The following conditions commonly require surgery:
- Spleen conditions
- Bowel conditions
- Pilonidal conditions
- Carpal tunnel syndrome
- Skin lesions
Read more about these conditions below.
A 'hernia' (from the Latin word for 'rupture') describes any situation where a rupture or a hole in the muscle wall of either the stomach (abdomen) or chest allows internal organs to push through the muscle wall.
Certain hernias are more common in men than women, and vice-versa. For example 1 in 4 men will develop a groin hernia in their lives, whereas only 3 in 100 women will develop this type of hernia.
Hernias consist of three components including a defect in the abdominal wall, sac and contents.
There are a number of different hernias and common hernias include:
- Inguinal Hernia/ Femoral hernia – presents as a lump in the groin, which may cause discomfort
- Umbilical hernia/ paraumbilical hernia
- Ventral/epigastric hernia
- Incisional hernia – presents as a swelling over the site of a previous incision
- Internal hernia – hernia involving a defect within the abdominal cavity such as a defect in the mesentery causing bowel obstruction
- Uncommon hernias - Spigelian hernia, hiatus hernia, obturator hernia
Symptoms of hernias may include:
- Swelling and discomfort – reducible when lying down or pushed on
- Irreducible hernia – which can lead to complications such as
- Bowel obstruction – abdominal pain, distension and vomiting
- Ischaemia of hernia contents –small bowel, large bowel or bladder
If there is only groin pain but no evidence of a lump in the groin, the cause of the groin pain is unlikely due to a hernia, despite an ultrasound showing a small hernia. It is important to be seen by a specialist to have your symptoms reviewed.
Surgery is often the best option for an abdominal wall hernia. Once an abdominal wall hernia occurs, this will not disappear unless it is surgically repaired.
Success of incisional hernia repair depends on many factors. In particular, the size of defect, weight/Body Mass Index (BMI) of patients, other medical conditions and smoking history are important determinants of long-term success of hernia repair. In morbidly obese patients, significant preoperative weight loss may be necessary to ensure the long-term success of hernia repair.
Hernias can be repaired by either open or laparoscopic approach depending on the nature of hernia.
View Hernia surgery for more information.
The spleen (the word derives from the Greek word for 'heart', in an idiomatic rather than medical sense) helps the body fight off infection, particularly severe infections. It functions as a filter for the blood by removing old red blood cells, recycling iron in the body and keeping a reserve of blood. It also has a role in the formation of new blood cells and functions as a part of the body's immune system by synthesising antibodies.
It is brownish in colour, around the size of a small fist and is located on the left side of the body in the abdominal cavity just under the ribs.
It may need to be surgically removed in the following circumstances -
A range of blood disorders, such as sickle cell anaemia, may as a last resort be treated by removal of the spleen; also where other treatments have not worked, such as for idiopathic thrombocytopenic purpure (ITP).
Cancerous / Non Cancerous Cyst or Tumour
Cancers related to the blood, such as Hodgkins and non-Hodgkins lymphoma and chronic lymphocytic leukaemia may require removal of the spleen as part of the diagnosis or treatment. Cancer can also have spread to the spleen from other organs, or if large non-cancerous cysts or tumours within the spleen are present, the spleen may need to be removed.
Where the spleen becomes enlarged it tends to destroy red blood cells and platelets and is more likely to rupture in day-to-day activity.
An abdominal injury may result in a ruptured spleen, which causes internal bleeding. In this case the spleen may need to be removed. This type of injury occurs most frequently while playing sport.
View Splenectomy for more information.
Surgery to the bowel may be necessary in the case of either medical emergencies or for medical conditions affecting the bowel.
The most common small bowel conditions that may require surgery include:
- Small bowel obstruction – due to adhesions, hernia, tumour, radiation, Crohn’s disease
- Small bowel tumour – primary adenocarcinoma, GIST (gastrointestinal stromal tumour), NET (neuroendocrine tumour or carcinoids), lymphoma and secondary tumour
- Small bowel perforation – due to a foreign body, ischaemia due to obstruction
- Ischaemic gut (SB ischaemia secondary to embolus / thrombus to the superior mesenteric artery)
The common large bowel conditions that may require surgery include:
- Colon cancer causing obstruction/ perforation, anaemia, malignant polyp
- Complicated appendicitis
- Complications of acute diverticulitis such as perforation, stricture, fistula and rarely bleeding
- Sigmoid or caecal volvulus
- Complicated appendicitis
- Ulcerative colitis/ Crohn’s disease
View Small and large bowel surgery for more information.
The appendix is a tube-like appendage normally around 9cm long, which attaches to the caecum, (the first section of the duodenum - the small intestine) where it connects with the stomach. It is normally located on the right hand side of the body, but is sometimes positioned on the left side.
For a long time it was regarded as a 'redundant organ, a 'vestigial' part of the body i.e. no longer having a useful function (even if it may have had in past humans). However recent scientific studies have indicated it may in fact play a role in maintaining a health gut flora and may be a storage place for beneficial bacteria, which are needed from time to time to flush other bacteria from the gut. It may also perform an immune function.
Appendicitis - inflammation of the appendix - can have several causes, such as the presence of a foreign body, a viral infection causing the lymphatic tissue in the appendix to swell, a bowel adhesion (scar tissue) or a small hard lump of faeces (called a faecalith) blocking the appendix. If appendicitis is not treated quickly, the appendix may rupture and then infected material is released into the abdominal cavity. This in turn may cause peritonitis, inflammation of the membranes lining the abdominal wall and organs, which is a very serious and potentially life threatening condition.
