General and Laparoscopic Surgery

 

Doctor List

  • Dr. Debarchan Ghosh, MBBS, MS, DIP, LS (Gold Medalist) HOD (Full Time Consultant)

  • Dr. Abhishek Guha Thakurta, MBBS, DNB (Gen Surgery) (Full Time Consultant)

  • Dr. Sumanta Dey MS , DNB , MNAMS , FMAS , FNB - Minimal Access Surgery (Full Time Consultant)

  • Dr. Soumit Dey, MBBS, MS (General Surgery) (Registrar)

  • Dr. Anirban Nandi, MBBS, MS (Gen Surg)

  • Dr. Sougata Deb, MS, FRCS

  • Dr. Debjani Chatterjee, MBBS, MS

  • Dr. Dhiraj Choudhury, MS, FRCS

  • Dr. Zayd Ashok Rahman, MBBS, MS (Gen Surg)

  • Dr. Dhritman Maitra, MBBS, MS, DNB (General Surgery), M.CH (Breast Endocrine Surgery & GL Surg), FIAGES

  • Dr. Susenjit Prasad Mahato, MBBS, MS, FMAS, MRCS (Part I)

  • Dr. Rahul Dhar, MBBS, MS (Gen Surgery), MRCS (Edinburgh)

  • Dr. Somak Ghosh, MBBS, DNB (Gen Surgery), MNAMS, FMAS, Certificate in Laser Proctology

 

Apart from high specialty areas such as Cardiac, Cardio Thoracic and Neuro-surgery, surgeons at Ruby Hospital also undertake a variety of relatively minor but popular repair work of the body like appendix removal surgery and thyroid surgery. In many cases patients can be released after a few hours on a day-care basis surgeries. At the other end of the spectrum, there are emergency surgical cases for patients in intensive care or coming through the Emergency Department.

 

Principal Procedures

Appendix Removal (Appendectomy)

An appendectomy is a surgery to remove the appendix when it is infected. This condition is called appendicitis. Appendectomy is a common emergency surgery. The appendix is a long narrow tube (a few inches in length) that attaches to the first part of the colon. It is usually located in the lower right quadrant of the abdominal cavity. There are two types of surgery to remove the appendix. The standard method is an open appendectomy and a less invasive method is laparoscopic appendectomy.

Open appendectomy - A cut or incision about 2 to 4 inches long is made in the lower right-hand side of the belly or abdomen. The appendix is taken out through the incision.

Laparoscopic appendectomy - This method is less invasive. That means it is done without a large incision. Surgeons operate through 3 small incisions (each ¼ to ½ inch). A long, thin tube called a laparoscope is put into one of the incisions. It has a tiny video camera and surgical tools. The surgeon looks at a TV monitor to see inside the abdomen and guide the tools. The appendix is removed through one of the incisions. In some cases, one of the small openings may be lengthened to complete the procedure.

Laparoscopic appendectomy - This method is less invasive. That means it is done without a large incision. Surgeons operate through 3 small incisions (each ¼ to ½ inch). A long, thin tube called a laparoscope is put into one of the incisions. It has a tiny video camera and surgical tools. The surgeon looks at a TV monitor to see inside the abdomen and guide the tools. The appendix is removed through one of the incisions. In some cases, one of the small openings may be lengthened to complete the procedure.

Advantages of laparoscopic appendectomy

Results may vary depending upon the type of procedure and patient’s overall condition. Common advantages are:

  • Less post-operative pain

  • Faster recovery and return to normal activity

  • Shorter hospital stay

  • Less post-operative complications

  • Minimally sized incisions/scars

  • In most cases, patients can be discharged within 24 to 36 hours.

 

Cholesystectomy (Gall Bladder)

Cholecystectomy is the surgical removal of the gallbladder. The operation is done to remove the gallbladder due to gallstones causing pain or infection.

There are two main ways of removing a gallbladder:

Laparoscopic (keyhole) cholecystectomy - Several small cuts (incisions) are made in the abdomen and fine surgical instruments are used to access and remove the gallbladder. During the surgery, a small incision (about 2 to 3cm) is made by the belly button and 2 or 3 smaller incisions (about 1cm or less) are made on the right side of the abdomen. A small tube is inserted into one of the incisions and carbon dioxide gas is pumped into the abdomen, inflating it to make it easier for the surgeon to access the gallbladder. A laparoscope (a long, thin telescope with a light and camera at the end) is inserted through the larger incision, which allows the surgeon to see inside the abdomen on a monitor. Special surgical instruments are inserted through the other incisions and are used to remove the gallbladder. The gas is released from the abdomen, and the incisions are closed with sutures, surgical clips or glue. One can usually go home later the same day.

Open cholecystectomy - A single larger incision is made in the abdomen to access and remove the gallbladder. The surgeon makes an incision approximately 6 inches long in the upper right side of the abdomen and cuts through the fat and muscle to the gallbladder. The gallbladder is removed, and any ducts are clamped off. The site is stapled or sutured closed. A small drain may be placed going from the inside to the outside of the abdomen. The drain is usually removed in the hospital.

Non surgical treatment :

Results may vary depending upon the type of procedure and patient’s overall condition. Common advantages are:

  • Thinning Bile with Acid Pills can dissolve gallstones

  • Small gallstones can be broken apart with Shock Waves

  • Endoscopic drainage follows the gallbladder’s natural path

  • Percutaneous Cholecystostomy is best for seriously ill patients

  • Transmural Drainage decompresses a swollen gallbladder

  • Acute Cholecystostomy, an ultrasound-guided drainage procedure

 

Spleenectomy

Splenectomies can be performed as laparoscopic surgeries if the spleen is not too enlarged. In a laparoscopic splenectomy, the surgeon makes just a few small cuts in the abdomen. In this technique, a tube is inserted into the abdomen and the space is inflated with carbon dioxide. The surgeon places other tubes into the abdomen through other small holes, allowing the placement of instruments. The spleen is cut free of all connections, put inside a special bag, and pulled through one of the largest holes in the abdomen. This type of surgery is minimally invasive and has a quicker and less painful recovery time than open surgery.

Open splenectomy - A traditional open surgery involves making a cut down the center of the abdomen. The surgeon then moves aside other tissues to remove the spleen. The incision is then closed with stitches. Open surgery is preferred if there is scar tissue from other surgeries or if the spleen has been ruptured.

