Surgery can help with the following
Cataract surgery has made extraordinary and exciting advances over the past 20 years. In 2006, over two and one-half million Americans underwent cataract surgery. And, greater than 95% of those patients now enjoy improved vision.
The type and cause of hyperthyroidism, along with symptoms will determine if surgery is necessary. You should work with a specialist to make sure the right course of action is being taken. Surgery is usually reserved for cases of cancer, enlargement causing difficulty swallowing, and where radioactive iodine was ineffective or where there were side effects to antithyroid medication.
The thymus is thought to play an important role in the development of the disease by supplying helper T cells sensitized against thymic nicotinic receptors. In most patients with myasthenia gravis, the thymus is enlarged, and 10-15% have thymomas. Thymectomy is indicated if a thymoma is suspected. In patients with generalized myasthenia without thymoma, thymectomy induces remission in 35% and improves symptoms in another 45%.
The thymus is the master gland of immunity, and removing this gland weakens the body’s ability to fight infections and cancer. The thymus normally shrinks and becomes less useful with age. It would seem logical that thymectomy in a younger person could have greater negative long term consequences than thymectomy in an older person.
Some researchers believe that the variability of thymectomy outcomes is due to other pockets of thymus tissue that may be present in the neck area, which are not removed during surgery. These will often be sufficient to maintain a reasonable manganese metabolism and, with this, enable an eventual recovery. On the other hand, if all thymus tissue has been removed, then a full recovery may not be possible with nutritional means.
(Canada – May 2008)—Reuters reports that Multiple Sclerosis (MS) patients who received bone marrow stem-cell transplants in a study by Canadian researchers have mysteriously gone into remission.
Dr. Mark Freedman of the University of Ottawa, who is not sure why they went into remission, said: “Not a single patient, and it’s almost seven years, has ever had a relapse.”
Originally, Freedman was said to have set up an experiment in which doctors destroyed the bone marrow (and thus the immune systems of MS patients); then blood-forming stem cells taken from the bone marrow were transplanted back into the patients.
“We weren’t looking for improvement,” said Freedman, who was quoted as saying once MS is diagnosed it’s too late. “We figured we would reboot the immune system and watch the disease evolve. It failed.” Instead, he noted, improvements actually began to show up two years after the treatment.
“We have yet to get the disease to restart,” he added, noting that “those with a lot of inflammation going on were the most likely to benefit (from the treatment).”
Any of the following may require surgery.
Hyperparathyroidism can be cured with a routine operation which caries a success rate of about 95% and a complication rate of around 1% or less. Some centers are even performing minimal surgery for this disease which can be accomplished under local anesthesia on an outpatient basis. See www.parathyroid.com for additional excellent information about this condition and the importance of selecting an experienced surgeon.
If you have mild hyperparathyroidism, you may not need any treatment, although your blood-calcium levels, kidney function and bone health will need to be regularly checked. When your kidneys or bones are affected, or you have bothersome symptoms, surgery may be the best option.
Cushing’s disease is best treated with the surgical removal of the pituitary tumor (when this is the cause), usually with a technique called transsphenoidal resection (behind the nose) by a neurosurgeon. Occasionally, the entire pituitary gland will need to be removed or injured in order to cure the Cushing’s disease, leaving the person with a deficiency of ACTH and the other pituitary hormones. This can be treated by giving replacement hormones for cortisol, thyroid and gonadal (sex) hormones. Fertility can be restored with special hormonal therapies. If the pituitary tumor cannot be removed, radiation therapy to the pituitary can be used, but the improvement in the Cushing’s Syndrome is much slower. Before transsphenoidal surgery became available, the surgical removal of both adrenal glands was common, but this always produced adrenal insufficiency and sometimes caused large ACTH producing pituitary tumors to grow (called Nelson’s syndrome). That is why pituitary surgery rather than adrenal surgery is usually preferred for Cushing’s disease.
Ectopic ACTH producing tumors are usually malignant (cancer). Removing this cancer or treating it with radiation or chemotherapy may help in improving the Cushing’s Syndrome. If the tumor is benign, or it can be completely removed, surgery may be a cure. Most of the time, reduction of the cortisol production from the adrenals with medications such as metyrapone, amino-glutethimide or ketoconazole is useful while the ACTH-producing tumor is treated.