A vague central abdominal pain, which localises to constant, severe right iliac fossa abdominal pain associated with nausea, vomiting and low-grade fever are the main symptoms of appendicitis. The diagnosis is usually achieved on clinical history and examinations. Ultrasound and/or CT scan are sometimes used to confirm or exclude the diagnosis of appendicitis. Laparoscopic appendicectomy is one of the most common emergency general surgical operations.
View Appendicectomy for more information.
The word 'pilonidal' comes from the Latin words for 'nest' (nidum) and 'hair' (pilorum) and so literally means a nest of hair. In medical terminology it describes a condition that affects the skin and tissue at the top of the cleft between the buttocks (called the 'natal cleft' or 'tailbone'), where a sinus (a cavity causing constant purulent discharge), or an abscess forms.
It is more common in men than women and particularly affects men aged between 15 and 40.
There are different theories as to what causes pilonidal abscesses and sinuses. One theory - from which the name is derived - is that it is caused by the collection of loose hair from the back, which collects in the top of the cleft, which then causes infection and a resulting cyst or abscess. Another theory is that it is in fact one or more hair follicles in the cleft, which expand and subsequently become infected.
Potential risk factors for pilonidal conditions include:
- family history of the condition
- a history of acne, boils, cysts etc. caused by blocked hair follicles
- other skin conditions
- amount and coarseness of natural hair on the back and buttocks
- shape of natal cleft - the deeper the cleft the higher the risk factor
- activities involving high impact in the cleft area (e.g. horse-riding)
- trauma (e.g. a fall or a kick affecting the cleft area)
- activity that involves sitting for long periods of time (e.g. truck driving)
Pilonidal conditions can be very painful and may occur over time (a 'chronic' condition) or in some cases can come on quite quickly (an 'acute' condition).
View Pilonidal surgery for more information.
The word 'haemorrhoid' (from ancient Greek words for blood - 'haima', and flow - 'rhoos') are generally first usually noticed after sitting on the toilet, either as blood on the toilet paper or in the faeces or drops of blood in the bowl. Also known as 'piles', haemorrhoids are small blood vessels in and around the anal area that distend. Haemorrhoids are a similar condition to varicose veins and are either 'internal' (inside the body), or 'external' (on the outside of the anus), or 'prolapsed' (where internal veins are pushed through to the outside - these are the most severe and painful form).
Haemorrhoids develop over long time periods and are common with over 300,000 Australians treated for the condition every year. They are more common in people over 50, during pregnancy, for people who suffer regular constipation and in people who are overweight.
Mild haemorrhoids can be treated with topical ointments, treatment of constipation, maintaining healthy bowel habits using regular fibre supplements (psyllium husk), increased daily water intake (1.5L/day) and regular exercise. Symptomatic haemorrhoids are associated with rectal bleeding (usually small volume bright bleeding not mixed with stool) and a painful perianal lump. Other treatment options include colonoscopy/flexible sigmoidoscopy with the application of haemorrhoidal bands or haemorrhoidectomy.
View Haemorrhoid surgery for more information.
Carpal tunnel syndrome
The carpal tunnel is a narrow passage in the centre of the wrist, through which runs the median nerve (which transmits sensation from the thumb and the all the fingers except the little finger) and flexor tendons. It sits on top of the wrist bones and under the transverse carpal ligament.
Carpal tunnel syndrome (CTS) is a condition caused by pressure to the median nerve, generally due to inflammation to the tendons running through the carpal tunnel. Statistics from the US indicate around 5% of the population are affected by CTS.
Symptoms of Carpal Tunnel Syndrome include tingling, numbness and pain and/or a burning sensation in the thumb and fingers (except the little finger) and in more severe cases an inability to move the thumb or hold objects. Pain may extend up the arm of the affected hand and generally pain and numbness can be particularly bad at night.
Some activities and conditions increase the risk of developing CTS:
- repetitive motion of hands and / or wrists e.g. working for long periods on computers or with vibrating tools e.g. drills or where a strong grip is required for extended periods
- fractures and / or sprains of the wrist or near to the wrist
- congenital abnormalities
- pregnancy and/or hormonal imbalance
Some other conditions may also increase the risk of developing CTS including obesity, rheumatoid arthritis, hyperthyroidism and diabetes, and any cyst or tumour in the carpal tunnel itself. There is some evidence that lack of physical activity is also a factor.
View Carpal tunnel surgery for more information.
In Australia, far and away the most common types of skin lesions requiring surgical removal are cancerous and pre-cancerous lesions (e.g. Actinic Keratoses, also known as sunspots, which are scaly lesions caused by sun exposure). There are three types of skin cancer...
Squamous Cell Carcinoma
This is the type of cancer that affects the flat shaped cells on the outer layer of the skin and it can be fast growing and aggressive.
Basal Cell Carcinoma
This cancer can form in cells beneath the outer layer of squamous cells, which continually divide to form new squamous cells. This is the commonest form of skin cancer.
Cancer of the melanocytes (skin cells whose main role is to protect the skin from the sun - they produce the pigment melanin) is called melanoma. It is the fourth most common cancer in Australia after prostate, breast and bowel cancers. Roughly 13,000 Australians are diagnosed with melanoma every year.
View Skin lesions for more information.