Surgery

Surgery is the physical effect on tissues and organs for the purpose of diagnosis or treatment associated with anatomical violation of the integrity of tissues. The impact on the fabric can be mechanical (the most common surgical operations), thermal and electric power (electrosurgery), low temperature (cryosurgery).
Depending on the purpose of the intervention of surgical operations are divided into diagnostic, under which main task is further diagnosis (for example, test laparotomy, puncture bodies and cavities, biopsy and others), and treatment aimed impact on any pathological process. Often diagnostic operation, undertaken to determine the nature of the lesion becomes medical and medical-for example, when the tumor, which was newdecimal, only specifies the diagnosis.
By the method of exposure to distinguish surgery bloody, accompanied with infliction of a wound, and bloodless, in which the integrity of the exterior of the skin is not broken (for example, vpravljenie fractures, reposition of fragments of fractures, some of rodorazreshajushchaja operations - forceps delivery, turn the leg, and so on). The most common surgical operations - bloody accompanied not only a violation of the integrity of skin or mucous membrane, but also the deep tissues and organs. Rational accesses to the authorities, methods and techniques of operational techniques section develops surgery - surgical surgery. Because of the danger of introducing infection in open surgery tissue bloody surgical operations require careful observance of aseptic (see) and antiseptics (see). To bloodless surgery include the removal of foreign bodies from the bronchi, esophagus, vpravljenie fractures, reposition of fragments of bone fractures., endoscopy (see), catheterization (see) and other
There are surgical operations asepticsure ("clean")when a wound infection can be prevented and wound during a transaction not subject bacterial contamination, and neasteptate, when it is impossible to exclude bacterial contamination, such as surgical operation, related to the opening of the intestinal lumen, opening the abscess etc.
Depending on the deadline surgery may be an emergency (emergency), which produce immediately on admission the patient, as any delay threatens the life of the patient (stop external or internal bleeding, tracheotomy to restore the patency of Airways); emergency operation is also shown in the perforation of the stomach, the vermiform process, strangulated hernia, rupture of the colon, in many types of intestinal obstruction and other
Urgent called surgical operations, the implementation of which can be postponed for a short time (some forms of acute cholecystitis, mechanical jaundice, partial intestinal obstruction and others).
Elective (planned) call such surgical procedures that without damage to health can be performed after a thorough preoperative preparation (varicose veins, available hernia, chronic cholecystitis, benign and malignant tumors of the number of bodies and others).
There are radical surgery in which result when you remove a lesion or body, you can count on the full elimination of the pathological process (amputation, the removal of organs, such as the gall bladder, Appendix, tumors). In contrast, palliative surgery are only intended the elimination of suffering or the most dangerous and severe forms of the disease (bypass anastomoses in malignant tumors of the stomach and intestinal, gastric or intestinal fistula and others).
For the name of surgical operations are terms consisting of the foundations of Greek or Latin words - the name of the Agency producing the operation (for example, the stomach is "gastro"), and the nature of the intervention (for example, dissection - "Tome", fistula between the bodies or external fistula - "stonia", deleting all of the body - "ectomy" or part of "excision", podselenie - "pension"). In some cases, indicate surgery two terms, such as "resection of the stomach", "extirpation of a kidney" and others Sometimes surgery or method is called by the name of the bidder, its author (operation Pirogov, graineterie on Bassini and so on).

Surgery (synonym: surgery, surgical intervention) - diagnostic measures taken by the traumatic effects on tissues and organs of the patient. Depending on the nature of the operative trauma surgery divided into bloody associated with the infliction of a wound, and bloodless, in which the integrity of the skin or mucous membrane is not disturbed. In the vast majority of used in modern practice surgery - bloody. Bloodless surgery a few: the bulk of them are various methods of bloodless reset, reposition of fragments of fractures, some of rodorazreshajushchaja operations (forceps delivery, turn on foot and others), a therapeutic and diagnostic manipulations in the lumen of hollow organs (bairovna in the strictures, removal of foreign bodies through natural orifices of the body, endoscopy) and some others.
