Surgical Procedures

Abdomino-Perineal Resection of Rectum
What is it?
Some of the lowest part of your bowel, the rectum, is diseased and has to be taken
out. Because the disease is so near to the opening in the back passage, this has to
be taken out as well. If the back passage were left in place, you would be unable to
control your bowel motions. You might also get complications from the underlying
disease. A new opening for the bowel is made in the wall of your tummy. This is
called a colostomy. The waste runs into a special stick-on plastic bag.
Diagram © Copyright EMIS and PIP 2005
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The Operation
You will have a general , and will be asleep for the whole operation. A cut about 40
cm (15 inches) long is made in the skin and muscle of the central lower part of the
tummy wall. The lower bowel within reach is freed from its bed. Another cut is made
around the back passage, which is also freed. The whole of the lower bowel is taken
out. A fresh opening is made in the tummy wall for the remaining bowel which is
made into a colostomy. The wounds are stitched up. You should plan to leave
hospital about two weeks after the operation.
Any Alternatives
Doing nothing will lead to bleeding, discharge, pain and possibly a complete blockage
of the bowel. Taking out the diseased bowel, but leaving the back passage in place in
your case is risky. You would end up with little control of the bowels and a risk of the
disease causing further problems. X-ray treatment and drug treatment on their own
are not very good. They may be useful if added to the operation. The surgeon can
talk to you about this.. Keyhole operations for this operation are not always possible
and only carried out in very selective cases in highly specialized centers.
Before the operation

Stop smoking and get your weight down if you are overweight. (See Healthy Living).
If you know that you have problems with your blood pressure, your heart, or your
lungs, ask your family doctor to check that these are under control. Check the
hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check
you have a relative or friend who can come with you to the hospital, take you home,
and look after you for the first week after the operation. Bring all your tablets and
medicines with you to the hospital. On the ward, you may be checked for past
illnesses and may have special tests to make sure that you are well prepared and
that you can have the operation as safely as possible.. You will be asked to fill in an
operation consent form. Many hospitals now run special preadmission clinics, where
you visit for an hour or two, a few weeks or so before the operation for these checks.
You will meet the stoma nurse who will help you through the operation and also
afterwards.
After - In Hospital
You will most likely have a fine plastic tube coming out of your nose and connected
to another plastic bag to drain your stomach. Swallowing may be a little
uncomfortable. You will have a dressing on your wounds and a drainage tube nearby,
connected to a plastic bag. This is to drain any residual blood from the operation. For
the same reason, you will have plastic drainage tubes coming out of the skin near
your lower wound. The wounds are painful for two or three days, and you will be
given injections and, later, tablets to control this. You may have a fine tube in your
back to help control the pain. Ask for more if the pain is not controlled or if it gets
worse. A general will make you slow, clumsy and forgetful for about 24 hours. The
nurses will help you with everything you need until you are able to do things for
yourself. Do not make important decisions during this time. You will probably have a
fine drainage tube (catheter) in the penis or front passage to drain the urine from
the bladder until you are able to get out of bed easily. You should be eating and
drinking normally after about four to six days. The wound has a dressing which may
show some staining with old blood in the first 24 hours. There may be stitches or
clips in the skin. Sometimes seven or eight stitches are put across the wound to add
strength. Stitches and clips are removed after about 7 to 10 days. The drain tube is
removed after about 4 days. Your stoma nurse will show you how to manage your
colostomy. You can wash as soon as the dressing has been removed but try to keep
2
the wound area dry until the stitches/clips come out. Soap and tap water are entirely
adequate. Salted water is not necessary. You will be given an appointment to visit
the outpatient department for a check-up about one month after you leave hospital.
The stoma nurse will keep in contact with you at home. The nurses will advise about
sick notes, certificates etc.
After - At Home
You are likely to feel very tired and need rests two or three times a day for a month
or more. You will gradually improve so that by the time three months have passed
you will be able to return completely to your usual level of activity. At first discomfort
in the wound will prevent you from harming yourself by too heavy lifting. After three
months you can lift as much as you used to lift before your operation. You can drive
as soon as you can make an emergency stop without discomfort in the wound, i.e.
after about four weeks. You can restart sexual relations within three to four weeks
when the wound is comfortable enough. There may be some damage to the sex
nerves following this operation (some studies suggest that it happens in up to 50%
of cases). The Surgeon will talk to you about this. You should be able to return to a
light job within eight weeks. Some heavy jobs may not be suitable because of the
colostomy.
Possible Complications
As with any operation under general , there is a very small risk of complications
related to your heart and lungs. The tests that you will have before the operation will
make sure that you can have the operation in the safest possible way and will bring
the risk for such complications very close to zero.
This is a major operation and complications can occur more frequently compared
with other operations of the bowel. When they happen, they are rapidly recognized
and dealt with by surgical staff. If you think that all is not well, please let the doctors
or nurses know.
Chest infections may arise, particularly in smokers. Getting out of bed as soon as
possible, getting as mobile as possible and co-operating with the physiotherapists to
clear the air passages is important to prevent chest infections.
Occasionally the bowel is slow to start working again. This may take a week or more.
Your food and water intake will continue through your vein tubing until the bowel
works. Sometimes there is some discharge from the drain by the wound. This stops
given time.
Wound infection is sometimes seen. This happens relatively more frequently in any
bowel operation compared to other 'clean' operations such as taking out your
gallbladder and the reason is that the bowel has many bugs that can cause an
infection. The infection settles down with antibiotics in a week of two.
Very rarely, during the operation, another part of your bowel, your bladder or a
blood vessel can be damaged and this may require another operation to deal with
the problem.
Complications related to the colostomy are a skin rash, infection or abscess (a pool
of pus) around the colostomy, narrowing/stricture or necrosis (tissue death) of the
bowel at or near to the colostomy and also a hernia of the colostomy, a situation
where the bowel falls through the skin. These complications occur in approximately 4
to 30% of cases. If you get such complications it is likely that you will need another
operation to fix the problem.
3
Aches and twinges may be felt in the wound for up to six months. Sometimes the
lower wound is slow to heal. Sometimes the stoma is troublesome. Sometimes there
is some damage to the bladder and sex nerves.
General Advice
The operation should not be underestimated. Some patients are surprised how slowly
they regain their normal stamina. Virtually all patients are back doing their normal
duties within three months. You will be surprised how good the modern appliances
are. Your social life should not be affected by the operation. The stoma nurses will
keep in touch with you always. We hope these notes will help you through your
operation. They are a general guide. They do not cover everything. Also, all hospitals
and surgeons vary a little. If you have any queries or problems, please ask the
doctors or nurses.
Abdominoplasty
What is it?
Abdominoplasty means removal of excess skin and fatty tissue from the anterior
abdominal walls. It is also called an apronectomy. The end result is to improve the
shape of the anterior abdominal wall and to decrease the bulging that can occur
between the umbilicus and the pubic bone area.
The Operation
You will be given a general anesthetic and be completely asleep during the surgery.
The operation takes from about one hour to an hour and a half to perform.
Any Alternatives
Excess fat on the anterior abdominal wall may be caused by being generally
overweight or having been pregnant with the skin stretching over the abdominal wall
which has lost its elasticity and does not return to its pre-pregnancy state. Weakness
of the anterior abdominal wall muscles can be related to excess weight gain,
pregnancy, or general abdominal wall weakness.
If the problem is related to simple accumulation of fat in limited areas, liposuction

can be performed. This can be successful if there are good underlying abdominal
wall muscles and if the skin elasticity is normal.
If however the skin has lost its elasticity, removal of the fat can result in the
overlying skin becoming wrinkly and indented. The exact type of operation that
would be performed, the amount of skin that would be removed and the potential
use of liposuction during the surgery would be discussed with each individual, prior
to the operation.
The surgery is likely to be of most benefit and last longer if you have finished having
your family. It is probably unwise to go through this major surgical operation if you
have any chance of having children in the future. Pregnancy is likely to undo all the
work that has been done, and would therefore be something that most surgeons
would be reluctant to undertake this procedure unless there were very firm
assurances that you did not wish to become pregnant in the future.
4
Before the Operation
It would be important for your surgeon to assess your general medical condition
prior to the operation. It may be necessary to have advice from other doctors
depending on your weight, blood pressure and general overall health. In general it is
important to avoid smoking as this can decrease the blood supply to the skin that is
going to be stretched tight over your stomach and can cause areas of the skin to
become damaged or partially dead, and may even require skin grafting should
healing not occur. It is important to be at the ideal weight as weight loss subsequent
to the abdominoplasty type procedure can interfere with the final results.
After the Operation

If it has been necessary to tighten up your stomach, you will find that on return to
the ward you will be nursed with your knees and hips bent. This may be with you
lying on the left or right side or if lying on your back, with some pillows underneath
your knees. This is to take the pressure off the muscle to help with post-operative
pain and discomfort. It is also likely that there will be drains and you will be required
to wear anti-embolism stockings. The nurses will make regular post-operative
checks of temperature, blood pressure and pulse rate. It is likely that there will be an
intravenous drip in place, in order to provide fluids until you feel like eating and
drinking again. It is likely there will be a firm bandage around your stomach, which
may have Velcro fastenings that can be loosened if it becomes too uncomfortable.
This supports the surgery that has been done and decreases swelling.
You may experience some pain and discomfort after surgery for which you may need
painkilling injections or tablets. When lying in bed, it is very important to continue to
move your feet and legs (up and down) to promote circulation and prevent clot
formation in the veins of the legs. It is also important to take regular deep breaths
to expand your lungs following the surgery. Occasionally it is uncomfortable to do
this, particularly if the stomach has been tightened significantly. You will be asked to
mobilise gently over the next few days with assistance from the nurses and
physiotherapists, as required. If the muscle has been tightened it will be a gradual
process of straightening up. This means that for some weeks following surgery you
may walk with a stooped-over gait. Assistance will be given with hygiene until you
are able to manage independently. The drains will be removed when they are no
longer draining significant amounts. You will need to wear a firm dressing or corset
around your stomach in order to continue to give it support on going home.
You may stay in hospital for two or three days depending on the extent of the
surgery. It is important to maintain a good healthy diet and to avoid becoming
constipated as straining can make the stomach uncomfortable.
After - At Home
An abdominoplasty is a major surgical procedure and you may feel tired on returning
home. It is likely that you will be able to be self-caring but you should avoid doing
any heavy lifting, straining, bending or lifting. You will be given advice as to how to
get up from a sitting position and as to how to roll rather than sit straight up out of
bed. The wounds can be cleaned when they are sealed, usually from about a week.
The firm corset should be worn all the time in order to try and reduce the swelling
and improve the discomfort. If the stomach muscle needed to be tightened up, you
will still walk with a stoop, which may take a few weeks to straighten up altogether.
It is important not to try and straighten up immediately as this can tear some of the
sutures that have been used to hold the muscles together and can lead to
5
subsequent problems with further weakness of the anterior abdominal wall.
You can return to driving when you are comfortable enough to do an emergency stop
and do not feel any discomfort when moving your feet around when sitting in a car.
A safety belt should always be worn.
As with any major surgical procedure, bleeding can occur during and after the
surgery. Drains are placed to prevent significant bleeding accumulating under the
skin following surgery and it is most unusual to have to return to theatre for excess
bleeding. However, there are sometimes small amounts of fluids that can collect
underneath the skin and these may need to be removed at a later date either by
surgery or by needle aspiration.
There is a large amount of undermining of the skin on the anterior abdominal wall in
order to allow it to move into a new position and reshape the tummy. This interferes
with the skin's blood supply and can cause some areas of the skin to become
ischemic (significant decrease in blood supply) and subsequently not heal properly.
Should this be the case occasionally skin grafting is required. The position of the
scar is discussed with the surgeon prior to surgery and on most occasions, heals
leaves a good scar. However, reactions can occur to the suture materials used and
the scars can become red, raised and lumpy above the surrounding skin. The design
of the scar is such to try and hide it under normal underwear/swimwear.
The shape of the anterior abdominal wall is changed and this may cause other areas
of the body to become more prominent, particularly aspects of the hips and the
flanks. It is not always possible to address this at the time of surgery and
irregularities in the skin may become obvious when the swelling has diminished. At
the time of surgery liposuction may be used around the flanks in order to try and
improve the overall appearance when looking at the tummy from the front.
The most serious complication that can occur during an abdominoplasty procedure is
the formation of clots in the veins in the legs. These can then travel to the heart and
lungs and cause severe difficulty with breathing. The surgeon will arrange to try and
prevent this occurring both by using anti-clot stockings and pumps that are placed
on the legs during surgery to improve blood flow. Frequently blood-thinning agents
are also given so that clot formation is decreased.
The altered sensation of the skin over the anterior abdominal wall may be
uncomfortable as time progresses. You are also likely to feel uncomfortable and
have a feeling of tightness on the skin, particularly for a few weeks following
surgery. If the muscle tightening has been required to improve your shape, it may
be necessary to avoid physical activity such as swimming and gym work for up to
three months following surgery. You would need to discuss this with your surgeon.
There may be some irregularities in the skin of the anterior abdominal wall following
the surgery and it can take some time for these to settle. Very occasionally the
umbilicus can become red and inflamed.
General Advice
Abdominoplasty type procedures can produce very satisfactory results for trimming
the anterior abdominal wall and decreasing the lower abdominal bulge. Although it
may address these problems it can make other areas such as the hips and flanks
more obvious. These other areas may be improved by continued weight loss. In
6
some circumstances however, it may be necessary to perform further surgery at the
flanks to improve the position. Very occasionally, when there is a lot of excess tissue
around the back, a similar type operation as performed on the anterior skin of the
stomach can be performed on the back. This will leave a scar directly across the
back from side to side.
Abscess - Intra Abdominal
What is it?
You have an abscess which has formed deep inside your abdomen. This is something
brought on by infection after, for example, appendicitis, a burst ulcer, or an
operation. The abscess is a pool of half a pint (250ml) or more of liquid pus. It
makes you feel ill and feverish. If left, it can get worse can cause serious problems
and even, rarely, threaten your life. Commonly these abscesses only show up two or
more weeks after the infection. Also they often need to be left even longer than this
before they are 'ripe' enough to be opened up and drained safely. The abscess can
form high up under the ribs, or deep down in the pelvis, or anywhere in between.
Sometimes there are more than one.
The Operation
You will have a general anesthetic, and will be asleep for the whole operation. A cut
about 3 inches long (8cm) is made in the skin of the tummy as near as possible to
the abscess. The cut is deepened until the surgeon reaches the abscess. The pus
then drains out to the skin. The surgeon also washes out the area of the abscess
using a lot of fluid containing medicines, such as antibiotics to protect against
infection. A rubber drainage tube is put down into the abscess space to drain out any
further pus. This tube stays in place until it is clear from X-ray tests that the abscess
space is getting smaller. The tube can then be shortened, bit by bit. Finally the
wound dries up and heals over.
Any Alternatives
If you leave things as they are, the abscess may drain out through your skin after
many days. You may become very ill and weakened during this waiting time.
Sometimes the abscess drains into other organs such as the bowel and the lung or
spreads around inside your tummy. These can be very serious for you. Antibiotics
have not done the trick in your case. . Draining the abscess is all that should be done
at this stage. If there is an underlying disease, this will need to be left for later. In
some cases the drainage tube can be placed in the abscess without an operation. A
small area of the skin on top of the abscess is numbed with an injection of anesthetic
(like when you go to the dentist) and a very small (1/2 inch/1.3cm) cut is made in
this area. Via the small cut and with the help of special X-rays, the drainage tube is
put into your abdomen and directed into the abscess to allow it to drain through the
skin. Although this procedure is obviously simpler compared to an operation, it is not
always successful and it doesn’t work in situations like yours where the liquid pus in
the abscess is very thick and therefore doesn’t drain freely through the drainage
tube.

You may well be in hospital already, so some of the notes below are only for new
comers. Stop smoking and get your weight down if you are overweight. (See Healthy
Living)If you know that you have problems with your blood pressure, your heart, or
your lungs, ask your family doctor to check that these are under control. Check the
7
you have a relative or friend who can come with you to hospital, take you home, and
look after you for the first week after the operation. Sort out any tablets, medicines,
inhalers that you are using. Keep them in their original boxes and packets. Bring
them to hospital with you.
On the ward, you will be checked for past illnesses and will have special tests to
prepare you and make sure you can have the operation safely. Please tell the doctors
and nurses of any allergies to tablets, medicines or dressings. You will have the
operation explained to you and will be asked to fill in an operation consent form.
Many hospitals now run special pre-admission clinics, where you visit for an hour or
two, a week or so before the operation for these checks.
After - In Hospital
You will have a drip tube in an arm vein connected to a plastic bag on a stand,
containing a salt solution or blood. You may have a fine plastic tube coming out of
your nose and connected to another plastic bag to drain your stomach. Swallowing
may be a little uncomfortable. You will have a rubber drainage tube coming out of
your wound. The tube is connected to a plastic bag. There is a dressing on the
wound. You may be given oxygen from a face mask for a few hours if you have had
any chest problems in the past. The wound is a little painful. You will be given tablets
or injections to control this. Sometimes, the drainage tube tugs painfully on the skin
after three or four days. Ask for more painkillers as needed. A general anesthetic will
make you slow, clumsy and forgetful for about 24 hours. The nurses will help you
until you can do things for yourself.
You will be able to get out of bed the day after operation despite some discomfort.
You will not do the wound any harm, and the exercise is very helpful for you. You
should be able to walk (with the tube and bags) about 25 yards further each day
than the day before. Because of the drainage tube (catheter) in the bladder, passing
urine should not be a problem. Sometimes there is a feeling that there is a leakage
all the time, but this is just an irritation by the tubing and it passes off. Once you can
walk about in reasonable comfort, the catheter is taken out. If you cannot pass urine
after this catheter is taken out let the nurses know. A little dark red blood, changing
to a yellow liquid after a day or two, may ooze around the drain tube. Once the X-ray
tests on the drain tube are all right, the tube is taken out inch by inch over several
days. This does not hurt. The wound then heals up in five or six days. If there is
more discharge for a time, a collecting bag can be stuck onto the skin over the
wound. Sometimes the tube needs to stay in place for a week or two, while the
abscess space inside your body closes down. You can wash but try to keep the tube
and the skin area around it dry. . Once the tube is out you can wash or bathe
normally. Ordinary soap and water are all you need. Salt water is not needed. You
will be given an appointment to visit the outpatient department for a check-up about
one month after you leave the hospital. Some hospitals leave check-ups to the
general practitioner. The nurses will advise about sick notes, certificates etc.
After - At Home
You are likely to feel very tired and need rest for a month or more. It may be one to
two months before you are back to your normal strength. You can build up your
walking by an extra 50 yards each day. At first discomfort in the wound will prevent
you from harming yourself by lifting things that are too heavy. After two months,
you can lift as much as you used to before the operation. There is no value in trying
to speed the recovery of the wound by special exercises before the months are out.
8
You can drive as soon as you can make an emergency stop without discomfort in the
wound, i.e. about three weeks. You can restart sexual relations after three weeks
when the wound is comfortable enough. You should be able to go back to a light job
after about one month. It may be two months or more before you can return to a
heavy job.
Complications can happen because of the original infection. Other abscesses can
come to light. The surgeon will talk to you about them. Sometimes the wound
drainage goes on and on. . Although in most cases the drainage stops and the
abscess heals up in the end there is a very small chance that you might need
another operation to drain what is left of the abscess. Aches and twinges may be felt
in the wound for up to six months.
General Advice
they regain their normal stamina - but virtually all patients are back doing their
normal duties within three months of leaving hospital. These notes will help you
through your operation. They are a general guide. They do not cover everything.
Also, all hospitals and surgeons vary a little. If you have any queries or problems,
please ask the doctors or nurses.
Abscess - Pelvic
What is it?
You have an abscess which has formed in the lower part of your abdomen. This is
something brought on by infection after, for example, appendicitis, a burst ulcer, or
an operation. The abscess is a pool of half a pint (250 ml) or more of liquid pus. It
makes you feel ill and feverish. If left, it can get worse , can cause serious problems
and even, rarely, threaten your life. Commonly these abscesses only show up two or
more weeks after the infection. Also they often need to be left even longer than this
before they are 'ripe' enough to be opened up and drained safely. The abscess can
form high up under the ribs, or deep down in the pelvis, or anywhere in between.
Sometimes there are more than one.
The Operation
about 3 inches long (8 cm) is made in the skin of the tummy as near as possible to
then drains out to the skin. The surgeon will also wash out the area of the abscess
with a lot of fluid. This fluid sometimes contains medicines, such as antibiotics, to
prevent infection. A rubber drainage tube is put down into the abscess space to drain
out any further pus. This tube stays in place until it is clear from X-ray tests that the
abscess space is getting smaller. The tube can then be shortened, bit by bit. Finally
the wound dries up and heals over.
Any Alternatives
Sometimes the abscess drains into another organ such as your bowel or spreads
around inside your tummy. These can be very serious for you. Antibiotics have not
done the trick in your case. . Draining the abscess is all that should be done at this
9
stage. If there is an underlying disease, that needs to be left for later. In some cases
the drainage tube can be placed in the abscess without the need for an operation. A
small area of the skin on top of the abscess is numbed with an injection of local
anesthetic (like when you go to the dentist). A very small (1/2 inch/ 1.3 cm) cut is
made in this area and with the help of special X-rays, the drainage tube is directed
into the abscess to allow it to drain through the skin. Although this procedure is
obviously simpler than an operation, it is not always successful and it doesn’t work in
situations like yours when the liquid pus in the abscess is very thick and therefore
doesn’t drain freely through the drainage tube.

comers. Stop smoking and get your weight down if you are overweight. If you know
that you have problems with your blood pressure, your heart, or your lungs, ask
your family doctor to check that these are under control. Check the hospital's advice
about taking the Pill or hormone replacement therapy (HRT). Check you have a
relative or friend who can come with you to hospital, take you home, and look after
you for the first week after the operation. Sort out any tablets, medicines, inhalers
that you are using. Keep them in their original boxes and packets. Bring them to
hospital with you.
On the ward, you may be checked for past illnesses and may have special tests, to
After - In Hospital
make you slow, clumsy and forgetful for about 24 hours. Do not make important
decisions during that time. The nurses will help you until you are able to do things
for yourself.
You will be able to get out of bed the day after the operation despite some
discomfort. You will not do the wound any harm, and the exercise is very helpful for
you. You should be able to walk (with the tube and bags) about 25 yards further
each day than the day before. Because of the drainage tube (catheter) in the
bladder, passing urine is not a problem. Sometimes there is a feeling that there is a
leakage all the time, but this is just an irritation by the tubing and it passes off. Once
you can walk about in reasonable comfort, the catheter is taken out. If you cannot
pass urine after this catheter is taken out let the nurses know. A little dark red blood,
changing to a yellow liquid after a day or two, may ooze around the drain tube. Once
the X-ray tests on the drain tube are all right, the tube is taken out inch by inch over
several days. This does not hurt. The wound then heals up in five or six days. If
10
there is more discharge for a time, a collecting bag can be stuck onto the skin over
the wound.
Sometimes the tube needs to stay in place for a week or two, while the abscess
space inside your body closes down. You can wash but try to keep the tube and the
area of the skin around it dry. Once the tube is out you can wash or bathe normally.
Ordinary soap and water are all you need. Salt water is not needed. You will be given
an appointment to visit the Out Patient Department for a check up about one month
after you leave the hospital. Some hospitals leave check-ups to the General
Practitioner. The nurses will advise about sick notes, certificates etc.
After - At Home
you from harming yourself by too heavy lifting. After two months, you can lift as you
usually do. There is no value in trying to speed the recovery of the wound by special
exercises before the months are out. You can drive as soon as you can make an
emergency stop without discomfort in the wound, i.e. about three weeks. You can
restart sexual relations after three weeks when the wound is comfortable enough.
You should be able to go back to a light job after about one month. A heavy job may
take two months or more.
drainage goes on and on. Although in most cases the drainage stops and the abscess
heals up in the end there is a very small chance that you might need another
operation to drain what is left of the abscess. Aches and twinges may be felt in the
wound for up to six months.
General Advice
Abscess - Perineal
What is it?
A perennial abscess is an infection in the wall of the lowest part of the back passage.
Pus is building under the skin causing swelling and pain. There is sometimes a
connection with the back passage itself.
The Operation
You will have a general anesthetic, and will be asleep for the whole operation. The
pus is let out through a cut in the skin. The wound is packed with swabs. Antibiotics
are given to help the healing. You should be able to go home after one or two days.
For the first week or so after the operation, the swabs are changed for clean ones
about every other day. This can be done on the ward while you are in the hospital or
11
in the outpatients clinic or in your GP's surgery when you leave the hospital. After
that you will not need any more swabs in the area and at about a month later the
wound is examined to see if any more treatment is needed.
Any Alternatives
If you let nature take its course, the abscess will discharge pus after several days.
While you are waiting, you will have a lot of pain and a high temperature. The
abscess will get much bigger than if you had it drained. Healing will take much
longer. You will be off work and off color for much longer. There is a considerable
chance that the abscess can spread and you could end up with a generalized
infection (sepsis) which could be potentially lethal. Antibiotics have not worked for
you. Heat treatment and ointments will not help.

