Other Surgical Treatment

General surgery focuses on the abdominal organs. Despite the term "general" surgeons that practice general surgery, they are skilled surgeons that typically operate on common abdominal complaints including appendix removal, hernias, gallbladder surgeries, stomach and intestinal issues. Breast care and Vascular surgery also comes under the broad term of General Surgery.

General surgery has recently been divided into a number of sub-specialties. This has been necessary due to the increasingly specialist nature of all surgery, and the need for individual surgeons to develop their skills in these specialist areas.

The hospital will ensure that your consultation is with a Consultant appropriate to your reason for referral.

Excision of Skin Lesions

Skin lesions are lumps and bumps such as moles, warts, fatty lumps (lipomas), cysts and skin tags. Most skin lesions do not cause problems but require removing because of practical or cosmetic reasons. Excision refers to the complete removal of the skin lesion usually by cutting it out, freezing it off with the use of liquid nitrogen or possibly with the use of chemicals.

The procedure is usually performed under a local anaesthetic. This temporarily numbs the skin around the lesion and you will be fully awake throughout. On rare occasions the lesion may require sedation or general anaesthetic depending on its size. The actual procedure will vary depending on the type of skin lesion but usually takes between fifteen and thirty minutes in total. Anything removed will usually be sent for analysis.

Hysteroscopy

A diagnostic hysteroscopy is a procedure used to look inside the uterus. The hysteroscope is a thin telescope like instrument with a camera that is inserted into the uterus via the vagina and cervix.

This is used to look for abnormalities and to identify the causes of heavy and / or painful periods, or any abnormal bleeding / discharge not associated with menstruation. It may also be useful to identify polyps or fibroids and may help when investigating causes of infertility.

An operative hysteroscopy is when an additional procedure or biopsy is carried out. Common treatments carried out at the time of the hysteroscopy include; removal of polyps, removal of adhesions or scar tissue, small fibroids, removal of contraceptive devices when required or the insertion of contraceptive devices.

It is quite usual for biopsies to be taken to aid diagnosis and treatment and you will be brought back at a later date for the results to be discussed with you.

This procedure is normally carried out as an outpatient or daycase procedure and would not generally involve an overnight stay.

What is a laparoscopy /What is a diagnostic laparoscopy

Laparoscopy is a procedure that Doctors use to look inside the abdomen. Prior to surgery taking place other investigations may be carried out such as xray or ultrasound scan. A laparoscopy is commonly used to investigate pelvic pain, period problems or problems relating to fertility. This is known as a diagnostic laparoscopy. Simple problems will be identified and treated at the time of the procedure. The Consultant will have explained what he expects to find and obtained consent to treat these findings beforehand.

Common problems identified via laparoscopy include endometriosis, pelvic inflammatory disease, ovarian cysts, fibroids or damaged fallopian tubes.

The procedure is usually done under a general anaesthetic and is often fairly short depending on the findings. The incision sites are small and are generally just below the umbilicus. It is common for a temporary catheter to be passed to keep the bladder empty which provides a better view for the Gynaecologist. This can be done as a daycase procedure and rarely involves an overnight stay.

FESS. Functional endoscopic sinus surgery

Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical procedure that opens up sinus air cells and sinus ostia (openings) with an endoscope. The purpose of FESS is to restore normal drainage of the sinuses. Normal function of the sinuses requires ventilation through the ostia (mouth-like opening) All sinuses need ventilation to prevent infection and inflammation, a condition known as sinusitis. The sinuses open into the middle meatus (curved passage in each nasal cavity) under the middle turbinate (thin, bony process that is the lower portion of the ethmoid bone in each nasal cavity), which together are known as the osteomeatal complex, the key area of the nose. The hair-like cilia direct the flow of mucus toward the ostia. Sinusitis develops when there is a problem in the area where the maxillary and frontal sinuses meet near the nose or, occasionally, by dental infection. When sinusitis occurs, the cilia work less efficiently, preventing the flow of mucus. The mucous membranes of the sinuses become engorged, resulting in ostia closure. Poor ventilation and accumulation of mucus then produce the conditions required for bacterial infection.

FESS offers several advantages:

• It is a minimally invasive procedure.
• It does not disturb healthy tissue.
• It is performed in less time with better results.

It minimizes bleeding and scarring

SMR (submucous resection)

The nasal septum is the partition inside the nose made of cartilage which separates the two nostrils. Usually the septum is straight and upright, and is in the middle of the nose. Inside your nose the septum can be bent over. You may feel that your nose is blocked or may have headaches and pain in the face. You may have sinus infection and even ear problems. Removing a small piece of cartilage from inside the septum will straighten it out. The surgeon will remove the bent piece of cartilage so that the passages on either side are the same. Further back, the septum changes into bone, and this may be crooked. The surgeon will remove small pieces of bone to make it straight again. The cut inside the nose will be closed with stitches which will dissolve on their own and do not need to be removed. Plastic splints and gauze packing soaked in Vaseline will then be put into the nose to keep everything straight and stop any bleeding. The nasal packing and splints will be removed on the second morning after your operation by the nurses on the ward. You should be fit to go home later that day.