Advantages of laparoscopic splenectomy :

Individual results may vary depending on the overall condition and health but the usual advantages are the following :

  • Less postoperative pain

  • Shorter hospital stay

  • Faster return to a regular, solid food diet

  • Quicker return to normal activities

  • Better cosmetic results

  • Fewer incisional hernias

 

Hernia Repair

A hernia occurs when fatty tissue or an organ pushes through a weak place in the surrounding connective tissue or muscle wall. Hernias usually don’t get better on their own. They tend to get bigger. In rare cases, they can lead to life-threatening complications. Hernia repair surgery or herniorrhaphy involves returning the displaced tissues to their proper position. A hernia is usually treated with surgery. The three main types of hernia surgery are open repair, laparoscopic (minimally invasive) repair, and robotic repair. 

Open surgery - It is done under local or general anaesthetic. An incision usually around 2.5 to 3 inches is made to the skin near the hernia and the surgeon pushes the hernia back into the abdomen. The incision is then either stitched closed or much more commonly a mesh is placed over the hole and fixed using fine stitches. The mesh acts like a scaffold and the tissue will regrow through the mesh to reinforce the weakened area without putting tension on the surrounding tissues.

Keyhole (laparoscopic) surgery - It is done under general anaesthetic, several smaller incisions are made to allow the surgeon to use a less invasive technique using various special instruments including a tiny telescopic camera to repair the hernia. A mesh may then be used to strengthen the abdominal wall. Laparoscopic (minimally invasive) hernia repair uses a laparoscope, a thin, telescope-like instrument that is inserted through a small incision at the umbilicus (belly button). This procedure is usually performed under general anesthesia, so before the surgery, one has to have an evaluation of the general state of health, including a history, physical exam and an electrocardiogram (EKG). The laparoscope is connected to a tiny video camera, that projects an "inside view" of the body onto television screens in the operating room. The abdomen is inflated with a harmless gas (carbon dioxide), which creates space and allows the doctor to view the internal structures. The peritoneum (the inner lining of the abdomen) is cut to expose the weakness in the abdominal wall. Mesh is then placed on the inside to cover the defects in the abdominal wall and strengthen the tissue. After the procedure is completed, the small abdominal incisions are closed with a stitch or two or with surgical tape. Within a few months, the incisions are barely visible.

The most frequently seen types of hernia include the following :

  •  Inguinal hernias : The most common hernia and seen more in men. It causes a bulge in the groin. The inguinal hernia appears through the inguinal canal, a narrow passage through which blood vessels pass through in the abdominal wall and, may reach the scrotum.

  •  Femoral hernias : It also causes a bulge in the groin, relatively uncommon and seen more in women. The femoral hernia happens at the hole in the abdominal wall where the femoral artery and vein pass from the abdomen into the leg.

  •  Hiatus hernias : They occur in the upper chest area when part of the stomach pushes up into the chest by squeezing through a gap in the diaphragm called the hiatus.

  •  Umbilical / periumbilical hernias – These occur at the umbilicus, a natural weakness in the abdominal wall, when fatty tissue or a part of the bowel pokes through the abdomen near the naval.

  •  Incisional hernia – They occur through a scar from past abdominal surgery as tissue pokes through the weak healed site in the abdominal wall.  

  •  Reducible hernia – When the hernia can be pushed back into the opening it came through.  

  • Irreducible or incarcerated hernia – When the organ or abdominal tissues have filled the hernia sac, and it cannot be pushed back through the hole it came through.  

  • Strangulated hernia – When part of an organ or tissue becomes stuck inside the hernia with its blood supply often cut off.  

 

Thyroid Surgery

The thyroid is a small gland shaped like a butterfly. It is located in the lower front part of the neck, just below the voice box. The thyroid produces hormones that the blood carries to every tissue in the body. It helps regulate metabolism — the process by which the body turns food into energy. It also plays a role in keeping the organs functioning properly and helping the body conserve heat.

The most common reason for thyroid surgery is the presence of nodules or tumors on the thyroid gland. Most nodules are benign, but some can be cancerous or precancerous. Even benign nodules can cause problems if they grow large enough to obstruct the throat, or if they stimulate the thyroid to overproduce hormones (a condition called hyperthyroidism).

Another reason for thyroid surgery is the swelling or enlargement of the thyroid gland. This is referred to as a goiter. Like large nodules, goiters can block the throat and interfere with eating, speaking, and breathing.

Types of Thyroid Surgery :

There are several different types of thyroid surgery. The most common are lobectomy, subtotal thyroidectomy, and total thyroidectomy.

Lobectomy - Sometimes a nodule, inflammation, or swelling affects only half of the thyroid gland. When this happens, the doctor will remove only one of the two lobes. The part left behind should retain some or all of its function. It is sometimes called a "diagnostic lobectomy" because the preoperative diagnosis may be uncertain and part of the reason for the operation is to make a diagnosis of cancer or no cancer. A diagnostic lobectomy may or may not involve a frozen section. A frozen section is biopsy of the nodule that is taken during the operation while the patient is still under anesthesia.

Subtotal Thyroidectomy - A subtotal thyroidectomy removes the thyroid gland but leaves behind a small amount of thyroid tissue. This preserves some thyroid function. It may be done for benign thyroid conditions that affect both thyroid lobes, such as large goiter or Graves’ disease, or it may be done for cancer. A subtotal thyroidectomy means that a very small amount of benign thyroid tissue is left behind. Thyroid tissue may be intentionally left behind in areas around important structures, such as the nerves that control the voice, swallowing, and breathing, or the parathyroid glands. Many individuals who undergo this type of surgery develop hypothyroidism, a condition that occurs when the thyroid doesn’t produce enough hormones. This is easily treated with daily hormone supplements.

Total Thyroidectomy - A total thyroidectomy removes the entire thyroid and the thyroid tissue. It may be done years later or it may be done soon after a lobectomy This surgery is appropriate when nodules, swelling, or inflammation affect the entire thyroid gland, or when cancer is present. All patients who undergo a completion thyroidectomy will need to be on life-long thyroid hormone replacement after surgery.

Minimally Invasive Thyroid Surgery - The typical incision made for thyroid surgery is known as a "collar incision" in which a large incision (around 5 to 6 inches) is made stretching from one side of the neck to the other just above the collar bone. Minimally invasive thyroid surgery refers to certain types of surgery in which the thyroid is removed through very small incisions (an inch to an inch and a half in length) using special techniques. In addition to using very small incisions, the surgeons "hide" the incision in a natural skin crease which acts like camouflage. Most people will not be able to notice the incision once the redness fades away.

