the 1530s until his death in 1590. The practice for cauterizing gunshot wounds on the battlefield had been to use boiling oil; an extremely dangerous and painful procedure. Paré began to employ a less irritating emollient, made of egg yolk, rose oil and turpentine. He also described more efficient techniques for the effective ligation of the blood vessels during an amputation.
Modern surgery The discipline of surgery was put on a sound, scientific footing during the Age of Enlightenment in Europe. An important figure in this regard was the Scottish surgical scientist, John Hunter, generally regarded as the father of modern scientific surgery. He brought an empirical and experimental approach to the science and was renowned around Europe for the quality of his research and his written works.
Hunter reconstructed surgical knowledge from scratch; refusing to rely on the testimonies of others, he conducted his own surgical experiments to determine the truth of the matter. To aid comparative analysis, he built up a collection of over 13,000 specimens of separate organ systems, from the simplest plants and animals to humans. He greatly advanced knowledge of venereal disease and introduced many new techniques of surgery, including new methods for repairing damage to the Achilles tendon and a more effective method for applying ligature of the arteries in case of an aneurysm.
 He was also one of the first to understand the importance of pathology, the danger of the spread of infection and how the problem of inflammation of the wound, bone lesions and even tuberculosis often undid any benefit that was gained from the intervention. He consequently adopted the position that all surgical procedures should be used only as a last resort. Other important 18th- and early 19th-century surgeons included Percival Pott (1713–1788) who described tuberculosis on the spine and first demonstrated that a cancer may be caused by an environmental carcinogen (he noticed a connection between chimney sweep's exposure to soot and their high incidence of scrotal cancer).
Astley Paston Cooper (1768–1841) first performed a successful ligation of the abdominal aorta, and James Syme (1799–1870) pioneered the Symes Amputation for the ankle joint and successfully carried out the first hip disarticulation. Modern pain control through anesthesia was discovered in the mid-19th century. Before the advent of anesthesia, surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient suffering.
This also meant that operations were largely restricted to amputations and external growth removals. Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as ether, first used by the American surgeon Crawford Long, and chloroform, discovered by Scottish obstetrician James Young Simpson and later pioneered by John Snow, physician to Queen Victoria.
 In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. In addition, the discovery of muscle relaxants such as curare allowed for safer applications. Infection and antisepsis Unfortunately, the introduction of anesthetics encouraged more surgery, which inadvertently caused more dangerous patient post-operative infections.
The concept of infection was unknown until relatively modern times. The first progress in combating infection was made in 1847 by the Hungarian doctor Ignaz Semmelweis who noticed that medical students fresh from the dissecting room were causing excess maternal death compared to midwives. Semmelweis, despite ridicule and opposition, introduced compulsory handwashing for everyone entering the maternal wards and was rewarded with a plunge in maternal and fetal deaths, however the Royal Society dismissed his advice.
Joseph Lister, pioneer of antiseptic surgery Until the pioneering work of British surgeon Joseph Lister in the 1860s, most medical men believed that chemical damage from exposures to bad air (see "miasma") was responsible for infections in wounds, and facilities for washing hands or a patient's wounds were not available. Lister became aware of the work of French chemist Louis Pasteur, who showed that rotting and fermentation could occur under anaerobic conditions if micro-organisms were present.
Pasteur suggested three methods to eliminate the micro-organisms responsible for gangrene: filtration, exposure to heat, or exposure to chemical solutions. Lister confirmed Pasteur's conclusions with his own experiments and decided to use his findings to develop antiseptic techniques for wounds. As the first two methods suggested by Pasteur were inappropriate for the treatment of human tissue, Lister experimented with the third, spraying carbolic acid on his instruments.
He found that this remarkably reduced the incidence of gangrene and he published his results in The Lancet. Later, on 9 August 1867, he read a paper before the British Medical Association in Dublin, on the Antiseptic Principle of the Practice of Surgery, which was reprinted in The British Medical Journal. His work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern antiseptic operating theatres widely used within 50 years.
Lister continued to develop improved methods of antisepsis and asepsis when he realised that infection could be better avoided by preventing bacteria from getting into wounds in the first place. This led to the rise of sterile surgery. Lister introduced the Steam Steriliser to sterilize equipment, instituted rigorous hand washing and later implemented the wearing of rubber gloves. These three crucial advances – the adoption of a scientific methodology toward surgical operations, the use of anaesthetic and the introduction of sterilised equipment – laid the groundwork for the modern invasive surgical techniques of today.
The use of X-rays as an important medical diagnostic tool began with their discovery in 1895 by German physicist Wilhelm Röntgen. He noticed that these rays could penetrate the skin, allowing the skeletal structure to be captured on a specially treated photographic plate. Hieronymus Fabricius, Operationes chirurgicae, 1685 John Syng Dorsey wrote the first American textbook on surgery An operation in 1753, painted by Gaspare Traversi.
Surgical specialties General surgery Breast Cardiothoracic Colorectal Craniofacial surgery Dental surgery Endocrine Gynaecology Neurosurgery Ophthalmology Oncological Oral and maxillofacial surgery Transplant Orthopaedic surgery Otolaryngology Paediatric (Pediatric) Plastic Podiatric surgery Skin Trauma Urology Vascular National societies American College of Surgeons American Academy of Orthopedic Surgeons American College of Foot and Ankle Surgeons Royal Australasian College of Surgeons Royal Australasian College of Dental Surgeons Royal College of Physicians and Surgeons of Canada Royal College of Surgeons in Ireland Royal College of Surgeons of Edinburgh Royal College of Physicians and Surgeons of Glasgow Royal College of Surgeons of England See also Anesthesia ASA physical status classification system Biomaterial Cardiac surgery Current Procedural Terminology (CPT; for outpatient surgical procedures medical coding) Surgical drain Endoscopy Fluorescence image-guided surgery Hypnosurgery ICD-10-PCS (International Classification of Diseases, 10th edition, Procedural Coding System; inpatient surgical procedures medical coding) Jet ventilation List of surgical procedures Minimally invasive procedure Operative report Perioperative mortality Remote surgery Robotic surgery Surgeon's assistant Surgical Outcomes Analysis and Research Surgical Sieve Trauma surgery Reconstructive surgery Rheumasurgery WHO Surgical Safety Checklist Notes and references ^ Fingar KR, Stocks C, Weiss AJ, Steiner CA (December 2014).
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ISBN 9781419154317. Check date values in: |date= (help) ^ The Lancet, "On a new method of treating compound fracture, abscess, etc.: with observation on the conditions of suppuration". Five articles running from: Volume 89, Issue 2272, 16 March 1867, pages 326–329 (Originally published as Volume 1, Issue 2272) to: Volume 90, Issue 2291, 27 July 1867, pages 95–96 Originally published as Volume 2, Issue 2291 ^ Lister J (21 September 1867).
"On the Antiseptic Principle in the Practice of Surgery". The British Medical Journal. 2 (351): 245–260. doi:10.1136/bmj.2.351.246. PMC 2310614 . PMID 20744875.. Reprinted in Lister, BJ (2010). "The classic: On the antiseptic principle in the practice of surgery. 1867". Clinical orthopaedics and related research. 468 (8): 2012–6. doi:10.1007/s11999-010-1320-x. PMC 2895849 . PMID 20361283.