Stop smoking and get your weight down if you are overweight. If you know that you
have problems with your blood pressure, your heart, or your lungs, ask your family
doctor to check that these are under control. Check the hospital's advice about
taking the Pill or hormone replacement therapy (HRT). Check you have a relative or
friend who can come with you to the hospital, take you home, and look after you for
the first week after the operation. Sort out any tablets, medicines, inhalers that you
are using. Keep them in their original boxes and packets. Bring them to the hospital
with you.
On the ward, you may be checked for past illnesses and may have special tests to
make sure that you are well prepared and that you can have the operation as safely
as possible. Please tell the nurses of any allergies to tablets, medicines or dressings.
You will have the operation explained to you and will be asked to fill in an operation
consent form. Many hospitals now run special preadmission clinics, where you visit
for an hour or two, a few weeks or so before the operation for these checks.
After - In Hospital
There is some discomfort on moving rather than severe pain. You will be given
injections or tablets to control this as required. Ask for more if the pain is not
controlled or if it gets worse.. A general anesthetic will make you slow, clumsy and
forgetful for about 24 hours. The nurses will help you with everything you need until
you are able to do things for yourself. Do not make important decisions, drive a car,
use machinery, or even boil a kettle during this time.
You will most likely be able to get out of bed with help of the nurse the day after
operation despite some discomfort. You will not do the wound any harm, and the
exercise is very helpful for you. You should be comfortable enough to go home within
one or two days. The first time you open your bowels it may be a bit painful but this
rapidly improves. It is important that you pass urine and empty your bladder within
6 to 12 hours of the operation. If you find using a bed pan or a bottle difficult, the
nurses will assist you to a commode or a toilet. If you still cannot pass urine let the
nurses know and steps will be taken to correct the problem. The wound has a
dressing held on by elastic netting pants. There may be some staining with old blood
during the first 12 hours. The dressings will be removed the day after operation and
will be replaced with a lighter dressing.
There may be stitches in the wound. You can wash as soon as the dressings have
been removed but try to keep the wound area dry for the time (about a week) you
will have swabs in the wound. Soap and tap water are entirely adequate. Salted
water is not necessary. You may be given an appointment to visit the outpatient
12
department for a check up one week after you leave hospital. Any stitches will be
taken out at this visit. Some hospitals arrange a check-up about one month after you
leave hospital. Others leave check-ups to the general practitioner. The nurses will
advise about sick notes, certificates etc.
After - At Home
You will be given dressings to use at home as needed. You will be given a supply of
antibiotics. You may be uncomfortable for three to four days. The wound should heal
within two weeks. You can drive as soon as you can make an emergency stop
without discomfort in the wound, i.e. after about 10 days. You can restart sexual
activities within a week or two, when the wound is comfortable enough. You should
be able to return to a light job after about one week, and any heavy job within two
weeks.
As with any operation under general anesthetic, there is a very small risk of
complications related to your heart and lungs. The tests that you will have before the
operation will make sure that you can have the operation in the safest possible way
and will bring the risk for such complications very close to zero.
Complications are relatively rare and seldom serious. If you think that all is not well,
please let the doctors or nurses know. The wound is always a bit moist for a week or
two. There is likely to be a discharge of yellow matter and even some dark blood on
the dressings during this time. Opening your bowels will rapidly become easier,
particularly if you take a laxative. DO NOT however take bran or a high-fibre diet
until the back passage is pain-free in case you end up with a blockage.
There is a very small chance that you may experience some persistent bleeding after
the operation or, even more rarely, there is chance that some damage will be caused
to a vessel, a nerve or your back passage during the operation. In a situation like
this you will need another operation to fix the problem.
The operation to drain the abscess solves the problem completely in just over 50%
of cases. In the remaining patients a small permanent communication (fistula) can
develop between the back passage and the skin with recurrent local infection, which
can, in some people (like the elderly or diabetic patients) develop into an abscess
again. If this is the case you will probably need another operation correct the fistula
between the back passage and the skin.
If you have any problems or queries, please ask the doctors or nurses.
General Advice
These notes will help you through your operation. They are a general guide. They do
not cover everything. Also, all hospitals and surgeons vary a little. If you have any
queries or problems, please ask the doctors or nurses.
Abscess - Subphrenic
What is it?
You have an abscess which has formed in the upper part of your abdomen just under
your chest. This is something brought on by infection after, for example,
appendicitis, a burst ulcer, or an operation. The abscess is a pool of half a pint
(250ml) or more of liquid pus. It makes you feel ill and feverish. If left, it can get
13
worse, cause serious problems and even, rarely, threaten your life. Commonly these
abscesses only show up two or more weeks after the infection. Also they often need
to be left even longer than this before they are 'ripe' enough to be opened up and
drained safely. The abscess can form high up under the ribs, or deep down in the
pelvis, or anywhere in between. Sometimes there are more than one.
The Operation
about 3 inches long (8cm) is made in the skin of the tummy as near as possible to
then drains out to the skin. A rubber drainage tube is put down into the abscess
space to drain out any further pus. This tube stays in place until it is clear from X-ray
tests that the abscess space is getting smaller. The tube can then be shortened, bit
by bit. Finally the wound dries up and heals over.
Any Alternatives
Sometimes the abscess drains into the lung or spreads around inside your tummy.
These can be very serious for you. Antibiotics have not done the trick in your case.
Heat treatment and laser treatment will not be helpful. Draining the abscess is all
that should be done at this stage. If there is an underlying disease, that needs to be
left for later.

comers. Stop smoking and get your weight down if you are overweight. (See Healthy
Living.) If you know that you have problems with your blood pressure, your heart, or
On the ward, you will be checked for past illnesses and will have special tests to
where you visit for an hour or two, a week or so before the operation for these
checks.
After - In Hospital
14
make you slow, clumsy and forgetful for about 24 hours. The nurses will help until
you can do things for yourself. .
You will be able to get out of bed the day after operation despite some discomfort.
You will not do the wound any harm, and the exercise is very helpful for you. You
should be able to walk (with the tube and bags) about 25 yards further each day
than the day before. Because of the drainage tube (catheter) in the bladder, passing
urine should not be a problem. Sometimes there is a feeling that there is a leakage
all the time, but this is just an irritation by the tubing and it passes off. Once you can
walk about in reasonable comfort, the catheter is taken out. If you cannot pass urine
after this catheter is taken out let the nurses know. A little dark red blood, changing
to a yellow liquid after a day or two, may ooze around the drain tube. Once the X-ray
tests on the drain tube are all right, the tube is taken out inch by inch over several
days. This does not hurt. The wound then heals up in five or six days. If there is
more discharge for a time, a collecting bag can be stuck onto the skin over the
wound. Sometimes the tube needs to stay in place for a week or two, while the
abscess space inside your body closes down. You can wash but try to keep the tube
and the area of the skin around it dry.. Once the tube is out you can wash or bathe
normally. Ordinary soap and water are all you need. Salt water is not needed. You
will be given an appointment to visit the outpatient department for a check-up about
one month after you leave the hospital. Some hospitals leave check-ups to the
After - At Home
you from harming yourself by lifting things that are too heavy. After two months,
you can lift as much as you could before you had the operation. There is no value in
trying to speed the recovery of the wound by special exercises before the months are
out. You can drive as soon as you can make an emergency stop without discomfort
in the wound, i.e. after about three weeks. You can restart sexual relations after
three weeks when the wound is comfortable enough. You should be able to go back
to a light job after about one month. It may be two months or more before you can
return to a heavy job.
drainage goes on and on. Although in most cases the drainage stops and the abscess
heals up in the end there is a very small chance that you might need another
operation to drain what is left of the abscess. Aches and twinges may be felt in the
wound for up to six months.
General Advice
15
Adenoidectomy
What is it?
Adenoids are swellings in the back of the nose. You can't see them because they are
hidden behind the floppy part of the roof of the mouth. But they are like the tonsils
you can see in the back of the throat. They are near the little tubes in the back of
the nose which pass to the ears. The adenoids are made of gland tissue, like the
tonsils. This tissue swells up to fight infection. Usually the swelling settles down after
the infection passes. Your child's adenoids are now swollen all the time after many
attacks of infection. They are blocking the back of the nose. This makes breathing
through the nose difficult. They can also block the tubes in the back of the nose
which pass to the ears. Blockage here can cause earache and deafness. Taking out
the adenoids will stop these nose and ear problems. After taking out the adenoids,
there is plenty of gland tissue elsewhere in the head and neck, and throughout the
body, to fight infection. This condition is not the parents' fault.
The Operation
Your child will have a general anesthetic and will be completely asleep. Special
instruments are passed into the back of the mouth. The adenoids are freed off and
taken away. A special instrument called diathermia (a Greek word which means by
applying heat) is usually used which can free the tonsils and adenoids and at the
same time can stop the bleeding by applying a wave of heat on the small blood
vessels. There are no cuts in the skin. Because your child will be completely asleep,
he or she will not feel any pain at all during the operation. Your child should be fit to
go home the next morning.
Any Alternatives
Usually adenoids shrink away on their own when the child reaches the age of 12 or
13. Waiting this long is not a happy prospect for a child. It may lead to life-long
hearing difficulties. Tablets or medicines will not make the adenoids get smaller or go
away.

Sort out any tablets, medicines, inhalers that your child is using. Keep them in their
original boxes and packets. Bring them to the hospital with you. On the ward, your
child may be checked for past illnesses and may have special tests to make sure that
he or she is well prepared and can have the operation as safely as possible. Please
tell the doctors and nurses of any allergies to tablets, medicines or dressings. You
and your child will have the operation explained to you and you will be asked to fill in
an operation consent form for your child. Many hospitals now run special
preadmission clinics, where you and your child visit for an hour or two, a week or so
before the operation for these checks. If your child has a cold in the week before
admission to hospital, please telephone the ward and let the ward sister know.
Usually, the operation will have to be put off. Your child needs to get over the cold
before the operation can be done because by having an anesthetic the cold could
turn into a serious infection in the chest. Because the surgeon will be working inside
your child's mouth, you must tell him if your child has any loose teeth.
After - In Hospital
Usually the throat is only slightly sore after this operation. The nurses will give your
child some medicine to help relieve the sore throat. A general anesthetic may make
your child slow, clumsy and forgetful for about 24 hours. The nurses will support you
to help your child until he or she feels better. Your child will be able to drink about
16
two to three hours after he or she returns to the ward, and will be eating normally
later on in the day. Before you leave the ward you may be given an appointment
card to bring your child back to the ENT (ear, nose and throat) outpatient clinic for a
check-up. Some hospitals arrange a check-up about one month after the operation.
Others leave check-ups to the general practitioner.
After - At Home
Use paracetamol suspension to settle any sore throat. If possible, try and avoid your
child catching a cold or cough within the first week at home. Avoid having friends
round to play if they have a cold. For the same reason your child should stay off
nursery or school for a week after the operation. If your child does develop a cold,
you should take your child to see your general practitioner for a course of antibiotics.
Your child should not go swimming until the throat has healed. This is usually after
about three weeks.
complications related to the heart and the lungs. The tests that your child will have
before the operation will make sure that he or she she can have the operation in the
safest possible way and will bring the risk for such complications very close to zero.
If you follow the advice given above, your child is unlikely to have any problems.
Sometimes (in less than 1% of cases) the surgeon has to control oozing of blood
from the adenoid area. This means tucking a length of gauze into the nose for 24
hours or so. When the surgeon is certain that the bleeding has stopped, the gauze is
taken out. A second very short operation will be needed to do this.
Bleeding can also occur a week or so after the operation, usually due to an infection.
If an infection is developing your child might also have increasing pain at the area of
the operation, a headache or temperature. If this happens, bring your child back to
the ward. Your child will probably stay on the ward for a day or two and take
antibiotics for one to two weeks. Another operation is not usually needed.
There is a very small chance (no more than 6 in a 1000) that when the adenoids are
removed the area close to where they used to be is not closing properly and this can
affect your child’s speech. In the majority of cases this can improve with speech
therapy and only in a few cases is an operation needed to fix the problem.
General Advice
These notes should help you and your child through his operation. They are a
general guide. They do not cover everything. Also, all hospitals and surgeons vary a
little. If you have any queries or problems, please ask the doctors or nurses.
Amputation - Above Knee

What is it?
There is not enough blood getting down your leg to keep it alive. The lack of blood
causes severe pain and allows serious infection to take hold. The only choice is to
take off the damaged part. This must be done high enough to get proper healing of
the stump. In your case it means an amputation through the thigh.
The Operation
You will probably have a general anesthetic, and will be asleep for the whole
operation. Sometimes patients are numbed from the waist down with an injection in
17
the back. In this case you will be awake but you will not feel any pain from the waist
down. A cut is made so that after removing the diseased part, you end up with a
rounded stump made of healthy skin. You should plan to be in the hospital for up to
six weeks to cover any delay in healing of the wound. You may well be out before
this.
Any Alternatives
An alternative is to amputate lower down, such as through the knee, or at the mid-
shin level. But the lower the level, the higher the risk of poor healing, more
operations, and a longer stay in hospital. A direct operation on the arteries will not
help at this stage. Laser treatment and X-ray guided stretching of the arteries will
not work for you. Overall, your best plan is an above-knee amputation.

Stop smoking and try to get your weight down if you are overweight. (See Healthy
Living). If you know that you have problems with your blood pressure, your heart, or
and look after you after the operation. Sort out any tablets, medicines, inhalers that
you are using. Keep them in their original boxes and packets. Bring them to the
hospital with you. On the ward, you may be checked for past illnesses and may have
special tests to make sure that you are well prepared and that you can have the
operation as safely as possible. Please tell the doctors and the nurses of any allergies
to tablets, medicines or dressings. You will have the operation explained to you and
will be asked to fill in an operation consent form. Many hospitals now run special
preadmission clinics, where you visit for an hour or two, a few weeks or so before
the operation for these checks.
After - In Hospital
You may be given oxygen from a face mask for a few hours if you have had chest
problems in the past. You will have a fine, thin plastic tube in your arm to give you a
blood transfusion (if necessary) or salt solutions. You will have a fine, plastic
drainage tube coming out of the skin near the wound, connected to a container. This
is to drain any residual blood or other fluid from the area of the operation. You may
have a tube draining urine from the bladder to make your nursing easier. There is
some discomfort on moving rather than severe pain. You will be given injections or
tablets to control this as required. Ask for more if the pain is not well controlled or if
it gets worse. Your original pain will have gone, but you may still feel as if the leg is
still there. This is called a 'phantom limb' and is something that it is expected and
something that most patients experience after an amputation. The feeling fades in
time. A general anesthetic will make you slow, clumsy and forgetful for about 24
hours. The nurses will help you with everything you need until you are able to do
things for yourself. Do not make important decisions during this time. By the end of
one week the wound should be virtually pain-free. You will be helped out of bed after
24 hours. You should be sitting out of bed comfortably in a week. You should be
trying to stand and walk with crutches after a week or so. Your phantom limb may
make you forget you have had an amputation. Always have a nurse to help you out
of bed, or you may fall and injure yourself. It is important for you to pass urine and
empty your bladder after the operation. If you have any difficulty, ask the nurses or
doctors. The wound has a dressing on it. The dressing will be changed every two to
three days for two weeks to see if the wound is healing well. Any stitches may be
taken out after about two weeks. The wound drain is taken out after 48 hours or so.
18
When you first see the wound, the stump will look very bulgy, but this smoothes off
in a week or two. The hospital will arrange for you to see the limb fitter once the
wound is fully healed. You will have a go at walking with a temporary limb in the
physiotherapy department before you see the fitter. You can wash as soon as the
dressing has been removed but try to keep the wound area dry until the stitches
come out. Soap and warm tap water are entirely adequate. Salted water is not
necessary. You can shower or take a bath as often as you want. You will be given an
appointment to visit the surgical outpatient Department for a check-up about one
month after you leave hospital. The nurses will advise about sick notes, certificates
etc.
After - At Home
You may need alterations to your home, e.g. bath handles and ramps which will help
you when you return. These will be arranged by the hospital through the social work
department. You will need a temporary wheelchair and to learn how to use it. You
may even need to think about a change in your housing if your present home is
unsuitable for you after the operation. The social workers will advise you here. You
may need convalescence. You are likely to feel tired and need to rest two or three
times a day for a month or two after the operation. You will gradually improve. The
physiotherapists will train you up towards having an artificial limb. The limb fitting
centre will see whether you can manage to use one. It often takes three months or
more before you have a limb that fits you exactly, since the stump is changing and
firming up all the time. How soon you can drive again depends on how quickly you
cope with the artificial limb. You may well be able to drive an automatic car or one
specially modified for your needs. You will be helped with this. You can restart sexual
relations once the wound has healed. How soon you can return to work depends on
how quickly you heal up. It is unlikely that you could do a heavy manual job, but
many other jobs are perfectly feasible.
If you have this operation under general anesthetic, there is a risk of complications
make sure that you can have the operation in the safest possible way and will reduce
the chances for such complications. The chance of dying after an amputation is 3 to
10%. The chances are higher for elderly people with other health problems such
diabetes, or disease of the arteries that feed the heart with blood. More than 50% of
deaths after an amputation are because of heart problems and about 25% because
of lung problems.
If you have an anesthetic injection at the back, there is a very small chance of a
blood clot forming on top of your spine which can cause a feeling of numbness or
pins and needles in your legs. The clot usually dissolves on its own and this solves
the problem. Extremely rarely, the injections can cause permanent damage to your
spine. Chest infections may arise, particularly in smokers. Do not smoke. Being as
mobile as possible and co-operating with the physiotherapists to clear the air
passages is important in preventing chest infections.
Another possible complication is the formation of clots in the deep veins (draining
pipes for the blood) of your legs (deep vein thrombosis or DVT). A piece of one of
these clots can get detached and “travel” all the way to the blood pipes of your
lungs. There it can cause partial or complete obstruction of the blood vessels in the
lungs which can be lethal. You will be given injections of blood thinners (heparin)
after the operation to prevent a DVT. In addition, being as mobile as possible and co-
19
operating with the nurses and physiotherapists after the operation are very
important in preventing a DVT.
Slow healing is sometimes seen and shows up within the first week or two. The
doctors will discuss this with you. Rarely, you might need another operation to clean
any dying (necrotic) or tissue that is not healing well. Even more rarely, it may be
necessary to amputate the leg higher up to be able to get in healthy margins that
will heal well when they are stitched together.
Infection sometimes happens. This is usually localized in the wound area and very
rarely spreads into your blood stream. You will be given antibiotics to prevent this
and you will be given more if an infection actually occurs. The antibiotics take care of
the problem in most cases, but there is a chance that you will need another
operation to clean the infected tissues.
Another possible complication after this operation is the development of pressure

sores (openings in the skin which can be painful). This happens more frequently in
areas of the body under pressure from the bed, the lower part of your back and the
area close to your back passage being two typical examples. The use of special beds
and mattresses as well as being as mobile as possible after the operation with the
help of the nurses and the physiotherapists can help a lot in preventing pressure
sores.
As we discussed, most patients feel (especially during the early days after the
operation) that the limb is still there (phantom limb). In addition, a lot of patients
feel pain in the limb area as if the limb was still there (phantom limb pain). This is
usually mild to moderate and rarely severe pain and most of the time gets better as
time goes by. In some cases the pain can last for a long time. If this happens the
doctor will discuss the best way to deal with the problem.
Aches and twinges in the wound may be felt for six months or more but will settle
down.
Finally, some patients face psychological problems after the operation. The sense of
loss and disability can be very frustrating at times. If this happens you will get the
necessary psychological support that can effectively help you to overcome this
problem.
General Advice
The operation brings a major change to you, but you will end up much better off
than before it. Provided you have enough muscle power and good balance, you will
have no great difficulty walking on the new limb. The limb fitting process is rather
slow and tedious, but will be worth it in the end. These notes will help you through
your operation. They are a general guide. They do not cover everything. Also, all
hospitals and surgeons vary a little. If you have any queries or problems, please ask
the doctors or nurses.
Amputation - Below Knee
What is it?
There is not enough blood getting down your leg to keep the foot and toes alive. The
lack of blood causes severe pain and allows serious infection to take hold. The only
choice is to cut off the damaged part. This must be done high enough to get proper
healing of the stump. In your case it means an amputation just below your knee.
20
Sometimes the amputation is needed because of a serious injury to the limb.
The Operation
You will have a general anesthetic and be asleep or sometimes just an injection to
numb you below the waist. If the latter takes place, you will be awake but you will
not feel any pain from the waist down. A cut is made so that, after removing the
diseased part, you end up with a rounded stump made of healthy skin. You should
plan to be in the hospital for a month to cover any delay in healing of the wound.
You may well be out before this. You may need alterations to your home, such as
bath handles, and ramps, which will help you when you return. You will need to have
a temporary wheelchair and learn how to use it.
Any Alternatives
If you leave things as they are, your leg will certainly get worse. Life threatening
infection may start. An operation to bypass or core out your leg arteries will not work
in your case. Laser treatment and X-ray guided stretching of the arteries will not
work for you. Injecting the nerve to your blood vessels will not work. Antibiotics are
not enough by themselves. An alternative to a below-knee operation is one higher
up, such as through the knee, or at the mid-thigh level. But the higher the level, the
greater the risks of the operation, and the smaller the chances of you walking again.
A lower amputation such as through your toe or foot will not heal.

Stop smoking and get your weight down if your are overweight. (See Healthy
medicines with you to the hospital.
as possible. Many hospitals now run special preadmission clinics, where you visit for
an hour or two, a few weeks or so before the operation for these checks.
After - In Hospital
problems in the past. You will have a fine, thin plastic tube in your arm to give you a
blood transfusion (if necessary) or salt solutions. You will have a fine, plastic
drainage tube coming out of the skin near the wound, connected to a container. This
is to drain any residual blood or other fluid form the area of the operation.
The wound is painful. You will be given injections and later tablets to control this.
Ask for more if the pain is not well controlled or if it gets worse. Your original pain
will have gone, but you may still feel as if the foot and toes are still there. This is
called a "phantom limb" and is something that it is expected and something that
most patients experience after an amputation. The phantom limb feeling may make
you forget you have had an amputation. This feeling fades in time.
By the end of one week the wound should be virtually pain-free. You will be helped
out of bed after 24 hours. You should be sitting out of bed comfortably in a week.
Always ask a nurse to help you get out of bed, or you may fall and injure yourself.
You should be trying to walk with crutches in a week or so. A general anesthetic will
21
with everything you need until you are able to do things for yourself. Do not make
important decisions during this time. It is important that you pass urine and empty
your bladder within 6 to 12 hours of the operation. You will need to use a bottle or a
bed pan with help from the nurses at first. If you still cannot pass urine let the
doctors and nurses know and steps will be taken to correct the problem. The wound
has a simple dressing on it. The doctors will change the dressing every two to three
days for two weeks after the operation to see if the wound is healing well. There will
be stitches that will come out about two weeks after the operation. The wound drain
is taken out after 48 hours or so.
When you first see the wound, the stump will look very bulgy, but this smoothes off
after a week or two. The hospital will arrange for you to see the limb fitter once the
wound is fully healed. But you will be practicing walking with a temporary limb in the
physiotherapy department before you see them. You can wash as soon as the
dressing has been removed but try to keep the wound dry until the stitches come
out. Soap and warm tap water are entirely adequate. Salted water is not necessary.
You can shower or take a bath as often as you like. The nurses will advise about sick
notes, certificates etc.
After - At Home
You are likely to feel tired and need to rest two or three times a day. You will
gradually improve. You will be in the hands of the limb fitters once the wound has
healed. It often takes three or more months before you have a limb which suits you
exactly, since the stump is changing and firming up all the time. The physiotherapy
department will continue your training. How soon you can drive again depends on
how quickly you cope with the artificial limb. You may well be able to drive an
automatic car or one specially modified for your needs. You can restart sexual
relations once the wound is healed. How soon you can return to work depends on
how quickly you heal up. It is unlikely that you could do a heavy manual job, but
many other jobs are perfectly feasible.
the chances for such complications. The chance of dying after an amputation is 3 to
10%. The chances are higher for elderly people with other health problems such
diabetes, or disease of the arteries that feed the heart with blood. More than 50% of
the deaths after an amputation are because of heart problems and about 25%
because of lung problems.
If you have an anesthetic injection in the back, there is a very small chance of a
the problem. Extremely rarely the injections can cause permanent damage to your
spine.
Chest infections may arise, particularly in smokers. Do not smoke. Being as mobile
as possible and co-operating with the physiotherapists to clear the air passages is
important in preventing chest infections. Another possible complication is the
formation of clots in the deep veins (draining pipes for the blood) of your legs (deep
vein thrombosis or DVT). A piece of one of these clots can get detached and “travel”
22
all the way to the blood pipes of your lungs. There it can cause partial or complete
obstruction of the blood vessels of the lungs which can be lethal. You will be given
injections of blood thinners (heparin) after the operation to prevent a DVT. In
addition, being as mobile as possible and co-operating with the nurses and
physiotherapists after the operation are very important in preventing a DVT.
Slow healing is sometimes seen and shows up within the first week or two. The
doctors will discuss this with you. Rarely, you might need another operation to clean
any dying (necrotic) or tissue that is not healing well. Even more rarely, it may be
necessary to amputate the leg higher up to be able to get in healthy margins that
will heal well when they are stitched together.
Infection sometimes happens. This is usually localized in the wound area and very
rarely spreads into your blood stream. You will be given antibiotics to prevent this
and you will be given more if an infection actually occurs. The antibiotics take care of
the problem in most cases, but there is a chance that you will need another
operation to clean the infected tissues
Another possible complication after this operation is the development of pressure

sores (openings in the skin which can be painful). This happens more frequently in
areas of the body under pressure from the bed, the lower part of your back and the
area close to your back passage being two typical examples. The use of special beds
and mattresses as well as being as mobile as possible after the operation with the
help of the nurses and the physiotherapists can help a lot in preventing pressure
sores.
As we discussed, most patients feel (especially during the early days after the
operation) that the limb is still there (phantom limb). In addition, a lot of patients
feel pain in the limb area as if the limb was still there (phantom limb pain). This is
usually mild to moderate and rarely severe pain and most of the time gets better as
time goes by. In some cases the pain can last for a long time. If this happens the
doctors will discuss the best way to deal with the problem.
Aches and twinges in the wound may be felt for six months or more but will settle
down.
Finally, some patients face psychological problems after the operation. The sense of
loss and disability can be very frustrating at times. If this happens you will get the
necessary psychological support that can effectively help you to overcome this
problem.
General Advice
The operation must not be underestimated but you will end up much better off than
before it. Most patients are able to walk without difficulty on the new limb. The fitting
of the new limb is rather tedious and slow but is well worth it in the end. We hope
these notes will help you through your operation. They are a general guide. They do
Amputation - Toe
23
What is it?
There is not enough blood getting into your toe to keep it alive. The lack of blood
causes severe pain and allows serious infection to take hold. The only choice is to
take off the toe. Sometimes the toe has shriveled up and is a nuisance. Sometimes
more than one toe needs to come off. Sometimes the operation is done at the same
time as an operation on the blood vessels.
The Operation
operation. Sometimes patients are numbed from the waist down with an injection in
the back. Your toe is taken off. The surgeon may need to take off some of the skin
from the foot near the toe to get the best healing. Usually the skin can be stitched
up over the wound after removing the toe. Sometimes it is better to let the wound
heal up by itself without any stitches. This takes 3 or 4 weeks or more. How long you
will be in hospital depends very much on your general condition. Ideally you can go
home after a day or so. Often patients find it more convenient to stay for a week or
longer.
Any Alternatives
If you leave things as they are, your toe will certainly get worse. Infection may
spread to your other toes and foot. An operation to bypass or core out your leg
arteries will not work in your case. Laser treatment and x-ray guided stretching of
the arteries will not work for you. Injecting the nerve to your blood vessels will not
work. Antibiotics are not enough by themselves. An alternative to a toe amputation
is an amputation higher up. This may heal up better at the cost of loss of part of
your limb. Amputations through the foot do not heal very much better than toe
amputations, but an amputation just below your knee would heal very well. Overall,
your best plan is a toe amputation at the present moment.

