Introduction to surgery. Definition of general surgery and its types.

1. GENERAL SURGERY
Dr, Syed Altaf
Assistant Professor

2. Objectives
• Introduction to surgery.
• Definition of general surgery and its
types.
• Preparation of patient for surgery.
• Assessment of patient before surgery.
• Indication & contraindication of surgery.

3. Surgery is a procedure that involves
cutting of a patient's tissues or closure of a
previously sustained wound.
(Or)
Surgery is defined as the treatment of
injuries or disorders of the body by
incision or manipulation, especially with
instruments.
SURGERY
“Surgery” word is derived from Greek
(HAND WORKING)

4. General surgery• General Surgery is a medical discipline
that involves performing various types
of surgical procedures to treat a broad
range of health problems and diseases.
• These include bile ducts, liver,
pancreas, spleen, appendix, small and
large intestine, rectum, and the
stomach etc.

5. Surgical procedures are
classified based On
1.Urgency
2.Risk
3.Purpose
TYPES OF SURGERY

6. 1.Elective surgery
2.Urgent surgery
3.Emergency surgery
SURGERY BASED ON URGENCY

7. • It is a procedure that is pre planned
and based on patients choice and
availability of scheduling for the
patient, surgeon and the facility.
• Delay of surgery has no ill effects.
ELECTIVE SURGERY

8. Examples are…
 Hernia repair
 Cataract extraction
 Tonsillectomy
 Hip prosthesis
ELECTIVE SURGERY

9. • Must be done with in a reasonably
short time frame to preserve health.
Usually done with in 24 – 48 hours.
• Examples are…
 Removal of gall bladder
Amputation
Appendectomy
URGENT SURGERY

10. • Must be done immediately to
preserve life, a body part or
function.
• Examples are…
Control of haemorrhage
Repair of trauma ,perforated
ulcers , intestinal obstruction..
EMERGENCY SURGERY

11. 1.Major surgery
2.Minor surgery
SURGERY BASED ON DEGREE OF RISK

12. • Major surgery requires
hospitalization and specialized
care, is usually prolonged, has a
higher degree of risk, involves
major body organs or life
threatening situations, and has a
greater risk for postoperative
complications.
MAJOR SURGERY

13. • Examples are…
 Open Cholecystectomy
 Nephrectomy
 Hysterectomy
 Radical mastectomy
 Laparotomy
MAJOR SURGERY

14. • Minor surgery is usually brief,
carries a low risk and results
in few complications. Minor
surgeries are mostly elective.
• Examples are…
Teeth extraction
Cataract extraction
MINOR SURGERY

15. 1.Diagnostic
2.Ablative
3.Palliative (Intestinal Obst)
4.Reconstructive
5.Transplantation
6.Constructive
SURGERIES BASED ON PURPOSE

16. Surgeries to make or confirm a
diagnosis.
1. DIAGNOSTIC SURGERY
•Examples are…
 Biopsy
 Bronchoscopy
 Endoscopy

17. ABLATIVE SURGERY
• Surgeries To remove a
diseased body part.
•Examples are…
Appendectomy
Amputation

18. PALLIATIVE SURGERY
• Surgeries to relieve or reduce
intensity of an illness.
• It is not curative.
•Examples are…
Colostomy
Nerve root resection

19. RECONSTRUCTIVE SURGERY
• Surgeries to restore function to
traumatized or malfunctioning
tissue or to improve self concept.
Examples are…
Scar revision
Plastic surgery
Internal fixation of a fracture
Breast reconstruction

20. TRANSPLANTATION SURGERY
• Surgeries to replace organs
or structures that are
diseased or malfunctioning
• Examples are…
 Kidney, liver, heart
transplantation.