^ Lister, Joseph. "Modern History Sourcebook: Joseph Lister (1827–1912): Antiseptic Principle Of The Practice Of Surgery, 1867". Fordham University. Retrieved 2 September 2011.Modernized version of text ^ Lister, Joseph. "On the Antiseptic Principle of the Practice of Surgery by Baron Joseph Lister". Project Gutenberg. Retrieved 2 September 2011. E-text, audio at Project Gutenberg. External links Find more aboutSurgeryat Wikipedia's sister projects Definitions from Wiktionary Media from Wikimedia Commons News from Wikinews Quotations from Wikiquote Texts from Wikisource Textbooks from Wikibooks Learning resources from Wikiversity v t e Medicine Outline History Specialties andsubspecialties Surgery Cardiac surgery Cardiothoracic surgery Colorectal surgery Eye surgery General surgery Neurosurgery Oral and maxillofacial surgery Orthopedic surgery Hand surgery Otolaryngology (ENT) Pediatric surgery Plastic surgery Reproductive surgery Surgical oncology Thoracic surgery Transplant surgery Trauma surgery Urology Andrology Vascular surgery Internal medicine Allergy / Immunology Angiology Cardiology Endocrinology Gastroenterology Hepatology Geriatrics Hematology Hospital medicine Infectious disease Nephrology Oncology Pulmonology Rheumatology Obstetrics and gynaecology Gynaecology Gynecologic oncology Maternal–fetal medicine Obstetrics Reproductive endocrinology and infertility Urogynecology Diagnostic Radiology Interventional radiology Nuclear medicine Pathology Anatomical pathology Clinical pathology Clinical chemistry Clinical immunology Cytopathology Medical microbiology Transfusion medicine Other specialties Addiction medicine Adolescent medicine Anesthesiology Dermatology Disaster medicine Diving medicine Emergency medicine Mass-gathering medicine Family medicine General practice Hospital medicine Intensive-care medicine Medical genetics Neurology Clinical neurophysiology Occupational medicine Ophthalmology Oral medicine Pain management Palliative care Pediatrics Neonatology Physical medicine and rehabilitation (PM&R) Preventive medicine Psychiatry Public health Radiation oncology Reproductive medicine Sexual medicine Sleep medicine Sports medicine Transplantation medicine Tropical medicine Travel medicine Venereology Medical education Medical school Bachelor of Medicine, Bachelor of Surgery Bachelor of Medical Sciences Master of Medicine Master of Surgery Doctor of Medicine Doctor of Osteopathic Medicine MD–PhD Related topics Allied health Dentistry Podiatry Physiotherapy Nanomedicine Molecular oncology Personalized medicine Veterinary medicine Physician Chief physician History of medicine Book v t e Neurosurgical and other procedures (ICD-9-CM V3 01–05+89.
1, ICD-10-PCS 00–01) Skull Craniotomy Decompressive craniectomy Cranioplasty CNS Brain thalamus and globus pallidus: Thalamotomy Thalamic stimulator Pallidotomy ventricular system: Ventriculostomy Suboccipital puncture Intracranial pressure monitoring cerebrum: Psychosurgery Lobotomy Bilateral cingulotomy Hemispherectomy Anterior temporal lobectomy pituitary gland: Hypophysectomy hippocampus: Amygdalohippocampectomy Brain biopsy Cerebral meninges Meningeal biopsy Spinal cord and spinal canal Spinal cord and roots Cordotomy Rhizotomy Vertebrae and intervertebral discs: see Template:Bone, cartilage, and joint procedures Medical imaging Computed tomography of the head Cerebral angiography Pneumoencephalography Echoencephalography/Transcranial Doppler Magnetic resonance imaging of the brain Brain PET Myelography Diagnostic Electroencephalography Lumbar puncture Polysomnography CPRs Glasgow Coma Scale Mini–mental state examination National Institutes of Health Stroke Scale CHADS2 score PNS Cranial and peripheral nerves Nerve block Vagotomy Sympathetic nerves or ganglia Ganglionectomy Sympathectomy Endoscopic thoracic sympathectomy Nerves (general) Axotomy Neurectomy Nerve biopsy Diagnostic Nerve conduction study Electromyography Medical imaging Magnetic resonance neurography v t e Surgery involving the endocrine system (ICD-9-CM V3 06–07, ICD-10-PCS 0G) Pancreas Islet cell transplantation see also digestive system procedures Pituitary Hypophysectomy Transsphenoidal surgery Combined rapid anterior pituitary evaluation panel Thyroid Thyroidectomy Parathyroidectomy Tests Radioactive iodine uptake test Sestamibi parathyroid scan TRH stimulation test Adrenal gland Adrenalectomy Tests Dexamethasone suppression test ACTH stimulation test Captopril suppression test Fluid deprivation test Pineal gland Pinealectomy v t e Eye surgery and other procedures (ICD-9-CM V3 08–16+95.
0–95.2, ICD-10-PCS 08) Adnexa Eyelids Blepharoplasty East Asian blepharoplasty Epicanthoplasty Tarsorrhaphy Lacrimal system Dacryocystorhinostomy Punctoplasty Globe Cornea Radial keratotomy Mini asymmetric radial keratotomy LASIK Keratomileusis Epikeratophakia Corneal transplantation Photorefractive keratectomy Intrastromal corneal ring segment Corneal collagen cross-linking Iris, ciliary body,sclera, and anterior chamber Glaucoma surgery: Trabeculectomy Iridectomy Lens Phacoemulsification Cataract surgery Capsulorhexis Retina, choroid,vitreous, and posterior chamber Vitrectomy Orbit and eyeball Enucleation of the eye Extraocular muscles Harada–Ito procedure Strabismus surgery Botulinum toxin therapy of strabismus Medical imaging Fluorescein angiography Fundus photography Corneal topography Optical coherence tomography Electrodiagnosis: Electrooculography Electroretinography Electronystagmography Eye examination Gonioscopy Dilated fundus examination Ocular tonometry Ophthalmoscopy Retinoscopy Color perception test Visual field test/Perimetry Radiotherapy Plaque radiotherapy v t e Operations, surgery and other procedures on the ear (ICD-9-CM V3 18–20+95.
4, ICD-10-PCS 09) Outer ear Otoplasty Middle ear Myringotomy Stapedectomy Tympanoplasty Tympanocentesis Myringoplasty Inner ear Mastoidectomy Epley maneuver Diagnosis Caloric reflex test ABR Electronystagmography v t e Procedures relating to the mouth and pharynx (ICD-9-CM V3 25–29, ICD-10-PCS 09) Mouth lip: Labial frenectomy Lip lift Lip augmentation Cheiloplasty tongue: Lingual frenectomy Genioglossus advancement Glossectomy teeth: see Template:Endodontology gingiva: see Template:Periodontology Stomatoplasty Oropharynx palate: Palatoplasty Pharyngeal flap surgery tonsil: Tonsillectomy Adenoidectomy uvula: Uvulotomy Uvulopalatoplasty Uvulopalatopharyngoplasty v t e Tests, surgery and other procedures involving the respiratory system (ICD-9-CM V3 21–22, 30–34, ICD-10-PCS 0B) Upper RT nose Rhinoplasty Septoplasty Alarplasty Rhinectomy Rhinomanometry sinus Sinusotomy larynx Laryngoscopy Laryngectomy Laryngotomy Thyrotomy Laryngotracheal reconstruction Lower RT trachea Cricothyrotomy Tracheoesophageal puncture Tracheotomy bronchus Bronchoscopy lung Pneumonectomy Lobectomy Wedge resection Lung transplantation Decortication of lung Heart-lung transplant Chest wall, pleura,mediastinum, and diaphragm pleura/pleural cavity Thoracentesis Pleurodesis Thoracoscopy Thoracotomy Chest tube mediastinum Mediastinoscopy Nuss procedure Medical imaging Bronchography CT pulmonary angiogram High-resolution computed tomography Spiral CT Ventilation/perfusion scan CPRs Pneumonia severity index CURB-65 Lung function test Body plethysmography Spirometry Bronchial challenge test Capnography Diffusion capacity Cytology Sputum culture Bronchoalveolar lavage Respiratory therapy/intubation Artificial respiration CPR Hyperbaric medicine Decompression chamber Heliox Mechanical ventilation Nebulizer Negative pressure ventilator Oxygen therapy Positive pressure ventilation Postural drainage Surgical airway management v t e Surgery and other procedures involving the heart (ICD-9-CM V3 35–37+89.