Grommett Insertion

Grommet insertion is necessary when patients are suffering from a build up of fluid in the middle ear, which can lead to hearing difficulties and infection. By making a small cut in the eardrum, the surgeon pushes a thin sucking instrument through the hole and into the middle ear. With this instrument, the surgeon draws out the fluid. To complete the grommet insertion surgery, the surgeon plugs the hole with a small, hollow plastic tube into the middle ear to dry up any remaining fluid. The entire procedure can be performed as an inpatient procedure, and both ears can be treated on the same day if necessary.

After grommet insertion surgery, most patients feel little to no pain. The fluid remaining in the middle ear dries within 6 to 8 weeks, leading to improved hearing. The grommet remains in place for approximately 1 year. As the fluid dies up, the hole in the ear drum reduces in size and squeezes the grommet out, which often gets stuck in ear wax in the ear tube.

Myringoplasty

A myringoplasty is performed to close a hole (perforation) in the ear drum. Closing the perforation will provide one or more of the following benefits:

1. Fewer ear infections.
2. The freedom to get the ear wet.
3. Improved hearing.

The ear drum may be approached by two different routes. Reaching the drum through the ear canal may be possible in some circumstances, but many operations require a post-aural approach. This involves making a cut behind the ear and flipping it forward. Tissue is taken from another cut behind the ear and made into a graft. The hole is then prepared and the graft slipped behind the drum to cover the perforation. The ear is packed with antiseptic ribbon. There can be complications.

1. Graft failure - sometimes, the graft will not be successful in making the ear drum heal. This occurs in 20-30% of the cases.
2. Infection - both the wound and the ear may become infected.
3. Scar - there will be a small scar behind the ear.
4. Rare (<1% chance) complications:
   Loss of hearing - it is a very rare complication that hearing may be damaged, reduced or lost entirely in that ear.
5. Tinnitus - there is a very small chance you may be left with a ringing noise in your ear.
6. You may experience an alteration in the taste of food or notice a metallic taste in your mouth. This can be temporary or permanent.

Pinnaplasty (bat ears)

Pinnaplasty (bat ears), more commonly known as ear reshaping or ear corrective surgery, is a popular and common cosmetic surgery procedure within the UK. The aim of pinnaplasty is to improve the contour and shape of the ears and this is achieved by removing skin and reshaping cartilage from the ear. A pinnaplasty procedure can be performed under a local anaesthetic or general and usually takes about 1-hour. Protruding ears is the main motivation for an ear reshaping procedure. Often patients complain of having ears that are ‘too large’ when this is not always the problem - what people do not realise is that the problem is not necessarily the size of the ears but that they may stick out too far. In most cases pinning the ears alongside the head solves the problem completely. Patients seek ear reshaping to improve upon a perceived imperfection and these imperfections can often cause a psychological impact. Ex-patients have revealed that the psychological benefits of the ear reshaping procedure exceeded their expectations – increased self confidence and self esteem. The visual improvements following pinnaplasty can often make the final result very rewarding.

Septoplasty

Septoplasty is a surgical procedure to correct the shape of the septum of the nose. The goal of this procedure is to correct defects or deformities of the septum. The nasal septum is the separation between the two nostrils. In adults, the septum is composed partly of cartilage and partly of bone. Septal deviations are either congenital (present from birth) or develop as a result of an injury. The nasal septum has three functions: to support the nose, to regulate air flow, and to support the mucous membranes (mucosa) of the nose. Septoplasty is done to correct the shape of the nose caused by a deformed septum or correct deregulated airflow caused by a deviated septum. During surgery, the patient's own cartilage that has been removed can be reused to provide support for the nose if needed. External septum supports are not usually needed. Internal Splints may be needed occasionally to support cartilage when extensive cutting has been done. External splints can be used to support the cartilage for the first few days of healing. Gauze is inserted in the nostril to support the flaps and cartilage and to absorb any bleeding or mucus.