Stop smoking and try to get your weight down if you are overweight. If you know
about taking the pill or hormone replacement therapy (HRT). Check you have a
special tests, ready for the operation. Please tell the nurses of any allergies to
tablets, medicines or dressings. You will have the operation explained to you and will
be asked to fill in an operation consent form. Many hospitals now run special
After - In Hospital
problems in the past. There is some discomfort on moving rather than severe pain.
You will be given injections or tablets to control this as required. Ask for more if the
pain is still unpleasant. A general anesthetic will make you slow, clumsy and forgetful
for about 24 hours. Do not make important decisions during that time. You will be
expected to get out of bed the day after operation despite the discomfort. You will
not do the wound any harm, and the exercise is very helpful for you. The second day
after operation you should be able to spend most of your time out of bed and in
24
reasonable comfort. You should be able to walk slowly along the corridor. By the end
of one week the wound should be virtually pain-free. It is important that you pass
urine and empty your bladder within 6-12 hours of the operation. If you cannot pass
urine let the nurses know and steps will be taken to correct the problem. The wound
has a dressing which may show some staining with old blood in the first 24 hours.
The doctors will look at the wound after a week or so. There may be stitches in the
wound which will be removed after 10 days or so. If the wound has not been stitched
it will be redressed from time to time. You can wash the wound area as soon as the
dressing has been removed. Soap and warm tap water are entirely adequate. Salted
water is not necessary. You can shower or take a bath as often as you want. You will
be given an appointment to visit the Surgical Out Patient Department for a check up
about one month after you leave hospital. The nurses will advise about sick notes,
certificates etc.
After - At Home
You should feel well within a week of the operation. You can lift anything you want
once the wound is comfortable. You can drive as soon as you can make an
emergency stop without discomfort in the wound and the wound is healed. i.e. after
about 4 weeks. You can restart sexual relations within a week or two, when the
wound is comfortable. You should be able to return to a your job when the wound is
healed.
Delayed healing sometimes happens. The doctors will talk to you about this. If you
think that all is not well, please ask the nurses or doctors. Infection is sometimes
seen. You will be given antibiotics to prevent this. Aches and twinges may be felt in
the wound for up to 6 months. Occasionally there are numb patches in the skin
around the wound which get better after 2 to 3 months.
General Advice
The operation is a small one and usually causes no problems. However trouble with
your circulation or diabetes causing the toe to be diseased needs very careful
watching. These notes will help you through your operation. They are a general
guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If
you have any queries or problems, please ask the doctors or nurses.
Anal Fissure
What is it?
A fissure is simply a crack or split in a sensitive part of the skin of the back passage.
It is made worse by tightening or spasm of the ring muscle that holds the back
passage shut. The fissure causes pain and often some bleeding.
The Operation
ring muscle is cut. This allows the fissure to heal - a process which takes a week or
so. You should be able to leave hospital after 3 or 4 hours.
Any Alternatives
Simple ointments and creams have not been helpful for you. Your fissure will not go
away if you just wait and see. Stretching the muscle is an alternative to cutting it,
but there is less control of the wind and motions after stretching. Cutting out the
25
fissure is rarely helpful. Sometimes the area can be numbed with an injection,
avoiding a general anesthetic

hospital's advice about taking the pill or hormone replacement therapy (HRT). Check
you have a relative or friend who can come with you to hospital and take you home.
Bring all your tablets and medicines with you to hospital.
On the ward, you may be checked for past illnesses and may have special tests,
ready for the operation. Many hospitals now run special preadmission clinics, where
you visit for an hour or two, a few weeks or so before the operation for these
checks.
After - In Hospital
injections or tablets to control this as required. Ask for more if the pain is still
unpleasant. A general will make you slow, clumsy and forgetful for about 24 hours.
Do not make important decisions, drive a car, or even boil a kettle in that time. The
discomfort of the operation can make it difficult to pass urine and empty the bladder.
It is important that your bladder does not seize up completely. If you cannot get the
urine flowing properly after 6 hours, contact the nurses or your doctor.
You may have some of your old discomfort on opening the bowels at first, but this
should improve in a week or so. There may be some difficulty controlling the wind
from the back passage for a day or two, but this improves rapidly. You can bathe or
shower as often as you want, using soap and tap water. Salted water is not
necessary. Some hospitals arrange a check up about one month after you leave
hospital. Others leave check-ups to the General Practitioner. The nurses will advise
about sick notes, certificates etc.
After - At Home
You may feel sore in the back passage for a week or more. This gradually improves
so that by the end of a month you are well. There may be some difficulty controlling
the wind or even the motion for a week or so but this gets better rapidly. You can
drive as soon as you can make an emergency stop without discomfort in the wound
i.e. after about 3 days. You can restart sexual relations within a week or two, when
the wound is comfortable enough. You should be able to return to work within a day
or so.
Complications are rare and seldom serious. If you think that all is not well, ask the
nurses or doctors. There may be some bruising which settles down in a week or so.
Infection is a rare problem and settles down with antibiotics in a week or two. You
may need a further examination of the bowel once the fissure has healed, and the
back passage is comfortable.
General Advice
The treatment usually leads to complete healing in a week or two. These notes will
26
help you through your operation. They are a general guide. They do not cover
everything. Also, all hospitals and surgeons vary a little. If you have any queries or
problems, please ask the doctors or nurses.
Anal Fistula
What is it?
An anal fistula is a narrow tunnel running from the skin near the back passage and
opening into the back passage higher up. It often shows up after there has been an
abscess near the back passage.
The Operation
The roof of the fistula is cut away. This changes it from a tunnel into a trench. The
trench becomes shallower as it heals, and ends up as a flat scar after a month or
two. The operation can either be done as a day case, which means that you come
into hospital on the day of the operation and go home the same day, or as an in-
patient case, which means spending one or two nights in hospital.
Any Alternatives
You can leave things as they are. This means that the fistula will carry on
discharging. You may well get more painful abscesses. The condition is not
dangerous, but can be a great nuisance. Antibiotics do not make the track close off.
Sometimes the tracks are very deep, and need more than simple coring out at a
later date. The surgeon may only find this out when he examines you under
anesthetic. If this happens, he will talk to you about what to do next, after you wake
up. Heat treatment and laser treatment do not work.

You may already be in hospital. If not, stop smoking and get your weight down. (See
Healthy Living). If you know that you have problems with your blood pressure, your
heart, or your lungs, ask your family doctor to check that these are under control.
Check the hospital's advice about taking the pill or hormone replacement therapy
(HRT). Check you have a relative or friend who can come with you to hospital, take
you home, and look after you for the first week after the operation. Bring all your
tablets and medicines with you to hospital.
checks.
After - In Hospital
The wound has a dressing probably held on with elastic netting pants. There may be
some staining with old blood during the first 12 hours. There will be some yellowish
discharge from the wound for a week or more. This will lessen as the wound heals.
tablets or injections to control this as required. Ask for more if the pain is still
unpleasant.
By the end of one week the wound should be virtually pain-free. A general anesthetic
will make you slow, clumsy and forgetful for about 24 hours. Do not make important
decisions, drive a car, use machinery, or even boil a kettle during that time. If your
operation is a day case, you should feel fit enough to go home after an hour or two
on the ward. If your operation is not a day case, you will be expected to get out of
27
bed the day after operation despite the discomfort. You will not do the wound any
harm, and the exercise is very helpful to you. The second day after the operation you
should be able to spend most of your time out of bed and in reasonable comfort. You
should be able to walk slowly along the corridor. You can wash the wound area as
soon as the dressing has been removed. Soap and tap water are entirely adequate.
Salted water is not necessary. T
he discomfort of the operation can make it difficult to pass urine and empty the
bladder. It is important that your bladder does not seize up completely. If you cannot
get the urine flowing properly after 6 hours, contact the nurses or your doctor. Some
hospitals arrange a check up about one month after you leave hospital. Others leave
check-ups to the General Practitioner. The nurses will advise about sick notes,
certificates etc.
After - At Home
You are likely to feel tired and need rests for a week or so. You will gradually
improve so that by the time a month has passed you will be able to return
completely to your usual level of activity. The wound is always a bit moist for 3 to 6
weeks. There is likely to be a discharge of yellow matter and for a week or so even
some dark blood. Sometimes a deep fistula is slower to heal than normal. You need
to be patient. Opening your bowels becomes rapidly easier particularly if you take a
laxative. DO NOT however take bran or a high fibre diet until the back passage is
pain-free in case you end up with a blockage. Occasionally you may notice difficulty
controlling the wind or even the motion through your back passage. This improves
after a week or two. You will need to have the wound dressed by the district nurses
or the hospital nurses until the wound has firmly healed. This may take a month or
more. You can drive as soon as you can make an emergency stop without discomfort
in the wound, i.e. after about 10 days. You can restart sexual relations within a week
or two, when the wound is comfortable enough. You should be able to return to a
light job after about 2 weeks, and any heavy job within 4 weeks.
Complications are rare and seldom serious. Sometimes the control of wind or
motions is weakened. The chance of the fistula coming back again is about 1 in 10. If
there is a very deep fistula, you will need a different treatment, which you will be
informed about. Rarely, the fistula is a sign of inflammation higher up the bowel. You
may need hospital tests for this.
General Advice
In general the operation is not particularly painful. But the final healing sometimes
takes more than 8 weeks. You should, however, be able to return to work before the
wound has healed. We hope these notes will help you through your operation. They
are a general guide. They do not cover everything. Also, all hospitals and surgeons
vary a little. If you have any queries or problems, please ask the doctors or nurses.
Ankle Fusion Operation - Arthodesis
What is it?
You have developed arthritis in your ankle. The surfaces of your joint are no longer
smooth. The bones are rough and the cartilage lining has worn away. As a result,
your ankle is painful and stiff.
The Operation
28
The main aim of the operation is to stop the pain in your ankle. The ankle joint is
made completely stiff, but you will still be able to move the joint below the ankle and
the joints in the foot. This operation is called either a fusion of the ankle, or
arthrodesis. You will be given a general anesthetic and be asleep for the whole
operation. One or two cuts will be made over your ankle. The damaged joint surfaces
of your ankle will be removed. A separate cut will be made over the rim of your
pelvic bone. This is so bone can be taken from your pelvis and used to fill any gaps
between the bones in your ankle. The bones may then be held together with screws.
A plaster cast will then be put on up to your thigh. Sometimes an external fixator is
used instead of screws and a plaster. An external fixator is a frame that is fixed to
the outside of your leg, above and below your ankle. The skin will then be closed up
with stitches. A plastic tube drain runs from the wound through the skin. You will be
in hospital for three to five days following your operation. You will be allowed to go
home when you can walk safely with crutches.
Any Alternatives
Steroid injections into your ankle will not give permanent pain relief. Physiotherapy
will not lessen the pain. If the pain in your ankle interferes with your life and the X-
rays show that the joint is severely damaged, then you should have your ankle
fused. Replacement ankle joints are being developed but are still experimental and
not generally available.

illnesses and may have special tests, to make sure that you are well prepared and
that you can have the operation as safely as possible. . Many hospitals now run
special preadmission clinics, where you visit for an hour or two, a few weeks or so
before the operation for these checks.
After - In Hospital
The wound may be painful. You will be given injections or tablets to control this. Ask
for more if the pain is getting worse. A general anesthetic will make you slow,
clumsy and forgetful for about 24 hours. The nurses will help you with everything
you need until you are able to do things for yourself. Do not make important
decisions during this time. You will be able to drink within a few hours after the
operation provided you are not feeling sick. The next day you should be able to
manage normal food. The wounds will have simple adhesive dressings over them.
The nurses will usually pull out your wound drain one or two days after your
operation. This does not hurt. Your stitches are taken out 10 to 12 days after the
operation. You must not put weight on your foot until the doctor tells you, This is
usually 6 to 12 weeks after the operation. The physiotherapist will teach you to hop
with a frame or crutches. You must not let your plaster cast become wet. You must
not get your leg wet if you have had an external fixator fitted. You will be given an
appointment to visit the orthopedic outpatient Department about six weeks after
your operation. The nurses will advise about sick notes, certificates etc.
After - At Home
29
When you go home, you should be able to move around the house using the
crutches. You should not put weight on the ankle for six weeks or so. The plaster will
probably be changed at six weeks, and as long as it is healing well, you should be
able to start putting weight on the ankle.. The plaster may be finally taken off at
about 14 weeks. The external fixator would be taken out at this time with a little
operation. Your leg will continue to improve for at least one year. You will not be able
to go shopping for the first few weeks after you go home. Please make arrangements
for friends or family to shop for you. How soon you get back to work depends on
your job. If you can get to work without driving yourself or by using public transport
you may be able to return to work six weeks after your operation. You should not do
manual work until your ankle is solidly fused, which will take at least 14 weeks or
more. You may never be able to perform heavy manual tasks following your
operation. You must not drive until you have been told that your ankle is soundly
fused. You are unlikely to drive for at least four months after your operation.
As with any operation under general anesthetic there is a very small risk of
complications related to your heart or your lungs. The tests that you will have before
the operation will make sure that you can have the operation in the safest possible
way and will bring the risk for such complications very close to zero.
Wound infection sometimes happens. You will be given antibiotics to try and prevent
this. You can develop a blood clot in the veins of your calf (deep vein thrombosis
DVT). A combination of medicine (an injection of a blood thinner) and compression
stockings will be used to try and prevent this. The bones may not fuse. If this
happens, a further operation would be necessary. If an external frame has been put
on your leg, the pins may become infected. If this occurs, you will be given
antibiotics. The pins would then be replaced under a general anesthetic.
Very rarely, a nerve or a blood vessel can be damaged during the operation and you
might need another operation to fix the problem
General Advice
The operation is a major one. We hope these notes will help you through your
doctors or nurses.
30
Anterior Repair
What is it?
The bladder and the vagina are no longer held up properly. The bladder is dropping
down onto the front of the vagina, making a weakness or bulge. The bulge is called a
prolapse. A prolapsed bladder is called a cystocele. The prolapsed bladder may not
empty properly when you pass urine. The prolapse makes you feel uncomfortable in
the vagina. You may also feel as if the bladder is full all the time. The prolapse
happens if the supports to the bladder and vagina stretch during pregnancy and do
not get back to normal properly afterwards. This may not show up until after the
menopause. Having either a heavy job, a chronic cough, or being overweight will all
bring on a prolapse earlier. An operation will tighten up the supports to the bladder
and take away the bulge in the vagina.
31
The Operation
You will have a general anesthetic and be completely asleep. A cut is made through
the lining of the front (anterior) wall of the vagina. The supports to the bladder are
shortened with stitches and the bulging part of the vagina cut away. This repairs the
weakness. The wound in the vagina is then stitched up. You need to be in hospital
for about six to seven days.
Any Alternatives
If you leave things as they are, the prolapse will slowly get bigger. Your discomfort
and feeling of a full bladder will worsen. The bulge may even drop through the
vaginal opening and start to bleed. A prolapse is not a life-threatening condition but
it can seriously effect the quality of your life.The operation to fix it is relatively easy
to do and works well most of the time. The best way forward is to have the
operation.

If you are past the menopause, your vagina may be short of the female hormone
oestrogen. You will heal better if you have some hormone replacement treatment
(HRT). You may be started on this before your operation using tablets, patches, or a
vaginal cream. This will be for a month or two to cover the operation only. You don’t
need to decide at this stage about having long-term HRT. Stop smoking and get your
weight down if you are overweight. If you know that you have problems with your
blood pressure, your heart, or your lungs, ask your family doctor to check that these
are under control. Check you have a relative or friend who can come with you to the
hospital, take you home, and look after you for the first week after the operation.
Sort out any tablets, medicines, inhalers that you are using. Keep them in their
original boxes and packets. Bring them to hospital with you. On the ward, you may
be checked for past illnesses and may have special tests to make sure that you are
well prepared and that you can have the operation as safely as possible. . Please tell
the doctors and nurses of any allergies to tablets, medicines or dressings. You will
have the operation explained to you and will be asked to fill in an operation consent
form. Many hospitals now run special preadmission clinics, where you visit for an
hour or two, a few weeks or so before the operation for these checks.
After - In Hospital
You will have a sanitary pad in place. The wound can be a little painful. You may
have a button switch (PCA Patient Controlled Analgesic) on your wrist to press when
you have pain. This gives you a small dose of a pain relieving drug into a vein. You
may be given injections by the nurses for the pain. If the pain is still there, tell the
nurses. A general anesthetic will make you slow, clumsy and forgetful for about 24
things for yourself. Do not make important decisions during that time. .The next day,
all you will need for the pain is tablets. You will have some blood and urine tests
after your operation. These will check you are not anemic and have no infection in
your urine. You may continue your course of HRT to cover the next month or two.
You may have a tube or catheter draining the bladder for a few days. The catheter
will make you feel as though you need to pass urine. This is a false alarm. If you do
not have a catheter, you need to pass urine within six hours after the operation. If
you have any difficulty, tell the nurses. You should wear pads as dressings. Do not
use tampons for six weeks. There are stitches in the skin wound in the vagina. The
parts of the stitches under the skin will melt away by themselves. The surface knots
32
of the stitches will appear on the pads after about two weeks. This is quite normal.
There will be slight bleeding like the end of a period. It should be almost nil by the
time you leave hospital. There may be a little bleeding again after about two weeks
when the knots become free. This is nothing to worry about. The hospital may
arrange a check up about one month after you leave hospital. The nurses will advise
After - At Home
At home, you are likely to feel tired and need rest two or three times a day for three
to four weeks. You will gradually improve. After three months, you should be able to
return completely to your usual level of activity. You can drive as soon as you can
make an emergency stop without discomfort, generally after three weeks. You can
start sexual relations before you return for your six week check, if you feel
comfortable enough, and you have no blood loss. You should be able to return to a
light job after about six weeks and to a heavy or busy job after about 12 weeks.
As with any operation under general there is a very small risk of complications
related to your heart or you lungs. The tests that you will have before the operation
will make sure that you can have the operation in the safest possible way and will
bring the risk for such complications very close to zero.
Most vaginal repairs are without complications. Minor complications occur in 3 to 4%

of cases. If you think that all is not well, please ask the nurses or doctors.
Sometimes the bladder is slow to start working again. Be patient. Sometimes the
catheter needs to go back into the bladder for a few days. Wound infection is
sometimes seen. This settles down with antibiotics in a week or two. Aches and
twinges may be felt in the vaginal area for up to three months.
More serious complications such severe bleeding, damage to your bowel by the
operation, or a creation of a passage between your vagina and the bowel (fistula) are
rare (1-2% of cases) and may require another operation to fix them.

General Advice
We hope these notes will help you through your operation. They are a general guide.
They do not cover everything. Also, all hospitals and surgeons vary a little. If you
have any queries or problems, please ask the doctors or nurses.
33
Anterior Resection of Rectum
What is it?
The bowel is a tube of intestine which runs from the stomach to the back passage.
The lower half of the bowel is called the colon. The colon runs from the right side of
the waist line, up to the right ribs, loops across the upper part of the belly and
passes down the left side. There it runs backwards into the pelvis as the back
passage, where it is called the rectum. In your case, the problem lies in the left side
of the colon or upper rectum. The left side of the colon and upper rectum is taken
out, and the ends are joined up whenever possible.
The Operation
is made in the skin to the left of the tummy button about 40 cm (15 inches) long.
The left side of the colon loop and the upper rectum are freed from the inside of the
tummy. The diseased part is cut out and usually the ends are joined together.
Sometimes it is safer if the ends are not joined together. Then the bowel waste is
channelled through the bowel which opens in the front of your tummy (a colostomy),
and you need to wear a bag. Usually the ends are joined up at a later date.
Sometimes the ends are joined up at the first operation, but a short term colostomy
is made as well. This keeps the bowel waste away from the join while it is healing
up. You should plan to leave hospital 2 weeks after the operation. Very rarely, if the
problem area is in the lower part of the rectum, at operation, the back passage may
need to be removed as well. You would be warned about this before the operation.
Any Alternatives
Simply waiting and seeing is not a good plan. The trouble you are having with the
34
bowel will simply get worse and may well lead to very serious problems. Tablets and
medicines will not be helpful, neither will x-ray and laser treatment. Keyhole
operations are still quite rare.

look after you for the first week after the operation. Bring all your tablets and
medicines with you to hospital. On the ward, you may be checked for past illnesses
and may have special tests, ready for the operation. You will be asked to fill in an
checks.
After - In Hospital
You will probably have a fine plastic tube coming out of your nose and connected to
another plastic bag to drain your stomach. Swallowing may be a little uncomfortable.
You will have a dressing on your wound and a drainage tube nearby, connected to
another plastic bag. You may have a colostomy. The wound is painful and you will be
given injections and, later, tablets to control this. Ask for more if the pain is still
unpleasant. You will be expected to get out of bed the day after operation despite
the discomfort. You will not do the wound any harm, and the exercise is very helpful
for you.
The second day after operation you should be able to spend an hour or two out of
bed. By the end of four days you should have little pain. A general anesthetic will
decisions during that time. You will probably have a fine drainage tube in the penis
or front passage to drain the urine from the bladder until you are able to get out of
bed easily. You should be eating and drinking normally after about four days. The
wound has a dressing which may show some staining with old blood in the first 24
hours. There may be stitches or clips in the skin. Sometimes 7 or 8 stitches are put
across the wound to add strength. Stitches and clips are removed after about 8 days.
The drain tube is removed after 4 days or so. If you have a colostomy, special nurses
will show you how to manage it. You will be given an appointment to visit the Out
Patient Department for a check up about one month after you leave hospital. You will
know the results of the examination of the bowel by then. The nurses will advise
After - At Home
You are likely to feel very tired and need rests 2 or 3 times a day for a month or
more. You will gradually improve so that by the time 3 months has passed you will
be able to return completely to your usual level of activity. You can drive as soon as
you can make an emergency stop without discomfort in the wound, i.e. after about 3
weeks. You can restart sexual relations within 2 or 3 weeks when the wound is
comfortable enough. Sometimes the operation will upset the nerves which control
sex in the male. The surgeon can discuss this with you. You should be able to return
to a light job after about 6 weeks and any heavy job within 12 weeks.
Complications are unusual but are rapidly recognized and dealt with by the nursing
35
and surgical staff. If you think that all is not well, ask the nurses or doctors. Chest
infections may arise, particularly in smokers. Co-operation with the physiotherapists
to clear the air passages is important in preventing the condition. Do not smoke.
Occasionally the bowel is slow to start working again. This requires patience. Your
food and water intake will continue through your vein tubing. Sometimes there is
some discharge from the drain by the wound. This stops given time. Sometimes the
join in the bowel can leak. Wound infection is sometimes seen. This settles down
with antibiotics in a week of two. Aches and twinges may be felt in the wound for up
to 6 months. Occasionally there are numb patches in the skin around the wound
which get better after 2 to 3 months. If you have a colostomy, you will be given help
and advice from the Stoma Nurses.
General Advice
The operation is a major one, but is routine for most hospitals. Some patients are
surprised how slowly they regain their normal stamina - but virtually all patients are
back doing their normal duties within 3 months. We hope these notes will help you
Aortic Aneurysm
What is it?
The aorta is a big pipe (artery) which carries blood from your heart to your legs. It
runs deep in your tummy down to the level of your navel. There it branches into the
two arteries which run down to your legs. Sometimes the aorta forms a blow-out like
a balloon (an aneurysm). This is dangerous because the aneurysm can leak or burst,
causing fatal internal bleeding. Sometimes pieces of the lining of the aneurysm break
off and block the leg arteries. The aneurysm needs to be replaced by a new artery.
The Operation
You will have a general anesthetic and be completely asleep during the operation. A
cut is made in the skin of the tummy, usually to the left of the navel, from the ribs
down to the groin. A new pipe (artery) , made of a tube of very strong plastic fabric,
is used to replace the diseased part of the aorta and is stitched in place inside the
36
aneurysm. It is called a graft. The cut in your tummy is then stitched up. Sometimes
the two arteries which run to your legs have aneurysms as well. A new pipe made
from the same material as described before, is shaped like a pair of trousers is then
used to make the repair. The turnups of the trousers are stitched to the leg arteries.
An extra cut in each groin is needed for this type of operation. If one or more
arteries are blocked, they may be operated on at the same time. The new pipes last
for 20 years and more. The operation takes about three to four hours.
Any Alternatives
If you leave things as they are, there is a high chance of the aneurysm bursting
(rupturing). Also, as the aneurysm gets bigger, it becomes more difficult to operate
on. Smaller operations do not work. Wrapping the aneurysm to support it, taking out
the aneurysm, and filling the aneurysm to prevent it leaking are not as good as
grafting the aorta. Tablets and medicines will not be helpful, neither will X-ray and
laser treatment. In some very selective cases and only in highly specialized centers it
is possible to place the new pipes into the aneurysm via small cuts in one or more of
your leg arteries and by using special radiological techniques. This method however,
is not widely used. The best way forward for you is to have the planned operation.

You may have come to hospital as an emergency. If not, stop smoking and get your
weight down if you are overweight. (See Healthy Living). If you know that you have
problems with your blood pressure, your heart, or your lungs, ask your family doctor
to check that these are under control. Check the hospital's advice about taking the
Pill or hormone replacement therapy (HRT). Check you have a relative or friend who
can come with you to the hospital, take you home, and look after you for the first
month after the operation. Bring all your tablets and medicines with you to the
hospital. On the ward, you may be checked for past illnesses and may have special
tests to make sure that you are well prepared and that you can have the operation
as safely as possible. Many hospitals now run special preadmission clinics, where you
visit for an hour or two, a few weeks or so before the operation for these checks. If
you come to the hospital as an emergency, there may not be time to do more than
the essential checks. Nevertheless, everything possible will be done to ensure that
you will go to theatre for your operation in the safest possible condition.
After - In Hospital
You are unlikely to remember anything for several hours after the operation. You will
probably be taken to the Intensive Therapy Unit (ITU) and wake up in a bed there. It
is quite likely that you will be connected to an anesthetic ventilator for a day or two
to help you get better. This means that there will be a tube down your mouth
passing into your windpipe. The machine will be pumping oxygen in and out for you.
You will have sedatives to help you relax if you need them. There will be lots of other
tubes and wires connecting part of you to various gadgets. For instance, there will be
a tube down the back of your nose to keep your stomach empty. There will be a
wound drainage tube in the skin of your tummy. This is to drain any residual blood or
other fluid form the area of the operation. There will be a tube in your bladder to
collect urine. This may make you feel that you are wanting to pass urine all the time,
but it will pass off. You will have one or more fine, thin plastic tubes in the veins of
your arms and on the side of your neck to give you liquids. There will be several
wires attached to your chest to check your heart action. You will have a cuff on one
arm which squeezes automatically every few minutes to measure your blood
pressure. As you get better the various tubes are taken out. After a day or two, you
will be able to go back to your original surgical ward without any tubing.
37
The pain of the wounds will be controlled by painkillers. These may be given in
several different ways. Until the bowel starts up again, you will be given water, salts,
and sugar solutions into your arm vein. Each wound has a dressing which may show
some staining with old blood in the first 24 hours. There will be stitches or clips in
the skin. You will probably need 14 days or more in hospital before you are strong
enough to leave hospital. You will have an appointment to visit the outpatient
department for a check up about one month after you leave hospital. Please ask the
nurses for sick notes, certificates etc.
After - At Home
You are likely to feel very tired for a month or more. You should be feeling back to
normal after about three months. You can drive as soon as you can make an
emergency stop without discomfort in the wound, i.e. after about six weeks.
As with any operation under general anesthetic there is a risk of complications
related to your heart or your lungs. The tests that you will have before the operation
will make sure that you can have the operation in the safest possible way and will
significantly reduce the risk for such complications. The chances of complications
increase significantly when the operation is being done as an emergency for a
ruptured aneurysm. Only 50% of patients survive such an emergency operation.
Because of the difficulty of the operation, there is a possibility of bleeding which will
require another operation to stop it. There is also a chance of infection. If this is
localized in the wound it is usually treatable with antibiotics. If it spreads into your
bloodstream or if it involves the new pipes that were used to repair the aneurysm, it
is a very difficult and potentially lethal condition.
Sometimes there are problems with the circulation to the legs, feet or toes. This is
because of poor blood flow below the area of the repair of the aneurysm. This can be
something that can be fixed with a new operation or might result in the need to
amputate the area that has the poor blood supply such as the toe or the leg.
There is a chance that your kidneys will be affected by this operation. This happens
either because your blood pressure was very low for a long period of time during the
operation or because the arteries that connect the aorta with the kidneys and feed
the kidneys with blood get partially or completely damaged during the operation.
This happens in 6% of patients who have the operation electively (not as an
emergency procedure) and in 75% of patients who have an emergency procedure for
a ruptured aneurysm. Your kidneys might be affected to the point where you will
need dialysis. In this case, a machine removes all the extra fluid and waste products
from your body that your kidneys can’t get rid of anymore. In the majority of cases,
your kidneys recover relatively soon, but there is chance that they will be
permanently damaged and you will need dialysis for the rest of your life.
There is up to a 6% chance that the blood supply to part of your bowel will be
affected during the operation. This is a very serious and potentially lethal condition
since this part of the bowel can get necrotic (start dying) and an operation will be
necessary to remove it.
Another serious complication which happens relatively rarely is paralysis of your legs.
This happens because the blood supply to the your spinal cord can be affected during
this operation especially if it is done as an emergency.
38
Sometimes the operation will upset the nerves that control sex in the male. This will
be discussed with you.
General Advice
Although the operation is performed routinely in many hospitals it should not be
underestimated. These notes should help you through your operation. They are a
Apicetomy - Tooth Root Operation
What is it?
The white shiny part of each tooth is called the crown. The part that fits into its
socket in your jaw is called the root. The deepest part of the root is called the apex.
The apex of your tooth has an infection with germs in it. The infection may have
ended up forming a cyst. A cyst is a little pocket with some liquid in it. It is about
half an inch (1.2cm) across, in the jaw bone, near the apex of the tooth. This is
called a dental cyst. The cyst and infection is cleaned out through a small opening in
the gum and bone. The opening is then closed up. This operation is called an
apicectomy.
The Operation
You will have a local anesthetic, a local anesthetic with some sedation or a general
anesthetic. When you have a local anesthetic, the area of the operation is numbed
with an anesthetic injection. You will not feel any pain but you will be awake and
conscious. The sedation is sometimes added to the local anesthetic to help you relax
39
and allow you to go through the operation. If you are sedated, you will be conscious
during the operation, but will not be aware of what is going on. Finally, if you have a
general anesthetic you will be completely asleep during the operation and you will
not feel any pain. The decision about the type of anesthetic will be discussed
between you and your surgeon. Although most apicectomies can be done safely and
comfortably just with local anesthetic, it is better to have some sedation or a general
anesthetic if it is anticipated that the operation will be difficult. A small cut will be
made into the gum over the infected apex or the cyst. The surgeon will drill or chisel
into the jaw bone down to the apex. All the infected material, any cyst, and a small
part of the root will be taken out. Some of the infected tissue will be sent to the
laboratory to be tested for germs. The end of the root may be sealed off, using a
special filler material, to fill the space that has been made. The cut in the gum is
then closed with stitches. These are usually special stitches that melt away in 7 to 10
days. Sometimes the surgeon uses stitches that need to be taken out after about
two weeks. Your operation can be done as a day case. This means that you come
into hospital on the day of your operation, and go home the same day.
Any Alternatives
If you leave things as they are, the infection will get worse and may form an abscess
(a collection of infected fluid or pus). It may spread to the roots of other teeth. If
there is a cyst, this will get bigger. It may seriously weaken your jaw. There is too
much infected apex to clear by drilling through from the crown of your tooth into the
root. Fillings put in by your dentist may not have sealed the root properly. The root
may no longer be hollow enough for drilling, due to your age. Or, there is too much
of a cyst to clear this way. Your tooth could be taken out to get rid of the infection.
You would then need a false tooth to fill in the space. Drugs and medicines will not
help at this stage to control the infection or to shrink the cyst.