4+99.6, ICD-10-PCS 02) Surgery and IC Heart valves and septa Valve repair Valvulotomy Mitral valve repair Valvuloplasty aortic mitral Valve replacement Aortic valve repair Aortic valve replacement Ross procedure Percutaneous aortic valve replacement Mitral valve replacement production of septal defect in heart enlargement of existing septal defect Atrial septostomy Balloon septostomy creation of septal defect in heart Blalock–Hanlon procedure shunt from heart chamber to blood vessel atrium to pulmonary artery Fontan procedure left ventricle to aorta Rastelli procedure right ventricle to pulmonary artery Sano shunt compound procedures for transposition of great vessels Jatene procedure Mustard procedure for univentricular defect Norwood procedure Kawashima procedure shunt from blood vessel to blood vessel systemic circulation to pulmonary artery shunt Blalock–Taussig shunt SVC to the right PA Glenn procedure Cardiac vessels CHD Angioplasty Bypass/Coronary artery bypass MIDCAB Off-pump CAB TECAB Coronary stent Bare-metal stent Drug-eluting stent Bentall procedure Valve-sparing aortic root replacement Other Pericardium Pericardiocentesis Pericardial window Pericardiectomy Myocardium Cardiomyoplasty Dor procedure Septal myectomy Ventricular reduction Alcohol septal ablation Conduction system Maze procedure Cox maze and minimaze Catheter ablation Cryoablation Radiofrequency ablation Pacemaker insertion Left atrial appendage occlusion Cardiotomy Heart transplantation Diagnostic tests and procedures Electrophysiology Electrocardiography Vectorcardiography Holter monitor Implantable loop recorder Cardiac stress test Bruce protocol Electrophysiology study Cardiac imaging Angiocardiography Echocardiography TTE TEE Myocardial perfusion imaging Cardiovascular MRI Ventriculography Radionuclide ventriculography Cardiac catheterization/Coronary catheterization Cardiac CT Cardiac PET sound Phonocardiogram Function tests Impedance cardiography Ballistocardiography Cardiotocography Pacing Cardioversion Transcutaneous pacing v t e Vascular surgery ICD-9-CM V3 38–39, ICD-10-PCS 03–6 Vascular andEndovascular surgery Arterial disease Vascular bypass Angioplasty Atherectomy Endarterectomy Carotid endarterectomy Stenting Carotid stenting Venous disease Ambulatory phlebectomy Laser surgery Sclerotherapy Vein stripping Arterial and venous access Venous cutdown Arteriotomy Phlebotomy Aortic aneurysm / dissection: Endovascular aneurysm repair Open aortic surgery Other Cardiopulmonary bypass Cardioplegia Extracorporeal membrane oxygenation Vascular access Revascularization First rib resection Seldinger technique Vascular snare Medical imaging Angiography Digital subtraction angiography Cerebral angiography Aortography Fluorescein angiography Radionuclide angiography Magnetic resonance angiography Venography Portography Impedance phlebography Ultrasound Intravascular ultrasound Carotid ultrasonography Other diagnostic Angioscopy Ankle brachial pressure index Toe pressure Tilt table test v t e Operations/surgeries and other procedures of the blood and lymphatic system (ICD-9-CM V3 40–41, ICD-10-PCS 07) Bone marrow Stem cell transplantation/Hematopoietic stem cell transplantation Thymus Thymectomy Thymus transplantation Spleen Splenectomy Spleen transplantation Lymph nodes Lymphadenectomy Neck dissection Retroperitoneal lymph node dissection Lymph node biopsy Tonsils see Template:Procedures on the mouth and pharynx Imaging Lymphogram v t e Surgical procedures involving the digestive system (ICD-9-CM V3 42–54, ICD-10-PCS 0D) Digestive tract Upper GI tract SGs / Esophagus Esophagectomy Heller myotomy Sialography Impedance–pH monitoring Esophageal pH monitoring Esophageal motility study Stomach Bariatric surgery Adjustable gastric band Gastric bypass surgery Sleeve gastrectomy Vertical banded gastroplasty surgery Collis gastroplasty Gastrectomy Billroth I Billroth II Roux-en-Y Gastroenterostomy Gastropexy Gastrostomy Percutaneous endoscopic gastrostomy Hill repair Nissen fundoplication Pyloromyotomy Medical imaging Endoscopy: Esophagogastroduodenoscopy Barium swallow Upper gastrointestinal series Lower GI tract Small bowel Bariatric surgery Duodenal switch Jejunoileal bypass Bowel resection Ileostomy Intestine transplantation Jejunostomy Partial ileal bypass surgery Strictureplasty Large bowel Appendicectomy Colectomy Colonic polypectomy Colostomy Hartmann's operation Rectum Abdominoperineal resection / Miles operation Lower anterior resection Total mesorectal excision Anal canal Anal sphincterotomy Anorectal manometry Lateral internal sphincterotomy Rubber band ligation Transanal hemorrhoidal dearterialization Medical imaging Endoscopy: Colonoscopy Anoscopy Capsule endoscopy Enteroscopy Proctoscopy Sigmoidoscopy Abdominal ultrasonography Defecography Double-contrast barium enema Endoanal ultrasound Enteroclysis Lower gastrointestinal series Small-bowel follow-through Transrectal ultrasonography Virtual colonoscopy Stool tests Fecal fat test Fecal pH test Stool guaiac test Accessory Liver Artificial extracorporeal liver support Bioartificial liver devices Liver dialysis Hepatectomy Liver biopsy Liver transplantation Portal hypertension Transjugular intrahepatic portosystemic shunt [TIPS] Distal splenorenal shunt procedure Gallbladder, bile duct Cholecystectomy Cholecystostomy ERCP Hepatoportoenterostomy Medical imaging: Cholangiography IV MRCP PTC Cholecystography Cholescintigraphy Pancreas Frey's procedure Pancreas transplantation Pancreatectomy Pancreaticoduodenectomy Puestow procedure Abdominopelvic Peritoneum Diagnostic peritoneal lavage Intraperitoneal injection Laparoscopy Omentopexy Paracentesis Peritoneal dialysis Hernia Hernia repair: Inguinal hernia surgery Femoral hernia repair Other Laparotomy Exploratory laparotomy Rapid urease test / Urea breath test CPRs MELD PELD UKELD Child–Pugh score Ranson criteria Milan criteria v t e Urologic surgical and other procedures (ICD-9-CM V3 55–59+89.