 

Oesophageal surgery

Surgery is often used to treat esophageal cancer. The type of surgery one has depends mainly on the size, stage and location of the cancer. Doctors may classify esophageal cancer as resectable or unresectable. Resectable means that a tumour can be removed with surgery. Sometimes doctors cannot tell exactly how big an esophageal tumour is, or if it can be completely removed, until they do surgery. They may think that a tumour is resectable based on tests, but then they discover during surgery that it cannot be removed or that it has spread, or metastasized. If doctors find out that the tumour is unresectable or that it has spread, they may do palliative surgery to relieve pain or to prevent or treat symptoms of a blockage.

Types of Oesophageal surgery :

Different approaches or methods can be used to esophageal cancer and do reconstructive surgery. The type of approach used depends on the size and location of the tumour, how much or which part of the esophagus needs to be removed, whether or not the stomach will be removed, the overall health and the surgeon’s preference. The approach used does not affect whether or not the surgeon can successfully remove the tumour or the side effects, or complications, that can develop after surgery.

Transthoracic approach - The transthoracic approach is also called the Ivor-Lewis approach. It can be used for tumours in the middle or lower esophagus. The surgeon makes a cut, or incision, from the bottom of the breast bone to the belly button to reach the stomach. The stomach is cut away from the tissues that hold it in place. Then the surgeon makes a cut in the right side of the chest, or thorax, to open the chest wall (called a thoracotomy). The surgeon removes the part of the esophagus that has cancer or the entire esophagus followed by reconstructive surgery.

Transhiatal approach - The transhiatal approach is commonly used for early stage tumours in the middle or lower esophagus. It may also be used for advanced esophageal cancer when the patient is unable to have a thoracotomy (a surgical cut to open the chest wall).
The surgeon makes a cut, or incision, from the bottom of the breast bone to the belly button to reach the stomach and esophagus. The stomach and lower part of the esophagus are cut away from the tissues that hold them in place. A cut in the left side of the neck is made to reach the upper and middle parts of the esophagus. These parts of the esophagus are cut away from the tissues that hold them in place. The surgeon removes the part of the esophagus that has cancer or the entire esophagus followed by reconstructive surgery.

Left thoracoabdominal approach - The left thoracoabdominal approach can be used for cancers in the lower esophagus or gastroesophageal (GE) junction, where the esophagus joins the stomach.
A cut, or incison is made from the middle of the abdomen upwards to the left side of the chest. The esophagus is cut away from the tissues that hold it in place. The surgeon removes the part of the esophagus that has cancer or the entire esophagus. The surgeon may also make a cut in the left side of the neck to reach the upper and middle parts of the esophagus followed by reconstructive surgery.

Minimally invasive (MIS) esophagectomy - During minimally invasive (MIS) esophagectomy, the doctor uses an endoscope (a tube-like instrument with a light and lens). In an endoscopic resection, the tumour is removed using a long, flexible tube (endoscope). This is the preferred option for removing very early-stage oesophageal tumours. It involves less risk and a faster recovery than an oesophagectomy. Preparation and recovery are similar to endoscopy. This may be the only treatment needed for some people with early-stage oesophageal cancer. As a result, people who have endoscopic techniques usually have a shorter hospital stay and faster recovery time.
MIS esophagectomy and reconstructive surgery are done using both laparoscopic and thoracoscopic surgery.

Laparoscopic surgery is done using a long, flexible tube with a light and lens (called a laparoscope) to view structures or organs inside the body and to remove tissues. The doctor makes 4–6 small cuts in the abdomen to place the laparoscope.

Thoracoscopic surgery is done using a long, flexible tube with a light and lens (called a thoracoscope) to view structures and organs inside the chest, or thorax. The doctor makes small cuts through the chest wall. The thoracoscope and the surgical instruments are passed through separate cuts into the chest cavity. Sometimes doctors pass a small video camera through the thoracoscope to help them see inside the chest cavity. This is called video-assisted thoracoscopy (VAT), or video-assisted thoracic surgery (VATS).

Oesophagectomy Oesophagectomy is the most common type of surgery used to treat esophageal cancer. This procedure removes the cancerous sections of the oesophagus. Lymph nodes close to the esophagus are also removed during surgery to see if cancer has spread to them. Depending on how far the cancer has spread, the surgeon may also remove part of the upper stomach, lymph nodes and other tissue. This is the preferred option for tumours that have spread deeper into the walls of the oesophagus or nearby lymph nodes. Usually chemotherapy and/or radiation therapy is performed before an oesophagectomy to shrink large tumours and destroy any cancer cells that may have spread
Sometimes, cancer develops in the lower part of the esophagus near the stomach or at the gastroesophageal (GE) junction, where the esophagus and stomach meet. The surgeon will remove the cancerous part of the esophagus, 8–10 cm of normal esophagus above the tumour and part of the stomach. The stomach is then joined to part of the remaining esophagus, which is in either the upper chest or neck.
If the tumour is in the middle esophagus, most of the esophagus is removed. The surgeon brings up the stomach and joins it to the part of the esophagus left in the neck. In some cases, the surgeon uses a piece of the colon to replace the part of the esophagus that was removed. Then the colon is joined to the part of the esophagus left in the neck and to the stomach.
If the tumour is in the upper part of the esophagus, surgery is not usually used.

Reconstructive surgery Reconstructive surgery is usually done at the same time as surgery to remove the tumour in the esophagus. Reconstructive surgery helps the gastrointestinal (GI) tract work as normally as possible after the cancer is removed.
The type of reconstructive surgery done is based on the personal needs, the overall health, the location and size of the tumour and any treatments already taken. Different surgeons have different preferences and expertise with certain surgical procedures.

Gastric pull-up  When part or the total esophagus is removed, the best option is a gastric pull-up. The surgeon pulls the stomach up, reshapes it into a tube and joins it to the part of the esophagus that is left. The connection made between the esophagus and the stomach is called an anastomosis.

Reconstruction using the colon or small intestine  The surgeon might use a piece of the colon (the longest part of the large intestine) or a piece of the small intestine to replace the esophagus. This type of surgery is done if the stomach cannot be used for reconstruction. For example, the colon or part of the small intestine may be used if one already has had surgery to the stomach.

Placement of a feeding tube  Surgery may be used to place a feeding tube directly into the middle part of the small intestine (called the jejunum) through an incision, or cut, in the abdomen. This is called a surgical jejunostomy tube. This allows a person to get all the nutrients needed as he / she recovers from surgery. In some cases, a feeding tube may be placed directly into the stomach through an incision in the abdomen. This is called a surgical gastrostomy tube.