Adenoidectomy

The adenoids are removed if they block breathing through the nose and if they cause chronic earaches or deafness. They are located near the tonsils, which are two other lumps of similar tissue. In childhood, adenoids and tonsils are believed to play a role in fighting infections by producing antibodies that attack bacteria entering the body through the mouth and nose. In adulthood however, it is unlikely that the adenoids are involved in maintaining health, and they normally shrink and disappear. Between the ages of two and six, the adenoids can become chronically infected, swelling up and becoming inflamed. This can cause breathing difficulties, especially during sleep. The swelling can also block the eustachian tubes that connect the back of the throat to the ears, leading to hearing problems until the blockage is relieved. The purpose of an adenoidectomy is to remove infected adenoids. Since they are often associated with infected tonsils, they are often removed as part of a combined operation that also removes the tonsils. An adenoidectomy is performed under general anesthesia. The surgeon removes the adenoids from behind the palate. Stitches are usually not required. Adenoidectomy is an operation that has very good outcomes, and patients are expected to make a full and quick recovery once the initial pain has subsided.

Bladder Botox ®

A procedure known as bladder Botox ® is being used for the treatment of over-active bladder syndrome and suitable for females over the age of 40 with urinary frequency, episodes of leakage and failed medical therapy.

The over-active bladder can be a nuisance factor and the use of Botulinium Toxin has been used for decades in therapeutic medicine. Having been used for bladders conditions for 20 years it has been popularised over the last 8 years.

It is effective and simple and is performed by injecting down a telescope known as a cystoscopy, into the bladder area. This procedure is performed on an out-patient basis under local anaesthetic and can be repeated at a 7 monthly interval. This treatment is carried out at Abbey Sefton Hospital, Liverpool.

Cystoscopy

A cystoscopy is a procedure that uses a special instrument, called a cystoscope, to examine the inside of the bladder. It is usually carried out for a number of reasons for example, to help make a diagnosis or to carry out minor surgery.

A cystoscope is a thin telescope that is passed into your body and allows the doctor to look inside your bladder and other parts of your urinary system.

The cystoscope has channels down which small instruments can be passed and used to carry out procedures for example, a thin grabbing instrument may be used to take a small tissue sample to send away to be tested.

There are two types of cystoscope:

• Flexible cystoscope: is a thin, flexible, fibre-optic telescope which is about as thick as a pencil and allows your consultant to see around bends. It is usually used to examine the inside of your urinary system, either to help make a diagnosis or to make sure that treatment has worked. The flexible cystoscope shows views of the inside of your body to a monitor for your consultant to look at.
• Rigid cystoscope: is often used to take samples or to carry out surgery by passing instruments through separate channels.

A flexible cystoscope is the type most commonly used as it can be passed easily along the curves of the urethra. As the flexible tip can be moved easily, it enables your consultant to examine the inside lining of the bladder.

Both flexible and rigid cystoscopes can be used for carrying out procedures, although the rigid cystoscope allows a greater variety of devices to be passed down its channels.

A cystoscopy may be carried out to diagnose the cause of symptoms.

• Frequent urinary tract infections,
• blood in your urine
• incontinence (partial or total loss of control
• unusual cells found in a urine sample
• Difficulty in passing urine which may be due to prostate enlargement or a
• Narrowing of the urethra.
• serious or repeated infections,

How it is performed

A cystoscopy is usually done as an outpatient or day case. However, if surgery is being carried out, or a large sample of tissue taken, you may have to stay in hospital overnight. A cystoscopy is usually done while you are awake, although some people are given a sedative to help them relax.

During the procedure, you will lie on a couch, on your back, and the cystoscope will be pushed in through your urethra as gently as possible. You may have a local anaesthetic to numb the lining of the urethra, to help the cystoscope pass in with as little discomfort as possible. Occasionally, a general anaesthetic may be given, particularly if a rigid cystoscope is being used.

Your consultant will look carefully at the lining of the urethra and bladder. A saline solution may be passed down a channel in the cystoscope to slowly fill your bladder. This gives your consultant a better view of the lining of the bladder. However, as your bladder fills, you will feel the urge to pass urine which may be uncomfortable.

A cystoscopy will take about 5-10 minutes, if it is being done to simply look inside your bladder. However, it will take longer to carry out a procedure - for example, take a biopsy (small tissue sample) from the bladder lining.

Following a cystoscopy, you should recover quite quickly. If you have not had a general anaesthetic, you will be allowed to go home the same day. If you have had a general anaesthetic, then you may need to stay in hospital over night.

For about a day or so after the cystoscopy, you may experience some mild discomfort and have a slight burning sensation when you pass urine. You will possibly need to urinate more frequently and may pass a little blood in your urine.

TURP

Sometimes surgery is needed to remove the part of a prostate cancer that is pressing on the urethra - the tube that carries urine from your bladder. Your consultant may suggest an operation that will take away some of the cancer so that you can pass urine more easily again. This operation is not done to cure your cancer. But it can relieve symptoms. This operation is also often used for men who have a non-cancerous swelling of the prostate gland called BPH. This type of surgery is called a TUR or TURP, which stands for 'transurethral resection of the prostate'.