you have a relative or friend who can come with you to the hospital and take you
home. Sort out any tablets, medicines, inhalers that you are using. Keep them in
their original boxes and packets. Bring them to the hospital with you. On the ward,
you may be checked for past illnesses and may have special tests to make sure that
you are well prepared and that you can have the operation as safely as possible.
Please tell the doctors and nurses of any allergies to tablets, medicines or dressings.
After - In Hospital
After the operation, you will be taken on a trolley to the recovery ward for a few
minutes. After your anesthetic has worn off, the nurse from the ward will take you
back to your ward. If you have had a general anesthetic, although you will be
conscious a few minutes after the operation ends, you are unlikely to remember
anything until you are back in your bed on the ward. The same thing happens with
sedation but to a lesser degree. Some patients feel a bit sick after the operation, but
this passes off quickly. You may be given oxygen from a face mask for a few hours if
you have had any chest problems in the past. A general anesthetic will make you
slow, clumsy and forgetful for about 24 hours. Again, the same, but to a lesser
40
degree, happens with sedation. The nurses will help you with everything you need
until you are able to do things for yourself. Do not make important decisions, drive a
car, use machinery, or even boil a kettle during this time. The mouth will feel bruised
and swollen. The jaw will be slightly stiff, usually with some discomfort. The gum
with the stitches will swell a little, with slight bruising of the skin. You will be given
painkilling tablets to help with any discomfort. The swelling, bruising and stiffness of
the jaw will disappear over a week to 10 days. You will be able to drink two to three
hours after the operation. Avoid eating until any sickness has passed, and after the
feeling has come back to your mouth and tongue. Before you leave the ward, you
may be given an appointment to come back to the dental outpatient clinic to see the
surgeon. This will be about two weeks after the operation. The surgeon will check
that the wound has healed. He will take out any stitches if needed. He will make sure
that the infection and any cyst have settled down. He will have the report from the
laboratory about the tissue from the apex and any cyst. You may have a further X-
ray of your teeth. You may need to visit the outpatient clinic again for further checks.
After - At Home
Take two painkiller tablets every six hours to control any pain or discomfort. Chewing
may be painful on your tooth and gum for three or four days. So you should eat a
softer diet and avoid very 'spicy' or 'vinegary' foods. You need to keep the mouth
cleaner than normal to prevent infection of your wounds. Gently brush your teeth
with ordinary toothpaste three times a day. Follow this with a warm salt water mouth
bath. This is a pinch of salt to half a pint of warm water. Hold a mouthful for one
minute on each side of the mouth. Then follow the salt mouth with the antiseptic
mouthwash for one minute. You may have aches and twinges in your teeth for a
month or two. These will settle down gradually. You will be fit to go back to work the
second day after your operation. You will be fit to drive 24 hours after the operation.
Avoid strenuous sports and swimming until the gum has fully healed in a month or
so.
If you have this operation under general anesthetic, there is a very small risk of
complications related to your heart and lungs. The same is true for sedation but to a
lesser degree. The tests that you will have before the operation will make sure that
you can have the operation in the safest possible way and will bring the risk for such
complications very close to zero.
If you follow the advice given above, you are unlikely to have any problems.
Complications are rare. Some slight bleeding is normal for a day or two after this
operation. If the bleeding is heavy and carries on for more than an hour, phone the
hospital or your GP for advice. They will tell you how to bite on a small pack of gauze
for 20 minutes or so to stop the bleeding. Rarely patients need to come back to
hospital for treatment of bleeding.
If you experience increasing pain at the area of the operation, you feel that is getting
more swollen and you have a temperature, it most probably means that the area of
the operation is infected. This happens relatively rarely and taking antibiotics for a
week or two usually solves the problem. In a very small number of patients the
infection can be evry bad and lead to a collection of infected fluid or pus (abscess) at
the area of the operation. In this situation you will need another operation to drain
the infected fluid or pus.
Sometimes, there is some numbness around the gum after any anesthetic has worn
41
off. This may be caused by bruising around or damage to small nerves near the tooth
root. Usually the feeling comes back in a day or so. Rarely, it takes six weeks or
more.
In about 9 out of 10 cases, the infection and any cyst heal up. In the other cases,
the tooth has to come out, or, rarely, another apicectomy is needed.

General Advice
These notes should help you through your operation. They are a general guide. They
do not cover everything. Also, all hospitals and surgeons vary a little. If you have
any queries or problems, please ask the doctors or nurses.
Appendicectomy
What is it?
The appendix is an out-pouching of the bowel about the size of your little finger. It
lies low down in the right side of your tummy. It is of no practical use in humans, but
is important in grass-eating animals. Quite commonly the appendix gets swollen and
causes pain. If left it can end up by bursting inside the tummy causing serious
infection and illness. Sometimes the appendix scars up from past infections and
causes pains (grumbling appendix). A diseased appendix needs to be taken out.
Sometimes in patients with these signs, the appendix is normal when it is taken out.
In cases of doubt, it is safer to remove the appendix than to risk the problem of
leaving a diseased appendix inside.
The Operation
The operation is called an appendicectomy. You will have a general anesthetic, and
will be asleep for the whole operation. The appendix may be taken out by the
keyhole method, or by the open method. The doctors will discuss this with you. If
taking out your appendix using the keyhole method is not best for you, the open
42
method is performed. This means making a cut in the skin and muscle over the
appendix. The appendix is cut off and the hole in the bowel is closed. The wound is
then stitched up. Alternatively, the key-hole method means making 3 or more tiny
openings less than an inch across in the lower part of your tummy. The appendix is
freed and taken out through one of the openings. The openings are then closed up.
Sometimes the appendix is so stuck or swollen that it has to be taken out using the
open method. The surgeon can only tell this at the time of the operation. Usually
after 2 to 3 days from the time of the keyhole operation, or 3 to 5 days from the
time of open operation you will be fit enough to leave hospital provided there is
someone to look after you.
Any Alternatives
If you leave things as they are, they will probably get much worse. You can become
very ill with infection and bowel problems. Antibiotics on their own are not helpful.
There is no x-ray or laser treatment.

You may have come to hospital as an emergency. If not, stop smoking and try to get
your weight down if you are overweight. If you know that you have problems with
your blood pressure, your heart, or your lungs, ask your family doctor to check that
these are under control. Check the hospital's advice about taking the pill or hormone
replacement therapy (HRT). Check you have a relative or friend who can come with
you to hospital, take you home, and look after you for the first week after the
operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in
their original boxes and packets. Bring them to hospital with you. On the ward, you
may be checked for past illnesses and may have special tests, ready for the
operation. Please tell the nurses of any allergies to tablets, medicines or dressings.
After - In Hospital
problems in the past. You may have a fine plastic tube running down the back of
your nose to drain your stomach for a few days. You may have a fine tube in an arm
vein connected to a plastic bottle to give you salt, sugar and water until the bowel
recovers from the operation. You may have a drainage tube coming out of your skin
near the wound to get rid of secretions. There is some discomfort on moving rather
than severe pain. You will be given injections or tablets to control this as required.
Ask for more if the pain is still unpleasant. A general anesthetic will make you slow,
clumsy and forgetful for about 24 hours. Do not make important decisions during
that time. You will be expected to get out of bed the day after operation despite the
you. The second day after operation you should be able to spend most of your time
out of bed and in reasonable comfort. By the end of one week the wound should be
virtually pain-free. It is important that you pass urine and empty your bladder within
6-12 hours of the operation. If you cannot pass urine let the nurses know. Any
wounds will have a dressing which may show some staining with old blood in the first
24 hours. There may be some purple bruising around a wound, which spreads
downward by gravity and fades to a yellow color after 2 to 3 days. It is not
important.
There may be some swelling of the surrounding skin which also improves in 2 to 3
days. After 7 to 10 days, slight crusts on a wound will fall off. Occasionally minor
43
match head sized blebs form on the wound line. These settle down after discharging
a blob of yellow fluid for a day or so. Any wound drain is usually taken out in 3 or 4
days. If you have had the keyhole operation, the dressings will be changed as
necessary. You can take the dressing off after 48 hours. There is no need for a
dressing after this unless the wound is painful when rubbed by clothing. There may
be stitches or clips in the skin. You can wash the wound area as soon as the dressing
has been removed. Soap and warm tap water are entirely adequate. Salted water is
not necessary. You can shower or take a bath as often as you want. Some hospitals
arrange a check up about one month after you leave hospital. Others leave check-
ups to the General Practitioner. The nurses will advise about sick notes, certificates
etc. Arrangements will be made for removal of any stitches or clips.
After - At Home
You are likely to feel tired and need rests 2 or 3 times a day for 2 weeks or more.
You will gradually improve so that after a month you should be fit enough for your
normal activities. At first discomfort in the wound will prevent you from harming
yourself by too heavy lifting. After one month you can lift whatever you like. There is
no value in attempting to speed the recovery of the wound by special exercises
before the month is out. You can drive as soon as you can make an emergency stop
without discomfort in the wound, i.e. after about 10 days. You can restart sexual
relations within a week or two, when the wound is comfortable enough. You should
be able to return to a light job after about 3 weeks and any heavy job within 6
weeks.
Complications are sometimes seen mainly because of infection from the appendix.
You will be given antibiotics to counter this. If you think that all is not well, please
ask the nurses or doctors. Bruising and swelling may be troublesome. The swelling
make take 4 to 6 weeks to settle down. Your recovery can be slower if the appendix
has burst by the time of operation. Occasionally there is a discharge from the wound
as infection clears itself. Rarely infection gathers inside the tummy and needs to be
drained. Aches and twinges may be felt in the wound for up to 6 months.
General Advice
The operation should not be underestimated, but practically all patients are back to
normal duties within 6 weeks. these notes will help you through your operation. They
44
Axillo-Femoral Bypass
What is it?
The main artery that carries blood from your heart down to your legs is blocked near
your tummy button. The legs are starved of blood. This causes pain in the legs, the
risk of serious infection and even loss of the limbs. The arteries below the blockage
are in much better shape. They could take more blood flow. You would then get rid
of the pain in your legs, and infection would heal up. In your case a supply of blood
can be channeled from an artery just below your collar-bone to your leg arteries in
the groins. This is done by threading a new artificial plastic artery under the skin
from the collar-bone artery to the groin arteries. Sometimes a new artery is put
down each side. Sometimes a Y-shaped artery is used to take blood from one collar-
bone artery to both groin arteries. The exact plan for you will be explained. If all
goes well, the arm and head should not be starved of blood by these operations. You
can feel the new artery beating but this is not troublesome.
The Operation
You will have a general anesthetic, and will be asleep for the whole operation. One
cut is made into the skin below the collar-bone and a cut is made in each groin to
find the arteries. Tunnels are made under the skin to make a path for the new
artificial artery. Sometimes an extra skin cut is needed over the bottom of your ribs
where the new artery runs. The arteries are joined up and the cuts are stitched up.
You should notice warm feet and loss of pain within 24 hours. If all goes well, you
should plan to leave the hospital seven days after the operation.
Any Alternatives
You will have a general anesthetic, and will be asleep for the whole operation. One
cut is made into the skin below the collar-bone and a cut is made in each groin to
find the arteries. Tunnels are made under the skin to make a path for the new
artificial artery. Sometimes an extra skin cut is needed over the bottom of your ribs
where the new artery runs. The arteries are joined up and the cuts are stitched up.
You should notice warm feet and loss of pain within 24 hours. If all goes well, you
should plan to leave the hospital seven days after the operation.

and look after you for the first week after the operation. Sort out any tablets,
medicines, inhalers that you are using. Keep them in their original boxes and
packets. Bring them to the hospital with you. On the ward, you may be checked for
past illnesses and may have special tests to make sure that you are well prepared
and that you can have the operation in the safest possible way. Please tell the
doctors and nurses of any allergies to tablets, medicines or dressings. You will have
the operation explained to you and will be asked to fill in an operation consent form.
Many hospitals now run special preadmission clinics, where you visit for an hour or
two, a few weeks or so before the operation for these checks.
After - In Hospital
You will have a fine, thin plastic drip tube in an arm vein connected to a plastic bag
45
on a stand containing a salt solution or blood. You will have dressings on your
wounds and possibly fine, plastic drainage tubes in the nearby skin connected to
plastic containers. These are in order to drain any residual blood or other fluid from
the area of the operation. You may be given oxygen from a face mask for a few
hours if you have had chest problems in the past. The wounds may be painful and
you will be given injections and later tablets to control this. Ask for more if the pain
is not well controlled or if it gets worse.
A general anesthetic will make you slow, clumsy and forgetful for about 24 hours. Do
not make important decisions during this time. The nurses will help you with
everything you need until you are able to do things for yourself. You will most likely
be able to get out of bed with the help of the nurses the day after the operation
despite some discomfort. You will not do the wound any harm, and the exercise is
very helpful for you. The second day after the operation you should be able to spend
an hour or two out of bed. By the end of four days you should have little pain.
It is important that you pass urine and empty your bladder within 6 to 12 hours of
the operation. If you cannot pass urine, let the doctors and nurses know. They will
take steps to correct the problem. Each wound has a dressing which may show some
staining with old blood in the first 24 hours. You can take the dressings off after 48
hours. There is no need for dressings after this unless the wounds are painful when
rubbed by clothing. There may be stitches or clips in the skin. The wounds may be
held together underneath the skin with stitches that are dissolvable and don’t need
to be removed. Any plastic drainage tube is taken out after two days or so.
There may be some purple bruising around the wound which spreads downwards by
gravity and fades to a yellow color after two to three days. This is expected and you
should not worry about it. There may be some swelling of the surrounding skin which
also improves in two to three days. After 7 to 10 days, slight crusts on the wound
will fall off. Occasionally minor match head sized blebs (blisters) form on the wound
line. These settle down after discharging a blob of yellow fluid for a day or so. You
can wash as soon as the dressing has been removed. Try to keep the wounds dry
until the stitches/clips come out which happens about 10 to 14 days after the
operation. If there are only stitches under the skin, try to keep the wounds dry for a
week. Soap and warm tap water are entirely adequate. Salted water is not
necessary. You can shower or bath as often as you want. You will be given an
appointment to visit the outpatient department for a check-up about one month after
you leave hospital. The nurses will advise about sick notes, certificates etc.
After - At Home
the area of the operation. You may be given oxygen from a face mask for a few
hours if you have had chest problems in the past. The wounds may be painful and
not make important decisions during this time. The nurses will help you with
everything you need until you are able to do things for yourself. You will most likely
be able to get out of bed with the help of the nurses the day after the operation
despite some discomfort. You will not do the wound any harm, and the exercise is
46
very helpful for you. The second day after the operation you should be able to spend
an hour or two out of bed. By the end of four days you should have little pain.
It is important that you pass urine and empty your bladder within 6 to 12 hours of
the operation. If you cannot pass urine, let the doctors and nurses know. They will
take steps to correct the problem. Each wound has a dressing which may show some
staining with old blood in the first 24 hours. You can take the dressings off after 48
hours. There is no need for dressings after this unless the wounds are painful when
rubbed by clothing. There may be stitches or clips in the skin. The wounds may be
held together underneath the skin with stitches that are dissolvable and don’t need
to be removed. Any plastic drainage tube is taken out after two days or so.
gravity and fades to a yellow color after two to three days. This is expected and you
will fall off. Occasionally minor match head sized blebs (blisters) form on the wound
line. These settle down after discharging a blob of yellow fluid for a day or so. You
can wash as soon as the dressing has been removed. Try to keep the wounds dry
until the stitches/clips come out which happens about 10 to 14 days after the
operation. If there are only stitches under the skin, try to keep the wounds dry for a
you leave hospital. The nurses will advise about sick notes, certificates etc.
As with any operation that is done under general anesthetic, there is a risk of
and will reduce the chances for such complications.
Complications are rapidly recognized and dealt with by the surgical staff. If you think
that all is not well, please let the doctors and the nurses know. Sometimes there is
some bleeding under the wounds which causes more severe bruising. This settles
down. However, there is a small chance of severe bleeding in the area of the
operation that might require another operation to stop it.
Sometimes the blood in the new artificial artery clots. This usually needs a second
operation to clear the blockage. Sometimes the arteries further down on one or both
legs cannot take the extra flow of blood. The next steps to deal with this will be
discussed with you. The worst case scenario is that the a satisfactory blood supply to
the leg cannot be restored in which case you may need an amputation (removal of
the diseased part of the leg).
Wound infection is sometimes seen. This settles down with antibiotics in a week or
two. It is much more serious if the infection spreads in your bloodstream or if the
new artificial artery gets infected. If this is the case you will need antibiotics for
much longer and it may be that the new artificial artery has to be removed to allow
the infection to clear. Sometimes fluid builds up under the wounds. This settles down
with time.
There is a very small chance that you will experience in your arm, forearm or hand
on the side of the collar bone where the new artificial artery is stitched what is called
steal syndrome. This is a feeling of pins and needles, numbness, coldness or even
47
pain. This happens because the new artificial artery “steals” or diverts more blood
than your upper healthy limb can afford to give to the diseased leg(s). The upper
limb needs this blood to maintain its circulation and function. The problems that you
experience in your upper limb usually get better but there is a chance that the
artificial artery has to be removed to save your upper limb and prevent further
problems.
Extremely rarely, when the new artificial artery is much shorter than it should be, it
can be ripped off the artery under the collar bone when you stretch (abduct) your.
This is very serious and life-threatening complication and requires an emergency
Aches and twinges may be felt in the wound for up to six months. Occasionally there
are numb patches in the skin around the wound which get better after two to three
months.
You should avoid tight clothing or corsets and avoid sleeping on the side of the new
artery especially if you are overweight because this can collapse and clot the artery.
The overall results of this operation are relatively good. About 50% of artificial
arteries in axillo-femoral bypasses remain open five years after the operation and
patients enjoy a good quality of life.
General Advice
The operation may sound unusual, but is routine in many hospitals. However, as with
all operations in blood vessels it should not be underestimated. You should never
smoke after the operation. These notes will help you through your operation. They
vary a little If you have any queries or problems, please ask the doctors or nurses.
48
Bartholins Gland Marsupialisation
What is it?
You have a swelling on one side of the vulva at the opening of the vagina. The
swelling is a build up of liquid under the skin. The liquid is made in glands called
Bartholin's glands. These are like the sweat glands you have in your armpit.
Normally the liquid seeps out to keep the skin of the vulva moist. If the exit from a
Bartholin's gland gets blocked, the liquid builds up as a swelling. Sometimes the
liquid will build up for a time and then seep away again. Sometimes germs grow in
the liquid, infecting it. This makes the swelling much bigger and painful. This can
happen within a few hours, and needs an operation right away.
The Operation
You will have a general anesthetic, and be completely asleep during the operation.
Alternatively, the operation can be done under local anesthetic (by numbing the area
with a local anesthetic injection, like when you go to the dentist). Although a few
centres do this operation successfully under local anesthetic, many perform it under
general anesthetic since this is a very sensitive area of the body and you can
sometimes feel rather uncomfortable during the procedure.
A cut is made about an inch long through the skin into the swollen gland. This lets
the liquid drain out through a wide opening. The gland then forms a little pouch. This
is called marsupialisation. You will recall that an animal with a pouch, such as a
49
kangaroo, is a marsupial. A dressing will be put over the wound and sometimes a
length of dressing is packed inside as well to help healing. Antibiotics are given if
there is any infection. You should be able to have the operation on the day you come
in to hospital, and go home the same day.
Any Alternatives
If you leave things as they are, the infected gland will burst in a week or so. This will
be a most painful time for you. The opening will not be big enough to drain properly.
You may find the swelling comes back again. Sometimes, antibiotics alone will settle
the infection. You will probably have more trouble in the future. The best plan for
you is this operation.

and look after you for the first day after the operation. Bring all your tablets and
and may have special tests to make sure that you are well prepared and that you
can have the operation as safely as possible.. Many hospitals now run special
the operation for these checks. If you come into hospital as an emergency, you will
bypass all these arrangements.
After - In Hospital
You will have a sanitary pad held on with elasticized net pants. Any packing in the
wound will be taken out after 24 hours or so. There may be some staining with old
blood during the first day or two. You can put a new sanitary pad on as often as you
like. The vulva will feel a little painful for 24 hours or so after the operation. You will
be given painkilling tablets to control this, and antibiotics if there was any infection.
Injections are given for severe pain if needed. Take shallow baths three times a day
to keep the vulva clean and to help healing. You need to pass urine before you leave
the ward. If you have any difficulty, tell the nurses. You can wash the wound area as
soon as you wish. Soap and tap water are entirely adequate. Salted water is not
necessary. You can bathe or shower as often as you wish. You will be able to drink
within an hour or two of the operation as long as you are not feeling sick. The next
day you should be able to manage small helpings of normal food. You should plan to
leave hospital the day of your operation. The District Nurse may call on you at home
as required. You will be able to stay in hospital longer, if you are not ready to go
home the same day. Some hospitals arrange a check-up about one month after you
leave hospital. Others leave check-ups to the General Practitioner. The nurses will
advise about sick notes, certificates etc. You should be able to return to a light job
after about one week, and any heavy job within two weeks.
After - At Home
Go to bed and rest for at least six hours. You can start sexual relations again when
you feel comfortable, usually after a week or two.
This operation is a minor one. Complications are very rare. Severe infection can slow
healing down. Very rarely there is bleeding from the wound which needs stitches or
50
packing. Sometimes the swellings refill or appear in a different part of the vulva.
These can always be treated again. There is sometimes some bleeding after two
weeks or so. This will settle down.
If the same gland gets swollen again and again, then, it may be, that at some stage
(when there is no swelling and you are well) it has to be removed completely. This
requires another operation under general anesthetic. The skin is cut around the
gland and the gland is removed along with the skin which lies on top of it. The
wound (which is about an inch long) is then closed with dissolvable stitches. It is a
relatively simple and successful operation with very low chances for complications.
General Advice
Bladder Outlet Incision
What is it?
The prostate gland is a thick ring of muscle and gristle that lies between the outlet of
the bladder and the penis. It is rather like the bung in the outlet of a home made
wine bottle, holding the outflow tube in place. It lies deeply behind the bone in the
front of the pelvis (which is the lower part of your abdomen). It makes the fluid that
carries sperm. Sometimes the center of the prostate ring becomes narrow because of
overgrowth or scarring. This causes difficulty in passing urine, as well as back-
pressure effects on the bladder and kidneys.
The Operation
The back wall of the prostate ring is cut using an instrument passed up the penis.
Most patients have a general anesthetic, so that they are asleep during the
operation. It is quite common, however, for patients to be numbed from the waist
down with an injection in the back. If this is the case, you will be awake during the
operation, but feel no pain. The operation takes about 20 minutes. You will be in
hospital for about two days.
51
Any Alternatives
If you just have a little slowness when passing urine and are having to get up once
or twice at night to pass urine, simply waiting and seeing if you have more trouble is
a reasonable idea. If you find your life is being upset by the prostate problem, then
treatment is sensible. Drug treatment may be helpful in the short term, but there
may be side-effects. A complete blockage definitely needs treatment, at first with a
drainage tube (catheter) through the penis or through the lower tummy wall,
followed usually with a cut of the back wall of the prostate ring made through the
penis. A formal coring out of the prostate is needed if the gland is over a certain size.
Keeping the path through the prostate using short indwelling tubes are experimental.
An open operation through the tummy is rarely needed, unless the prostate is very
big, or you have some bladder condition such as large bladder stones or a blowout
on the bladder wall. Sometimes a permanent catheter with a collecting bag for urine
strapped to the leg is the best plan if an operation would be very risky.