2, ICD-10-PCS 0T) Kidney Nephrostomy (Percutaneous nephrostomy) Nephrotomy Endoscopy Nephroscopy Renal biopsy Nephrectomy Kidney transplantation Nephropexy Ureter Ureterostomy Urinary diversion Ureterosigmoidostomy Ureterolysis Ureteroscopy Urinary bladder Cystectomy Suprapubic cystostomy Cystoscopy Urethra Urethropexy Urethrotomy Urethral sounding Urethroplasty Urethral bulking injections Cystourethrography General Medical imaging: Pyelogram (Intravenous pyelogram, Retrograde pyelogram) Kidneys, ureters, and bladder x-ray Radioisotope renography Cystography Retrograde urethrogram Voiding cystourethrogram Urodynamic testing Cystometry other: Urinary catheterization Dialysis Lithotripsy: Laser lithotripsy Extracorporeal shock wave lithotripsy v t e Female genital surgical and other procedures (gynecological surgery) (ICD-9-CM V3 65–71, ICD-10-PCS 0U) Adnexa Ovaries Oophorectomy Salpingoophorectomy Fallopian tubes Falloposcopy Salpingectomy Tubal ligation Essure Tubal reversal Uterus general: Genitoplasty Hysterectomy Hysterotomy Pelvic exenteration Uterine artery embolization Transplantation uterine cavity: Hysteroscopy Vacuum aspiration endometrium: Endometrial biopsy Endometrial ablation myometrium: Uterine myomectomy cervix: Colposcopy Cervical conization LEEP Cervical cerclage Cervical screening (pap test) Cervicectomy Vagina Vaginectomy Culdoscopy Culdocentesis Episiotomy Husband stitch Hymenotomy Colpocleisis Hymenorrhaphy Vaginal wet mount Vaginal transplantation Vulva Vulvectomy Female genital mutilation Labiaplasty Clitoral hood reduction Vestibulectomy Medical imaging Gynecologic ultrasonography Hysterosalpingography v t e Obstetrical surgery and other procedures (ICD-9-CM V3 72–75, ICD-10-PCS 1) Diagnostic Pregnancy test Leopold's maneuvers Cardiotocography Fetoscopy Fetal scalp blood testing Fetal scalp stimulation test sampling: fetal tissue Chorionic villus sampling Amniocentesis blood Triple test Percutaneous umbilical cord blood sampling Apt test Kleihauer–Betke test lung maturity Lecithin–sphingomyelin ratio Lamellar body count Fetal fibronectin test obstetric ultrasonography: Nuchal scan Anomaly scan antenatal testing: Fetal movement counting Contraction stress test Nonstress test Vibroacoustic stimulation Biophysical profile Amniotic fluid index Intervention Fetal surgery Fetendo Podalic version External cephalic version Amnioinfusion Delivery Vaginal delivery Induction Artificial rupture of membranes Episiotomy Symphysiotomy Forceps in childbirth Ventouse in childbirth Odón Device Dystocia management McRoberts maneuver Woods' screw maneuver Zavanelli maneuver Third stage of labor Manual placenta removal Caesarean section Elective On maternal request EXIT procedure Resuscitative hysterotomy Postpartum hemorrhage Hysterectomy B-Lynch suture Sengstaken–Blakemore tube v t e Orthopedic surgery, operations/surgeries and other procedures on bones and joints (ICD-9-CM V3 76–81, ICD-10-PCS 0P–S) Bones Facial Jaw reduction Dentofacial osteotomy Genioplasty/Mentoplasty Chin augmentation Orthognathic surgery Spine Coccygectomy Laminotomy Laminectomy Laminoplasty Corpectomy Facetectomy Foraminotomy Vertebral fixation Percutaneous vertebroplasty Upper extremity Acromioplasty Lower extremity Femoral head ostectomy Astragalectomy Distraction osteogenesis Ilizarov apparatus General Ostectomy Bone grafting Osteotomy Epiphysiodesis Reduction Internal fixation External fixation Tension band wiring Cartilage Articular cartilage repair Microfracture surgery Knee cartilage replacement therapy Autologous chondrocyte implantation Joints Spine Arthrodesis Spinal fusion Intervertebral discs Discectomy Annuloplasty Arthroplasty Upper extremity Shoulder surgery Shoulder replacement Bankart repair Weaver–Dunn procedure Ulnar collateral ligament reconstruction Hand surgery Brunelli procedure Lower extremity Hip resurfacing Hip replacement Rotationplasty Anterior cruciate ligament reconstruction Knee replacement/Unicompartmental knee arthroplasty Ankle replacement Broström procedure Triple arthrodesis General Arthrotomy Arthroplasty Synovectomy Arthroscopy Replacement joint imaging: Arthrogram Arthrocentesis v t e Orthopedic surgery, operations/surgeries and other procedures on muscle/soft tissue (ICD-9-CM V3 82–84, ICD-10-PCS 0K–L) Muscle, tendon,fascia, and bursa muscle: Myotomy Heller myotomy Muscle biopsy tendon: Tenotomy Tendon transfer fascia: Fasciotomy bursa: Bursectomy Other Amputation Hemipelvectomy Hemicorporectomy Replantation v t e Operations/surgeries and other procedures of the breast (ICD-9-CM V3 85, ICD-10-PCS 0H) Breast surgery Breast-conserving surgery Lumpectomy Mastectomy Radical mastectomy Mammoplasty Breast implant Breast reduction plasty SPAIR Mastopexy Breast reconstruction Breast biopsy Fine-needle aspiration Interventions on the Lactiferous ducts Ductal lavage Ductoscopy Microdochectomy Central duct excision Breast imaging Mammography Positron emission mammography Tomosynthesis Xeromammography Galactography Breast MRI Breast ultrasound Automated whole-breast ultrasound Scintimammography Tactile imaging Other Breast cancer screening Breast self-examination v t e Operations/surgeries and other procedures of the skin and subcutaneous tissue (ICD-9-CM V3 86, ICD-10-PCS 0H) Skin Escharotomy Suture Skin grafting Mohs surgery Free flap Rotation flap TRAM flap Electrodesiccation and curettage Cryosurgery Skin biopsy Rhytidectomy Liposuction Z-plasty Medical imaging Wood's lamp Hair Hair transplantation Authority control LCCN: sh85130766 GND: 4009987-8 NDL: 00562311 Retrieved from "https://en.
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Hernia Definition Hernia is a general term used to describe a bulge or protrusion of an organ through the structure or muscle that usually contains it. Description There are many different types of hernias. The most familiar type are those that occur in the abdomen, in which part of the intestines protrude through the abdominal wall. This may occur in different areas and, depending on the location, the hernia is given a different name.
An inguinal hernia appears as a bulge in the groin and may come and go depending on the position of the person or their level of physical activity. It can occur with or without pain. In men, the protrusion may descend into the scrotum. Inguinal hernias account for 80% of all hernias and are more common in men. Femoral hernias are similar to inguinal hernias but appear as a bulge slightly lower. They are more common in women due to the strain of pregnancy.
A ventral hernia is also called an incisional hernia because it generally occurs as a bulge in the abdomen at the site of an old surgical scar. It is caused by thinning or stretching of the scar tissue, and occurs more frequently in people who are obese or pregnant. An umbilical hernia appears as a soft bulge at the navel (umbilicus). It is caused by a weakening of the area or an imperfect closure of the area in infants.
This type of hernia is more common in women due to pregnancy, and in Chinese and black infants. Some umbilical hernias in infants disappear without treatment within the first year. A hiatal or diaphragmatic hernia is different from abdominal hernias in that it is not visible on the outside of the body. With a hiatal hernia, the stomach bulges upward through the muscle that separates the chest from the abdomen (the diaphragm).
This type of hernia occurs more often in women than in men, and it is treated differently from other types of hernias. Causes and symptoms Most hernias result from a weakness in the abdominal wall that either develops or that an infant is born with (congenital). Any increase in pressure in the abdomen, such as coughing, straining, heavy lifting, or pregnancy, can be a considered causative factor in developing an abdominal hernia.
Obesity or recent excessive weight loss, as well as aging and previous surgery, are also risk factors. Most abdominal hernias appear suddenly when the abdominal muscles are strained. The person may feel tenderness, a slight burning sensation, or a feeling of heaviness in the bulge. It may be possible for the person to push the hernia back into place with gentle pressure, or the hernia may disappear by itself when the person reclines.
Being able to push the hernia back is called reducing it. On the other hand, some hernias cannot be pushed back into place, and are termed incarcerated or irreducible. A hiatal hernia may also be caused by obesity, pregnancy, aging, or previous surgery. About 50% of all people with hiatal hernias do not have any symptoms. If symptoms exist they will include heartburn, usually 30-60 minutes following a meal.
There may be some mid chest pain due to gastric acid from the stomach being pushed up into the esophagus. The pain and heartburn are usually worse when lying down. Frequent belching and feelings of abdominal fullness may also be present. Diagnosis Generally, abdominal hernias need to be seen and felt to be diagnosed. Usually the hernia will increase in size with an increase in abdominal pressure, so the doctor may ask the person to cough while he or she feels the area.
Once a diagnosis of an abdominal hernia is made, the doctor will usually send the person to a surgeon for a consultation. Surgery provides the only cure for a hernia through the abdominal wall. With a hiatal hernia, the diagnosis is based on the symptoms reported by the person. The doctor may then order tests to confirm the diagnosis. If a barium swallow is ordered, the person drinks a chalky white barium solution, which will help any protrusion through the diaphragm show up on the x ray that follows.