Adrenal adenomas are always treated by surgically removing the tumor with either an abdominal or side (flank) incision. The other adrenal is left in, and will grow back to normal size or function. After the surgery, replacement steroid hormones are given and slowly tapered over a few months as the remaining adrenal responds to the normal ACTH production from the pituitary.
Adrenal carcinomas (cancer) can be cured if removed early. Unfortunately, they are usually discovered after they have already spread beyond the adrenal gland and are then not curable. Chemotherapy is often used to try to control the tumor but does not cure it. The excess cortisol production can be controlled with medications like those mentioned for ectopic ACTH production: metyrapone, aminoglutethimide and ketoconazole. These medicines can be used to treat any form of inoperable or incurable Cushing’s Syndrome, including Cushing’s disease, but they can have serious side effects and require very careful monitoring and balancing with steroid hormone replacement therapies. Surgical cure of the primary cause of the Cushing’s Syndrome is always the best, if possible.
In the following conditions, surgery may be needed to deal with a prolactin secreting pituitary adenoma:
Your periodontist may recommend periodontal surgery. This is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired by non-surgical means. Special deep cleaning procedures may prevent the need for surgery.
Often no cause is found for the disorder and the gynecomastia may not resolve on it’s own. In these cases, surgery is frequently the best solution.
Two 2005 studies indicate that gastric bypass surgery could have severely dangerous side effects, including severe hypoglycemia (low blood glucose level) and even death.
The first study demonstrated that gastric bypass surgery can result in a potentially dangerous hypoglycemia (low blood glucose) complication that may require quick treatment. It examined the history of three patients who suffered such severe hypoglycemia following meals, as a result of high insulin levels, that they became confused and sometimes blacked out. In two cases, this caused automobile collisions. None of the patients responded to medication, and they all eventually needed partial or complete removal of the pancreas, the major source of insulin, in order to prevent them from undergoing dangerous declines in blood glucose.
A possible reason for the postprandial (after-meal) hypoglycemia they experienced is “dumping syndrome,” which occurs when the small intestine fills too quickly with undigested food from the stomach. This can happen following gastric bypass surgery.
However, the failure of the symptoms to respond to treatment suggests there are other mechanisms at work as well, such as increased insulin sensitivity following the surgery, and abnormal hormone secretion patterns resulting from alteration of the intestinal tract.
At the same time, other research has uncovered a higher-than-expected risk of death following surgery for obesity, even among younger patients. In a study of more than 16,000 subjects, more than 5 percent of men and nearly 3 percent of women aged 35 to 44 were dead within a year of the surgery. The rates increased with older people.
The potentially deadly complications can include malnutrition, infection, and bowel and gallbladder problems. The surgery itself can be a dangerous shock to the system, particularly for older patients.
Gastric bypass is the most common U.S. obesity surgery. About 160,000 people undergo gastric bypass surgery every year. [Journal of the American Medical Association October 19, 2005; 294(15): pp.1903-1908]
There are now some surgeons in the United States that are performing a French technique called Needle Aponeurotomy, also called ‘Needle Fasciotomy’, in place of traditional surgery. Dr. Charles Eaton of Jupiter, Florida has performed over 800 of these procedures including one client who reports “My ring and little finger went from 30 degrees to completely flat in 45 minutes. I played golf 2 days later.”.
Most hernias require surgical intervention. Laparoscopic hernia repair is a minimally invasive surgical procedure to repair the hernia. Usually a patch (mesh) is placed over the weakened area to reinforce the muscle layer and repair the hernia.
Many surgical techniques can be used to correct the curves of scoliosis. The main surgical procedure is correction, stabilization, and fusion of the curve. Orthopedic surgeons can advise you on what procedure is the most likely to help.
Peyronie’s disease often occurs in a mild form that heals without treatment in 6-15 months. It is not clear why this occurs without intervention. However, once a plaque has calcified, it is unlikely to resolve and surgery is the only solution.
Surgical resection of the aorta is recommended when:
1. Aortic aneurysm size on echocardiogram, MRI or CAT scan exceeds 4.5 to 5 cm in diameter
2. When the ascending aortic diameter is twice the diameter of the descending thoracic aorta
3. In children, when the ascending aortic diameter is twice the expected diameter for person this age and size.
Mitral valve repair or replacement may be necessary.