Stop smoking and get your weight down. (See Healthy Living). If you know that you
doctor to check that these are under control. Bring all your tablets and medicines
with you to the hospital. On the ward, you may be checked for past illnesses and
may have special tests to make sure that you are well prepared and that you can
have the operation as safely as possible. Many hospitals now run special
After - In Hospital
You should be able to return to a light job in one week and a heavy one in two
weeks. You may restart sexual relations within a week or two, when the wound is
comfortable enough. You may find that at intercourse no liquid comes, and that
afterwards you notice milky fluid in the urine. This can happen in up to 80% of cases
and is because the widened prostate ring allows the sperm to pass up into the
bladder instead of down the penis. You may be sterile. Some men (5-10%) find that
after the operation they cannot have sex as well as they could before it.
After - At Home
blood clot forming on top of your spine which can lead to a feeling of numbness or
pins and needles in your legs. Most of the time the clot dissolves on its own and this
solves the problem. Extremely rarely, the injections can cause permanent damage to
your spine.
In the first 48 hours, bleeding in the urine may be a problem. The medical and
nursing staff will deal with this. There is a 5% chance that a blood transfusion may
be required because of the blood loss.
Chest infections may arise, particularly in smokers. Do not smoke. Getting out of bed
as quickly as possible, being as mobile as possible and co-operating with the
physiotherapists to clear the air passages is important in preventing an infection.
52
When the catheter is first removed you may notice that you want to pass urine every
few minutes. This is normal and passes off in a day or two. Sometimes after removal
of the catheter there is difficulty passing urine at all. It may mean replacing the
catheter for three days or more. Sometimes after removal of the catheter there is
some dribbling or moistness from the penis after passing urine. This improves with
time and the improvement can continue gradually for up to three months. However,
there is about 1% chance that you may experience mild to moderate urine
incontinence in the long term. Ask the surgeon for advice if it is troublesome.
Infection of the urine can give a burning feeling and a need to pass urine every hour
or so. This can be tested and treated by the surgical team. Sometimes blood stains
the urine again 7 to 10 days after the operation. You should seek medical advice, but
the condition settles down.
There is 10-15% chance that the prostate ring becomes narrow again over months
or years. If this happens you should seek medical advice. It is most likely you will
need another operation to fix the problem.
your spine.
nursing staff will deal with this. There is a 5% chance that a blood transfusion may
be required because of the blood loss.
of the catheter there is difficulty passing urine at all. It may mean replacing the
catheter for three days or more. Sometimes after removal of the catheter there is
some dribbling or moistness from the penis after passing urine. This improves with
time and the improvement can continue gradually for up to three months. However,
there is about 1% chance that you may experience mild to moderate urine
incontinence in the long term. Ask the surgeon for advice if it is troublesome.
the condition settles down.
There is 10-15% chance that the prostate ring becomes narrow again over months
or years. If this happens you should seek medical advice. It is most likely you will
need another operation to fix the problem.
53
General Advice
The operation gives good results. Patients are usually surprised how quickly they get
better. However, there are many technical points in the operation and they vary for
patient to patient. The surgical and nursing staff will be pleased to explain what is
happening in your particular case. These notes should help you through your
doctors or nurses.
Breast - Wide Excision and Axillary Sample
What is it?
You have a very small cancer in the breast, or there is something in your breast
which may be one. The plan is to take out the diseased part of the breast with a
clear rim of healthy breast. At the same time glands will be taken from your armpit
(axilla). This is what is meant by a wide excision and axillary sample. Sometimes all
the glands are taken from your armpit. This is called an axillary clearance. The two
pieces of tissue are looked at under the microscope in the laboratory.
© Copyright EMIS and PIP 2005
The Operation
You will have a general anesthetic and be completely asleep. A cut is made in the
skin of the breast over the swelling. Sometimes a piece of skin is taken out as well.
The swelling or problem area in the breast with a rim of breast tissue is taken out.
Often glands can be taken from the armpit through this cut. If the first cut is too far
from the armpit, a second cut is needed there. The breast may end up a little
smaller. The operation takes about 45 minutes. Usually there is a fine plastic
drainage tube in the wound. The drain comes out through the skin usually in the skin
fold under the breast. The skin is closed with stitches or clips. The tissue is sent to
the laboratory to be looked at under a microscope to find out what is going on. It
takes about one week to get an answer. You may well be able to have the operation
on the day you come in, and go home the same day. You may need to stay in for a
day or two, if the swelling is large, if you are over 50, have other illnesses, or if you
54
cannot manage at home.
Any Alternatives
Removing the whole breast, (a mastectomy) would be equally good treatment as a
first choice, but it is not necessary in your case. X-ray treatment on its own would
not be as good in your case. Neither would drug treatment on its own. The same
applies to alternative therapies such as aromatherapy and reflexology. If you do
nothing, the problem in the breast will get steadily worse.

taking the pill or hormone replacement therapy (HRT). Check you have a relative or
friend who can come with you to hospital, take you home, and look after you for the
first week after the operation. Bring all your tablets and medicines with you to
tests, ready for the operation. Many hospitals now run special preadmission clinics,
where you visit for an hour or two, a few weeks or so before the operation for these
checks.
After - In Hospital
There may be some discomfort on moving. Pain killing tablets or injections should
easily control this discomfort. A general anesthetic will make you slow, clumsy and
forgetful for about 24 hours. Do not make important decisions, drive a car, use
machinery, or even boil a kettle during that time. The wound may be closed with
stitches, clips, or paper strips, which need to be taken out by the nurses about a
week after the operation. Sometimes there are stitches under the skin instead. These
melt away, so that the wound does not need any more attention. You can wash,
bathe, or shower as soon as the stitches, clips or paper strips are taken off. Soap
and tap water are quite all right. Salted water is not needed. The hospitals will
arrange a check up about a week after you leave hospital to give you the
results. The nurses will advise about sick notes, certificates etc.
After - At Home
Have plenty of rest. Take mild painkillers as needed to control discomfort. You can
drive as soon as you can make an emergency stop without discomfort in the wound,
i.e. after about 2 days. You should be able to return to a light job after about 3 or 4
days , and any heavy job within 2 weeks.
Complications are rare and seldom serious. Bruising and swelling may be
troublesome, particularly if the wound was large. The wound swelling may take 4 to
6 weeks to settle down. Infection is a rare problem and settles down with antibiotics
in a week or two.
General Advice
55
Breast Augmentation
What is it?
Breast Augmentation is an operation to increase the size of the breasts using
implants. The implants have a silicone shell that can contain either sterile
saline/water or silicone liquid/gel.
The Operation
Depending on the size of the breast, a pocket is surgically created either underneath
the breast tissue or underneath the muscle underneath the breast. The surgery is
performed under general anesthesia. Depending on the type of implant used, it can
be performed either through a scar around the nipple, a scar underneath the breast,
a scar in the armpit or very occasionally, through a scar around the belly button.
Any Alternatives
In the past, silicone itself was directly injected into the breast tissue but this is not
something that is recommended at present. There are some external suction
devices, which can be applied to the breast, and this has been reported to increase
breast size following sustained use. It is not as yet absolutely clear if this is a
permanent increase in size. Sterile derivatives of Soya Oil have also been used as
'fillers' for implants but these should no longer be used.

It is important for your surgeon to assess the type of breast augmentation that is
requested. It is also important to understand why it is requested, as to whether it is
brought about by a change in life circumstances or a problem that has been ongoing
for some time. It is also important to try and understand the patient's expectations
as to the outcome and size of breast implants. There are a large number of breast
implants available and the exact type of implant, whether round, shaped, containing
saline sterile solution or silicone jelly, would all need to be discussed in detail with
your surgeon prior to the operation. Pre-operative review would also assess how fit
you were for surgery. The type of scar and the exact site and placement of the
implant would be discussed in combination with a physical examination of your
breasts. This will indicate the extent of breast tissue that is available and where the
implants should be placed. The size of implants should also be discussed taking into
consideration the amount of skin laxity and breast tissue that is present. If the
breasts are very droopy, breast augmentation alone may not be sufficient and
corrective surgery may be required in order to place the nipples in a different
position. The site of the scarring would also be agreed. It is likely that the surgeon
may also want to take some photographs prior to surgery. These are kept in your
patient records. Your surgeon is likely to have the type of implant available for you
to feel and understand how it works. It may also be helpful to get an idea of the
type of volume that you require by filling bags of water with various volumes of fluid
to gauge the breast size that you might wish for.
After in Hospital
The operation is likely to take around one hour. On return to the ward you will have
dressings around your new breasts and these may be in the form of a comfortably
fitting bra, or some wrap-around padded dressings. It is also likely that there will be
drains in each breast. You may be nursed in a semi-upright position, as this can
tend to minimize swelling and hence make you feel more comfortable. Your chest
may feel quite sore following your return to the ward. The nurses will be able to give
56
you painkillers for this, either by injection or tablet form. You may also feel your
breathing somewhat restricted as the surgery to create the pockets to place the
implants can often make the chest feel slightly tight. The nurse will make regular
checks and monitor blood pressure, pulse and temperature. The drains are usually
taken out on the day following surgery. Should there be more fluid in the drains than
expected, you may well be able to be discharged from hospital and then return to
have the drains removed a few days later.
After at Home
It is important that you rest on your return home. Excess use of the arms and upper
chest area by regular activities which one would normally undertake can cause
further irritation and bleeding. It is best to continue to wear a firm tight fitting bra
both night and day for a further two weeks. The bra may be removed for washing
but one should avoid getting the wounds wet for probably one week following
surgery. You should also avoid sleeping face downwards for one month. It is
probably best to avoid doing any heavy activities, particularly lifting the elbows
above the shoulder level, or any heavy lifting for a further three to four weeks. You
may also find that your nipples have altered sensation following the surgery but this
is likely to improve as time passes. The scars themselves may be massaged from
two weeks following surgery. However, it is not often necessary to massage the
breasts themselves. It is probably best for you not to drive for at least a week
following surgery. You should then be quite sure that you are able to perform an
emergency stop.
Complications
As with any surgical procedure, bleeding can occur but the drains that are left after
the operation are usually sufficient to control this. Very occasionally if bleeding
continues to be a problem, it may be necessary to return to theatre to stop the
bleeding. In making a pocket into which is placed the implant, one of the structures
that can occasionally be damaged is the nerve supply to the nipple. This can result
in complete loss of sensation to the nipple but more often results in either decreased
or very occasionally increased sensitivity. This increased sensitivity can be
uncomfortable. Any time an object is placed within the body, the body forms a film
around it. This film can occasionally instead of staying nice and loose, increase in
thickness, become scarred and occasionally become uncomfortable. This is known as
'capsule formation'. This tends to occur in about 10% of patients who have breast
augmentation. It occasionally will only affect one side as opposed to both sides
where bilateral breast augmentation has been performed. The type of capsule can
vary from a firm feeling to one where the breast becomes very firm and hard, like a
tennis ball. In these situations the treatment depends on the ongoing problem.
Occasionally it may be necessary to remove the implant entirely and to replace it.
Infection can also occur. If the implant becomes infected then it is likely that the
best option is to remove it.
There has been some controversy as to the use of silicone implants. Many surgeons
continue to use silicone implants both for reconstruction and for aesthetic
augmentation. There have been a number of studies which indicate that there is no
definite evidence that silicone causes any problems within the body. However, there
are undoubtedly some people who have had breast implants that do have some
unexplained symptoms. Most people benefit from having breast augmentation
performed.
57
General advice
Having a bilateral breast augmentation performed can be somewhat uncomfortable.
It is important to avoid driving for about a week following surgery and to be sure
that one is able to perform an emergency stop. If the sensitivity of the nipple has
been altered by the surgery, this may take some months to recover and indeed may
never fully return to normal. It is important that placement of the implants is
discussed with the surgeon prior to surgery. The implants will tend to stay where
they are placed and will not move around the chest wall, as a normal jelly-like breast
would do. The patient would need to have an understanding about this prior to
surgery.
Breast Biopsy
What is it?
The part of the breast tissue that has formed a lump, or a cyst, or is not normal, is
removed.
The Operation
You will have a general anesthetic and will be completely asleep during the
operation. A cut is made in the skin over or near the affected part of the breast. A
place will be chosen that will heal nicely. Only the affected part of the breast is
removed. The cut in the skin is closed up. There may be a fine plastic drain tube
running from the wound. Your operation can usually be done as a day case. This
means that you come into hospital on the day of the operation and go home the
same day.
Any Alternatives
If you leave the breast as it is, the problem remains. We will not be clear what is
going on. You may miss out on important treatment. X-rays and scans will not tell us
any more about the problem area in the breast. Treatment by antibiotics or
hormones is not a good idea if the cause of the problem is not known.
58
friend who can come with you to hospital and take you home. Bring all your tablets
and medicines with you to hospital. On the ward, you may be checked for past
illnesses and may have special tests, ready for the operation. Many hospitals now
run special preadmission clinics, where you visit for an hour or two, a few weeks or
so before the operation for these checks.
After - In Hospital
There may be some discomfort in the breast. Pain killing tablets should easily control
this. If not, you can have painkilling injections. By the end of one week the wound
should be just about pain-free. A general anesthetic will make you slow, clumsy and
machinery, or even boil a kettle during that time. The wound may be closed with
stitches, clips, or paper strips, which need to be taken out by the nurses about a
week after the operation. Sometimes there are stitches under the skin instead.
These melt away, so that the wound does not need any more attention. Any
drainage tube is usually removed when the wound is redressed, before you go home.
You can wash, bathe, or shower as soon as the stitches, clips or paper strips are
taken off. Soap and tap water are quite all right. Salted water is not needed. Most
hospitals arrange a check up about one week or so after you leave hospital. The
result of the examination of the breast tissue will be ready then. The nurses will
After - At Home
Have plenty of rest. Take mild painkillers as needed to control discomfort. You can
i.e. after about 2 days. You should be able to return to a light job after about 3 or 4
days , and any heavy job within 2 weeks.
Complications are rare and seldom serious. In the first 24 hours: Look out for any
bleeding coming through the dressings. After the first 24 hours: Bruising and
swelling may be troublesome, particularly if the wound was large. The wound
swelling may take 4 to 6 weeks to settle down. Infection is a rare problem and
settles down with antibiotics in a week or two.
General Advice
59
Breast Reduction
What is it?
Breast reduction is the removal of excess skin and breast tissue with re-positioning
of the nipple to a higher situation. It is most frequently performed for heavy breasts
that results in physical problems, rather than for cosmetic appearance.
The Operation
The surgery is performed under general anesthesia. There are different techniques
depending on how big the breasts are and how much tissue needs to be removed.
The surgery is performed with pre-operative marks as guidelines. In moderate size
breasts the nipple is left attached to underlying breast tissue, excess skin and breast
tissue is removed and then the nipple is placed in a new higher position. The
remaining skin and breast tissue is sutured together. The types of scars that
commonly arise are, a scar that goes around the nipple at its new position and a scar
that extends from the new nipple position downward underneath the breast. In
bigger breasts, there is often a scar that goes underneath the breast from the
midline to the side. Drains are usually required and a supportive dressing is placed
after surgery.
Any Alternatives
Weight loss can occasionally make breasts smaller but this does not usually lead to
re-positioning of the nipple in a higher more youthful appearance. Weight loss can
also cause empty sagging breasts.

Breast reduction surgery takes between two and three hours to do and therefore is a
major operative procedure. It is important that the patient's general health has
been assessed and it is advisable to stop smoking. The surgeon will visit pre-
operatively and discuss the size the patient wishes. Marks will then be placed on the
patient's chest according to the type of operative procedure to be performed. Blood
tests may also be taken prior to surgery, as very occasionally a blood transfusion is
required. It may also be necessary to take a course of iron tablets following the
surgery. As the operation takes some time to do, measures to prevent clots in the
legs are undertaken usually along the lines of special stockings, improvement of the
blood flow in legs during surgery, or the addition of blood thinning agents prior to
surgery.
After - In Hospital
You may notice a firm bandage around your chest when you wake up. This may also
make your breathing slightly restricted. It is there to provide comfort and also to
decrease swelling around the breasts after surgery. It is likely that you will be in a
semi-upright position following surgery. Again this helps to decrease swelling and
pain. Pain and discomfort following surgery is common and can be treated with
pain-killing injections or tablets. Regular painkillers will be needed on return home
along the lines of Paracetamol. There will be a drain in each breast to remove
excess fluid that can accumulate following surgery. It is also likely that there will be
an intravenous drip, which is usually removed when you are able to tolerate diet and
fluids comfortably. The nurse will check your blood pressure, temperature and pulse
60
rate following the surgery and in some operations it will be necessary to check the
blood supply to the nipple on a regular basis. After the surgery you will be
encouraged to gradually increase your mobility and independence. Assistance will be
given with shallow bathing and general hygiene until you are able to manage this
independently. The dressings usually remain intact for twenty-four to forty-eight
hours following surgery at which time the drains are usually removed. The stitch line
will then be cleaned as necessary and a new dressing applied. It is often useful at
this time to have soft support type bra that can accommodate a small dressing. This
gives support to the breast and decreases pain. Your stay in hospital will be variable
and will depend on the type of surgery that has been performed and the amount of
drainage from the breasts. You may expect to go home within two to three days
following surgery.
After - At Home
You may experience pain and discomfort in your breasts, which is usually adequately
treated with simple painkillers. Should you find increased unexpected pain it will be
most important to let the hospital know of your pain and discomfort. As with any
major surgical procedure, you may feel tired following the surgery and may need
assistance in doing ordinary daily tasks. It is important to avoid getting the suture
line wet. It is likely that you will be asked to attend the outpatients if only to review
the dressings. It is probably best to also avoid driving at this time as pain and
discomfort may prevent adequate control of the steering wheel.
On most occasions, the sutures that are used to close the breast reduction surgery
are of a dissolvable type but occasionally some sutures may need to be removed.
This usually takes place some two weeks following surgery.
Breast reduction surgery takes some time to perform and may be considered a major
operative procedure. As with any major surgery you may bleed during the surgery
and very occasionally a blood transfusion may be required. The drains are placed in
the breasts after surgery as there is often some bleeding that can occur. Very rarely
bleeding can continue to such an extent that a return to theatre is required. This is
why it is important to have regular post-operative checks on the ward by the nurses.
Infection can occur in the post-operative phase and this is minimized by good
surgical technique. Antibiotics are sometimes given around the time of surgery.
Regular reviews after surgery indicates if there is evidence of infection and
occasionally it is necessary to have a course of antibiotics. Often, due to the extent
of the surgery, the skin of the breasts appears red. This is more commonly related to
inflammation rather than infection.
There is often some irregularities around the scars immediately following surgery but
these tend to settle down and get better as the swelling disperses and the skin
tightens. Occasionally there are some areas underneath the breast where the skin
does not heal immediately and dressings may be required for up to six to eight
weeks afterwards. This is related to the tension that is needed to reshape the new
breast, which the skin does not tolerate. Very occasionally, skin grafting may be
required if significant skin breakdown occurs. Personal care and hygiene can be
maintained once the wounds have become sealed. This varies from one to two
weeks. If dressings are required because of minor wound problems, your doctor
may still be happy for you to shower, dab the area dry and have it redressed.
Supportive bras, which are not under wired, can keep the breasts comfortable
61
following surgery. It is sometimes necessary to wear them at nighttime as well for
comfort.
Return to work can take place from two to three weeks after surgery depending on
the physical requirements.
When driving it would important to make sure that there is no interference with
turning the wheel or areas of pain which may cause some difficulty with the need to
perform an emergency stop.

Direct trauma onto the breast can cause the wounds to split open. However, one
should wear a safety belt when driving or a passenger in a car.
It may take some time for the redness of the skin underneath the breast to settle
down. If the breasts are very big prior to surgery, the ends of the scars may remain
prominent. Should this be the case they may need to be 'tidied up'. This is a
procedure that can usually be performed under local anesthesia.
General Advice
The majority of people who have breast reductions are happy with the size and
shape of the breasts following surgery. It can take six to nine months for the
swelling to subside entirely. The outcome of the surgery that some people are not
so happy with is the scarring. The scars, although they look neat initially, can
become red itchy and raised above the level of the surrounding skin. As well as
becoming somewhat unsightly they can also give rise to concern. Some techniques
are available to try and make the scars more comfortable including local silicone
sheet dressings, local massage or the occasional use of laser treatment. The scars
may become particularly troublesome close to the midline and most surgeons try and
avoid placing scars too close to the midline. This helps with the problems with the
scar formation but also avoids putting scars where the patient may want to show
their cleavage. The breasts tend to remain in a satisfactory position but as time
goes by, droopiness of the breasts can occur again. Excess weight gain or
pregnancy can precipitate increased size and therefore droopiness to occur more
rapidly.
It is not always possible to match the breast sizes following surgery and this may
become more apparent when the swelling has decreased. Depending on the type of
breast surgery that has been performed it may be possible to breast-feed if one
becomes pregnant.
Broken Ankle - Open Reduction and Fixation
What is it?
Your ankle is broken. The bones are not in their proper place. If the bones are left to
heal in this position, you may develop arthritis in your ankle. Your ankle is broken in
such a way that you cannot be treated in just a plaster cast. Fractured means
broken. There is no difference in severity between a fractured bone and a broken
bone.
The Operation
You will be given a general anesthetic so that you will be completely asleep. A cut on
one or both sides of your ankle is made. The pieces of your broken bone are brought
62
together. Special screws and plates are used to hold the pieces in place while the
bone heals. The skin wound is then closed up with stitches. A temporary plaster cast
is put on your leg. The plaster extends from just below your knee to your toes.
Any Alternatives
If you leave things as they are, the ankle will be painful and will get arthritis in a
year or more.

You will have come to the hospital as an emergency. You need to let the doctors and
nurses know about your general health, past illnesses, and drug treatment.
Arrangements will be made for you to have the operation done within 24 hours or so
of the injury.
After - In Hospital
The physiotherapist will help you to get out of bed with crutches once the swelling of
the ankle has gone down. The physiotherapist will teach you how to walk and how to
go up and down stairs with crutches. The surgeon who performs your operation will
give you instructions about when you may start to move your ankle. Some surgeons
prefer to get your ankle moving in hospital before putting your ankle in a plaster cast
and sending you home. Other surgeons will not get your ankle moving before
sending you home in a plaster cast. For the first two weeks after your operation, you
should rest with your leg elevated when your are not walking. This is because your
ankle will tend to swell within the plaster when you are upright. You must not get
your plaster cast wet. You will be in hospital two or three nights after the operation.
You will have an x-ray of your ankle before you go home. You will be given an
appointment to come to the orthopedic out patient department ten days or so after
your operation. Your stitches will then be removed. You will be given an appointment
to visit the orthopedic out patient department to have check X-rays. You will be in a
plaster cast for approximately six weeks. The nurses will advise about sick notes,
certificates etc.
After - At Home
When you go home, you will be able to move around the house and manage stairs.
You will not be able to go shopping for the first few weeks after you go home. Please
make arrangements for friends or family to shop for you. Your ankle will continue to
improve for up to twelve months. Looking after a plaster cast. Do not press on your
plaster for 48 hours. Do not let your plaster cast get wet. Do not cut or bang your
plaster. Do not put anything down the inside of your plaster (e.g. coins). Do not use
anything to scratch under your plaster. Come back to the hospital if: you have pins
and needles or numbness in your toes. you cannot move your toes. your toes go
blue. your toes become very swollen. you have severe pain. Come back to see the
plaster technician if: the plaster cracks the plaster becomes soft the plaster is
loose. How soon you can return to work depends on your job. If you sit whilst at
work, you will be able to return to work two or three weeks after your operation. This
also depends on you being able to get to work. If your job is manual you will be
unable to work for at least three months. You may play light sports twelve weeks
after your operation. You may not play contact sports until you have been told that
the break has soundly healed. When you start playing, you will not be able to play
for as long as normal. Your leg will ache at the end of a game. Your leg will continue
to improve for up to twelve months. The screws and plates do not have to be
63
removed. If they become uncomfortable, they can be removed eighteen months or
more after your operation. Physiotherapy will be arranged for you.
Wound infection sometimes happens. You will be given antibiotics to prevent this.
You can develop a blood clot in the veins of your calf. This is called a Deep Vein
Thrombosis (D.V.T.). A combination of medicine and compression stockings will be
used to try to prevent this. Occasionally the fracture does not heal. If this occurs you
will need another operation. If it is impossible to put the bones together so that the
joint surface is smooth, you may develop arthritis in your ankle.
General Advice
Your may have damaged your ankle quite badly. Even with an operation, it may
never be as good as before the injury. However you should be much better off by
having the operation. We hope these notes will help you through your operation.
They are a general guide. They do not cover everything. Also, all hospitals and
surgeons vary a little. If you have any queries or problems, please ask the doctors or
nurses.
64
Bronchoscopy - Elective
What is it?
When you breathe in, the air goes down the windpipe from your Adam's apple down
to the back of the middle of your breastbone. There, the windpipe branches into two
smaller tubes which carry the air into each of your two lungs. Each of these smaller
tubes is called a bronchus. Inside the left and right lungs, each bronchus branches
again and again to get the air into the depths of the lung. Sometimes swellings,
lumps, foreign bodies or infection in these air tubes cause problems. The windpipe
and the bronchus on each side need to be examined. This operation is called a
bronchoscopy
65
The Operation
You are likely to have some sedation and a spray to numb the lining of your
windpipe. You may have a general anesthetic and be asleep, if you do not like the
idea of sedation. The doctor passes a flexible telescope into your mouth and down
into your windpipe. He has a good look inside the windpipe and inside each
bronchus. There is plenty of room in your windpipe around this telescope for air to
get in and out of your lungs. He may pass very small instruments down the
telescope to take tiny snippets of any area that doesn’t look normal. This is called a
biopsy. He will send the biopsy to be looked at in the laboratory under a microscope.
If it looks as if there is some infection, the surgeon will draw some of the phlegm out
of the bronchus through the telescope. He sends the phlegm to the laboratory for
tests to identify the bugs causing the infection. The results take a week or so to
66
come back from the laboratory. The wound in the lining of the bronchus heals up
very quickly. There is no need for any stitches. There are no cuts in the skin. The
examination takes about 20 minutes. You should be fit to go home the same day as
your operation.
Any Alternatives
If you leave things as they are, the problems you are having will not go away. You
may be losing valuable time if you just wait and see. X-rays and scans do not tell the
doctors enough about what is wrong in your case. It is not a good idea for you to
start treatment, if the doctors do not know what they are dealing with. Drugs and
medicines may well not be the right thing for you in any case. A bronchoscopy is the
best way ahead.