Currently, a diagnosis of hiatal hernia is more frequently made by endoscopy. This procedure is done by a gastroenterologist (a specialist in digestive diseases). During an endoscopy the person is given an intravenous sedative and a small tube is inserted through the mouth, then into the esophagus and stomach where the doctor can visualize the hernia. The procedure takes about 30 minutes and usually causes no discomfort.
It is done on an outpatient basis. Treatment Once an abdominal hernia occurs it tends to increase in size. Some patients with abdominal hernias wait and watch for a while prior to choosing surgery. In these cases, they must avoid strenuous physical activity such as heavy lifting or straining with constipation. They may also wear a truss, which is a support worn like a belt to keep a small hernia from protruding.
People can tell if their hernia is getting worse if they develop severe constant pain, nausea and vomiting, or if the bulge does not return to normal when lying down or when they try to gently push it back in place. In these cases they should consult with their doctor immediately. But, ultimately, surgery is the treatment in almost all cases. There are risks to not repairing a hernia surgically. Left untreated, a hernia may become incarcerated, which means it can no longer be reduced or pushed back into place.
With an incarcerated hernia the intestines become trapped outside the abdomen. This could lead to a blockage in the intestine. If it is severe enough it may cut off the blood supply to the intestine and part of the intestine might actually die. When the blood supply is cut off, the hernia is termed "strangulated." Because of the risk of tissue death (necrosis) and gangrene, and because the hernia can block food from moving through the bowel, a strangulated hernia is a medical emergency requiring immediate surgery.
Repairing a hernia before it becomes incarcerated or strangulated is much safer than waiting until complications develop. Surgical repair of a hernia is called a herniorrhaphy. The surgeon will push the bulging part of the intestine back into place and sew the overlying muscle back together. When the muscle is not strong enough, the surgeon may reinforce it with a synthetic mesh. Surgery can be done on an outpatient basis.
It usually takes 30 minutes in children and 60 minutes in adults. It can be done under either local or general anesthesia and is frequently done with a laparoscope. In this type of surgery, a tube that allows visualization of the abdominal cavity is inserted through a small puncture wound. Several small punctures are made to allow surgical instruments to be inserted. This type of surgery avoids a larger incision.
A hiatal hernia is treated differently. Medical treatment is preferred. Treatments include: avoiding reclining after meals avoiding spicy foods, acidic foods, alcohol, and tobacco eating small, frequent, bland meals eating a high-fiber diet. There are also several types of medications that help to manage the symptoms of a hiatal hernia. Antacids are used to neutralize gastric acid and decrease heartburn.
Drugs that reduce the amount of acid produced in the stomach (H2 blockers) are also used. This class of drugs includes famotidine (sold under the name Pepcid), cimetidine (Tagamet), and ranitidine (Zantac). Omeprazole (Prilosec) is not an H2 blocker, but is another drug that suppresses gastric acid secretion and is used for hiatal hernias. Another option may be metoclopramide (Reglan), a drug that increases the tone of the muscle around the esophagus and causes the stomach to empty more quickly.
Alternative treatment There are alternative therapies for hiatal hernia. Visceral manipulation, done by a trained therapist, can help replace the stomach to its proper positioning. Other options in addition to H2 blockers are available to help regulate stomach acid production and balance. One of them, deglycyrrhizinated licorice (DGL), helps balance stomach acid by improving the protective substances that line the stomach and intestines and by improving blood supply to these tissues.
DGL does not interrupt the normal function of stomach acid. As with traditional therapy, dietary modifications are important. Small, frequent meals will keep pressure down on the esophageal sphincter. Also, raising the head of the bed several inches with blocks or books can help with both the quality and quantity of sleep. Prognosis Abdominal hernias generally do not recur in children but can recur in up to 10% of adult patients.
Surgery is considered the only cure, and the prognosis is excellent if the hernia is corrected before it becomes strangulated. Hiatal hernias are treated successfully with medication and diet modifications 85% of the time. The prognosis remains excellent even if surgery is required in adults who are in otherwise good health. Prevention Some hernias can be prevented by maintaining a reasonable weight, avoiding heavy lifting and constipation, and following a moderate exercise program to maintain good abdominal muscle tone.
Resources Books Bare, Brenda G., and Suzanne C. Smeltzer. Brunner and Suddarth's Textbook of Medical-Surgical Nursing. 8th ed. Philadelphia: Lippincott-Raven Publishers, 1996. Key terms Endoscopy — A diagnostic procedure in which a tube is inserted through the mouth, into the esophagus and stomach. It is used to visualize various digestive disorders, including hiatal hernias. Incarcerated hernia — A hernia that can not be reduced, or pushed back into place inside the intestinal wall.
Reducible hernia — A hernia that can be gently pushed back into place or that disappears when the person lies down. Strangulated hernia — A hernia that is so tightly incarcerated outside the abdominal wall that the intestine is blocked and the blood supply to that part of the intestine is cut off. hernia [her´ne-ah] the abnormal protrusion of part of an organ or tissue through the structures normally containing it.
adj., adj her´nial. A weak spot or other abnormal opening in a body wall permits part of the organ to bulge through. A hernia may develop in various parts of the body, most commonly in the region of the abdomen (abdominal hernia), and may be either acquired or congenital. An old popular term for hernia is rupture, but this term is misleading because it suggests tearing and nothing is torn in a hernia.
Although various supports and trusses can be tried in an effort to contain the hernia, the best treatment for this condition is herniorrhaphy, surgical repair of the weakness in the muscle wall through which the hernia protrudes. Bochdalek's hernia congenital posterolateral diaphragmatic hernia, with extrusion of bowel and other abdominal viscera into the thorax; due to failure of closure of the pleuroperitoneal hiatus.
cerebral hernia (hernia ce´rebri) protrusion of brain substance through a defect in the skull. fat hernia hernial protrusion of peritoneal fat through the abdominal wall. femoral hernia protrusion of a loop of intestine into the femoral canal, a tubular passageway that carries nerves and blood vessels to the thigh; this type occurs more often in women than in men. Called also crural hernia and femorocele.
hiatal hernia (hiatus hernia) protrusion of a structure, often a portion of the stomach, through the esophageal hiatus of the diaphragm; see diaphragmatic hernia. Holthouse's hernia an inguinal hernia that has turned outward into the groin. incarcerated hernia a hernia so occluded that it cannot be returned by manipulation; it may or may not become strangulated. Called also irreducible hernia. incisional hernia hernia after operation at the site of the surgical incision, owing to improper healing or to excessive strain on the healing tissue; such strain may be caused by excessive muscular effort, such as that involved in lifting or severe coughing, or by obesity, which creates additional pressure on the weakened area.
inguinal hernia hernia occurring in the groin, or inguen, where the abdominal folds of flesh meet the thighs. It is often the result of increased pressure within the abdomen, whether due to lifting, coughing, straining, or accident. Inguinal hernia accounts for about 75 per cent of all hernias.A sac formed from the peritoneum and containing a portion of the intestine or omentum, or both, pushes either directly outward through the weakest point in the abdominal wall (direct hernia) or downward at an angle into the inguinal canal (indirect hernia).
Indirect inguinal hernia (the common form) occurs more often in males because it follows the tract that develops when the testes descend into the scrotum before birth, and the hernia itself may descend into the scrotum. In the female, the hernia follows the course of the round ligament of the uterus.Inguinal hernia begins usually as a small breakthrough. It may be hardly noticeable, appearing as a soft lump under the skin, no larger than a marble, and there may be little pain.