A TURP is carried out by passing a thin tube up the urethra via your penis. The tube is a telescope, so your consultant can see inside your urethra. The blockage is removed using an instrument attached to the telescope that can cut away the abnormal areas. This operation usually means about 2 or 3 nights in hospital

You usually have a TURP under a general anaesthetic, but for some men, it is done with a spinal anaesthetic. This means you are awake, but can't feel anything below the level of the anaesthetic injection into your spine. Your doctor will suggest a spinal anaesthetic if there are reasons why you shouldn't have a general anaesthetic, for example if your lungs are not as healthy as they might be.

After a TURP

It's best if you can start moving around as soon as possible. You'll probably be up and about within 24 hours.

You may have a tube (catheter) into your bladder to drain your urine into a collecting bag. After this surgery, it is quite normal to have blood clots forming in your urine. To prevent the blood clots blocking this catheter, 'bladder irrigation' may be used. This means that fluid is passed into your bladder and drained out through the catheter. The blood in your urine will slowly clear and then the catheter can come out. This is normally about 2 or 3 days after your surgery.

Vasectomy

A vasectomy is a very reliant form of permanent form of contraception and therefore is only appropriate for men who have decided that they do not want children or further children in the future. Due to the permanent nature of the procedure the risks and benefits of the surgery will be discussed prior to consent for this procedure taking place as Vasectomy reversal is not usually available on the NHS and not always successful.

It involves cutting the vas deferens which are the tubes that take sperm from the testes to the penis. Once these tubes are cut the sperm cannot mix with the semen, you will still have erections and produce the same amount of semen when you ejaculate.

The procedure is commonly carried out under local anaesthetic which blocks feeling to the scrotal area and you will be awake during the surgery, alternatively it can be carried out under general anaesthetic if necessary. It involves two small cuts which are usually closed with absorbable sutures.

Following the procedure it is safe to resume sexual intercourse as soon as you feel comfortable to do so but the use of contraception should continue until you have been advised that you are sperm free. This is normally three to four months after surgery.

Vasectomy Reversal

A vasectomy involves cutting the vas-deferens which are tubes that take sperm from the testes to the penis. Once these tubes are cut the sperm cannot mix with the semen, therefore you are unable to have children.

A vasectomy reversal is an operation to rejoin these tubes so they can carry the sperm from the testes and allow it to mix with the semen. The sooner this procedure is carried out following the original vasectomy the more likely it is to be successful with the success rate dropping considerably if more than ten years has elapsed. It is important to understand that the success of this procedure cannot be guaranteed and sometimes it is only possible to reconnect one of the vas-deferens (tubes)

The surgery is more complex than the original vasectomy and is usually done under general anaesthetic and takes between 1 and 2 hours. The surgery involves cutting through the scars from the original surgery to check the tubes and whether there is signs of sperm in the fluid. The surgeon will then need to reconnect the tubes which are tiny and therefore this is not always possible.

The hospital stay could be either a daycase or a one night stay but your Consultant will discuss this with you.

kidney Stones

If a kidney stone does not move through the ureter within 30 days, surgery is considered. Several procedures are used to break up, remove, or bypass kidney stones. At Abbey Hospitals we offer different procedures across our 4 Hopitals,please check with your hospital of choice which of the below that they can offer.

Uretoroscopy

This procedure can be used to remove or break up (fragment) stones located in the ureter. A special telescopic instrument resembling a long, thin telescope (ureteroscope) is inserted through the urethra and passed through the bladder and up the ureter to the stone. Once the stone is located, the urologist either removes it with a small basket inserted through the ureteroscope (called basket extraction) or breaks up the stone with a laser or similar device. The fragments are then passed by the patient. Ureteroscopy is performed under general or regional anesthesia on an outpatient basis.

Lithotripsy

This procedure is most effective for stones in the kidney or upper ureter. Lithotripsy uses an instrument, machine, or probe to break the stone into tiny particles that can pass naturally. This procedure is not appropriate for patients with very large stones or certain other medical conditions.

Ultrasonic lithotripsy uses high frequency sound waves delivered through an electronic probe inserted into the ureter to break up the kidney stone. The fragments are passed by the patient or removed surgically.

Electrohydraulic lithotripsy (EHL) uses a flexible probe to break up small stones with shock waves generated by electricity. The probe is positioned close to the stone through a flexible ureteroscope. Fragments can be passed by the patient or extracted. EHL requires general anesthesia and can be used to break stones anywhere in the urinary system.

Extracorporeal shock wave lithotripsy (ESWL) uses highly focused impulses projected and focused from outside the body to pulverize kidney stones anywhere in the urinary system. The stone usually is reduced to sand-like granules that can be passed in the patient's urine. Large stones may require several ESWL treatments.

Patients undergoing lithotripsy are given a sedative and general or regional anesthesia, and the procedure takes over an hour. More than one treatment may be required.