On its goal of surgery is divided into therapeutic and diagnostic. Often the intervention diagnostic purposes, turns into treatment, and Vice versa: when a surgical operation is designed as a therapeutic intervention, sometimes it is necessary to be limited only to further diagnosis (such as a tumor, which was newdecimal). Medical surgical operation is divided into radical, calculated on the elimination painful process, and palliative that resolves the most painful manifestations of the disease, but no significant impact on the further development of the pathological process. Radical or palliative value surgery sometimes is determined not only by the method of surgical intervention, but also the nature of the disease. So, creating a workaround stenosis caused by malignant tumor, palliative surgery in cicatricial stenosis it may in some cases to ensure full recovery. And, Vice versa, the most radical in its methodology surgery sometimes is almost palliative, as it provides only a prolongation of life of the patient (for example, resection of the stomach in far advanced cancer.
Surgery used to treat various injuries, divided into primary, the indication for which is itself injury (otherwise the operation on the primary reasons), and secondary taken in the presence of an already existing complications (otherwise the operation on the secondary indications).
The division into primary and secondary sometimes is carried out in respect of surgical interventions in some acute diseases. For example, embolectomy when embolism arteries limbs - primary surgery and amputation about the upcoming ischemic gangrene secondary.
Secondary operations should not be confused with repeated as secondary intervention may be the first in the patient. The most important tasks of surgery: removal of the pathological accumulations or abnormalities of the cavity tissues and organs; the removal of tissues and organs - the partial or full; restoration of violated in anatomic correlations between tissues and organs; the replacement of lost or changed organs and tissue sections; creation of new anatomical relationships, not normal, but functionally advantageous for this pathological condition. Many surgical operations solve several of these tasks, and methods of solution are very diverse in different cases. However, with the development of surgical techniques and increasing the number of patients applying for surgical use, more surgical operations, which are typical, i.e. are always on a methodology for a particular plan, certain techniques.
With all surgeries plan and techniques of intervention is necessary each time to build original, applying to the peculiarities of the disease and the individuality of the patient.
Depending on the duration of the operation, and most importantly to the severity of the operative trauma allocate "large" surgical operation and "small" surgery that make up the area of the so-called minor surgery. The concept of "small" surgical operation implies operations that can be performed on an outpatient basis, without hospitalization of the patient. However, the idea of "small" surgery and small surgical operations completely conditionally; any surgery associated with known more or less harmful to the patient, which is the main feature of surgical treatment. This danger is caused by several things: pain stimuli that can cause shock (see), the possibility of bleeding (see) with significant blood loss (see) and especially the possible emergence of wound infections (see the Wounds, wounds). The dangerous moments may arise in connection with the use of anesthesia (see), hypothermia, trauma etc., the Extent of all these hazards vary considerably at different surgical operations, but the struggle with them mandatory in all cases. It boils down to impeccably precise execution of all requirements of asepsis, rules surgical technique to correct determination of indications and contraindications, rational choice of the method of anesthesia, the appropriate preoperative preparation of the patient and good care after the operation (see the Preoperative period. Postoperative period). The lack of attention to any of these questions or minor technical error can do the most dangerous and small surgical operation.
Depending on the possibilities to prevent wound infection surgery have to share on aseptique where bacterial contamination of the operative field can be practically excluded by the rules of reimbursement, and on neasteptate when you cannot avoid bacterial contamination (for example, surgical operations on the rectum, mouth and so on). Careful handling of fabrics and the use of antibacterial means prevent the development of wound infection. When the so-called purulent surgery when the surgeon manipulates in tissues with existing purulent or anaerobic process, wound infection is almost inevitable. A correct assessment of the probability of infectious wound complications after surgery is extremely important, as it allows to decide on the stitching of the wound or its drainage.


During the bloody surgical operation it is necessary to distinguish three stages or phases: 1) prompt access - manipulation through which the surgeon exposes organs or tissues that serve as the object of surgical intervention; 2) operational reception - the manipulation of these organs or tissues; 3) the final event - the manipulation of the tissues damaged by surgery if access is stitches or wound drainage, etc. Decisive stage surgery is a surgical technique, but the value of prompt access is also very large, because it should provide maximum freedom of operative reception at the least traumatic intervention. These two contradictory requirements: dimensions of access are determined by the angle formed by the lines connecting the ends of the cut is the deepest point of the operating field (corner of operative activity); increasing this angle, i.e. with increased access, increased and injuring the latter. However, the decrease in the angle of operative activity, and therefore injure-level access is difficult manipulation in the depth of the surgical field and can dramatically increase the trauma of operative reception and duration of the intervention.