A review in 2007, which was requested and funded by HHS’ Centers for Disease Control and Prevention, failed to find convincing evidence of benefit from arthroscopic surgery to clean the knee joint with or without removal of debris and loose cartilage.
An estimated 12% of Americans aged 65 and older have osteoarthritis of the knee. A popular operation for arthritis of the knee worked no better than a sham procedure in which patients were sedated while surgeons pretended to operate, researchers are reporting. Tests of knee functions revealed that the operation had not helped, and those who got the placebo surgery reported feeling just as good as those who had had the real operation.
Placebo studies of surgery are almost never done. Many doctors consider them unethical because patients could undergo risks with no benefits. [NEJM July 11, 2002;347: pp.81-88, 132-133]
This supports the idea that what you think is sometimes reflected in your experience.
(San Antonio, Texas)—Patients seeking help for facial paralysis have a treatment option available now offered by doctors at Wilford Hall Medical Center at Lackland Air Force Base, Texas. Col. (Dr.) Alan Holck and Maj. (Dr.) Manuel Lopez are among only a few military or civilian surgeons in the country who perform a recently developed procedure called temporalis tendon transfer to treat patients suffering from facial paralysis due to conditions such as trauma, tumors, strokes, cancer, some surgeries and Bell’s palsy. The only other physicians who offer this treatment practice are at Johns Hopkins Hospital in Baltimore.
Proliferative retinopathy is treatable in many cases by laser beam (photocoagulation), which stops the fragile blood vessels from leaking.
There are medications designed to dissolve gallstones. However, when obstruction of the outflow of bile from the gallbladder occurs causing symptoms, the best option is removal of the gallbladder. Laparoscopic gallbladder surgery is appropriate for the vast majority of patients who need gallbladder surgery.
In emergency situations there is no natural treatment that will work quickly enough and the risk of complication is too great to wait for slower treatments.
When an enlarged spleen causes serious complications or the underlying problem can not be identified or treated, surgical removal (splenectomy) may be an option. In chronic or critical cases, surgery may offer the best hope for recovery.
However, elective spleen removal requires careful consideration. While you can live an active life without a spleen, you are more likely to contract serious or even life-threatening infections, including an overwhelming post-splenectomy infection. Another treatment to consider is radiation. This can sometimes shrink the spleen so that surgery will not be needed.
Minor surgery may be required for cosmetic purposes if the stye / chalazion is not resolving on its own, or if it is desired that the lump be removed right away. A local anesthetic will be injected to make the procedure painless. The incision is often made under the eyelid so that no scar is visible. After the lump is removed, the eyelid may appear a little puffy and bruised for a few days. This surgery is generally very effective with few complications.
The doctor may alternatively inject the lump with an anti-inflammatory medication which can be effective in shrinking and clearing the infection.
If you suffer from a ruptured disk in your lower back your will recover whether you have surgery or not. However, your pain will be eased earlier if you have surgery. US researchers, in two new studies suggest there is no harm in waiting if you don’t want to undergo surgery.
There was some resistance to the trial from surgeons who felt it would be wrong to ask patients in pain to forfeit surgery just to see whether they would recover. However, the trial went ahead and the researchers concluded that both surgery and waiting are effective – neither one is better than the other. In other words, the patient can safely decide whether he/she wants to wait or undergo surgery. In the USA, surgery costs about $6,000.
One study involved 472 patients, with an average age of 42. They were all followed up for two years after being randomly assigned either surgery or non-invasive treatment. The non-invasive treatment included education, physiotherapy (physical therapy) and painkilling drugs. Surgery meant taking out part of the swollen disk (outpatient basis). The researchers found that both groups experienced similar improvements and relief of pain over the two year period. 4% of patients who had surgery needed another operation within 12 months. [JAMA, 22 Nov 2006]
Surgery to remove soft tissue from the palate and throat is an option in the treatment of OSA, but success rates tend to be disappointing. Still, surgery is an option that can successfully treat some apnea cases.
A new report published in the prestigious New England Journal of Medicine (NEJM – April 2007) shows that patients treated with bronchial thermoplasty, the first non-drug treatment for asthma, demonstrated an overall improvement in asthma control.