As time passes, the pressure of the contents of the abdomen against the weak abdominal wall may increase the size of the opening and, accordingly, the size of the lump formed by the hernia. In the early stages, an inguinal hernia is usually reducible—it can be pushed gently back into its normal place. Inguinal hernia usually requires herniorrhaphy. intra-abdominal hernia (intraperitoneal hernia) a congenital anomaly of intestinal positioning, occurring within the abdomen, in which a portion of bowel protrudes through a defect in the peritoneum or, as a result of abnormal rotation of the intestine during embryonic development, becomes trapped in a sac of peritoneum.
mesocolic hernia an intra-abdominal hernia in which the small intestine rotates incompletely during development and becomes trapped within the mesentery of the colon. Morgagni's hernia congenital retrosternal diaphragmatic hernia, with extrusion of tissue into the thorax through the foramen of Morgagni. paraesophageal hernia hiatal hernia in which part or almost all of the stomach protrudes through the hiatus into the thorax to the left of the esophagus, with the gastroesophageal junction remaining in place.
Paraesophageal hernia. From Dorland's, 2000. posterior vaginal hernia downward protrusion of the pouch of Douglas, with its intestinal contents, between the posterior vaginal wall and the rectum; called also enterocele. See illustration. Posterior vaginal hernia. From McKinney et al., 2000. reducible hernia one that can be returned by manipulation. sliding hernia hernia of the cecum (on the right) or the sigmoid colon (on the left) in which the wall of the viscus forms a portion of the hernial sac, the remainder of the sac being formed by the parietal peritoneum.
sliding hiatal hernia the most common type of diaphragmatic hernia; a hiatal hernia in which the upper stomach and the cardioesophageal junction protrude upward into the posterior mediastinum. The protrusion, which may be fixed or intermittent, is partially covered by a peritoneal sac. Sliding hiatal hernia. From Dorland's, 2000. strangulated hernia one that is tightly constricted. As any hernia progresses and bulges out through the weak point in its containing wall, the opening in the wall tends to close behind it, forming a narrow neck.
If the neck becomes pinched tight enough to cut off the blood supply, the hernia will quickly swell and become strangulated. This is a very dangerous condition that can appear suddenly and requires immediate surgical attention. Unless the blood supply is restored promptly, gangrene can set in and may cause death. If a hernia suddenly grows larger, becomes tense, and will not go back into place, and there is pain and nausea, it is strangulated.
Occasionally, especially in the elderly, hernia strangulation may occur without pain or tenderness. vaginal hernia hernia into the vagina; called also colpocele. her·ni·a , pl. her·ni·ae (her'nē-ă, her'nē-ē), Protrusion of a part or structure through the tissues normally containing it. [L. rupture] hernia /her·nia/ (her´ne-ah) [L.] protrusion of a portion of an organ or tissue through an abnormal opening.
her´nial abdominal hernia one through the abdominal wall, either a congenital defect or a complication of pregnancy or a surgical incision. Barth hernia one between the serosa of the abdominal wall and that of a persistent vitelline duct. cerebral hernia protrusion of brain substance through the cranium. complete hernia one in which the sac and its contents have passed through the hernial orifice.
congenital diaphragmatic hernia one due to failure of a foramen in the fetal diaphragm to close when the infant is born; abdominal viscera in the thoracic cavity may cause fatal respiratory failure. diaphragmatic hernia hernia through the diaphragm. diverticular hernia protrusion of a congenital diverticulum of the intestine. epigastric hernia a hernia through the linea alba above the navel.
fat hernia hernial protrusion of peritoneal fat through the abdominal wall. femoral hernia protrusion of a loop of intestine into the femoral canal. Hesselbach's hernia femoral hernia with a pouch through the cribriform fascia. hiatal hernia , hiatus hernia protrusion of any structure through the esophageal hiatus of the diaphragm. Holthouse's hernia an inguinal hernia that has turned outward into the groin.
incarcerated hernia a hernia so occluded that it cannot be returned by manipulation; it may or may not be strangulated. incisional hernia one through an old abdominal incision. inguinal hernia hernia into the inguinal canal. intermuscular hernia , interparietal hernia an interstitial hernia lying between one or another of the fascial or muscular planes of the abdomen. interstitial hernia one in which a knuckle of intestine lies between two layers of the abdominal wall.
intra-abdominal hernia congenital malpositioning of the intestine within the abdomen, with a portion of it protruding through a defect in the peritoneum or being trapped in a sac of peritoneum. labial hernia one into a labium majus. obturator hernia one protruding through the obturator foramen. ovarian hernia hernial protrusion of an ovary. paraduodenal hernia an intra-abdominal hernia in which the small intestine rotates incompletely during development and becomes trapped in the mesentery of the colon.
pectineal hernia a femoral hernia that enters the femoral canal and then perforates the aponeurosis of the pectineus muscle. perineal hernia herniation of intestine into the perineum through a fissure in the levator muscle and its fascia. preperitoneal hernia , properitoneal hernia an interstitial hernia lying between the parietal peritoneum and the transverse fascia. reducible hernia one that can be returned by manipulation.
retrograde hernia herniation of two loops of intestine, with the part between them being within the abdominal wall. Richter's hernia incarcerated or strangulated hernia in which only part of the circumference of the bowel wall is involved. sciatic hernia herniation of intestine through the greater or lesser sciatic foramen. sliding hernia hernia of the cecum (on the right) or the sigmoid colon (on the left) in which the intestinal wall forms part of the hernial sac and the rest of the sac is formed by parietal peritoneum.
sliding hiatal hernia hiatal hernia with the upper stomach and the esophagogastric junction protruding into the posterior mediastinum; the protrusion may be fixed or intermittent and is partially covered by a peritoneal sac. strangulated hernia incarcerated hernia so tightly constricted as to compromise the blood supply of the hernial sac, leading to gangrene of the sac and its contents. synovial hernia protrusion of the inner lining membrane through the fibrous membrane of an articular capsule.
umbilical hernia an abdominal hernia with intestine inside the umbilicus and the body wall defect and protruding intestine covered by skin and subcutaneous tissue. vaginal hernia vaginocele; a hernia into the vagina. hernia (hûr′nē-ə) n. pl. her·nias or her·niae (-nē-ē′) The protrusion of an organ or other bodily structure through the wall that normally contains it; a rupture. her′ni·al adj.
hernia [hur′nē·ə] Etymology: L, rupture protrusion or projection of an organ through an abnormal opening in the muscle wall of the cavity that surrounds it. A hernia may be congenital, may result from the failure of certain structures to close after birth, or may be acquired later in life as a result of obesity, muscular weakness, surgery, or illness. Kinds of hernia include abdominal, diaphragmatic, femoral, hiatal, inguinal, and umbilical.
See also herniorrhaphy. Common locations of hernias hernia Surgery The protrusion of tissue or prolapse from a normal site. See Abdominal hernia, Diaphragmatic hernia, Direct hernia, Femoral hernia, Hiatal hernia, Incarcerated hernia, Incisional hernia, Indirect hernia, Inguinal hernia, Sliding hernia, Stangulated hernia, Umbilical hernia, Ventral hernia.her·ni·a , pl. hernias, pl. herniae (hĕr'nē-ă, -ăz, -ē) Protrusion of a part or structure through the tissues normally containing it.
Synonym(s): rupture (1) . hernia (her'ne-a ) [L. hernia, rupture] COMMON LOCATIONS OF HERNIAS The protrusion of an anatomical structure through the wall that normally contains it. Synonym: rupture (2) See: illustration; herniotomyhernialhernioid, adjective Etiology Hernias may be caused by congenital defects in the formation of body structures, defects in collagen synthesis and repair, trauma, or surgery.
Conditions that increase intra-abdominal pressures, e.g., pregnancy, obesity, weight lifting, straining (the Valsalva maneuver), and abdominal tumors, may also contribute to hernia formation. Treatment Surgical or mechanical reduction is the treatment of choice. ABDOMINAL WALL HERNIA abdominal hernia A hernia through the abdominal wall. See: illustration acquired hernia A hernia that develops any time after birth in contrast to one that is present at birth (congenital hernia).
bladder hernia The protrusion of the bladder or part of the bladder through a normal or abnormal orifice. Synonym: cystic hernia Cloquet hernia See: Cloquet, Jules G. complete hernia A hernia in which the sac and its contents have passed through the aperture. concealed hernia A hernia that is not easily palpated. congenital hernia A hernia existing from birth. crural hernia A hernia that protrudes behind the femoral sheath.