 

Gastric resections

 

Wipple's Operation

The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. The Whipple procedure is used to treat tumors and other disorders of the pancreas, intestine and bile duct. It is generally the removal of the gallbladder, common bile duct, part of the duodenum, and the head of the pancreas. Surgery to remove a tumor offers the best chance for long-term control of all pancreatic cancer types. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation.

In a standard Whipple procedure, the surgeon removes the head of the pancreas, the gallbladder, the duodenum, a portion of the stomach and surrounding lymph nodes. The surgeon then reconnects the remaining pancreas and digestive organs.

In some cases, patients may undergo a modified version of the Whipple procedure, which keeps the entire stomach and the stomach valve called the pylorus. This is called a pylorus-preserving Whipple.

Whipple procedure is recommended to treat:

  • Pancreatic cancer

  • Pancreatic cysts

  • Pancreatic tumors

  • Pancreatitis

  • Ampullary cancer

  • Bile duct cancer

  • Neuroendocrine tumors

  • Small bowel cancer

  • Trauma to the pancreas or small intestine

  • Other tumors or disorders involving the pancreas, duodenum or bile ducts

A Whipple procedure may be done in various ways:

Open surgery:  During an open procedure, the surgeon makes an incision in the abdomen in order to access the pancreas.

Laparoscopic surgery:  During laparoscopic surgery, the surgeon makes several smaller incisions in the abdomen and inserts special instruments, including a camera that transmits video to a monitor in the operating room. The surgeon watches the monitor to guide the surgical tools in performing the Whipple procedure. Laparoscopic surgery is a type of minimally invasive surgery.

Pancreatic Surgery:  Surgery for pancreatic conditions addresses either tumors of the pancreas or conditions that cause inflammation (pancreatitis). Pancreatic tumors are uncommon but may be either malignant or benign. Surgery of the pancreas most often involves removing the diseased portion of the organ. Symptoms of pancreatic cancer include pancreatitis, abdominal pain that can radiate, and jaundice. Surgery remains the primary form of treatment for pancreatic cancer, although only a small portion of patients with this disease will be candidates for curative operations, in part because the cancer tends to be well advanced when diagnosed. Some of the patients will require only surgery, while some will also undergo chemotherapy or radiation therapy before or after surgery.

Types of Surgery :

  •  Whipple procedure : The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. When the pancreatic tumor is confined to this area, the standard surgical strategy is to remove this portion of the pancreas, as well as the gall bladder and part of the small intestine, bile duct, and stomach. The surgeon then reconnects the remaining portion of the pancreas, stomach, bile duct, and small intestine. Enough of the pancreas is left to produce digestive juices and insulin.

  •  Distal pancreatectomy : In this operation, the surgeon removes only the tail of the pancreas or the tail and a portion of the body of the pancreas. If the tumor is located in the body or tail of the pancreas, the surgical approach is to remove just these sections of the organ. Typically, the surgeon will also remove the spleen because of its proximity and tissue connections to the tail of the pancreas. Partly because the surgeon is removing the area that is distal to the connection of the pancreas with the other portions of the digestive system, no reconstructive surgery is necessary. Again, with a portion of the pancreas remaining after the operation, patients are unlikely to need to take insulin after undergoing this operation. Unfortunately, many of these tumors have usually already spread by the time they are found and surgery is not always an option.

  • Total Pancreatectomy : The extent of the cancer dictates whether the entire pancreas must be removed or not. This operation removes the entire pancreas, as well as the gallbladder, part of the stomach and small intestine, the spleen and some lymph nodes. This surgery might be an option if the cancer has spread throughout the pancreas but can still be removed. But this type of surgery is used less often than the other operations because there doesn’t seem to be a major advantage in removing the whole pancreas, and it can have major side effects. Those who undergo this surgery develop diabetes, which can be hard to manage because they are totally dependent on insulin shots. People who have had this surgery also need to take pancreatic enzyme pills to help them digest certain foods.

  •  Palliative Surgery – ometimes when imaging studies reveal that the cancer has spread too far to be removed completely, and that curative surgery is thus not possible, any surgery being considered would be palliative (intended to relieve symptoms). Pancreatic cancers can cause pain or obstruction of the digestive tract.
    Cancers growing in the head of the pancreas can block the nearby bile duct as it passes through this part of the pancreas. This can cause pain and digestive problems because bile can’t get into the intestine. The bile chemicals will also build up in the body, which can cause jaundice, nausea, vomiting, and other problems. There are two main options to relieve bile duct blockage in this situation:

    Minimally Invasive Pancreatic Resections - Laparoscopic surgery allows the surgeon to access the abdomen via a number of small "keyhole" incisions (less than one centimeter each). Many patients with pancreatic cysts that require surgery are candidates for this approach, which offers smaller incisions, shorter hospitalization, less pain, and a faster return to normal life.

    Enucleation of Pancreatic Tumors - A subset of benign or low-grade pancreatic tumors can be safely enucleated (carefully scooped out of the pancreas with a razor thin margin between tumor and pancreas) rather than requiring more extensive surgical removal of a portion of the pancreas. This strategy is technically demanding, but preserves pancreatic tissue and function.
    Endoscopic procedures are also possible, to place stents (tubes) to keep the bile duct open. The stent may drain to the outside of the body or into the small intestine. These procedures are more common for patients with extensive disease or who are too weakened to be candidates for an open surgical operation to relieve bile obstruction.
    Another type of palliative surgery is tumor resection for patients whose cancer has already spread to other parts of the body at the time of initial diagnosis. The step can help reduce later bleeding, blockages, pain, and other symptoms caused by masses and by tumor invasion of nearby organs.

    Stent placement - The most common approach to relieving a blocked bile duct does not involve actual surgery. Instead, a stent (small tube, usually made of metal) is put inside the duct to keep it open. This is usually done through an endoscope. Often this is part of an endoscopic retrograde cholangiopancreatography (ERCP). The doctor passes the endoscope down the throat and all the way into the small intestine. Through the endoscope, the doctor can then put the stent into the bile duct. The stent can also be put in place through the skin during a percutaneous transhepatic cholangiography (PTC). 

    Bypass surgery - In people who are healthy enough, another option for relieving a blocked bile duct is surgery to reroute the flow of bile from the common bile duct directly into the small intestine, bypassing the pancreas. This typically requires a large incision (cut) in the abdomen, and it can take weeks to recover from this. Sometimes surgery can be done through several small cuts in the abdomen using special long surgical tools. (This is known as laparoscopic or keyhole surgery.)

 

Colorectal surgery

It deals with disorders of the rectum, anus, and colon.