Co-Principal Investigators, Dr. Gerard Cox, respirologist at St. Joseph’s Healthcare Hamilton’s Firestone Institute for Respiratory Health, and Professor at McMaster University, and Dr. John Miller, Division Head of Thoracic Surgery at St. Joseph’s Healthcare Hamilton and McMaster University authored the study. The study revealed improved asthma control at one year following the bronchial thermoplasty procedure.
The publication entitled, “Asthma Control during the Year after Bronchial Thermoplasty”, showed that patients treated with bronchial thermoplasty, compared to another group that did not receive the procedure, showed significant positive changes such as: decreases in asthma attacks, increases in days with no asthma symptoms, improvement in quality of life, reduction in using medication, and an improvement in asthma control.
The most effective treatment of severe hyperhidrosis is by a procedure called Endoscopic Sympathetic Blockade (also called Sympathectomy). The classic procedure calls for cutting or destroying of the second or third nerve trunks called the Sympathetic nerve trunk or ganglion, but this renders the operation irreversible. The outpatient procedure takes about 30 minutes and most leave the surgical center in about an hour.
Draining an abscess is done by making a cut in the lining and providing an escape route for the pus, either through a drainage tube or by leaving the cavity open to the skin. The area around the abscess will be numbed before draining. Most people feel immediately better after drainage. Many abscesses subside after drainage alone; others subside after drainage and antibiotic use.
The most effective treatment for nasal blockage due to polyps is surgical removal. Most specialists will arrange an X-ray called a CT scan to show the extent of polyp tissue in the sinuses and the layout of the bony partitions in the area. Removal is generally carried out using an endoscope to look inside the nose. In some cases the polyps are simply cleared from the nose, while in others, polyp tissue is also removed from the sinuses. The procedure is performed under general anesthesia.
Unfortunately there is no guarantee that nasal polyps will not grow again after surgical removal. Some people seem to be much more susceptible to this condition than others and the polyps may grow back again many years after surgery. A further episode of nasal surgery may then be required.
Sebaceous cysts are usually ignored unless they become bothersome or infected. An infected cyst can form into a very painful abscess for which surgical incision and drainage is usually necessary for pain relief. Excision of the cyst and the surrounding sac may be necessary to prevent recurrence. Sebaceous cysts may disappear spontaneously, or remain in place without causing any problems.
A new procedure called Uterine Artery Embolization is considered to be less invasive than other procedures and enjoys a high success rate. It involves cutting off the blood supply to the fibroid by placing a catheter into the uterine arteries and injecting small particles. This blocks the blood flow and causes the fibroid to degenerate, leaving the remainder of the organ intact. Often this is a better approach than a hysterectomy.
Cryotherapy (cryoablation) is a proven and effective, minimally invasive treatment for prostate cancer that does not involve the difficulty and complications associated with surgery, nor the harmful properties of radiation.
Cryosurgery works best on prostates 40 grams or less in size as measured by ultrasound. Three to six months prior to the procedure, the patient is placed on hormone therapy to block production of male hormones, which cause prostate cancer to grow. Hormone therapy shrinks the prostate and cancer prior to cryosurgery and improves the chances of freezing the entire prostate.
Conventional surgery has become more refined with the use of robotics. Patients who underwent a robotic radical prostatectomy had significantly better erectile function outcomes than those who received conventional nerve-sparing surgery — without compromising cancer control, according to a year-long study conducted by doctors at Henry Ford Hospital’s Vattikuti Urology Institute. [British Journal of Urology, 2003] Blood loss is much less and recovery much quicker. “There’s no question this [DaVinci Robotic system] has revolutionized the surgery.”
The only definitive treatment is the complete surgical removal of the tumor, which is not often possible. If the cancer cannot be entirely removed, the principal goals of therapy become the relief of symptoms caused by the accumulation of bile, and relief from pain.
As with all cancers, the earlier the cancer is found the better your chances are of effective treatment. The type of treatment you receive will depend on the type and size of the cancer and your general health. Most cancers of the mouth and throat are treated with surgery. The part of your mouth or throat you have removed will depend on the location of the tumour. An operation to remove the tumor may be all the treatment you need. Some people may also need radiotherapy, either on it ‘s own on in addition to surgery. Some claims are bieng made that intense radiation alone may be effective without causing the consequences that major surgery would cause, like the lose of your voice box.