Synonym: femoral hernia. cystic hernia Bladder hernia. diaphragmatic hernia Herniation of abdominal contents into the thoracic cavity through an opening in the diaphragm. The condition may be congenital, acquired (traumatic), or esophageal. direct inguinal hernia Inguinal hernia. diverticular hernia The protrusion of an intestinal congenital diverticulum. encysted hernia A scrotal protrusion that, enveloped in its own sac, passes into the tunica vaginalis.
epigastric hernia A hernia through a defect in the linea alba above the umbilicus. fascial hernia Protrusion of muscular tissue through its fascial covering. fatty hernia The prolapse of fat from its normal, anatomical position, e.g., from behind the peritoneum into the inguinal canal. femoral hernia Crural hernia. hiatal hernia The protrusion of the stomach into the chest through the esophageal hiatus of the diaphragm.
; incarcerated hernia A hernia in which the presenting content cannot be returned to its site of origin, e.g., a hernia in which a segment of intestine cannot be returned to the abdominal cavity. It may produce pain or intestinal obstruction. If left untreated, an incarcerated hernia may cause strangulation of the bowel. incisional hernia A hernia through a surgical scar. incomplete hernia A hernia that has not gone completely through the aperture.
indirect inguinal hernia Inguinal hernia. inguinal hernia The protrusion of a hernial sac containing intraperitoneal contents (e.g., intestine, omentum, or ovary) at the superficial inguinal ring. In an indirect inguinal hernia, the sac protrudes lateral to the inferior epigastric artery through the internal inguinal ring into the inguinal canal, often descending into the scrotum (in males) or labia (in females).
In a direct inguinal hernia, the sac protrudes through the abdominal wall within Hesselbach's triangle, a region bounded by the rectus abdominis muscle, inguinal ligament, and inferior epigastric vessels. The sliding hernia is a kind of indirect inguinal hernia, in which a portion of the wall of the protruding cecum or sigmoid colon is part of the sac, the rest composed of parietal peritoneum. Femoral hernias occur where the femoral artery passes into the femoral canal.
Indirect and direct inguinal hernias and femoral hernias are collectively referred to as groin hernias. Inguinal hernias account for about 80% of all hernias. Synonym: direct inguinal hernia; indirect inguinal hernia ; hernia inguinalis; lateral hernia; medial hernia; oblique hernia Patient care Preoperative: The surgical procedure and expected postoperative course are explained to the patient. The patient should understand that the surgery will repair the defect caused by the hernia but that surgical failures can occur.
If the patient is undergoing elective surgery, recovery usually is rapid; if no complications occur, the patient probably will return home the same day as surgery and usually can resume normal activity within 4 to 6 weeks. Patients who undergo emergency surgery for a strangulated or incarcerated hernia may remain hospitalized longer commensurate with the degree of intestinal involvement. The patient is prepared for surgery.
Postoperative: Vital signs are monitored. The patient is instructed on the changing of position to avoid undue stress on the wound area. Stool softeners may be administered to prevent straining during defecation, and the patient is instructed in their use. Early ambulation is encouraged, but other physical activities are modified according to the surgeon's instructions. The patient should void prior to discharge and be able to tolerate oral fluids.
The patient is taught to check the incision and dressing for drainage, inflammation, and swelling and to monitor his/her temperature for fever, any of which should be reported to the surgeon. Analgesics are administered as prescribed, and the patient is taught about their use and supplied with a prescription for home use. Male patients are advised that scrotal swelling can be reduced by supporting the scrotum on a rolled towel and applying an ice bag.
The patient is warned to avoid lifting heavy objects or straining during bowel movements. Drinking plenty of fluids should help the patient prevent constipation and maintain hydration. The patient is advised to make and keep a postoperative surgical visit and to resume normal activity and return to work only as permitted by the surgeon. hernia inguinalis Inguinal hernia. inguinocrural hernia A hernia that is both femoral and inguinal.
internal hernia A hernia that occurs within the abdominal cavity. It may be intraperitoneal or retroperitoneal. interstitial hernia A form of inguinal hernia in which the hernial sac lies between the layers of the abdominal muscles. irreducible hernia A hernia that cannot be returned to its original position out of its sac by manual methods. See: incarcerated hernia labial hernia The protrusion of a loop of bowel or other intraperitoneal organ into the labia majora.
lateral hernia Inguinal hernia. lumbar hernia A hernia through the inferior lumbar triangle (Petit) or the superior lumbar triangle (Grynfelt). It occurs most often in association with surgery on the kidneys or ureters. medial hernia Inguinal hernia. mesocolic hernia A hernia between the layers of the mesocolon. Nuckian hernia A hernia into the canal of Nuck. oblique hernia Inguinal hernia. obturator hernia A hernia through the obturator foramen.
omental hernia A hernia containing a portion of the omentum. ovarian hernia The presence of an ovary in a hernial sac. parastomal hernia A hernia in the abdominal wall adjacent to a constructed stoma, e.g., a colostomy or iliostomy. perineal hernia Perineocele. phrenic hernia A hernia projecting through the diaphragm into one of the pleural cavities. posterior vaginal hernia A hernia of Douglas' sac downward between the rectum and posterior vaginal wall.
Synonym: enterocele (2) properitoneal hernia A hernia located between the parietal peritoneum and the transversalis fascia. REDUCIBLE HERNIA: Umbilical Hernia REDUCIBLE HERNIA: Hernia reduces with digital pressure reducible hernia A hernia whose contents can be replaced by manipulation. See: illustration retroperitoneal hernia A hernia protruding into the retroperitoneal space, e.g., duodenojejunal hernia, Treitz's hernia.
Richter's hernia A hernia in which only a portion of intestinal wall protrudes, the main portion of the intestine being excluded from the hernial sac and the lumen remaining open. The patient may present with groin swelling and vague abdominal complaints; when incarcerated the hernia may produce bowel ischemia and related complications. scrotal hernia A hernia that descends into the scrotum. sliding hernia A hernia in which a portion of the wall of the herniated structure forms part of the hernia sac, e.
g. an inguinal hernia in which a wall of the cecum or sigmoid colon forms a portion of the sac, the remainder of the sac being parietal peritoneum. Spigelian hernia A defect that occurs at or below the linea semicircularis but above the point at which the inferior epigastric vessels cross the lateral border of the rectus abdominis muscle. This type of hernia may contain preperitoneal fat or may be a peritoneal sac containing intraperitoneal contents.
It is rare and difficult to diagnose unless large, because it is typically not palpable when small. Large Spigelian hernias may be mistaken for sarcomas of the abdominal wall. Ultrasonography or computed tomography scans are often used in diagnosis. Treatment Small Spigelian hernias are easily repaired; larger ones may require a prosthesis. sports hernia Athletic pubalgia. strangulated hernia A hernia in which the protruding viscus is so tightly trapped that gangrene results, requiring prompt surgery.
Once strangulation of the contents occurs, a nonsurgical attempt to reduce it may severely compromise treatment and outcome. synovial hernia Protrusion of a portion of synovial membrane through a tear in the stratum fibrosum of a joint capsule. umbilical hernia A hernia occurring at the navel, seen mostly in children. Usually it requires no therapy if small and asymptomatic. An umbilical hernia usually resolves when the child begins to walk (and muscles strengthen).
uterine hernia The presence of the uterus in the hernial sac. vaginal hernia Pelvic organ prolapse. vaginolabial hernia A hernia of a viscus into the posterior end of the labia majora. ventral hernia hernia Abnormal protrusion of an organ or tissue through a natural or abnormal opening. Hernias commonly involve a loop of bowel and occur at weak points in the walls of body cavities, especially the abdomen.