Major colon and rectal diseases :

  • Colorectal Cancer

  • Anal cancer (rare)

  • Ulcerative Colitis

  • Rectal prolapse

  • Crohn's Disease

  • Birth Defects such as the Imperforate Anus

  • Irritable Bowel Syndrome (IBS)

  • Diverticular Disease

  • Hemorrhoids

  • Anal Fissure

  • Fistulas

  • Severe constipation

  • Bowel Incontinence

Types of Surgery :

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. It is often called surgical resection. This is the most common treatment for colorectal cancer. Part of the healthy colon or rectum and nearby lymph nodes will also be removed. Colorectal surgeons are also called proctologists.

Laparoscopic surgery - Laparoscopic surgery is a specialized minimally invasive surgery in which the surgeon uses several small abdominal incisions (0.5-1 cm) to insert several viewing scopes and surgical instruments into the abdominal cavity as well as a long thin lighted tube with a camera on the end called laparoscope. A larger incision, about 3 cm wide, is made to remove the resected tumor. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors in the operating room. The recovery time is often shorter than with standard colon surgery. Laparoscopic surgery is as effective as conventional colon surgery in removing the cancer.

Colostomy for rectal cancer - This is a surgical opening, or stoma, through which the colon is connected to the abdominal surface to provide a pathway for waste to exit the body. This waste is collected in a pouch worn by the patient. The surgeon creates a hole in the abdominal wall and pulls one end of the colon through the opening. Sometimes, the colostomy is only temporary to allow the rectum to heal, but it may be permanent. With modern surgical techniques and the use of radiation therapy and chemotherapy before surgery when needed, most people who receive treatment for rectal cancer do not need a permanent colostomy.

The colostomy is either temporary or permanent:

  • Temporary colostomies are performed for specific conditions that allow for the reattachment of the colon at a later point in time. The colostomy allows the affected area to heal because the stool is not passing through the area. Once the affected area has healed, a colostomy reversal procedure is performed.

  • Permanent colostomies are used in cases of chronic disease, such as Crohn’s disease and diverticular disease. The surgeon may also remove the infected area of the colon or rectum.

  • Radiofrequency ablation (RFA) or cryoablation - Some patients may be able to have surgery on the liver or lungs to remove tumors that have spread to those organs. Other ways include using radiofrequency waves to heat the tumors, called Radiofrequency Ablation (RFA), or to freeze the tumor, called cryoablation. RFA can be done through the skin or during surgery. While this can help avoid removing parts of the liver and lung tissue that might be removed in a regular surgery, there is also a chance that parts of a tumor might be left behind.

Left thoracoabdominal approach - The left thoracoabdominal approach can be used for cancers in the lower esophagus or gastroesophageal (GE) junction, where the esophagus joins the stomach.
A cut, or incison is made from the middle of the abdomen upwards to the left side of the chest. The esophagus is cut away from the tissues that hold it in place. The surgeon removes the part of the esophagus that has cancer or the entire esophagus. The surgeon may also make a cut in the left side of the neck to reach the upper and middle parts of the esophagus followed by reconstructive surgery.

Minimally invasive (MIS) esophagectomy - During minimally invasive (MIS) esophagectomy, the doctor uses an endoscope (a tube-like instrument with a light and lens). In an endoscopic resection, the tumour is removed using a long, flexible tube (endoscope). This is the preferred option for removing very early-stage oesophageal tumours. It involves less risk and a faster recovery than an oesophagectomy. Preparation and recovery are similar to endoscopy. This may be the only treatment needed for some people with early-stage oesophageal cancer. As a result, people who have endoscopic techniques usually have a shorter hospital stay and faster recovery time.
MIS esophagectomy and reconstructive surgery are done using both laparoscopic and thoracoscopic surgery.

Laparoscopic surgery is done using a long, flexible tube with a light and lens (called a laparoscope) to view structures or organs inside the body and to remove tissues. The doctor makes 4–6 small cuts in the abdomen to place the laparoscope.

Thoracoscopic surgery is done using a long, flexible tube with a light and lens (called a thoracoscope) to view structures and organs inside the chest, or thorax. The doctor makes small cuts through the chest wall. The thoracoscope and the surgical instruments are passed through separate cuts into the chest cavity. Sometimes doctors pass a small video camera through the thoracoscope to help them see inside the chest cavity. This is called video-assisted thoracoscopy (VAT), or video-assisted thoracic surgery (VATS).

Radiation therapy - Radiation therapy, which is used to destroy cancer cells is commonly used for treating rectal cancer because this tumor tends to recur near where it originally started. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

External-beam radiation therapy - This therapy uses a machine to deliver x-rays to where the cancer is located.

Stereotactic radiation therapy -  Stereotactic radiation therapy is a type of external-beam radiation therapy that may be used if a tumor has spread to the liver or lungs. This type of radiation therapy delivers a large, precise radiation dose to a small area. This technique can help save parts of the liver and lung tissue that might otherwise have to be removed during surgery. However, not all cancers that have spread to the liver or lungs can be treated in this way.

Other types of radiation therapy - Specialized radiation therapy techniques, such as intraoperative radiation therapy or brachytherapy, may help get rid of small areas of cancer that could not be removed with surgery.

  • Intraoperative radiation therapy - Intraoperative radiation therapy uses a single high dose of radiation therapy given during surgery.

  • Brachytherapy -  Brachytherapy is the use of radioactive "seeds" placed inside the body. In one type of brachytherapy with a product called SIR-Spheres, tiny amounts of a radioactive substance called yttrium-90 are injected into the liver to treat colorectal cancer that has spread to the liver when surgery is not an option. Some studies suggest that it may help slow the growth of cancer cells.

Radiation therapy for rectal cancer -  For rectal cancer, radiation therapy may be used before surgery, called neoadjuvant therapy, to shrink the tumor so that it is easier to be removed. It may also be used after surgery to destroy any remaining cancer cells. Chemotherapy is often given at the same time as radiation therapy, called chemoradiation therapy, to increase the effectiveness of the radiation therapy. Chemoradiation therapy is often used in rectal cancer before surgery to avoid colostomy or reduce the chance that the cancer will recur. Studies have shown that chemoradiation therapy before surgery worked better and caused fewer side effects than the same radiation therapy and chemotherapy given after surgery. The main benefits included a lower rate of the cancer returning in the area where it started, fewer patients who needed permanent colostomies, and fewer problems with scarring of the bowel where the radiation therapy was given.