If you have time before the operation, stop smoking and get your weight down if you
are overweight. (See Healthy Living). If you know that you have problems with your
blood pressure, your heart, or your lungs, ask your family doctor to check that these
are under control. Check you have a relative or friend who can come with you to the
hospital and take you home. Sort out any tablets, medicines, inhalers that you are
using. Keep them in their original boxes and packets. Bring them to the hospital with
you. On the ward, you may be checked for past illnesses and may have special tests
to make sure that you are well prepared and that you can have the operation as
safely as possible. Please tell the doctors and nurses of any allergies to tablets,
medicines or dressings. You will have the operation explained to you and will be
asked to fill in an operation consent form. Many hospitals now run special
the operation for these checks. If your case is not an emergency and you have a cold
in the week before your admission to hospital, please telephone the ward and let the
ward sister know. The operation will usually be put off, and you will be given time to
get better before being sent for again. You will need to get over the cold before the
operation can be done because by having an anesthetic the cold could turn into a
serious infection in the chest.
After - In Hospital
It is quite common for patients to have some coughing attacks after the operation.
The phlegm may have some streaks of blood in it. It settles down after an hour or
so. You will be given some treatment for sickness if necessary. You may be given
oxygen from a face mask for a few hours if you have had any chest problems in the
past. You will have a slightly sore throat after the operation where the telescope has
been rubbing inside the throat. Painkilling tablets should easily control this
discomfort. Ask for more if the pain is not well controlled or if it gets worse. A
general anesthetic may make you slow, clumsy and forgetful for about 24 hours. The
yourself. Do not make important decisions, drive a car, use machinery, or even boil a
kettle during this time. You will probably be given an appointment to come back to
the outpatient clinic to see the doctor again for a check-up. If any biopsies have
been taken, the results should be ready for you at the clinic. The nurses will advise
After - At Home
Take two painkilling tablets every six hours to control any sore throat.
67
As with any operation under general anesthetic (and the same is true for sedation),
there is a very small risk of complications related to your heart and lungs. The tests
that you will have before the operation will make sure that you can have the
operation in the safest possible way and will bring the risk for such complications
very close to zero.
If you follow the advice given above, you are unlikely to have any problems. There is
a small risk that you may cough up some fresh blood when you are at home. If this
is just a spot or two it is not important. If you cough up blood for more than an hour
or two (and there is a higher chance that this will happen if many biopsies were
taken or a foreign body was removed), come back to the ward or contact your GP. If
you have had a foreign body removed, sometimes the windpipe, the bronchus, or the
lung can be damaged by the foreign body and the damaged area can get infected.
You will be told about this if it happens. There is also an extremely small possibility
that one of the areas from where the biopsies were taken can get infected. If you get
an infection, this nearly always gets settled with antibiotics.
Finally, extremely rarely, the telescope or the other instruments that were used
during the operation can damage the wind pipe, the bronchus or the lungs (one type
of very common and severe damage that can be caused is the creation of a
hole/perforation). If this happens you might need another operation to fix the
problem.
General Advice
68
Bunionectomy
What is it?
You have developed a bunion. This causes two problems. Your big toe is bending
towards your second toe. Also the bump on the joint of your big toe sticks out. It
usually makes finding comfortable shoes difficult. The bump on your toe may be red
and sore. The aim of the operation is to reduce the pain that you get from your
bunion.
The Operation
You will have a general anesthetic, and will be asleep for the whole operation. Your
toe will be straightened. This is done by breaking the bone and moving your toe into
a new position. This is called an osteotomy. A cut is made over the top of your
abnormal joint. The bony lump on the side of the joint is then removed. A bone in
your foot is cut and your toe moved into a better position. The bones may, or may
not, be held with a screw or special staple until they heal together. The skin wound is
then closed up with stitches. A plaster cast is put on your foot to hold your big toe in
its new position. You will be in hospital either just for the day of the operation or for
one more day. . You will be in a plaster for approximately six weeks.
Any Alternatives
Most people try pads from the chemists or the chiropodists before seeing an
orthopedic surgeon. If the pads have not helped, and your toe is painful, probably
the best plan is to straighten your toe. You should not have the operation just to
make your feet look better.

that you can have the operation as safely as possible. Many hospitals now run special
After - In Hospital
Your will have a plaster cast on your foot. Your foot may be painful. You will be given
injections or tablets to control this. Ask for more if the pain is getting worse. A
general anesthetic will make you slow, clumsy and forgetful for about 24 hours. The
yourself. Do not make important decisions during this time. Your plaster cast will be
changed and your stitches taken out three weeks or so after your operation. You
must not get your plaster cast wet. You will be given an appointment to visit the
orthopedic outpatient department three weeks or so after your operation. The nurses
will advise about sick notes, certificates etc.
After - At Home
When you go home, you must rest with your foot up but, you will be able to move
69
around the house and manage stairs. You will not be able to go shopping for the first
few weeks after you go home. Please make arrangements for friends or family to
shop for you. Your toe will continue to improve for at least six months. Looking after
a plaster cast:
• Do not press on the plaster for 48 hours.
• Do not let the plaster cast get wet.
• Do not cut or bang the plaster.
Do not put anything down the inside of the plaster (eg coins). Do not use anything to
scratch under the plaster.
Come back to the hospital if:
• you have pins and needles or numbness in your toes
• you cannot move your toes
• your toes go blue
• your toes become very swollen
• you have severe pain.
If you experience such problems it means that there is problem with the nerves
and/or the blood vessels of your foot or that there is an infection and you need to
come back to the hospital urgently.
Come back to see the plaster technician:
• if the plaster cracks
• the plaster becomes soft
• the plaster is getting loose.
You must not drive until your toe is completely comfortable. You are unlikely to drive
for at least eight weeks after your operation. How soon you can return to work
depends on your job. If you can get to work without driving yourself or by using
public transport you may be able to return to work six weeks after your operation.
Rarely, you can develop an infection in the area of the operation which can be settled
by taking antibiotics for a few days.
Also rarely, a nerve or a blood vessel can be damaged during the operation and you
might need another operation to fix the problem.
The bones may not join together firmly. If this occurs, a further operation may be
necessary.
General Advice
The operation is relatively minor. We hope these notes will help you through your
doctors or nurses.
70
Caesarean Section
What is it?
You obstetrician and yourself have discussed how your baby should be delivered. The
risks of delivering the baby through the vagina are greater than if you were delivered
by an elective Caesarean section. Elective means that the operation is not an
emergency.
Common reasons for a Caesarean section are high blood pressure, small pelvis, baby
in distress, baby in the breech (bottom first) position, twins, or triplets. It will be
safer if your baby is brought out through a cut in your tummy and womb. The
operation is usually arranged to take place a week to 10 days before the date your
baby is due. If you go into labor before this, it will be done as an emergency. The
hospital is ready for this type of operation to be done any time, day or night.
The Operation
You will either have a general anesthetic and be asleep during the operation, or be
made numb from the waist down with an injection in the back. This is an epidural
anesthetic. You will be awake, but will not feel any pain. The surgeon makes a cut in
the lower part of your tummy. This will normally be a "bikini" incision just above the
hair line. If he/she thinks he will need more space, or if you have had other surgery
there already, the surgeon may need to make an "up and down" cut below the
tummy button. He will discuss this with you before your operation. Your womb is
opened, and your baby and the afterbirth (placenta) are brought out. Your womb
and your tummy are then stitched up. You will be in hospital for about six days.
Any Alternatives
The decision to deliver your baby/babies by Caesarean section has been made by
your obstetrician and yourself. If you are unhappy with this decision or need further
information as to why the decision has been made, then you should speak to your
midwife or general practitioner. They will either answer your questions or arrange for
you to meet with your obstetrician again.

Ideally, your partner should come with you to the hospital for the operation and look
after you after that. If this is not possible, check that you have a relative or friend
who can come with you to the hospital, take you home, and look after you for the
first week after the operation. Sort out any tablets, medicines, inhalers that you are
using. Keep them in their original boxes and packets. Bring them to hospital with
to make sure that you are well prepared and that you can have the operation as
safely as possible. Please tell the doctors and midwives of any allergies to tablets,
preadmission clinics, where you visit for an hour or two, about a week before the
operation for these checks.
After - In Hospital
You will have a dressing on your wound. . You will have a small/thin plastic tube (a
drip) in an arm vein. This gives you salt and sugar and water, and sometimes blood,
for a day or so from a plastic bag on a stand. You will have a sanitary pad in place. If
you have an epidural, you will have a tube (catheter) in your front passage draining
71
the bladder. This is normally taken out the morning after your operation. By then
your numbness will have worn off. You will be able to pass urine normally. If you
have a general anesthetic, the catheter may be removed at the end of the operation.
A general anesthetic will make you slow, clumsy and forgetful for about 24 hours.
The midwives will help you with everything you need until you are able to do things
for yourself. Do not make important decisions during that time. The wound is painful,
but you will be given injections by the midwives for the pain. If the pain is still
unpleasant, tell the midwives.
After a day or so, all you will need for the pain is tablets. You will be expected to get
out of bed the day after the operation despite some discomfort. You will not do the
wound any harm, and the exercise is very helpful for you. On the second day you
should be able to spend an hour or two out of bed.
By the end of four days you should have little pain. You will be encouraged to breast
feed. This is good for your baby. It helps the womb to return to normal. The
midwives will be able to help you and your baby to start breast feeding. There will be
some vaginal bleeding for four to six weeks, but this should be slight before you are
discharged. The midwives will keep a watch out for this. Only use external pads for
any loss.
The tummy wound has a dressing which may show some staining with old blood in
the first 24 hours. The dressing will be removed. The wound may be sprayed with a
plastic dressing. There is no need for dressings after this, unless the wound is painful
when rubbed by clothing. . The skin is joined together with either stitches or small
metal clips. The clips are removed before you go home. Not all stitches need to be
removed, some dissolve themselves. You will be able to take a bath or shower. Try
to keep the wound area dry for about a week. It doesn’t really matter if the wound
gets slightly wet when you bathe or shower. . Just gently dry the area afterwards.
After - At Home
You will gradually get back to normal in three to four weeks. You will need help with
looking after your baby for two weeks or more. You can drive as soon as you can
make an emergency stop without discomfort in the wound. This will be after about
three weeks. You can start sexual relations before the six-week check. This is as long
as you feel comfortable enough, and you have not bled within three days. If you do
not wish to become pregnant again you should use contraception. Condoms can be
used at any time but any other form of contraception should be discussed with your
doctor.
As with any operation under general anesthetic there is a very small risk for
complications related to your heart or your lungs. If you have the operation under an
epidural anesthetic, you also have a very small risk of having a blood clot or an
injury to you spinal cord (the bundle of nerves that runs from your brain to the lower
area of your back). Regardless of which type of anesthetic you are going to have, the
tests that you will have before the operation will make sure that you can have the
operation in the safest possible way and will bring the risk for such complications
very close to zero.
Most Caesarean sections are without complication. The medical staff and midwives
will always look out for any problems which may arise. If you think that all is not
well, please ask the midwives or doctors.
72
Minor complications can happen in up to 2% of cases: Chest infections may arise,
particularly in smokers. Do not smoke. Occasionally the bladder is slow to start
working again. This requires patience. You may need the catheter back in the
bladder for a few days. Wound infection is sometimes seen. This settles down with
antibiotics in a week or two. Aches and twinges may be felt in the wound for up to
six months. Sometimes there are numb patches in the skin around the wound which
get better after two to three months.
More serious complications happen very rarely and can include severe bleeding or
damage to your womb, bladder, bowel and vessels and may require another
operation to fix them.
General Advice
Carpal Tunnel Decompression
What is it?
A nerve to your finger ends runs deep inside the front of your wrist (carpus). It runs
inside a little tunnel (the carpal tunnel). There is not enough room for the nerve as it
runs through the carpal tunnel. It causes pain and tingling in the fingers and hand,
and even higher up the forearm.
The Operation
A cut is made in your palm, next to the skin crease that runs up the center. The roof
of the tunnel is then cut to give your nerve more space. The wound is then closed up
with stitches or clips. You can be given a local or a general anesthetic. The choice
depends partly on which you prefer, and partly on the anesthetist and surgeon.
Having general anesthetic means that you will be completely asleep during the
operation. Having a local anesthetic means that you will be awake during the
operation, but will not be feel any pain in your hand since the area of the operation
73
is numbed with a local injection. After an hour or two on the ward following the
operation, you should feel fit enough to go home.
Any Alternatives
If your symptoms are mild you can try wearing a wrist splint or having a steroid
injection into the wrist. If your symptoms really bother you, the best plan is to have
the operation.

that you have a relative or friend who can come with you to the hospital, take you
home, and look after you for the first week after the operation. Bring all your tablets
and medicines with you to the hospital. On the ward, you may be checked for past
After - In Hospital
Usually the wound is pain-free. You may feel some discomfort. You will be given
painkillers to take home. They should easily control this discomfort. If you have had
a general anesthetic it will make you slow, clumsy and forgetful for about 24 hours.
The nurses will help you with everything you need until you are able to do things for
kettle during that time. Your hand will be in a bulky bandage when you go home.
Your arm will be in a sling to reduce any swelling. Wear your sling for the first 24
hours or so after your operation. Your bandage will be taken off and your stitches will
be taken out about 10-12 days after the operation. You will not need a dressing on
the wound after that. You may remove the sling to wash. Wash around the bandage
for the first 10 days. You can wash the wound area as soon as the dressing has been
removed. Soap and warm tap water are entirely adequate. Salted water is not
necessary. You can shower or take a bath as often as you like once the wound has
healed. Some hospitals arrange a check-up about one month after you leave the
After - At Home
Make sure a relative or friend can take you home. You should not be by yourself for
the first day after your operation. At home, rest. Take some painkillers to control any
pain. The second day after the operation, you should be reasonably comfortable. You
must move your fingers for five minutes every hour to exercise them. You cannot
drive whilst your hand is in the bandage. How soon you can return to work depends
on your job. If you can work one handed, you may be able to return to work two or
three days after your operation. This also depends on you being able to get to work.
If your job is manual you will be unable to work for six weeks. You should be able to
swim once your stitches are out. Your nerve pain and the pins and needles at night
should go immediately after your operation. If your fingers were partly numb before
the operation, they may take months to feel normal.
74
If you have the operation under general anesthetic there is a very small risk of
Complications are rare and seldom serious. Rarely, you can develop an infection in
the area of the operation which can be settled by taking antibiotics for a few days.
Also rarely, a nerve or a blood vessel can be damaged during the operation and you
Finally, very rarely after this operation, the hand can become very stiff, painful and
swollen and requires intensive long-term physiotherapy to get better.
Your hand should not hurt much after your operation. If you have severe pain,
telephone the ward. If you cannot get through to the ward, come straight away to
the casualty department of the hospital. Sometimes the operation is not as
successful as expected, especially if the pains had been there for years, or if there
are other causes for these pains.
General Advice
The operation is relatively minor. You should end up much better off after the
operation. These notes will help you through your operation. They are a general
Cataract Lens Replacement
What is it?
You are finding it difficult to see because you have a cataract. A cataract simply
means a cloudy lens in your eye. The lens is the clear part in the front of the eye
that helps to focus light or an image on the retina (the lining at the back of the eye)
which is sensitive to light. There the light or image is converted into nerve waves or
signals and these "travel" through the nerves o a certain area of the brain that finally
helps you to see the light and image. In an early cataract, the lens may become
yellow, or turn brown. This would make things look yellow or brown through that
eye. Some cataracts turn white. In the old days, people thought it really looked like
a waterfall, or a cataract. Cataracts usually form in both eyes. They steadily get
worse. One eye will probably be more trouble than the other. Cataracts are most
common in later years, but children and young people also get them. Sometimes,
they happen with other diseases, such as diabetes. Some drugs such as steroid
tablets can cause them. Smoking, alcohol and excessive exposure to sunlight are
three other risk factors for developing a cataract. Some cataracts run in families.
Finally, a cataract can develop years after a trauma in the eye or after exposure to
radiation. If you have other things wrong with your eye as well as a cataract, you
may not be able to see perfectly after the operation.
75
The Operation
The surgeon will usually operate on one eye at a time. This means two operations
with a wait of a few months in between. Most patients have the eye numbed with a
local anesthetic. Very rarely, a patient might need to be put to sleep with a general
anesthetic to allow him or her to have this operation comfortably, If you have a local
anesthetic, you will be awake during the operation, but will feel no pain and will not
see anything, because the injection stops the eye working. A small cut will be made
in the wall of the eye where the colored part (the iris) joins the white part. Most of
the lens will be taken out. A special plastic lens, or implant, will be placed where the
old lens was. The lens will last for your whole life. It does not wear out or go cloudy.
It does not need to be renewed. The cut in your eye may be closed with tiny stitches.
Sometimes, a slanted cut in the wall of the eye is made, which does not need
stitches. The operation takes about 60 minutes.
Any Alternatives
If you leave things as they are, your cataracts will not get better. You may find that
you can see well enough for your needs. You can make close-up jobs like reading
easier, by using a good light, big print, and a magnifying glass. If you are not living
life to the full, you should be thinking about treatment. If you are being clumsy and
you have accidents, you have left things long enough. If your optician has checked
your glasses in the last three to six months, changing your glasses will not help you
see through cataracts. There are no medicines or other ways to make your lens clear
again.

Stop smoking and get your weight down if you are overweight (See Healthy Living).
hospital's advice about taking the Pill or hormone replacement therapy (HRT). Bring
all your tablets and medicines with you to the hospital. On the ward, you may be
checked for past illnesses and may have special tests to make sure that you are well
prepared and that you can have the operation as safely as possible. Many hospitals
now run special preadmission clinics, where you visit for an hour or two, a few weeks
or so before the operation for these checks.
After - In Hospital
Most patients have little pain after a cataract operation. You may be given tablets or
an injection to control any pain or discomfort. You can wash, bathe, or shower
76
normally after the operation, but you must not get water in your eye for a month. If
you have your hair washed, have it done with your head leaning backwards. Do not
use makeup on your eyelids for one month. You will normally be able to go home on
the day of your operation. You will be given a supply of eye drops, and shown how to
put them in your eye. You will be given an appointment for the outpatient
department for a check-up one to two weeks after you leave hospital. The nurses will
After - At Home
Your eye will be covered by a pad and a protective plastic shield. This is to stop you
touching your eye, especially when you are half asleep. Many patients find they can
see dramatically better as soon as the pad is taken off. Sometimes it takes a few
days for a patient to see better, as the eye settles down after the operation. You
MUST wear the eye shield to protect the operated eye at night, or if you sleep during
the day. You will be told in the out patient clinic when you can stop using the shield
(normally about one month). During the day you can try wearing your old glasses,
but they may no longer suit you. Sun glasses are a good idea to protect your eyes
from the glare. If you have stitches in your eye, they usually stay in for ever and do
not cause problems. Sometimes they are uncomfortable after six to eight weeks, and
can be taken out if they are troublesome. A hard knock in the eye in the first month
can break the stitches and be very serious. If you wear contact lenses, do not put
one in the operated side for eight weeks. Plan to go back to light work in one to two
weeks, and a heavy manual job in three months.
In the rare case that you have this operation under general anesthetic, there is a
very small risk for complications related to your heart and lungs. The tests that you
will have before the operation will make sure that you can have the operation in the
Infection can be very serious, but is very rare. A serious infection can result in loss of
your sight on the operated eye. The eye drops that you will be given also contain
antibiotics, so it is important you use them as directed. A tiny amount of blood in the
eye may stop you seeing clearly. The blood usually goes in a few days, and you will
see better. Very seldom, there is severe bleeding in the back of your eye. This can
even lead to damage to the retina and require a second operation to correct the
problem.
The day after surgery, the pressure may go up in your eye. This causes pain and
blurred vision. It normally settles down with tablets and eye drops. If you have
severe pain on the night of the operation, please tell the nurses. Sometimes the
eyelids swell up, and the upper lid may droop. These usually settle down without any
treatment. Some patients get swelling at the back of the eye, leading to blurry
vision. In most cases this settles down by itself.
Very rarely, the operation on your lens can cause detachment of the retina from the
back of the eye. If you suddenly see dots, flashing lights, or something like a curtain
in the eye, come straight away to the Accident and Emergency department. You will
most probably need an operation to fix the retina back in place. The detachment of
the retina is an emergency situation that needs to be treated urgently. The longer
the delay, the greater the chance of significant or complete loss of your vision in the
affected eye. Even when the detachment of the retina is treated promptly it can
result in some loss of your vision.
77
Sometimes, the new lens implant has to be put in front of the iris (the colored part of
the eye) instead of behind it. Rarely, for technical reasons, a new lens cannot be put
in at all. You may then need thick glasses or a contact lens.
Sometimes, the eye tissues behind the new lens can become cloudy and affect your
vision. This happens months or years after the operation and it is called an after-
cataract. Approximately 25% of patients that have cataract surgery experience an
after-cataract. The condition is successfully treated with a minor operation: the
surgeon uses a laser to open a small hole in the cloudy tissues behind the lens to
allow the light to go through.
About 90% of patients who have the operation of replacing a lens affected by
cataract with a new lens have better vision compared to before the operation.
However, if you have more wrong with your eye than just a cataract, then you may
not be able to see as well as you had hoped after the operation.
You must be very careful with driving in the early stages, because you may not be
used to seeing well. Also your sight may not be as good as you think it is. Ask
whether your sight is good enough. If in doubt, don't drive.
General Advice
Cholecystectomy - Gall Bladder Removal
What is it?
The gallbladder lies behind your right ribs at the front, below the liver and above the
duodenum (gut). It is a pouch which is connected with the tubing (bile ducts) that
carries bile from the liver to the duodenum. Stones forming in the gallbladder often
cause pain. If stones escape from the gallbladder they can block the bile ducts and
cause pain, fever and yellow jaundice.
The Operation
There are two types of operation: Keyhole and Open. The keyhole method is the
most popular, but is not a good idea if you have scars from earlier operations, late
pregnancy, or very severe inflammation. In this case, the open method is done. The
keyhole method means making 3 wounds about half an inch long in the front of your
tummy, plus another wound in your tummy button. A very narrow telescope called a
laparoscope is passed through one of the wounds. The surgeon can see what is
going on inside your tummy on a television screen. Special narrow instruments are
passed through the other wounds. The gallbladder is freed and drawn out through
your tummy button wound. The removal is called a cholecystectomy. Using the
telescope makes it a laparoscopic cholecystectomy. The wounds are then closed with
stitches or sticky strips on the skin. Most patients can go home the day after this
operation. Rarely, the gallbladder cannot be safely taken out the this way . Then, the
open method has to be used to do the job. This can only be decided at the time of
the operation. This usually means being in hospital for 4 days or more. In the open
method a cut is made in the skin below the right ribs at the front. It is usually made
in a skin crease across your tummy so that it hardly shows afterwards. The
78
gallbladder and its stones are removed. X-rays are taken to show whether there are
any stones in the bile ducts. If there are, they are removed. The exact procedure
depends very much on the detailed findings at the time of the operation. The cut in
the skin is then closed up. This method is called an open cholecystectomy.
Any Alternatives
If you leave things as they are, you are likely to have more of the same trouble. This
may only be more pain from the gallbladder, which is unpleasant but not dangerous
on its own. If you have had only one attack, you may like to wait and see. If you feel
you could not take the operation, and especially if you are over 70 years old, this is
worth thinking about. If you have had yellow jaundice, or pancreatitis, you can get
seriously ill in another attack. If there are stones in the bile ducts, it is often possible
to clear them out from below. This is done through a special flexible telescope you
swallow. There may be no need to take out your gallbladder if this works.

checks.
After - In Hospital
If you have had the keyhole operation, your wounds are injected with a pain killing
drug during the operation. They are usually only a little uncomfortable. Ask for
tablets or even injections if the wounds are troubling you. You may notice some
discomfort in your shoulder tips for a day or two. This is caused by the special gas
used to help the surgeon see clearly in your tummy during the operation. It settles
down. If you have had the open operation, the wound is painful and you will be given
injections and later tablets to control this. Ask for more if the pain is still unpleasant.
not make important decisions during that time.
If you have had the keyhole operation you will have 4 little wounds; if you have had
the open operation you will have just one wound. The wounds will have a dressing
which may show some staining with old blood in the first 24 hours. In the keyhole
operation the wound dressings will be changed before you go home if they are
stained. Keep the dressings on for a week until you are seen at a follow up visit. In
the open operation there may be stitches or clips in the skin. Any plastic drain tube
is removed when it stops draining - usually after 48 hours. If there is a thick tube,
this means you have needed an additional procedure to get rid of misplaced stones.
This drain is taken out after 10 days. You can wash the wound area as soon as the
dressing has been removed. Soap and tap water are entirely adequate. Salted water
is not necessary. After the keyhole operation most patients can go home the day
after the operation. Some can even go home the same day. You can stay longer if
you are not feeling fit enough to go home so soon. For the open operation, if you
have only had a gallbladder removal, plan to go home in 5 days after the operation.
If you have had more done, 10 days is a sensible time for planning. Please ask the
79
nurses about sick notes, certificates etc.
After - At Home
You are likely to feel very tired and need rests 2 to 3 times a day for a week or
more. You will gradually improve so that after a week in the case of the keyhole
operation, or 2 months in the case of the open operation, you will be able to return
completely to your usual level of activity. You can drive as soon as you can make an
emergency stop without discomfort in the wound, i.e. after 1 to 3 weeks. After a
keyhole operation you should be able to return to work after 10 days. After an open
operation you should be able to return to a light job after about 4 weeks, and any
heavy job within 8 weeks. The wound may be closed with stitches, clips, or paper
strips, which need to be taken out by the nurses about a week after the operation.
Sometimes there are stitches under the skin instead. These melt away, so that the
wound does not need any more attention. A plaster on the wound makes it more
comfortable. You can wash, bathe, or shower as soon as the stitches, clips or paper
strips are taken off. Soap and tap water are quite all right. Salted water is not
needed. Some hospitals arrange a check up about one month after you leave
and surgical staff. If you think that all is not well, please ask the nurses or doctors.
Wound infection is a rare problem and settles down with antibiotics in a week or two.
Aches and twinges may be felt in the wound for up to 6 months. Occasionally there
are numb patches in the skin around a wound which get better after 2 to 3 months.
Rarely, not all the stones can be removed. This would be discussed with you by the
surgeon. If you have had the keyhole operation, sometimes bile can collect in your
tummy in the first 2-3 days after the operation. This can be uncomfortable and put
you off your food. Report it to your General Practitioner, or phone the ward. If you
have had the open operation, occasionally leakage of bile from the drainage tubes is
slow to stop. Patience is needed for a few days. Rarely the bile ducts can be
damaged by either operation.
General Advice
The keyhole operation should be straight forward. Patients are often surprised how
quickly they get back to normal health. The open operation should not be
underestimated. Some patients are surprised how slowly they regain their normal
stamina. However, virtually all patients are back doing their normal duties within 2
months. These notes should help you through your operation. They are a general
Circumcision
What is it?
A circumcision is an operation to remove the foreskin. The foreskin is the sleeve of
loose skin which covers the bulgy end of the penis (the glans). One end of the sleeve
grows from the base of the glans. The other end lies freely over the glans to protect
it. Sometimes the foreskin is tight, or thickened, and will not pull back from the
glans. This can cause discomfort and can lead to infection under the foreskin.
Sometimes the foreskin pulls back and gets stuck causing severe pain and swelling
80
of the bulb. Sometimes the foreskin needs to be removed to check that the
underlying glans is healthy. For children, please see "Child's Circumcision Operation".