They are common in the groin region INGUINAL HERNIA and FEMORAL HERNIA, at the umbilicus (UMBILICAL HERNIA) and at the opening in the diaphragm for the gullet (oesophagus). Herniation of the stomach up through the diaphragm is called a HIATUS HERNIA. Hernias that cannot be returned to their normal position are said to be incarcerated and if the blood supply is cut off by swelling they are said to be strangulated.
Hernias should be corrected by surgery. External supports (trusses) are not generally satisfactory. Although the great majority of hernias involve displaced bowel, many other structures or tissues can herniate from their normal position. These include part of the brain through the large opening for the spinal cord or through a defect in the skull; muscle tissue through its compartment wall; synovial membrane of a joint through the joint capsule; and the pulpy centre of an intervertebral disc (nucleus pulposus).
hernia the abnormal protrusion of part of an internal organ through an aperture in the surrounding structures, most commonly part of the intestine through a defect in the abdominal wall musculature. Weakness of the muscle may be due to injury or previous surgery; obesity or heavy lifting add to the risk. If the protrusion becomes stuck in the narrow gap (incarcerated hernia) the blood supply may be compromised (strangulated hernia) and surgery is required.
Common types of hernia include abdominal, femoral and inguinal. In sport the groin is a common site of pain or discomfort, and the term sportsman's hernia is sometimes used inappropriately for a variety of other conditions that cause it (including musculotendinous injuries and osteitis of the pubic bone). It is important to diagnose accurately the cause of groin pain, as treatment options, including those involving surgery, will differ, and particularly relevant to identify a true hernia, which may be due to a tear in the external oblique muscle for which there are various methods of surgical repair.
See also abdominal muscles.hernia, n condition in which a part of the peritoneum or an intestine protrudes through weakened muscles, either of the diaphragm or of the abdominal wall. Hernias are typically classified based on their location. Hernia. her·ni·a , pl. hernias, pl. herniae (hĕr'nē-ă, -ăz, -ē) Protrusion of a part or structure through the tissues normally containing it. hernia (hur´nēə), n the protrusion of an organ through an abnormal opening in the muscle wall of the cavity that surrounds it.
It may be congenital, may result from the failure of certain structures to close after birth, or may be acquired later in life because of obesity, muscular weakness, surgery, or illness. hernia, hiatal, n a protrusion of a portion of the stomach upward through the diaphragm. The condition occurs in approximately 40% of individuals and most people display few, if any, symptoms. The major difficulty is gastroesophageal reflux, which is the backflow of the acid contents of the stomach into the esophagus.
hernia, inguinal (direct), n a protrusion of the intestines into an opening between the deep epigastric artery and the edge of the rectus muscle; (indirect) involves the internal inguinal ring and passes into the inguinal canal. hernia the abnormal protrusion of part of an organ or tissue through the structures normally containing it. In this condition, a weak spot or other abnormal opening in a body wall permits part of the organ to bulge through.
A hernia may develop in various parts of the body; most commonly in the region of the abdomen. A layman's term for hernia is rupture. A hernia is either acquired or congenital. Anatomically specific hernias are listed under their individual sites. caudal abdominal h's cerebral hernia cord hernia a type of umbilical hernia in which the midgut has failed to return to the abdominal cavity during fetal development and remains within the umbilical cord.
crural hernia femoral hernia. external hernia protrusion of abdominal contents through an opening in the abdominal wall. false hernia a structural defect with contents but without a peritoneal sac. fat hernia hernial protrusion of peritoneal fat through the abdominal wall or through the vulvar wall during a difficult calving. incarcerated hernia hernia so occluded that it cannot be returned by manipulation; it may or may not become strangulated.
incisional hernia hernia after operation at the site of the surgical incision, owing to improper healing or to excessive strain on the healing tissue; such strain may be caused by excessive muscular effort, activity, or by obesity, which creates additional pressure on the weakened area. inguinoscrotal hernia see scrotal hernia (below). irreducible hernia incarcerated hernia. mesenteric hernia hernia of a loop of small intestine through a traumatic tear in the mesentery.
muscle hernia the belly of the muscle protrudes through a tear in the fascia and epimysium. paraesophageal hernia hiatal hernia in which part or almost all of the stomach protrudes through the hiatus into the thorax to the left of the esophagus, with the gastroesophageal junction remaining in place. pelvic hernia hernia caused by a loop of intestine becoming incarcerated in a hiatus between the wall of the pelvis and the ductus deferens, caused by tearing of the fold of the ductus at castration.
May occur many months after the castration operation. Can be resolved, if diagnosed early enough, by traction on the taut mesentery per rectum. pericardial hernia perineal hernia pleuroperitoneal hernia prepubic hernia the result of avulsion of the cranial pubic tendon. reducible hernia one that can be returned by manipulation. scrotal hernia inguinal hernia which has passed into the scrotum.
When these become strangulated they cause severe abdominal pain and acute local swelling. In large animals the tightened spermatic cord can be felt disappearing into the inguinal canal. See also intestinal obstruction. Scrotal hernia in a horse. By permission from Knottenbelt DC, Pascoe RR, Diseases and Disorders of the Horse, Saunders, 2003 sliding hiatal hernia hiatal hernia in which the stomach and the cardioesophageal junction protrude into the caudal mediastinum; the protrusion, which may be fixed or intermittent, is partially covered by a peritoneal sac.
slip hernia, slipped hernia sliding hernia. strangulated hernia one that is tightly constricted. As any hernia progresses and bulges out through the weak point in its containing wall, the opening in the wall tends to close behind it, forming a narrow neck. If this neck is pinched tight enough to cut off the venous return, the hernia will quickly swell and become strangulated. This is a very dangerous condition that can appear suddenly and requires immediate surgical attention.
Unless the blood supply is restored promptly, gangrene can set in and may cause death. traumatic hernia protrusion of abdominal viscera into a subcutaneous site because of traumatic injury to the abdominal muscles. uterine hernia a gravid uterus can prolapse through an inguinal hernia in dogs and cats. vaginal hernia hernia into the vagina; called also colpocele. ventral hernia trauma with tearing of the body wall results in prolapse of abdominal contents into the subcutaneous tissue.
Also reported in ewes from violent straining during parturition. Patient discussion about hernia Q. do you know of a good gastro doctor in staten island ny. I have acid refex so bad cant sleep, or lay flat.. years ago was told I had a hiatus hernia, and would only have fLare ups once in a while, have taken nexium for years, and it worked, but not anymore.. I really need to find a good doctor to test me again.
A. yazmine, if you want, you can try consume daily yogurt with a little apple cider vinegar in it (just add 5ml of ACV in your yogurt). some of gastric problems are believed to be caused by some bacteria. apple cider vinegar will help regulate the normal condition inside your gastric mucosa, so that for the long run it probably can help improve your condition. Q. I have a low back pain that radiates to my leg when i pick up stuff.
Is it a disc herniation? I am a 43 years old bank teller. During the past 5 months I've suffered from a low back pain. The pain is not very strong, but it gets much worse while doing physical activity. When i walk or lift heavy things the pain is even stronger, and it radiates to my left leg. Can it be signs for disc herniation? A. It's possible that you have a nerve impingement from a disc herniation, but not necessarily so.
What you need to know is that even if you have a herniated disc, the question is what would the recommended treatment be?90% or more of herniated discs resolve without surgical treatment within 6 months. MRI imaging is generally only indicated if one is considering surgery; in other words, your pain and neurological status is such that surgery is clinically indicated. Then, an MRI may be helpful for the surgeon.
If surgery is not indicated based on clinical/symptoms, then it probably is unwise to get an MRI. They often show abnormalities that are simply 'red herrings' and often prompt people to proceed with surgery that really is not needed. Beware! More discussions about hernia