Types of colorectal cancer resection surgeries :

  • Right hemicolectomy

  • Sigmoid colectomy

  • Left hemicolectomy

  • Lower anterior resection (LAR)

 

Liver resection

A liver resection is the surgical removal of all or a portion of the liver. It is also referred to as a hepatectomy, full or partial. This operation is usually done to remove various types of liver tumors that are located in the resected portion of the liver. The surgeon considers resection if the cancer is small, the liver is healthy, and the cancer has not grown into the blood vessels. The goal of liver resection is to completely remove the tumor and the appropriate surrounding liver tissue without leaving any tumor behind. This operation is also for some types of liver cancer and for certain cases of metastatic colorectal cancer. 

Types of surgery :

Surgery gives the best chance of curing primary liver cancer. The procedure may be performed through a traditional open procedure or using minimally invasive techniques. The best option is with either surgical resection (removal of the tumor with surgery) or a liver transplant. Small liver cancers may also be cured with other types of treatment such as ablation or radiation.

There are different types of surgery for early liver cancer. These are:

  • Removal of part of the liver (liver resection or lobectomy)

  • Liver transplant

Lobectomy -  The surgeon might remove a lobe of the liver. This is called a lobectomy or hemi hepatectomy. The liver can grow back and work normally if there are no underlying problems, such as cirrhosis. A type of liver cancer called fibrolamellar cancer is more likely to develop in people without liver disease, which means that surgery is often possible.

Partial Hepatectomy -  Partial hepatectomy is a surgery to remove part of the liver. Only people with good liver function and are healthy enough for surgery and who have a single tumor that has not grown into blood vessels can have this operation.
Imaging tests, such as CT or MRI with angiography are done first to see if the cancer can be removed completely. But, sometimes during surgery the cancer is found to be too large or has spread too far to be removed, and the planned surgery cannot be performed.
Most patients with liver cancer also have cirrhosis. If someone has severe cirrhosis, removing even a small amount of liver tissue at the edges of a cancer might not leave enough liver behind to perform important functions. Such patients are typically eligible for surgery if there is only one tumor (that has not grown into blood vessels) and will still have a reasonable amount of liver function left once the tumor is removed.

Liver transplant - A liver transplant is possible in some people with hepatocellular liver cancer (HCC). Liver transplants can be an option for those with tumors that cannot be removed with surgery, either because of the location of the tumors or because the liver has too much disease for the patient to tolerate removing part of it. In general, a transplant is used to treat patients with no more than three small tumours in the liver, or a single tumour not more than 5cm across, or a single tumour 5 to 7 cm across and has not grown for at least six months and also that have not grown into nearby blood vessels. It can also rarely be an option for patients with resectable cancers (cancers that can be removed completely). With a transplant, not only is the risk of a second new liver cancer greatly reduced, but the new liver will function normally.

 

Mastectomy (Breast Removal) -

A mastectomy is a way of treating breast cancer by surgically removing a breast and sometimes other tissues near the breast, such as lymph nodes, are also removed. This surgery is most often used to treat breast cancer. It is aso often done when a woman cannot be treated with breast-conserving surgery (lumpectomy), which spares most of the breast. It can also be done if a woman chooses mastectomy over breast-conserving surgery for personal reasons. Women at very high risk of getting a second cancer sometimes have a double mastectomy, the removal of both breasts. In some cases, a mastectomy is done to help prevent breast cancer in women who have a high risk for it .

A mastectomy may be a treatment option for many types of breast cancer, including:

  • Ductal carcinoma in situ (DCIS), or noninvasive breast cancer

  • Stages I and II (early-stage) breast cancer

  • Stage III (locally advanced) breast cancer — after chemotherapy

  • Inflammatory breast cancer — after chemotherapy

  • Paget's disease of the breast

  • Locally recurrent breast cancer

  • Post radiotherapy treatment

Types of mastectomy :

There are several types of mastectomy. They include:

Total (simple) mastectomy - A total mastectomy, also known as a simple mastectomy, involves removal of the entire breast, including the breast tissue, areola and nipple. Some underarm lymph nodes may or may not be removed depending on the situation. A sentinel lymph node biopsy may be done at the time of a total mastectomy.

Double mastectomy - When mastectomy is done on both breasts, it is called a double (or bilateral) mastectomy. This involves the surgeon removing both breasts, usually as a preventive measure and often as a risk-reducing surgery for women who are at a very high risk for getting breast cancer — if genetic features indicate a high risk of breast cancer, for example.

Radical mastectomy - This involves the surgeon removing the entire breast, the axillary (underarm) lymph nodes, and the pectoral (chest wall) muscles under the breast. This was the standard surgery for many years, but less extensive surgery has been found to be just as effective and with fewer side effects, so this surgery is rarely done. This surgery may be advised for large tumors that are growing into the pectoral muscles.

Modified radical mastectomy - A modified radical mastectomy combines a simple mastectomy with the removal of the lymph nodes under the arm (called an axillary lymph node dissection). This involves the surgeon removing the entire breast and underarm lymph nodes but leaving the chest wall muscles intact. In some cases, part of the chest wall muscle is also removed.

Skin-sparing mastectomy - This involves removal of all the breast tissue, nipple and areola, but not the breast skin. The amount of breast tissue removed is the same as with a simple mastectomy. A sentinel lymph node biopsy also may be done. The surgeon also reconstructs the breast during the procedure. Implants or tissue from other parts of the body are used at the time of surgery to reconstruct the breast. . It may not be a good method for tumors that are large or near the skin surface. The risk of local cancer recurrence with this type of mastectomy is the same as with other types of mastectomies. 

Nipple-sparing mastectomy - Nipple-sparing mastectomy is similar to the skin-sparing mastectomy. It is sometimes called a total skin-sparing mastectomy This relatively new procedure involves removal of only breast tissue, sparing the skin, nipple and areola. This is followed by breast reconstruction. The surgeon often removes the breast tissue beneath the nipple (and areola) during the procedure to check for cancer cells. If cancer is found in this tissue, the nipple must then be removed. Even if no cancer is found under the nipple, some doctors give the nipple tissue a dose of radiation during or after the surgery to try to reduce the risk of the cancer coming back.

 

Circumcision

Circumcision is a surgical procedure to remove the foreskin, the skin that covers the tip of the penis. In the most common procedure, the foreskin is opened, adhesions are removed, and the foreskin is separated from the glans. After that, a circumcision device may be placed, and then the foreskin is cut off.

Medical reasons for circumcision :

  •  Tight foreskin (phimosis)  : Phimosis is where the foreskin is too tight to be pulled back over the head of the penis (glans). This can sometimes cause pain when the penis is erect and, in rare cases, passing urine may be difficult.