The Operation
Most of the foreskin, especially the free end, is removed. The remaining skin is
stitched to the base of the glans, so that there is no sleeve. The operation can be
done as a day case, meaning that you come into hospital on the day of the operation
and go home the same day, or as a non-day case, where you will spend one or two
nights in hospital.
Any Alternatives
If you leave things as they are the problems may well get worse. Stretching the
foreskin does not usually work. Slitting the narrow path of the foreskin using a local
anesthetic injection is easy to do, but this leaves the foreskin very untidy. Many
patients ask for a circumcision after this operation.

lungs, ask your family doctor to check that these are under control. Check you have
a relative or friend who can come with you to hospital, take you home, and look after
you for the first week after the operation. Bring all your tablets and medicines with
you to hospital.
checks.
After - In Hospital
There is some discomfort rather than severe pain. You will be given injections or
tablets to control this as required. Ask for more if the pain is still unpleasant. By the
end of one week the wound should be virtually pain-free. You will be able to get out
of bed after an hour or two despite the discomfort. A general anesthetic will make
you slow, clumsy and forgetful for about 24 hours. Do not make important decisions,
drive a car, use machinery, or even boil a kettle during that time.
If your operation is a day case you should feel fit enough to go home after an hour
or two on the ward. If it is not a day case, usually you will be able to leave hospital
the day after the operation. The wound has a moist dressing which can be removed
after 12 hours or so. You may be wearing net elastic pants to hold the dressing in
place. There are stitches in the wound which soften and drop out after 7 days or so.
gravity and fades to a yellow color after 2 or 3 days. It is not important. There may
be some swelling of the surrounding skin which also improves in 2 or 3 days. After 7
to 10 days crusts on the wound will drop off. Occasionally minor match head sized
blebs form on the wound line. These settle down after discharging a blob of yellow
fluid for a day or so. You can wash the wound area as soon as the dressing has been
removed. Soap and tap water are entirely adequate. Salted water is not necessary.
You can shower or take a bath as often as you want. Wear a dressing to keep your
underpants clean. Please ask the nurses about sick notes, certificates etc.
After - At Home
You are likely to feel a little sore for a week or so. By the time 2 weeks has passed
81
you should be able to return to your usual level of activity. You can drive as soon as
you can make an emergency stop without discomfort i.e. after about 3 days. You can
start sexual relations within 2 to 3 weeks, when the wound is comfortable enough.
You should be able to return to a light job after a week or so and a heavy job within
2 weeks.
Complications are rare and seldom serious. If you think that all is not well, please
ask the nurses or doctors. You may get painful erections in the first 2 or 3 days.
These can be controlled with painkillers. Infection is a rare problem and settles down
with antibiotics in a week or two. Aches and twinges may be felt for up to 2 months.
General Advice
Colectomy - Total - and Ileostomy
What is it?
The bowel is a tube of intestine which runs from the stomach to the back passage. It
is much longer than the inside of your belly (tummy). It fits in by coiling up in loops.
The upper part of the bowel is called the small bowel. It joins the lower part of the
bowel (the colon) just to the right of the waistline. This is where the appendix
pouches out from the colon. The colon runs up to the right ribs and loops across the
upper part of the belly. Then it passes down the left side to run backwards into the
pelvis towards the back passage, where it is called the rectum. If most of the colon is
diseased it can cause diarrhea, bleeding or general illness. It is better removed.
Sometimes the ends can be joined up inside your tummy. More often, the back
passage is not healthy enough to make a safe join. Then the lowest part of the small
bowel is brought out as a sort of spout (ileostomy) on the right side of the tummy.
The bowel waste runs into a special bag stuck over the ileostomy.
82
The Operation
is made in the skin 25 cm (10 inches) long. The colon is freed inside your tummy.
The diseased bowel is taken out. The lower end of remaining bowel is stitched shut.
The upper end is made to open as an ileostomy. The wound in the tummy is stitched
up. You should plan to leave hospital 2 weeks or so after the operation.
Any Alternatives
Leaving things as they are is risky. Bleeding or perforation mean that urgent
operation is a must. General ill health will not get better by carrying on with drug
treatment alone. A bigger operation to take out the back passage as well as the rest
of the colon is not needed. There are three ways of dealing with the stoma. The
simplest and most reliable is called a spout stoma, which the doctors are planning.
This means wearing a bag to collect the waste. A second way is to make a pouch out
of the bowel inside your tummy so that you can empty the pouch from time to time
and there is no need to wear a bag. A third way is to make a pouch joined to the
back passage so that the waste will pass out the normal way. The second and third
operations are under development and can give rise to problems. Both the last two
operations can be done on a spout stoma at a later date.
83
hospital with you.
ready for the operation. Please tell the nurses of any allergies to tablets, medicines
or dressings. You will have the operation explained to you and will be asked to fill in
an operation consent form. Many hospitals now run special preadmission clinics,
checks.
After - In Hospital
You will have a drip tube in an arm vein connected to a plastic bag on a stand
may be a little uncomfortable. You will have a dressing on your wound and a
drainage tube nearby, connected to yet another plastic bag. You may have a fine
rubber tube (catheter) passing into the bladder through the front passage. This lets
the bladder stay empty and small during the operation and helps control your body
fluids afterwards. A general anesthetic will make you slow, clumsy and forgetful for
about 24 hours. Do not make important decisions during that time.
You will be expected to get out of bed the day after operation despite the discomfort.
You will not do the wound any harm, and the exercise is very helpful for you. The
second day after operation you should be able to spend an hour or two out of bed.
By the end of four days you should have little pain. The ileostomy may not work for a
day or two. It is always runny. It does not smell. You will get special advice and help
from the Stoma Nurses. Because of the drainage tube (catheter) in the bladder,
passing urine is not a problem. Once you can walk about in reasonable comfort, the
catheter is taken out.
You can take the dressing off after 48 hours. Usually there are stitches or clips in the
skin. The wound may be held together underneath the skin and not need further
attention. There may be some purple bruising around the wound which spreads
downwards by gravity and fades to a yellow color after 2 to 3 days. It is not
important. There may be some swelling of the surrounding skin which also improves
in 2 to 3 days. You can wash the wound area as soon as the dressing has been
appointment to visit the Out Patient Department for a check up about one month
after you leave hospital. The stoma nurse will arrange to visit you at home. The
nurses will advise about sick notes, certificates etc. Arrangements will be made to
take out the stitches or clips.
After - At Home
You are likely to feel very tired and need rests 2 or 3 times a day for a month or more. You
will gradually improve so that by the time 3 months has passed you will be able to return
completely to your usual level of activity. You can drive as soon as you can make an
84
emergency stop without discomfort in the wound, i.e. after about 3 weeks. You can restart
sexual relations within 2 or 3 weeks when the wound is comfortable enough. Sometimes the
operation affects the sex nerves. This will be discussed with you. You should be able to return
to a light job after about 6 weeks and any heavy job within 12 weeks.
Chest infections may arise, particularly in smokers. Do not smoke. Occasionally the
bowel is slow to start working again. This requires patience. Your food and water
intake will continue through your vein tubing. Sometimes there is some discharge
from the drain by the wound. This stops given time. Wound infection is sometimes
seen. This settles down with antibiotics in a week of two. Aches and twinges may be
felt in the wound for up to 6 months. Occasionally there are numb patches in the
skin around the wound which get better after 2 to 3 months. The stoma can
sometimes swell, or shrink or irritate the skin. The Stoma Nurses will help you here.
General Advice
normal duties within 3 months. Most patients are delighted how well they feel. These
notes should help you through your operation. They are a general guide. They do not
cover everything. Also, all hospitals and surgeons vary a little. If you have any
85
Colon Polyp Removal
What is it?
Tests so far point to there being one or more polyps in your lower bowel. A polyp is
an overgrowth of the lining of the bowel wall. It usually looks like a raspberry
dangling from the lining on a short stalk. The best way of dealing with the polyp is by
doing a colonoscopy. Some patients, such as those who have had a polyp in the
bowel before, need to have repeated colonoscopies to check that the bowel is
healthy.
86
The Operation
You will have a sedative injection or a short general anesthetic. A colonoscopy means
passing a flexible telescope (colonoscope) up the back passage (rectum) into the
lower bowel (colon) for a distance of about 5 feet (1.4 metres). Usually, the polyp is
snared with a hot wire and removed whole through the colonoscope. Snippets of the
polyp can be taken through the colonoscope if the polyp is too large to be snared.
The polyp or the snippets (biopsies) are sent to be examined under the microscope.
The bowel has to be cleaned out beforehand to give a clear view. You can plan to go
home the evening of your colonoscopy, provided you have recovered from the
examination.
Any Alternatives
Leaving things as they are is really too risky for you. Polyps can change into bowel
cancer if left too long. Other forms of scanning are not as useful as a colonoscopy at
this stage.

You will be given instructions about cleaning the bowel out in the 48 hours or so
before the colonoscopy. Most colonoscopies are done on the day of coming into the
hospital. You should be able to leave the same day. Stop smoking and get your
weight down if you are overweight. (See Healthy Living). If you know that you have
problems with your blood pressure, your heart, or your lungs, ask your family doctor
to check that these are under control. Check the hospital's advice about taking the
Pill or hormone replacement therapy (HRT). Check you have a relative or friend who
can come with you to the hospital take you home and look after you for the first
week after the operation. Bring all your tablets and medicines with you to the
tests to make sure that you are well prepared and that you can have the procedure
as safely as possible. You will be asked to fill in a procedure consent form. Many
hospitals now run special preadmission clinics, where you visit for an hour or two, a
week or so before the procedure for these checks. You will be asked to go on a
special diet three days before the colonoscopy.
After - In Hospital
You may have slight tummy cramps as you get rid of air used during the
examination. You may notice slight bleeding from the back passage for a day or two.
A sedative injection will make you slow, clumsy and forgetful for about 24 hours. The
kettle during this time. The discomfort of the procedure can make it difficult to pass
urine and empty the bladder. It is important that your bladder does not seize up
completely. If you cannot get the urine flowing properly after six hours, contact the
nurses at the hospital or your doctor. You will probably be given an appointment to
visit the surgical outpatient department for a check-up about one week or so after
you leave the hospital. The results from the laboratory will be ready then. Some
hospitals leave check-ups to the general practitioner. The nurses will advise about
After - At Home
You are likely to feel back to normal within 24 hours of the procedure. You can start
driving again within 24 hours of the sedative. The test should not interfere with
sexual relations.
87
if you have this procedure under a short general anesthetic, there is a very small risk
of complications related to your heart and lungs. The tests that you will have before
Complications are relatively rare and seldom serious. Persistent bleeding from the
area of the bowel where the polyp was removed or from the area of the biopsies
occurs in 3% of cases. Making a hole in the colon wall is a rare event but a very
serious complication that can cause massive infection in the abdomen and can be
potentially lethal. If you have one of these serious complications you will most likely
need an operation to fix the problem. If you think that all is not well, please let the
nurses or doctors know.
General Advice
The colonoscopy and the removal of the polyp is a minor procedure and is very safe.
88
Colonoscopy
What is it?
Your symptoms point to your lower bowel being the cause of your condition. So far
the tests have not been too helpful. The best way of finding out now is to do a
colonoscopy. It has not been suggested before because it is a bit complicated and
needs a stay in hospital. Some patients, such as those who have had a polyp in the
bowel, need to have repeated colonoscopies to check that the bowel is healthy.
The Operation
You will have a sedative injection or a short general anesthetic. A colonoscopy
89
means passing a flexible telescope (colonoscope) up the back passage into the lower
bowel (colon) for a distance of about 5 feet (1.4 metres). Snippets of tissue can be
taken, and polyps can be snared during the test. The bowel has to be cleaned out
beforehand to give a clear view. You can plan to go home the evening of your
colonoscopy, provided you have recovered from the examination.
Any Alternatives
Leaving things as they are is really too risky for you. The tests so far are not an
answer in themselves. A colonoscopy at this stage is better than an operation. Other
forms of scanning are not as useful as a colonoscopy at this stage.

you have a relative or friend who can come with you to hospital and take you home.
Bring all your tablets and medicines with you to hospital.
ready for the operation. You will be asked to fill in an operation consent form. Many
few weeks or so before the operation for these checks. You will be asked to go on a
special diet 3 days before the colonoscopy. You will be given instructions about
medicines to clear out the bowel before the operation.
After - In Hospital
You may have slight tummy cramps as you get rid of air used during the
examination. A general anesthetic will make you slow, clumsy and forgetful for about
24 hours. Do not make important decisions, drive a car, use machinery, or even boil
a kettle during that time. The discomfort of the operation can make it difficult to pass
urine and empty the bladder. It is important that your bladder does not seize up
completely. If you cannot get the urine flowing properly after 6 hours, contact the
nurses or your doctor.
You may be given an appointment to visit the Surgical Out Patient Department for a
check up about one month or so after you leave hospital. Some hospitals leave
certificates etc. You are likely to feel back to normal within 24 hours of the operation.
You should not drive, use machinery or make important decisions for 24 hours after
the anesthetic. This is because the drugs used can slow the brain down for a time.
You can restart driving within 24 hours of the anesthetic. The test should not
interfere with sexual relations.
Complications are rare and seldom serious. Making a split in the bowel wall is very
rare. If you think that all is not well, please ask the nurses or doctors. There may be
some bleeding for a day or two if a polyp has been snared.
General Advice
The test is a minor procedure and is very safe. These notes should help you through
90
91
Colostomy - Defunctioning Loop
What is it?
The bowel is a tube of intestine which runs from the stomach to the back passage. It
is much longer than the inside of your belly (tummy). It fits in by coiling up in loops.
The upper part of the bowel is called the small bowel. It joins the lower part of the
bowel (the colon) just to the right of the waistline. This is where the appendix
pouches out from the colon. The colon runs up to the right ribs and loops across the
upper part of the belly. Then it passes down the left side to run backwards into the
pelvis towards the back passage, where it is called the rectum.
Your lower colon and rectum are diseased. You need to have a bypass operation to
keep the waste away from the diseased part. A loop of colon is brought out onto the
skin so that the waste runs into a special bag stuck over the opening. This is the
colostomy. Often the diseased part can be taken out later, when the bowel has
recovered from infection or being overstretched by a blockage. Then the colostomy
can be closed off. Sometimes it is too risky for you to have the diseased part taken
out. You can keep a colostomy for decades without coming to any harm. Sometimes
a colostomy is needed so that x-ray treatment can be given to the lowest parts of
the bowel safely.
The Operation
is made in the skin 25 cm (10 inches) long. The colon is freed inside your tummy. A
loop of colon is brought out and stitched to the skin. The opening of the bowel is
covered with a special bag. The original wound is closed up. Sometimes, if the colon
is free enough, a colostomy can be made without the first big wound. This is a bonus
for you. You should plan to leave hospital 2 weeks or so after the operation.
Any Alternatives
Leaving things as they are is risky. A blocked lower colon is a life-threatening
92
condition. You must have a bypass operation. it is not safe for you to have the
diseased bowel taken out now. Drug and x-ray treatment are not helpful by
themselves.

special tests, ready for the operation. Please tell the nurses of any allergies to
After - In Hospital
You will have a drip tube in an arm vein connected to a plastic bag on a stand
may be a little uncomfortable. You may have a fine tube (catheter) passing into the
bladder through the front passage. This lets the bladder stay empty and small during
the operation and helps control your body fluids afterwards. You will have a dressing
on your wound and possibly a drainage tube nearby, connected to yet another plastic
bag. You will have the colostomy with a plastic bag over it. A general anesthetic will
decisions, during that time.
You will be expected to get out of bed the day after operation despite the discomfort.
You will not do the wound any harm, and the exercise is very helpful for you. The
second day after operation you should be able to spend an hour or two out of bed.
By the end of four days you should have little pain. The colostomy may not work for
a day or two. It is always runny at first and rather smelly. It quickly gets better. You
will get special advice and help from the Stoma Nurses. Because of the drainage tube
(catheter) in the bladder, passing urine is not a problem. Usually there are no
stitches in the skin. The wound is held together underneath the skin and does not
need further attention. The drain tube is removed after 4 days or so. There may be
some purple bruising around the wound which spreads downwards by gravity and
fades to a yellow colour after 2 to 3 days. It is not important.
days. After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor
matchhead sized blebs form on the wound line. These settle down after discharging a
blob of yellow fluid for a day or so. You can wash the wound area as soon as the
water is not necessary. You can shower or bath as often as you want. You will be
given an appointment to visit the Out Patient Department for a check up about one
month after you leave hospital. The Stoma Nurse will arrange to visit you at home.
The nurses will advise about sick notes, certificates etc.
93
After - At Home
You are likely to feel very tired and need rests 2 or 3 times a day for a month or
comfortable enough. You should be able to return to a light job after about 6 weeks.
A heavy job may not be possible due to the colostomy.
skin around the wound which get better after 2 to 3 months. The colostomy can
sometimes swell, or shrink or irritate the skin. The Stoma Nurses will help you here.
General Advice
normal duties within 3 months. Most patients are delighted how well they feel. There
is a mass of advice, help, and contact from the Stoma Nurses and self-help groups,
once you leave hospital. These notes should help you through your operation. They
Colostomy Closure - Colorectal Anastomosis
What is it?
As you know, you have a colostomy. This is an opening of the bowel. It drains waste
out onto the skin, instead of down the normal way into the back passage. By now
you have had tests which show that it is time to close off the colostomy. The waste
will again run into the back passage.
94
The Operation
is made around the colostomy to free the bowel from the skin and the body wall. The
opening in the bowel is then joined up again inside the tummy, or sealed off, so that
the waste will drain the normal way to the back passage. The wound where the
colostomy once was, is then closed off. Sometimes the main wound in your tummy
has to be reopened to join the bowel up properly. The wound is stitched up again at
the end of the operation. You should plan to leave hospital 7 days after the
operation. If you have had the main wound reopened, plan for 10 days in hospital.
Any Alternatives
Leaving the colostomy as it is clearly an option. You do not put yourself at risk by
keeping the colostomy. There is a way of closing the colostomy using a special
clamp. This avoids an operation, but often leaves a troublesome weakness under the
scar.

hospital with you.
95
checks.
After - In Hospital
You may have a drip tube in an arm vein connected to a plastic bag on a stand
may be a little uncomfortable. You may have a fine tube (catheter) passing into the
bladder through the front passage. This lets the bladder stay empty and small during
the operation and helps control your body fluids afterwards. You will have a dressing
on your wound(s) and perhaps a drainage tube coming out of the skin. You may be
given oxygen from a face mask for a few hours if you have had chest problems in the
past. The wound is painful and you will be given injections and later tablets to control
this. Ask for more if the pain is still unpleasant. A general anesthetic will make you
slow, clumsy and forgetful for about 24 hours. Do not make important decisions
during that time.
You will be expected to get out of bed the day after the operation despite the
you. The second day after operation you should be able to spend an hour or two out
of bed. By the end of four days you should have little pain. Opening the bowels may
take a day or two. The bowel motion may be rather loose for a week or so at first.
Because of the drainage tube (catheter) in the bladder, passing urine is not a
problem. Once you can walk about in reasonable comfort, the catheter is taken out.
The wound has a dressing which may show some staining with old blood in the first
24 hours. You can take the dressing off after 48 hours. There is no need for a
be stitches or clips in the skin. The wound may be held together underneath the skin
and does not need further attention. The same applies if the main wound has been
reopened. Sometimes, however, 7 or 8 stitches are put across that wound to add
strength. They are removed after about 8 days. The drain tube is removed after
about 4 days. There may be some purple bruising around the wound which spreads
important.
days. After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor
match head sized blebs form on the wound line. These settle down after discharging
a blob of yellow fluid for a day or so. You can wash the wound area as soon as the
water is not necessary. You can shower or bath as often as you want. You will be
given an appointment to visit the Out Patient Department for a check up about one
etc.
After - At Home
You are likely to feel very tired and need rests 2 or 3 times a day for two weeks or
so. You will gradually improve so that by the time a month has passed you will be
able to return completely to your usual level of activity. You can drive as soon as you
can make an emergency stop without discomfort in the wound, i.e. after about 3
comfortable enough. You should be able to return to a light job after about 6 weeks
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and any heavy job within 8 weeks, or 12 weeks if the main wound was reopened.
skin around the wound which get better after 2 to 3 months. Very occasionally the
bowel cannot be joined up again. This will be discussed with you. Sometimes there is
a weakness where the colostomy has been closed. A rejoin operation may be needed
later.
General Advice
normal duties within 3 months. Most patients are delighted how well they feel. These
notes should help you through your operation. They are a general guide. They do not
Colposuspension
What is it?
You have been leaking urine if you strain, or cough, or run. This is called stress
incontinence, meaning the stress of physical activity, not emotional stress. The
problem lies in the floor of the pelvis. This is a sheet of special muscle stretching
across the inside of the pelvis. You can feel it tighten when you try to hold the urine
in. The uterus and the bladder both lie above the pelvic floor. The vagina and the
opening of the bladder (the urethra) pass through the floor. If the pelvic floor
weakens, the uterus and bladder drop down. The control of the urine is weakened.
The operation strengthens the pelvic floor to lift the uterus and bladder back up
again. It is called a colposuspension, from the Greek name for the vagina - colpos.
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The Operation
You will have a general anesthetic, and will be completely asleep. The skin is usually
opened with a cut across of the tummy. This will be a "bikini" incision , just above
the hair line. Sometimes an up and down incision is used. Sometimes any nearby
incisions from other operations are used instead. Ask the surgeon about this before
your operation. Under the skin, the bladder is freed up. The pelvic floor is tightened
up with special stitches. The wound and the skin are then closed.
Any Alternatives
If you leave things as they are, the leaking will steadily get worse. Exercises to
strengthen the pelvic floor have not worked. Electric implants to make the pelvic
floor stronger are experimental. Overall, your best plan is to have the operation.

and may have special tests to make sure that you are well prepared so that you can
After - In Hospital
You will have a small/thin plastic tube (a drip) in an arm vein. This gives you salt and
sugar and water, and sometimes blood, for a day or so from a plastic bag on a stand.
You will have a dressing plaster on your wound. There will be a plastic drain tube
nearby, coming through the skin to drain any blood from the operation. Your bladder
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will have a fine plastic tube or catheter to drain out the urine into a plastic bag at
your bedside. Usually it is brought out through the skin of your tummy. The wound is
a little painful. Usually pain killers are given by injection. You may have a button
switch (PCA Patient Controlled Analgesic) on your wrist to press when you have pain.
This gives you a small dose of a pain-relieving drug into a vein. Later you will only
need tablets.
By the end of four days you should have little pain. The skin will be closed with
stitches or clips or paper dressings. You will be told about arrangements for taking
out the stitches etc. You can bathe or shower but try to keep the area of the wound
dry for seven days. After a few days the bladder catheter will be closed to allow the
bladder to fill with urine. If you are able to pass urine and empty your bladder
naturally the bladder catheter can be removed. Any drain is usually removed the day
after the operation. You should plan to leave hospital about seven days after your
operation. The nurses will talk to you about your home arrangements, to fix the best
time for you to leave hospital. You will be given an appointment to visit the Out-
Patient Department for a check up about six weeks after you leave hospital.
After - At Home
You are likely to feel tired and need rest two or three times a day for three to four
weeks. You will gradually improve so that by the time 3 months have passed you will
you can make an emergency stop without discomfort in the wound, generally after
three weeks. You may have sex before your six week check, as long as you feel
comfortable. You should be able to go back to a light job after about six weeks.
Leave a very heavy job for 12 weeks.
complications related to your heart or you lungs. The tests that you will have before
Most colposuspensions are without complication. The chances of minor complications

are about 2%. The medical and nursing staff will look out for any problems. If you
think that all is not well, please ask the nurses or doctors. Occasionally the bladder is
slow to start working again. This may need a few more days in hospital. Wound
infection is sometimes seen. This settles down with antibiotics after a week or two.
damage to your womb, bladder, bowel and vessels and may require another
operation to fix them.
There is about a 5% chance that in the future you will develop either an irritable
bladder (feeling the urge to pass urine more frequently than usual) or have difficulty
passing urine. In this case you will be taught how to use a urine catheter on your
own to help you empty your bladder whenever you have difficulty passing urine.
The overall success rate of the colposuspension is about 85% and these women
enjoy a very good quality of life. If the first operation is not successful you might
need to have another operation in the future.
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General Advice
Cone Biopsy of Cervix
What is it?
An earlier examination shows that there are some abnormal cells on the neck of the
womb (the cervix) which could become malignant (cancer causing) if left untreated.
The surface layer of the cervix is taken away. This is called a biopsy. The biopsy is
shaped like a cone, giving the name cone biopsy. The biopsy is examined under the
microscope. Often, a cone biopsy is all that is needed. Sometimes, a bigger
operation on the womb is needed later. This depends on the microscope
examination.
The Operation
You will probably have a general anesthetic and be completely asleep. The surgeon
looks at the cervix through the vagina. With special instruments, he removes a cone
of the cervix. You will be in hospital for one to two days.
Any Alternatives
If you leave things as they are, the problem with the cervix is likely to get worse.
You may be missing the chance of having early treatment. Scans and X-rays will not
get the doctors any further forward. You do not need to have a large operation at
this stage.

100
and look after you for the first day or two after the operation. Sort out any tablets,
packets. Bring them to hospital with you. On the ward, you may be checked for past
illnesses and may have special tests, to prepare you for the operation. Please tell the
doctors and nurses of any allergies to tablets, medicines or dressings. You will have
the operation explained to you and will be asked to fill in an operation consent form.
two, a few weeks or so before the operation for these checks.
After - In Hospital
You may have a small/thin plastic tube (a drip) in an arm vein. This gives you
essential fluid, for a day or so from a plastic bag on a stand. You will have a sanitary
pad in place. You may have some lower abdominal pain or backache. This is usually
no worse than a period pain. You may need tablets for the pain. Tell the nurses if
you are still in pain. You will be expected to get out of bed soon after the operation.
You should be ready to go home either the same day or the day following surgery.
There will be slight bleeding like the end of a period. You should wear pads. Do not
use tampons for three to four weeks.
not make important decisions during that time. The nurses will help you with
everything you need until you can do things for yourself. The discomfort of the
operation can make it difficult to pass urine and empty the bladder. It is important
that your bladder does not seize up completely. If you cannot get the urine flowing
properly after six hours, contact the nurses or your doctor. You will be able to take a
bath or shower as often as you want. You will be informed of the results of the
biopsy when it is available. The nurses will advise about sick notes, certificates etc.
After - At Home
You may feel very tired for a day or two. You will be back to normal after a few days
or so. You can get back to driving after three days. You can start sexual relations,
after six weeks. You should be able to return to a light job after about one week.
Most cone biopsy operations are quite straightforward. Sometimes the cervix bleeds
heavily in the 24 hours or so after the operation. The cervix may need to be stitched
at a second operation. Contact your doctor or the ward if the bleeding happens when
you are at home. Rarely, the opening in the cervix narrows with scarring. This may
cause pain with the periods, or difficulty in labor. The doctors can advise you about
this. Very rarely, a large biopsy weakens the cervix. This may lead to miscarriage
and early labor. There are ways of dealing with this. A cone biopsy does not cut
down the chance of pregnancy. Rarely, the doctors are not sure about the biopsy,
and will need to take another piece. They will let you know about this in the clinic.
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General Advice
Corneal transplantation (Keratoplasty)
What is it?
The cornea is the clear/transparent film in the front of the eye that lies just in front
of the colored part (the iris). The cornea allows light to enter the eye and also
refracts/bends the light in such a way that we can focus and see objects close to or
far away from us.
Corneal transplantation is an operation that is carried out to replace a cornea that

has become opaque (not transparent) with a new transparent one. The operation is
also called keratoplasty, named after the keratocytes which are small but very
important cells in the centre of the cornea that produce collagen, the material that
offers structural support to the cornea.
Trauma (including burns from chemicals) is one of the most common causes of
corneal opacity. Other causes are scars after local infection (such as a herpes
infection), swelling of the cornea and poor function of its cells (a category of diseases
called dystrophies) and degeneration/destruction of the corneal cells combined with
distortion of its shape (keratoconus being the most typical example of this kind of
problem).
The main symptom of corneal opacity is gradual loss of vision and corneal
transplantation aims to restore satisfactory vision.
The operation
In most patients the operation is done by having the eye numbed with a local
anesthetic injection. Very rarely a patient might need to be put to sleep with a
general anesthetic to allow him or her to have this operation comfortably. If you
have a local anesthetic, you will be awake during the operation, but will feel no pain
and will not see anything, because the injection stops the eye working and you will
be able to go home on the same day of the operation (day surgery case). If you
have the operation under general anesthetic, you may need to stay in hospital for up
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to 24 hours after the operation.
The operation takes about an hour and is performed with the help of microscope.
Initially the surgeon uses a 'cookie cutter-like' instrument (called a trephine) to
remove the diseased, center part of the cornea. The same instrument is used to take
a piece of cornea from the eye of a donor (usually a person who has donated their
organs for transplantation) which is exactly the same size and shape as the one
removed from the cornea of the patient (recipient).
The new cornea (the corneal graft) is placed in the eye of the recipient in the spot
where the diseased cornea used to be and it is stitched with very fine stitches that
are not dissolvable (they don’t melt away). This is because the healing process in the
area of the cornea takes a long time and the stitches need to be there to keep the
corneal graft in place until the healing is complete and the graft is fixed in the correct
place. At the end of the operation, the eye will be covered with a patch.
Any alternatives?
Certain medications can delay the progress of some of the diseases that cause
corneal opacity. However, once the cornea loses its transparency the only solution is
a corneal transplant.