21. CONSTRUCTIVE SURGERY
• Surgeries To restore functions
in congenital anomalies.
• Examples are…
Cleft lip Repair
Closure of Atrial Septal Defect

22. Proper patient
- adequate indication of surgery
(lack of contraindications)
- written, informed consent
Proper timing
- wait for the best condition of the patient
(depends on the urgency of the case)
- preferably operate when the staff is in
the best condition.
Proper circumstances
- all the personal and material conditions
of a successful surgery are met – no time
PREREQUISITES OF SURGERY

23. Theoretical and practical knowledge
- knowledge of the possible treatment options
- assessment of the risk/benefit ratio
- experience – beyond the learning curve
- honor your limits – personal, material, etc.
- audition of the results – learn from the mistakes
Knowledge of the patient
- history
- examination
- disease course
- think out of the box – are there better non-
surgical
treatments?
Manual abilities
THE ROLE OF THE SURGEON

24. Vital
Can only be treated with immediate/urgent
surgery, timing cannot be chosen
-major bleeding, ileus, perforation, appendicitis.
-Absolute
Can only be treated with surgery, can be
scheduled
-tumors, symptomatic hernias or gall stones
-Relative
May be treated by non-surgical means /
no harm done without surgery
- asymptomatic hernia or gall stones, GERD
INDICATION OF SURGERY

25. Social/cosmetic
No harm done without surgery, intervention is
performed upon the request of the patient
- breast augmentation, bariatric surgery
Prophylactic
Aims to prevent a later disease or medical
condition
- FAP, „negative” appendectomy
Diagnostic
Aims to diagnose a disease or medical
condition
- lymph node biopsy, diagnostic laparoscopy
INDICATION OF SURGERY

26. Factors related to the indication of surgery
- Diagnosis
- Symptoms (if no exact diagnosis is known)
- Timing of the surgery
(immediate/urgent/scheduled)
- Operative load
- Operative tolerance
- Operability – technical, medical, oncological
- Alternative treatment modalities
- Prognosis
- Personal/material/(financial) circumstances
- Patient consent
ESTABLISHING THE INDICATION
Always consider cost/benefit ratio!

27. Medical/anesthesiological
- Laboratory parameters (ions [K!], blood sugar, Hb, INR)
- Age – decreased significance!
- General conditions, co-morbidities
- Drugs (e.g. Warfarin, antidepressants)
- Allergies, issues with anesthesia/intubation
Surgical
- Technical (depends on surgeon and institute)
- Oncological (curative intent/palliation)
Operability depends on
- the nature of intervention
- the type of indication
QUESTION OF OPERABILITY
Nil Nocere (don’t do harm)!

28. Absolute contraindication
- Moribund state, coma
- Severe cardiac failure
- Hemorrhagic shock (without surgical
cause:
e.g. gastrointestinal bleeding)
- Severe metabolic or haemostatic
imbalance
-Lack of written informed consent
(except in life-threatening cases)
CONTRAINDICATION OF SURGERY

29. - Age
–Pregnancy (depends on trimester)
–Co-morbidities
–Confirmed, end-stage incurable disease
–Better alternative treatment modalities
–Technical reasons (instruments, staff,
circumstances, etc.)
Relative contraindications

30. Before every surgery: lab tests, chest X-ray,
anesthesiology examination + special
investigations if necessary
Assessment of the general condition of the
patient
- Everyday activity of the patient =
cardiorespiratoric reserve, nutrition, diabetes,
age (biologic ↔ chronologic), emotional and
social conditions
Consultations
- Anesthesiology, specialists (cardiology, ECHO,
spirometry, etc.)
ASSESSMENT OF SURGICAL RISK

31. Factors that can be modified
- Diabetes, heart failure (pacemaker)
- Blood pressure
- Hematologic diseases (history)
- Nutritional state (obesity, cachexy)
- Infectious sources (teeth, ulcers, etc.)
- Certain medication (Warfarin, platelet
adhesion inhibitors, tricyclic
antidepressants)
Factors that cannot be modified
Age, sex, chronic diseases
PREPARATION FOR SURGERY
Well before the surgery

32. Per os feeding
- Nothing per os (NPO) from the night of the
surgery
Bowel preparation
Blood volume resuscitation
Metabolic balance
- DM, renal functions
Antibiotics
Thrombosis prophylaxis
- should be started before the surgery
Thorough cleaning (+surgical skin
preparation)
Emotional, psychological preparation
PREPARATION FOR SURGERY
Right before the surgery

34. Thank You