  •  Recurrent balanitis  : Balanitis is where the foreskin and head of the penis become inflamed and infected.

  •  Paraphimosis  : Paraphimosis is where the foreskin can't be returned to its original position after being pulled back, causing the head of the penis to become swollen and painful.

  •  Balanitis xerotica obliterans  : This condition causes phimosis and, in some cases, also affects the head of the penis, which can become scarred and inflamed.

 

Lumbar Sympathectomy

A lumbar sympathectomy injection is one method used to provide pain relief by blocking the pain-inducing sympathetic nerves in the lumbar (lower) region of the back. Sympathetic nerves are responsible for controlling the automatic functions of our body’s skin temperature, but can also be responsible for increasing pain we experience from an injury, long after the injury has healed. These are made close to the spine in the lumbar region. A lumbar sympathetic block will block nerves known as sympathetic nerves to try to improve the pain. The injection may be undertaken alongside other treatments such as physiotherapy.

 

Whipple Surgery

A Whipple procedure, also known as a pancreaticoduodenectomy is the primary surgical treatment for pancreatic cancer that occurs within the head of the gland. It is a surgery to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder, the bile duct, a portion of the stomach and surrounding lymph nodes. It is the most common surgery to remove tumors in the pancreas and to treat pancreatic cancer that is confined to the head of the pancreas. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation. In some cases, patients may undergo a modified version of the Whipple procedure, which keeps the entire stomach and the stomach valve called the pylorus. This is called a pylorus-preserving Whipple. The Whipple procedure has been used increasingly over the years in treating pain and other complications of chronic pancreatitis.

Doctors may recommend a Whipple procedure to treat:

  • Pancreatic cancer

  • Pancreatic cysts

  • Pancreatic tumors

  • Chronic Pancreatitis

  • Ampullary cancer

  • Bile duct cancer (Cholangiocarcinoma)

  • Neuroendocrine (Islet Cell) Tumours

  • Small bowel cancer

  • Trauma to the pancreas or small intestine

  • Other tumors or disorders involving the pancreas, duodenum or bile ducts

  • Cancer of the distal (lower portion) of the bile duct

  • Duodenal cancer

  • cancer of the small intestine

A Whipple procedure may be done in various ways:

  •  Open surgery  : During an open procedure, the surgeon makes an incision in the abdomen in order to access the pancreas. This is the most common approach and the most studied.

  •  Laparoscopic surgery  : During laparoscopic surgery, the surgeon makes several smaller incisions in the abdominal wall and inserts a laparoscope including a camera that transmits video to a monitor in the operating room. The surgeon watches the monitor to guide the surgical tools in performing the Whipple procedure. Laparoscopic surgery is a type of minimally invasive surgery.

 

Adrenalectomy

Adrenalectomy is the surgical removal of one or both (bilateral adrenalectomy) adrenal glands. The adrenal glands are two small organs, one located above each kidney. These glands produce hormones that helps regulate the daily functions of the body including the immune system, metabolism, blood sugar levels, and blood pressure control. Sometimes an adrenal tumor forms on the glands and cause the increase in hormone production. When this happens, the gland needs to be removed. Most adrenal tumors are noncancerous (benign). Surgery may be required to remove an adrenal gland if the tumor is producing excess hormones or is large in size (more than 2 inches or 4 to 5 centimeters). Surgery may also be required if the tumor is cancerous (malignant) or suspected to be cancerous. Adrenalectomy is usually advised for patients with tumors of the adrenal glands.

Types of adrenalectomy

Surgeons may perform an adrenalectomy through minimally invasive (laparoscopic) or traditional open surgery, or use cryoablation. The procedure recommended by the surgeon depends on the size and type of tumor or the condition affecting the adrenal gland.

  • Minimally invasive surgery  : Laparoscopic adrenalectomies are more common than open procedures. They also have a high success rate. Endocrine surgeons are often able to use minimally invasive (laparoscopic) surgery for tumors of the adrenal gland because the gland is relatively small. During a laparoscopic adrenalectomy, a surgeon makes small incisions in the abdomen and near the belly button to access the adrenal glands. A cannula (a narrow tube-like instrument) is placed into the abdominal cavity in the upper abdomen or flank just below the ribs. Laparoscopic surgery has many benefits, including smaller scars, less pain and a shorter recovery period than traditional open surgery. An alternative approach to laparoscopic surgery is a posterior retroperitoneoscopic adrenalectomy (PRA), in which surgeons make small incisions on the back.

  • Open surgery  : Doctors usually reserve open surgery for especially large or cancerous (malignant) tumors. They perform open surgery using traditional instruments and incisions. The surgeon makes large incisions under the ribcage or on the sides of the body. These incisions allow the surgeon access to the glands and the blood vessels attached to them.

  • Cryoablation  : In addition, doctors may use cryoablation to treat adrenal tumors. This procedure uses CT imaging to guide the insertion of a probe that freezes and destroys adrenal tumors. Interventional radiologists may use cryoablation as a treatment option for small tumors that have spread to the adrenal gland (metastasis), particularly when surgery carries a high risk.

 

Fundoplication

Fundoplication is the standard surgical method used for treating heartburn caused by gastroesophageal reflux disorder (GERD). GERD is a chronic backup of stomach acid or contents into the esophagus, which is the tube that food goes down when we eat. It causes inflammation, pain (heartburn), and other serious complications (such as scarring and stricture) of the esophagus. In patients with GERD, the sphincter does not function normally. The muscle is either weak or relaxes inappropriately. Fundoplication is a surgical technique that helps strengthen the barrier to acid reflux when the sphincter does not function normally. This procedure is usually successful and has a good long-term outlook.

Fundoplication surgery is most often used to treat GERD symptoms that are likely to be caused in part by a hiatal hernia and that have not been well controlled by medicines. The surgery may also be used for some people who do not have a hiatal hernia. Surgery also may be an option when:

  • Treatment with medicines does not completely relieve the symptoms, and the remaining symptoms are proved to be caused by reflux of stomach juices.

  • Because of side effects, one is unable to take medicines over an extended period of time to control the GERD symptoms, and one is willing to accept the risks of surgery.

  • One has symptoms that do not adequately improve when treated with medicines. Examples of these symptoms are asthma, hoarseness, or cough along with reflux.