Chemotherapy may be used either in addition to surgery or radiotherapy. Your doctor will discuss all options with you.
Risk factors are used to predict tumor aggressiveness and thereby provide logic on when to place medications into the bladder to treat the cancer (intravesical therapy). Patients with small, single low-grade tumor with a normal amount of DNA (diploid) that are limited to the urothelium are at low risk for recurrence. In these patients, random bladder biopsies and the results of post resection cytologic examinations are usually normal. Generally, these patients are treated by transurethral resection followed by periodic cystoscopy, cytology and DNA ploidy evaluations. In these, intravesical therapy in addition to removal of the tumor through the cystoscopic instrument is generally administered only following tumor recurrence.
When complete surgical removal of the bladder is performed, usually, in place of the bladder, a segment of small bowel is used to transfer urine directly from the kidneys and ureters through a stoma on the skin and into an external collection bag. This is called an ileal conduit. Most patients undergoing this form of diversion psychologically adjust to the change in body image with time. Since it is performed relatively quickly and with a low complication rate, the ileal conduit remains the diversion of choice with most surgeons. Today many patients opt for a form continent urinary reservoir, which eliminates the need for an external collection bag. Although the procedure requires special skills and increases the length of the operation, all appropriate candidates should be offered this form of diversion. Some continent diversions have a small stoma on the abdominal wall. The urine is drained 4 to 6 times daily by placing a catheter through the soma into a urinary reservoir made of bowel. The stoma which is flush with the skin is easily concealed with a gauze sponge.
Surgery is often used as a treatment for skin cancer. There are several types of surgery depending on the stage and location of cancer.
Radiation Therapy is treatment with high-energy rays (such as x-rays) to kill or shrink cancer cells. The radiation may come from outside the body (external beam radiation) or from radioactive materials placed directly in the tumor (internal or implant radiation).
Photodynamic Therapy is a two-step procedure that is done on an outpatient basis. You will be injected with a light-activated drug, which targets cancerous cells. Approximately 24-48 hours later, a laser light is directed through a scope onto tumor cells, exposing the cancerous tissue to a certain spectrum of light. The light “switches on” the drug, destroying the cancerous cells without damaging your surrounding healthy tissue.
Topical Chemotherapy is when medication is placed directly onto the skin rather than being given by mouth or injected into a vein.
Treatment for breast cancer usually begins a few weeks after diagnosis. In these weeks, you should meet with a surgeon, learn about your surgery choices, and think about what is important to you. Then choose which kind of surgery to have.
Most women who have DCIS or Stage I, IIA, IIB, or IIIA breast cancer have three basic surgery choices. They are:
Breast-sparing surgery followed by radiation therapy.
Mastectomy with breast reconstruction surgery.
Breast-sparing surgery means that the surgeon removes only your cancer and some normal tissue around it. This kind of surgery keeps your breast intact—looking a lot like it did before surgery. Other words for breast-sparing surgery include “lumpectomy,” “partial mastectomy,” “breast-conserving surgery,” or “segmental mastectomy.”
After breast-sparing surgery, most women also get radiation therapy. This type of treatment is very important because it could keep cancer from coming back in the same breast. Some women also need chemotherapy and hormone therapy.
In a mastectomy, the surgeon removes all of your breast and nipple. Sometimes, you will also need to have radiation therapy, chemotherapy, hormone therapy, or all three types of therapy. Here are some types of mastectomy:
Total (simple) mastectomy.
The surgeon removes all of your breast. Sometimes, the surgeon also takes out some of the lymph nodes under your arm.
Modified radical mastectomy.
The surgeon removes all of your breast, many of the lymph nodes under your arm, the lining over your chest muscles, and maybe a small chest muscle.
The surgeon removes both your breasts at the same time, even if your cancer is in only one breast. This surgery is rare and mostly used when the surgeon feels you have a high risk for getting cancer in the breast that does not have cancer.
