There are literally hundreds of operations that can be performed on each part of the body, and new operations are constantly being devised. Even so, often the most frequently performed are some of the most traditional with a long history of proven success.
A significant number of people in the Western world develop appendicitis and the removal of which is one of the most frequently performed emergency operations. The incision made is in the right lower quadrant of the abdomen, usually in a skin crease. The abdominal muscles and then the peritoneum (membrane lining the abdomen) have to be opened so that the abdominal contents can be inspected. If the appendix is inflamed it is removed after the blood vessels supplying it have been divided and ligated. The appendix stump, where it was joined to the large intestine, is ligated and buried in the bowel wall. If there is pus present this needs to be sucked out, and the area cleaned by washing with saline solution or an antiseptic. The peritoneum, muscle layers and skin are then closed in separate layers.
There are different types of hernia. In general, a hernia is an internal structure that has pushed through a weak area of muscle wall, either between two muscle sheets or through a section that has grown weak. The most common type of hernia is an inguinal hernia, which is noticed as a bulge or lump in the groin. An incision is made in the groin, the area is opened, the peritoneal sac is removed and the ends tied off with cat-gut or some other suture material. If there is a defect in the groin musculature this is repaired. The whole of the back wall of the area is repaired, using a strong material such as nylon, in a darning procedure. The area is then closed and the skin is sutured.
When someone breaks a bone it can be treated by either open or closed methods. Closed treatment does not involve incision and is by splinting, plaster of Paris or traction. Open treatment means an operation and is usually necessary if there is no hope of the fragments uniting spontaneously or if the broken bone end is damaging nerve or blood vessels. An operation to repair a fractured tibia (shin bone), for example, starts with the making of an incision through the skin, the muscle lining and the bone lining (periosteum), which is then lifted from the bone. Any small, unviable bone fragments are removed and the broken bones of the fracture are placed in the correct position. To maintain them in this position a metal plate is screwed to the ends of the bone pieces. This is rigid enough to bear all the body weight and allow walking. The muscle layers and the skin are then sutured.
A more difficult part of the body to reach is the brain. It is encased in bone – the skull – and so a surgeon operating on brain tissue needs to get through this first. Access for a relatively simple operation, such as the removal of a blood clot, is through ‘burr’ holes which are made in the skull by drilling out circles of bone. Larger surfaces of brain can be exposed by sawing between burr holes and folding-back segments of skull on flaps of skin.
After the operation the access hole can be repaired either with the folded-back skull itself, if it has a good blood supply from the skin, or by a metal (titanium) plate embedded in the tissues if the hole is large. Smaller holes can be left without bone.
This involves individually suturing all the blood vessels and nerves, as well as joining the skin, muscles and bones, of a limb or other part of the body that has been accidentally severed or otherwise detached from the body. Because many of the vessels are so minute it often requires the use of a special operating microscope and very fine instruments contained in a special rig in order to see and operate properly. Great advances in microsurgery have been made in recent years, involving long operations with teams of surgeons working in series. Unfortunately, because nerves do not heal very well, sometimes the result is a living, but functionless, appendage which cannot feel, or be moved. The best results are often achieved in attaching fingers.
Open-heart surgery, similar to microsurgery, requires special skills. First the chest needs to be opened, which means splitting the breast bone (sternum) up the centre and incising the lining of the chest cavity. Although some operations can be performed while the heart is beating, but not without difficulty, most of them need it to be still. So the heart is stopped with an electric shock, and to make sure that blood still circulates – vital, of course, not only for the brain but also for other body tissues – the patient is connected to a bypass machine which takes on the function of the heart and not only pumps blood but also oxygenates it. At the end of the operation, the heart is plumbed back into the circulation and started with another shock. The chest is then closed. Controlled cooling of the patient – hypothermia – reduces bodily oxygen consumption and makes the process safer.