  • Severe inflammation of the esophagus, the tube that runs from the mouth to the stomach

  • A narrowing of the esophagus that is not caused by cancer

  • Barrett's esophagus, a change in the cells because of acid reflux

Several types of fundoplication are possible

  • Nissen 360-degree wrap : The fundus is wrapped all the way around the bottom of the esophagus to tighten the sphincter. This prevents from any burping or vomiting that may make the GERD worse.

  • Toupet 270-degree posterior wrap  : The fundus is wrapped about two-thirds of the way around the back side, or posterior, of the bottom of the esophagus. This creates a sort of valve that easily lets one to release gas through burps or vomit when necessary.

  • Watson anterior 180-degree wrap  : The part of the esophagus next to the diaphragm is reconstructed. Then, the fundus is wrapped halfway around the front, or anterior, of the bottom of the esophagus and attached to part of the diaphragm tissue.

Each procedure can be done laparoscopically. This means that the surgeon makes several small incisions and inserts tiny surgical instruments and a small, thin tube with a camera and light to perform the surgery. This makes the recovery faster and leaves smaller scars than an open procedure.
During fundoplication surgery, the upper curve of the stomach (the fundus) is wrapped around the esophagus and sewn into place so that the lower portion of the esophagus passes through a small tunnel of stomach muscle. This surgery strengthens the valve between the esophagus and stomach (lower esophageal sphincter), which stops acid from backing up into the esophagus as easily. This allows the esophagus to heal.

Nissen Fundoplication : A Nissen fundoplication is the definitive surgical treatment for GERD where medical therapy has failed and to achieve a permanent solution to the problem of acid reflux backup into the stomach. During the Nissen fundoplication, the upper part of the stomach is wrapped around the LES to strengthen the sphincter, prevent acid reflux, and repair a hiatal hernia. The Nissen fundoplication is usually performed as a laparoscopic (minimally invasive) procedure. The doctor uses small instruments that hold a camera to look at the abdomen and pelvis. When performed by experienced surgeons, laparoscopic fundoplication is safe and effective in people of all ages, including infants.

 

Varicose Vein

Varicose veins, also known as varicoses or varicosities, are twisted, swollen veins that often appear on the legs and feet. That is because standing and walking upright increases the pressure in the veins of the lower body. They occur when the valves in the veins become dilated, do not work properly, become enlarged and overfilled with blood so the blood does not flow effectively. The veins rarely need treatment for health reasons, but if swelling, aching, and painful legs result, and if there is considerable discomfort, treatment is available.

Surgery

If varicose veins are large, they may need to be removed surgically.

  • Ligation and stripping : Two incisions are made, one near the groin at the top of the target vein, and the other is made further down the leg, either at the ankle or knee. A tunneling device is placed under the skin between the two points, and the saphenous vein is dragged or pulled out of the tunnel. The top of the vein is tied up and sealed. A thin, flexible wire is threaded through the bottom of the vein and then pulled out, taking the vein with it. This technique will leave not only scars from the incisions, but also a significant amount of bruising and possibly bleeding.

  • Sclerotherapy  : Sclerotherapy involves injecting a chemical inside small and medium-sized varicose veins that obliterates it and causes it to scar. Sclerotherapy is not completely successful in alleviating symptoms and preventing formation of more varicose veins. Complications associated with sclerotherapy include allergic reactions to the chemical used, stinging or burning at the various injection sites, inflammation, skin ulcerations, and permanent discoloration of the skin. Bandages often remain in place for as long as three weeks. Wearing compression stockings is usually recommended after sclerotherapy.

  • Radiofrequency ablation  : Ablation is a similar technique to endovascular laser therapy, but it uses heat to destroy the vein. A small incision is made either above or below the knee, and with the help of an ultrasound scan; a narrow tube (catheter) is threaded into the vein. The doctor inserts a probe into the catheter, which emits radiofrequency energy. The radiofrequency energy heats up the vein, causing its walls to collapse, effectively closing it and sealing it shut. This procedure is preferred for larger varicose veins.

  • Endovenous laser treatment  : Endovenous laser therapy is a technique that uses a laser to destroy the vein. A catheter is inserted into the patient's vein. A small laser is threaded through the catheter and positioned at the top of the target vein; it delivers short energy bursts that heat up the vein, sealing it shut. With the aid of an ultrasound scan, the doctor threads the laser all the way up the vein, gradually burning and sealing all of it. This procedure is done under local anesthetic.

  • Transilluminated powered phlebectomy  : An endoscopic transilluminator (special light) is threaded through an incision under the skin so that the doctor can see which veins need to be taken out. The target veins are cut and removed with a suction device through the incision.

 

A V Fistula

An arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. It may be congenital, it can occur at any point in the vascular system, and can be surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm. Normally, blood flows from the arteries to the capillaries to the veins. With an arteriovenous fistula the blood flows directly from the artery into the vein, bypassing the capillaries that are located downstream of the fistula, resulting in a diminished blood supply. Arteriovenous fistulas usually occur in the legs, but can develop anywhere in the body. Arteriovenous fistulas are often surgically created for use in dialysis in people with severe kidney disease. A large untreated arteriovenous fistula can lead to serious complications.

Causes of arteriovenous fistulas include:

  • Cardiac catheterization : An arteriovenous fistula may develop as a complication of a procedure called cardiac catheterization. During cardiac catheterization, a long, thin tube called a catheter is inserted in an artery or vein in the groin, neck or arm and threaded through the blood vessels to the heart. If the needle used in the catheterization crosses an artery and vein during the procedure, and the artery is widened (dilated), this can create an arteriovenous fistula. This rarely happens.

  • Injuries that pierce the skin  : It's also possible to develop an arteriovenous fistula after a piercing injury, such as a gunshot or stab wound. This may happen if the wound is on a part of the body where a vein and artery are side by side.

  • Being born with an arteriovenous fistula  : Some people are born with an arteriovenous fistula (congenital). In congenital arteriovenous fistulas the arteries and veins do not develop properly in the womb.

  • Genetic conditions  : Arteriovenous fistulas in the lungs (pulmonary arteriovenous fistulas) can be caused by a genetic disease (Osler-Weber-Rendu disease, also known as hereditary hemorrhagic telangiectasia) that causes blood vessels to develop abnormally throughout the body, but especially in the lungs.

  • Surgical creation (AV fistula procedure)  : People who have late-stage kidney failure may have an arteriovenous fistula surgically created to make it easier to perform dialysis. If a dialysis needle is inserted into a vein too many times, the vein may scar and be destroyed. Creating an arteriovenous fistula widens the vein by connecting it to a nearby artery, making it easier to insert a needle for dialysis and causing blood to flow faster. This AV fistula is usually created in the forearm.

 
 

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