Development of rational approaches to the authorities to perform various operational techniques on them is one of the tasks of operative surgery. For each body there is a certain, the most effective access to, and sometimes a few; in the latter case, the choice of the approach depends on the body type of the patient and a number of other individual characteristics. The most important condition for the implementation of the operational access is the separation of tissue layers. The introduction of layer-by-layer access was an important stage in the development of surgery. In an era when the pain was inevitable during surgery and forced surgeons strive to minimize the time of surgery, access was conducted by dissection of soft tissues to the depth of the wound. However to prevent accidental injuries subject organs dissection often made not from the surface down, and Vice versa: the surgeon worked hard pointed the knife at a certain depth obliquely and made an incision from the depth "on itself", cutting through the entire thickness of the tissue. With the introduction of surgical practice of anesthesia more slow layer-by-layer tissue cutting. Tiered access provides "all these" surgical operation, i.e. a clear orientation in topograficheskikh ratios essential to modern surgery. To anatomicheski" access and generally surgery was first mentioned by N. I. Pirogov is the Creator surgical (topographic) anatomy. When modern surgical equipment access can be carried out both by means of cutting tools, and by electrocautery (see Electrosurgical methods of treatment).
If all three stages of surgery followed one after another, the transaction is called a one-stage, when the gap in time between the different phases - dvuhmestnoe. Dvuhmestnoe surgery with an interval of several days between access and operational technique designed to reduce the severity of the operative trauma, as to the second point of intervention the patient has time to recover from the damage inflicted upon access (for example, dwuhlopastny surgery for prostate cancer, tumors of the cerebellum and other). With the improvement of methods of anesthesia and methods of postoperative shock and blood loss scope of application dvuhmestnij interventions of this kind are increasingly tapering. Dwuhlopastny surgery with a gap between the operational acceptance and final measures designed to reduce the risk of infectious complications of the wound. An everyday example is deferred seam (see the Wounds, wounds, surgical Sutures).
Depending on the evidence, which is the intervention, there are emergency operations and the operation of free choice (assuming the timing). The latter should not be confused with the "selection", i.e. the intervention, the most preferable in this case. For urgent (or emergency) surgical operations are those that must be met as soon as possible, because the delay threatens the destruction of the patient in the near future. The term "urgent surgery is often used as a synonym for emergency, but some surgeons determine them intervention that must be done in a known period of time from onset of illness (for example, in the first day with acute appendicitis, in the first 12 hours - accidental injury, etc).
For the item surgery is used mainly Greek, Latin less, terminology. When using the Greek term name surgery usually one compound word, derived from the names of the authorities, which is operative reception, and the name of reception: operation dissection, opening - Tamia (from the Greek. tome), the operation of superposition of external fistula, if you specify a single body, or fistula, if two bodies - stonia (from the Greek. stoma), surgery excision, remove ectomy (Grach, ektome), the operation fasteners, filing - pension (from the Greek. pexis), etc. When using the Latin term name surgery is given in several separate words, and an indication of operative reception precedes the designation of the authority (for example, exstirpatio renis instead nephrectoinia). There are terms, composed of Greek and Latin words (appendectomy, matchmobile and others). Some names of ancient origin do not reveal the essence of surgery (caesarean section) or characterize it wrong (lithotomy), but are held by tradition. Finally, the operations referred to as the names of the people who created them surgeons (operations Pirogov, Albee, Gritti, and others).
The right of production of surgical operations provided doctors with special training in the relevant field surgery or related specialty. But the technique of certain emergency operations (tracheotomy, microwave rodorazreshajushchaja intervention) should possess every doctor, regardless of specialty. The production of the most simple of minor surgical procedures in urgent cases can be trusted in the absence of a doctor worker with secondary medical education (section at surface abscess, tubal visible in the wound bleeding vessel, resetting of dislocation of the lower jaw or finger, etc.,).
In the manufacture of surgical operations, as a rule, should be involved two doctors - operating surgeon and assistant, average medical professional applying the tools and material, and during surgery, going under anesthesia,and narcotization (usually a specialist anaesthetist). If necessary, less complex intervention surgeon can perform without an assistant using the operating nurses applying tools for particularly complicated surgical operations, the number of participants increased by one or two assistants, assistant narcotization, employees who are tasked with performing protivosokovh activities, management of special devices and equipment. The primary responsibility for the proper organization of this surgery, for its implementation and the outcome shall be a surgeon. Surgical operations should be performed in a specially designed and equipped premises - operating, permanent or temporary (improvised). But absolutely urgent, vital intervention should be performed in any situation.
Cm. also Antiseptic, Asepsis, Sterilization (surgery).