Breast Reconstruction Surgery
If you have a mastectomy, you can also choose to have breast reconstruction surgery. This surgery is done by a reconstructive plastic surgeon and gives you a new breast-like shape and nipple. Your surgeon can also add a tattoo that looks like the areola (the dark area around your nipple). Or you may not want any more surgery and prefer to wear a prosthesis (breast-like form) in your bra. There are two types of breast reconstruction surgery:
In this kind of surgery, a reconstructive plastic surgeon puts an implant (filled with salt water or silicone gel) under your skin or chest muscle to build a new breast-like shape. While this shape looks like a breast, you will have little feeling in it because the nerves have been cut.
Breast implants do not last a lifetime. If you choose to have an implant, chances are you will need more surgery later on to remove or replace it. Implants can cause problems such as breast hardness, breast pain, and infection. The implant may also break, move, or shift. These problems can happen soon after surgery or years later.
In tissue flap surgery, a surgeon builds a new breast-like shape from muscle, fat, and skin taken from other parts of your body. This new breast-like shape should last the rest of your life.Women who are very thin or obese, smoke, or have other serious health problems often cannot have tissue flap surgery.
Tissue flap is major surgery. Healing often takes longer after this surgery than if you have breast implants. You may have other problems, as well. For example, you might lose strength in the part of your body where muscle was taken to build a new breast. Or you may get an infection or have trouble healing. Tissue flap surgery is best done by a reconstructive plastic surgeon who has done it many times before. [NCI – Agency for Healthcare Research and Quality]
A study presented at the American Society of Colon and Rectal Surgeons’ annual meeting found that receiving short-term radiation therapy before rectal cancer surgery benefits patients. The data came from the Swedish Rectal Cancer Trial, which examined more than 900 patients who received a surgical resection intended to cure rectal cancer. Some patients had surgery alone. Others had radiation first. The patients who received radiation first, enjoyed longer overall survival and lower recurrence rates.
The group that received preoperative radiation had a 72% cancer-specific survival rate, as opposed to 62% in the surgery-only group. The radiation group had a 9% local recurrence rate, as opposed to a 26% local recurrence rate in the surgery-only group.
Laser techniques to destroy endometrial tissue are currently popular in conventional medicine as is removing the uterus, ovaries (and perhaps appendix) thus stopping the menstrual cycle altogether.
Endometriosis is usually diagnosed on the basis of a history of pelvic pain, a physical examination, and a laparoscopy. Laparoscopy is the most important diagnostic tool for endometriosis, but not all women require a laparascopy. Patients with mild or moderate symptoms often choose hormonal treatment. If hormones are successful, laparascopy is not necessary. A laparascopy is necessary if initial hormone treatment does not work or if endometriosis is severe or debilitating.
Imaging tests may be used to locate endometrial lesions. Pelvic ultrasound or MRI may be used to identify individual endometrial lesions, but they are not used to determine the extent of the condition. The implants are not easily identified using these tests.
Looking for a biochemical marker that is indicative of endometriosis may also be helpful. The use of biochemical markers may eventually replace the need for laparascopy.
Two reports from physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center (Oct 2007) shed new light on male infertility. A first report shows that a common cause of male infertility — varicoceles, or varicose veins in the scrotum — also results in a depletion of testosterone. In a second related finding, researchers demonstrate that once a common, simple surgery is used to treat varicoceles and thereby restore fertility, testosterone levels are also improved.
Artificial insemination can be used to place sperm directly in the cervix or uterus. In vitro fertilization involves combining an egg with sperm in a laboratory, and then implanting the fertilized egg into the uterus.
The NovaSure System provides an effective and minimally invasive outpatient alternative to hysterectomy, while avoiding the potential side effects and long-term risks of drug therapy. The patented NovaSure System is a next-generation endometrial ablation device that delivers precisely measured electrical energy via a slender, hand-held device to remove the endometrial lining.
This quick, simple to schedule procedure requires no incisions, can be performed in an office or outpatient setting, and generally takes less than five minutes to perform. This is significantly shorter than any other endometrial ablation procedure.
According to recent studies, most women feel that endometrial ablation relieves the problem with their period. Up to 90% of women who have this procedure are satisfied with the results. After the procedure, the women who were satisfied with it reported lighter periods or normal periods. Some women said that their periods stopped completely after endometrial ablation.
Surgical treatment may include removal of painful areas such as the vulvar (bartholin’s) glands, excision of the pudendal nerve and/or laser therapy to destroy underlying vulvar blood vessels.
|May do some good|
|Likely to help|
|May have adverse consequences|