Stop smoking and get your weight down, if you are overweight. (See Healthy Living).
If you know that you have problems with your blood pressure, your heart or your
After - in hospital
Most patients have little pain after a corneal transplant and sometimes experience
some minor swelling of the eye. You may be given tablets to control any pain and
discomfort. You can wash, bathe, or shower normally after the operation, but you
must not get water in your eye for a month. If you have your hair washed, have it
done with your head leaning backwards. Do not use makeup on your eyelids for one
month.
You will be given a supply of steroid-containing eye drops, and shown how to put
them in your eye. The drops are used to prevent infection but also to prevent what is
called rejection. This is a basic problem after a corneal transplant (as with any
transplant) and it means that your body recognizes the corneal graft as a foreign
body and sends certain cells to attack and destroy it.
You will be given an appointment for the outpatient department for a check-up four
days after your operation. This is because it usually takes four days to get some
satisfactory healing of the surface of the corneal graft and this is probably the
earliest that the surgeon can check that progress is being made. If all is going well,
you will have appointments every two to three days for the first 7 to 14 days and
then, depending on your progress, less frequent appointments. During your
outpatient appointments the restoration of your vision will be checked and the
stitches that hold the corneal graft in place will gradually be removed. The removal
of the stitches is a simple and painless procedure that can easily be done in the
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outpatient department. The first stitches usually come out two months after the
operation and the last ones about a year later. The nurses will advise about sick
notes, certificates, etc. You are advised to arrange for somebody to accompany you
when you leave hospital.
After- at home
Even if everything is well during your first visit as an outpatient four days after your
operation, you will continue to have your eye covered by a pad and a protective
plastic shield. This is to stop you touching your eye, especially when you are asleep.
You MUST wear the eye shield to protect the eye at night, or if you sleep during the
day. You will be told in the outpatient clinic when you can stop using the shield
(usually about one month). During the day you can use any glasses you were using
before the operation. Sunglasses are a good idea to protect your eyes from the
glare. If you wear contact lenses, do not put one in the operated side for at least
eight weeks.
After the operation any activity that can jolt the eye must be avoided. Contact sports
must be avoided after corneal transplantation. Plan to go back to light work in two to
three weeks, and a more heavy/manual job in three to four months.
Your vision will start getting better a few weeks after the operation. In some cases it
takes months or up to a year to have satisfactory vision in the transplanted eye.
You must be very careful with driving because your sight may not be as good as you
think it is. Ask whether your sight is good enough. If in doubt, don't drive.
Possible complications
In the rare case where the operation is performed under general anesthetic, there is
a very small risk of complications related to your heart and lungs. The tests that you
Bleeding in the eye can cause pain and affect your vision. Usually, this settles by
itself but, very rarely, you will need surgery to fix the problem. The eye may also get
infected in the area of the operation. Drops of antibiotics and anti-swelling
medications will be needed to treat the infection. The stitches can sometimes break
or cause irritation of the eye. If this happens they may need to be removed earlier
than expected which can have an effect on the healing process of the corneal graft.
Some studies show that a corneal transplant increases the chances of a cataract (the
lens of the eye behind the iris becomes cloudy affecting your vision) or it can make
an existing cataract worse. In this situation you might need another operation to
replace the cloudy lens with a new synthetic one.
Rejection is the most serious complication after corneal transplantation. It happens

in 5 to 30% of patients and is more frequent in the first year after the transplant. As
with any transplant, rejection usually occurs when the recipient of the transplant
recognizes the transplanted organ as a foreign body and attacks and destroys it. This
'rejection mechanism' is usually triggered by molecules that lie mainly in the blood
vessels/pipes of the transplanted organ. Because the cornea doesn’t have blood
vessels, the problem of rejection is not so extensive as with other organs but it is
still present and, if left untreated, can quickly lead to the destruction of the corneal
graft and loss of vision. The symptoms of rejection are mainly redness of the eye,
discomfort/pain, sensitivity to light and problems with vision. Rejection is treated
with the application of eye drops containing steroids which, as already mentioned, is
a medication that stops the attack of the recipient’s body to the corneal graft.
Sometimes, in difficult cases, it is necessary to take steroids orally (in the form of
104
pills by mouth) or to take cyclosporine orally which is a much more powerful anti-
rejection medication. Rejection can be stopped in most cases, especially if it is
diagnosed and treated promptly. If treatment fails, another transplant will be
needed.
About 90% of patients who have a corneal transplant experience a significant
improvement in their vision. If the transplant fails (rejection being the main cause)
another transplant is possible although it is technically more difficult and the chances
of success are not as good as with the first transplant.
General advice
Correction of Prominent Ears (Pinnaplasty)
What is it?
A prominent ear protrudes excessively from the side of the head. It is frequently a
source of teasing, using names like 'Dumbo, FA Cup, Jug Ears, and Wing Nut'.
The Operation
Surgical correction of prominent ears is usually performed under general anesthesia
in children. It can also be done under local anesthesia. There are many ways of
performing this surgery. Most frequently, an incision is made behind the ear, some
skin is removed, and the cartilage remaining is marked on the front surface to allow
it to bend backwards towards the head. Dissolving sutures are then used to hold it
in the new position. A dressing is placed to keep the ear comfortable. Many
surgeons use cotton wool and a bandage to end up like a turban to avoid disturbing
the new position of the ear. The procedure is usually done as a Day Case.
Any Alternatives
The cartilage of the ear is very soft immediately after childbirth and it is possible to
have moulds made which can gently re-shape the ear in the first few weeks of life.
Some people get so upset about the prominence of their ears sticking out that they
have even used 'super glue' to hold them to the side of their head.

original boxes and packets. Bring them to hospital with you. On the ward, your child
may be checked for past illnesses and may have special tests, ready for the
operation. Many hospitals now run special preadmission clinics, where you visit for
an hour or two, a few weeks or so before the operation for these checks.
After - In Hospital
There may be some discomfort following the surgery. If the surgery is performed
under general anesthesia, local anesthesia is also given so that when the patient
wakes up they usually do not feel pain, but they may have some discomfort.
It is likely that there may be a bandage, dressing or turban around the head to
protect the ears in the new position. The dressing may cover the external ear canal
and make hearing difficult. One should not interfere with the dressings, however, as
this can lead to infection and poor healing of the operation scar. Children often try
105
and scratch their itchy ears under the dressings. This should be discouraged.
Some pain and discomfort will follow when the local anesthetic wears off. This is
usually well controlled using simple painkillers like Paracetamol. If there is
unexpected pain or discomfort it may be necessary to have the dressings removed
and the ear reviewed by a nurse or the surgeon.
After - At Home
It is useful to sleep upright the night following the surgery. The bandages should not
be interfered with and it is best to make sure that children do not stick their fingers
up to try and scratch the back of their ears. This can lead to infection. The head
bandage is left on for up to ten days following surgery. On removal of the head
bandage the ears are cleaned. Examination is performed to make sure there is no
collection of blood between the skin and the cartilage. Rough games should be
avoided for up to two months following surgery. A 'sweat band' at night-time is
useful for up to three weeks following surgery.
When the head bandage is removed, there is often bruising and swelling of the ears.
This can occasionally continue to make them look as if they are still sticking out. The
swelling and bruising does take some weeks to finally resolve. There may
occasionally be some bruising and scabbing over the skin on the front part of the
ear. This will heal by itself.
Complications are unusual. There can be a collection of blood between the skin and
the cartilage-giving rise to a 'cauliflower type' ear. This can be treated surgically.
The skin on the front of the ear is very thin and occasionally after surgery it may be
bruised. On rare occasions the skin can become scabbed and one needs to be
particularly careful, with regular reviews of dressings, to make sure that the
underlying cartilage does not become exposed and dry out. If the cartilage dries
out, it can lead to a misshapen ear.
The ears may be red and sensitive after the surgery and take some time to settle.
The scar behind the ear can sometimes become red and raised, exceeding the height
of the normal surrounding skin. It is often difficult to make both ears absolutely
symmetrical and there are often minor irregularities on the skin surface. Less than 1
in 10 patients require any surgical re-correction.
General Advice
It is often useful to try and have the surgery performed in children out of school
time. However this may not always be possible and some children have to go to
school wearing the turban type bandage in order to protect the ears.
Cysto-Diathermy
What is it?
The tests you have had so far point to your water-works (urinary system) as the
cause of your trouble. It is necessary to look inside the urinary system to find out
what is going on. A special telescope is used to see, or sometimes to take X-rays. At
106
the same time narrow parts can be widened, stones taken out, pieces of the lining
taken out, and diseased parts burnt out as needed.
The Operation
You can have a general anesthetic or you can be numbed from the waist down with
an injection in the back. The choice depends partly on which you prefer, and partly
on what your surgeon or anesthetists thinks is best. Having general anesthetic
means that you will be completely asleep during the operation. Having an injection in
107
the back means that you will be awake during the operation, but will not be able to
feel any pain from the waist down. If the surgeon believes that he only needs to
have a thorough look and take some X-rays or two to three pieces of tissue
(biopsies) from the lining of your urinary system to help him to clarify the problem,
you might not need a general anesthetic or an anesthetic injection in the back. As an
alternative the surgeon can flush some anesthetic jelly into your urethra (the tube
that connects your bladder with you penis or the area in the front of your vagina) so
that you will have only minimal discomfort when he passes the telescope up into
your bladder. If you are awake for the operation, you will have your legs held up in
stirrups. A nurse will chat to you during the operation.
A narrow tube is passed inside the penis in the male, (or into the front passage in
the female), up into the bladder. The surgeon then slides a telescope and other
instruments up the first tube. He then looks around, or takes X-rays, or operates as
planned. Finally all the equipment is taken out. After the operation it is sometimes
necessary to pass a tube (a catheter) back up into the bladder. This will allow urine
to drain freely into a bag for a time. Usually you can go home the same day. If there
are any problems with the operation, you will need to stay longer. The doctors will
let you know about this at the time.
Any Alternatives
Doing more X-rays, scans and other tests will not help find out what the trouble is.
To find out, at this point, it is necessary to have a look inside the bladder and higher
up towards the kidneys. The simplest step is to slide telescopes and other
instruments through the front passage into the bladder and beyond. Bigger
operations such as passing a telescope through the skin into the kidney are not
needed at this stage. In the same way the treatment can be done by this route.
Open operations are not needed at this stage.
If there is a growth in the bladder, burning or cutting the diseased lining away by
this method is usually all that is needed. Sometimes a drug treatment washed into
the bladder is very helpful. X-ray treatment is usually held in reserve. If you do
nothing you will not find out what is causing your problem. Also you will not get the
benefit of early treatment by this route which in certain situations, such as a
developing cancer, it is vital to get a diagnosis and start treatment as early as
possible. The problem will steadily get worse.

that you have a relative or friend who can come with you to the hospital, take you
home, and look after you after the operation. Sort out any tablets, medicines,
as possible. Please tell the nurses of any allergies to tablets, medicines or dressings.
108
After - In Hospital
You may have a fine tube (catheter) passing into the bladder through the front
passage. This is so that urine can drain into a collecting bag. This can feel
uncomfortable. Sometimes the catheter needs to be flushed out to keep the urine
flowing properly. You may be given oxygen from a face mask for a few hours if you
have had chest problems in the past. There may be some slight discomfort where the
instruments have been. You will not normally need painkillers. The feeling goes away
after a day or two. A general anesthetic will make you slow, clumsy and forgetful for
about 24 hours. The nurses will help you with everything you need until you are able
to do things for yourself. Do not make important decisions, drive a car, use
machinery, or even boil a kettle during this time.
If there is no catheter, you should be able to pass urine before you leave hospital. If
you cannot pass urine, let the doctors and nurses know. If there is a catheter, the
urine drains out automatically. The catheter will be taken out when the urine is clear
and when it is safe to do so. After that you will be checked to see that you are
passing urine properly. It is a good idea to drink an extra pint of water in addition to
what you normally drink each day. Do this for a week after the operation. This will
help to clean the urine. You will be given an appointment for the out-patient
department, or you will get a date for any repeat operation. Some hospitals arrange
a check up about one month after you leave hospital. Others leave check-ups to the
After - At Home
You may feel tired for a day or two after the operation. You should not drive for 24
hours after the anesthetic. You can start sexual relations within two to three days of
the operation. You should be able to go back to work within one or two days of
leaving hospital.
your spine.
Complications are unusual, but are rapidly recognized and dealt with by the surgical
and nursing staff. If you think that all is not well, please let the doctors or the nurses
know.
Sometimes there is blood in the urine and if the doctors expect this a catheter is
usually put in at the time of the operation. It may take some days to clear. You will
need to stay in hospital until it gets better.
Sometimes you can have an infection which is either localized in your urine stream
109
or gets into the bloodstream. You will be given antibiotics to treat the infection.
Extremely rarely (especially if many biopsies are taken or there is a lot of burning)
the telescope or other instruments used during the operation can create a hole
(perforation) or an extensive scratch in the lining of the urethra or the bladder. This
problem is usually corrected by putting a catheter back in for one or two weeks to
decompress the bladder and drain the urine until the hole or the scratch has healed.
Only in extreme circumstances will you need another operation to fix the problem.
General Advice
The operation is mostly simple, straightforward and quick. You should be prepared to
stay in hospital longer if needed. These notes will help you through your operation.
nurses.
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Cystoscopy
What is it?
The tests you have had so far point to your bladder as the cause of your trouble.
Your bladder is like a soft rubber balloon which has an opening into the penis or the
front of the vagina. You can feel it in the lower part of you tummy when it is full of
urine. It is necessary to look inside the bladder to find out what is going on. A special
telescope called a cystoscope is used. It is about half an inch in diameter. The
examination is called a cystoscopy. At the same time, X-rays of the kidneys can be
taken, narrow parts can be widened, stones can be taken out, pieces of the bladder
lining can be taken out, and diseased parts can be burned out as needed.
The Operation
You may have a general anesthetic and be completely asleep. It is quite common
however, for patients to be numbed from the waist down with an injection in the
back. If this is the case, you would be awake during the operation, but feel no pain.
The operation takes about 40 minutes. If the cystoscopy is being done so that the
surgeon can have a thorough look in your bladder and possibly take two or three
111
pieces of tissue from the lining of the bladder (biopsies) to see them under the
microscope to help clarify the problem, you might not need a general anesthetic or
an anesthetic injection in the back. As an alternative, the surgeon can flush some
anesthetic jelly into your urethra (the tube that connects your bladder with you penis
or the area in the front of your vagina) so that you will have only minimal discomfort
when he passes the cystoscope up into you. The procedure takes 5 to 10 minutes.
The cystoscope is passed through the penis or through the opening of the bladder in
the front of the vagina, for a look around inside. Other instruments may be passed
up the cystoscope to do the other things as needed. Finally all the equipment is
taken out. Sometimes, afterwards, it is necessary to pass a tube, a catheter, back up
into the bladder. This will allow urine to drain freely into a bag for a time. The
operation can usually be done as a day case. This means you come into hospital on
the day of the operation and go home the same day. You may come into hospital the
day before the operation and stay overnight if you are elderly, or have other
illnesses, or if there is no-one at home to look after you.
Any Alternatives
If you leave things as they are, any problems with the bladder are likely to get
worse. You may be missing the chance of receiving early treatment and this can be
extremely important particularly if it is something like a developing cancer which if
diagnosed at an early stage could be treated. . Scans and X-rays will not help any
further. It is generally not a good idea to start any treatment without knowing what
is wrong.

lungs, ask your family doctor to check that these are under control. For women,
check the hospital's advice about taking the Pill or hormone replacement therapy
(HRT). Check you have a relative or friend who can come with you to the hospital,
take you home, and look after you after the operation. Bring all your tablets and
that you can have the operation as safely as possible.. Many hospitals now run
After - In Hospital
You may have some discomfort in the penis or front passage for a day or so. This will
settle down. You need to pass urine before you leave the ward. If you have any
difficulty, tell the doctors or the nurses. If there is a catheter in the bladder, you will
be informed how long it should stay there. A general anesthetic will make you slow,
decisions, drive a car, use machinery, or even boil a kettle during this time. You will
be able to drink and eat some light food on the day of your operation. Drink plenty of
fluid if you do not feel like eating. You should be eating normally after a day or two.
You will be able to take a bath or shower as often as you want. You should plan to
leave the hospital the day of your operation. The nurses will talk to you about your
home arrangements to arrange a time for you to leave hospital. Please ask the
nurses about sick notes, certificates etc. Some hospitals arrange a check-up about
one month after you leave hospital. By that time the results of any biopsies taken
from your bladder should be available. Others leave check-ups to the general
112
practitioner.
After - At Home
You may feel very tired for a day or two. You will be back to normal after a week or
so. You can start driving again after 24 hours. You can start sexual relations any
time you feel comfortable enough. You should be able to return to a light job after
about two weeks.
your spine.
Complications are very rare. If any of the lining of the bladder is taken out or burned
away, there may be some blood-staining in the urine. If you are passing clots of
blood in the urine, or the blood-staining lasts more than two days, phone the ward.
You might need to have a catheter put back in the bladder if the clots don’t allow you
to pass urine freely. The catheter is removed as soon as your urine is getting clearer.
Sometimes the cyctoscopy stirs up an infection, causing scalding and tummy pains.
Antibiotics will help to control this.
Extremely rarely (especially if many biopsies are taken or there is a lot of burning in
the bladder) the cystoscope or the other instruments used during the cystoscopy can
create a hole (perforation) or an extensive scratch in the urethra or, more
frequently, the bladder. This problem is usually corrected by putting a catheter back
in for one or two weeks to decompress the bladder and drain the urine until the hole
or the scratch has healed. Only in extreme circumstances will you need another
General Advice
Cystoscopy is a very minor operation. It should give the doctors valuable information
about your bladder problem. These notes should help you through your operation.
nurses.
Dilation and Curretage - D and C
What is it?
You are having troublesome periods or irregular bleeding. The doctors need to find
out what is going on, and to find the best way to help.
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The Operation
D and C stands for "dilatation and curettage". Dilatation means gently stretching up
the opening in the neck of the womb with special instruments. Curettage means
passing a special scraping instrument through the opening into the body of the
womb. A little of the lining is scraped out to be looked at under a microscope. You
will have a general anesthetic and will be asleep for the operation. It takes about 10
minutes. The operation can be done as a day case. This means you come into
hospital on the day of the operation and go home the same day.
Any Alternatives
If you leave things as they are, the problem will not get better. Tablets and
medicines have not helped. Scans and X rays will not help at this stage. Your best
way forward is to have this little operation.

them to hospital with you. On the ward, you may be checked for past illnesses and
may have special tests, ready for the operation. Please tell the nurses of any
allergies to tablets, medicines or dressings. You will have the operation explained to
you and will be asked to fill in an operation consent form. Many hospitals now run
After - In Hospital
You will have a sanitary pad in place. You may have a mild pain like a period pain.
Take the same pain killers you would take for a painful period. A general anesthetic
will make you slow, clumsy and forgetful for about 24 hours. Do not make important
decisions, drive a car, use machinery, or even boil a kettle during that time. After an
hour or two on the ward, you should feel fit enough to go home. Some hospitals
arrange a check up after you leave hospital. Others leave check ups to the general
practitioners. A note will be forwarded to your General Practitioner. The nurses will
After - At Home
Go and rest for at least 6 hours. There will be slight bleeding from the vagina, like
the end of a period. It will last for a few days. Only use external pads for any loss.
Do not use tampons. You can have sex after your next natural period if you feel
comfortable enough.
All operations carry some risk, but a D and C is a common and a very safe operation.
Complications are very rare.
General Advice
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have any queries or problems, please ask the doctors or nurses
Discectomy - Slipped Disc
What is it?
Your backbone, or spine, is made up of 24 bones (vertebrae), like a tower of hollow
bricks held together by rubbery plates called discs. This arrangement helps you to
bend your back. The central part of a disc is soft. This part has slipped out of place
and is pressing on one of the nerves in your back. This makes you feel pain as if it is
coming from your leg (sciatica). You may also have weakness in part of your leg. You
may also have had, and still have, some back pain.
Images © Copyright EMIS and PIP 2005
The Operation
is made down to your backbone about three inches long, in your lower back. The soft
part of the damaged disc is removed. This takes the pressure off the nerve in your
back. The firm outer rim of the disc is not removed. The skin wound is then closed
up with stitches or clips. You will be in hospital for one to three days after the
operation. Previously a part of the vertebra, the lamina was always removed. The
operation was therefore called a laminectomy. The operation is now either called a
discectomy or a nerve root decompression.
Any Alternatives
Physiotherapy, and all the usual measures have not helped. If you leave things as
they are, the pain and weakness in your leg will probably remain as they are or even
get worse. More scans or X-rays will not help. The aim of the operation is to cure
115
your leg pain. Your back pain may remain unchanged after the operation. If your
back pain is more of a problem than your leg pain, you should not have the
operation. You should have the operation if:
• your leg pain is worse than your back pain
• you have had leg pain for several months and it is not getting better
• your leg pain is interfering with your life
• you have had a special scan that shows that you have a disc pressing on the nerve.
If you have all of the above you should have an operation.

After - In Hospital
for more if the pain is getting worse . A general anesthetic will make you slow,
decisions during that time. While you are in the hospital, you will gradually be able to
get out of bed and be able to walk around the ward.
The discomfort of the operation can make it difficult to pass urine and empty the
bladder. It is important that your bladder does not seize up completely. If you cannot
get the urine flowing properly after six hours, contact the nurses or your doctor. The
wound will have a simple adhesive dressing over it. The physiotherapist will teach
you some exercises and give you advice. You may be advised to wear a corset for
the few weeks after your operation.
Your stitches or clips are taken out 10 to 12 days or so after the operation. You will
not need a dressing on the wound after that. Wash around the dressing for the first
10 days. You can wash the wound area as soon as the dressing has been removed
and the stitches are out. Soap and warm tap water are entirely adequate. Salted
water is not necessary. You can shower or take a bath as often as you like once the
wound has healed. You will be given an appointment to visit the orthopaedic
outpatient department six weeks or so after your operation. The nurses will advise
After - At Home
You should follow the advice given to you. Physiotherapy may be arranged. You
should not drive for six weeks. Until three months after your operation you should
not drive for longer than half an hour at a time. If your job entails mainly walking
with no lifting, you may return to work after four weeks. If you mainly sit at work,
116
you may return after six weeks. If your job involves heavy work or a lot of driving,
you may return to lighter duties after 12 weeks. If your job involves very heavy
manual work, you may have to think of changing it to a lighter job. You may swim
six weeks after your operation. You may restart non-contact sports three months
after your operation. When you start playing, you will not be able to play for as long
as normal and your back will ache at the end of a game. If all goes well your leg pain
should be reduced after your operation. Do not be tempted to do too much too soon.
Your back will continue to improve for up to one year.
The nerve that the disc is pressing upon may be bruised during the operation. This
temporarily stops it working, making part of your leg numb and slightly weak. It is
very rare (1 in 1000 cases) for the nerve to be permanently damaged. There is a 1
in 10,000 chance of bowel or bladder incontinence after this operation. Wound
infection sometimes happens. You will be given antibiotics to try and prevent this.
Many people fear that if the surgeon's knife slips, they might be paralysed. This
complication is extremely rare, almost not existent with modern orthopaedic surgery.
General Advice
The operation is a neither very simple nor very complicated but somewhere in
between. You should end up much better off after the operation. We hope these
notes will help you through your operation. They are a general guide. They do not
Dupuytrens Contracture - Partial Fasciectomy
What is it?
The layer of tissue just under the skin in your palm, the fascia, has become
abnormal. The fascia has formed a band which is thicker than normal and is
shortened. The band prevents you fully straightening your finger. This is known as
Dupuytren's contracture. It is a condition that is common in adults. Both Ronald
Reagan and Margaret Thatcher had operations for it! Most people develop it for no
obvious reason. However, it is more frequent among older men, diabetics, alcoholics,
and heavy smokers as well as among people suffering from seizures (epilepsy) who
are treated with medications called phenytoins. It can also be hereditary.
The Operation
The operation to correct the skin and fascia in your palm is called a palmar
fasciectomy. If you have a general anesthetic, you will be asleep for the whole
operation. A cut is made along your palm and a zigzag cut up your finger. The
abnormal band of skin in your palm is cut out and the rest of the normal skin in your
palm is left behind. The skin wound is then closed up with stitches. Sometimes a fine
plastic drainage tube is led from the wound. The operation can either be done as a
day case, which means that you come into hospital on the day of the operation and
go home the same day, or as an inpatient case, which means you will be in hospital
117
one night after the operation. If your operation is done as a day case you can be
given a local or a general anesthetic. The choice depends partly on which you prefer,
and partly on your anesthetist and surgeon. Having a local anesthetic means that
you will be awake during the operation, but will not feel any pain in your hand since
the area of the operation will be numbed with an anesthetic injection. If your knuckle
joint is bent with the contracture, the surgeon can usually get it straight. If your
finger joint is bent, he often cannot get it to fully straighten. Afterwards, it is usually
half as bent as it was before the operation.
Any Alternatives
If you leave things as they are, the thickening and shortening will probably slowly
get worse. If you can lay your hand completely flat on a table top, an operation is
not recommended. Not all bands develop to need surgery. If you cannot straighten
your finger then an operation is best. Stretching exercises are not helpful. Injections
do not help. Bigger operations do not give better results.

and may have special tests, to make sure that you are well prepared and that you
can have the operation as safely as possible. . Many hospitals now run special
After - In Hospital
Your hand will be wrapped in a bulky bandage. Your arm will be raised up on a pillow
or in a roller towel to prevent the hand swelling. The wound may be a little sore. You
will be given injections or tablets to control this. Ask for more if the pain is gets
worse . Your arm may be put in a sling. A general anesthetic will make you slow,
you need until you can do things for yourself. Do not make important decisions, drive
a car, use machinery, or even boil a kettle during that time. If your operation is a
day case, you should feel fit enough to go home after an hour or two on the ward
after the operation. If a wound drain has been put in, a nurse will take it out after 24
hours or so. Your stitches will be taken out after 10 days. Wash around the dressing
for the first 10 days. You can wash the wound as soon as the dressing has been
necessary. You can shower or take a bath as often as you like. You will be seen for a
check-up about one or two weeks after you leave hospital. The nurses will advise
about sick notes, certificates etc. You may be made a splint for your hand by the
occupational therapist.
After - At Home
You cannot drive until your stitches have been removed. Your hand may be too sore
to hold a steering wheel for a further two weeks after your stitches have been
removed. This depends on the extent of your surgery. How soon you can return to
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work depends on your job. If you can work mainly one handed, you may be able to
return to work 10 days after the operation. This also depends on you being able to
get to work. If your job is manual you will be unable to work for three to six weeks.
You may play sport four weeks after the operation. Your hand will continue to
improve for three or four months.
Wound infection sometimes happens. . This can usually be settled by taking
antibiotics for a few days. After the release of a severe contracture, a small area of
skin may die. The surrounding skin grows in and replaces the lost skin. As a result
the wound needs repeated dressings for up to six weeks. The nerves that supply
feeling to the fingers run extremely close to where your surgery is performed.
Occasionally a nerve may be bruised or stretched during the operation. This
temporarily stops the nerve working. This gives you tingling or numbness in your
finger.
Occasionally, a nerve to a finger is cut. If this happens, part of your finger is

completely numb. You would still be able to bend and straighten the finger. If your
finger joint is bent, the surgeon often cannot get it fully straight.
Very rarely, patients who also suffer from diseases like diabetes or scleroderma,
which affect the blood vessels, can experience serious complications where the whole
finger is affected and goes dead. This often requires removal (amputation) of the
finger. Also rarely after this operation, the hand can become very stiff, painful and
swollen (a complication called algodystrophy) and requires intensive long-term
physiotherapy to get better.
Dupuytren's contractures often recur.
General Advice
The operation is delicate and not without hazards. However, if you cannot use your
hand properly because of your bent finger, you should end up much better off after
the operation. We hope these notes will help you through your operation. They are a
Endometrial ablation
What is it?
Many woman experience problems like heavy bleeding during their periods;
prolonged periods with a lot of bleeding; or bleeding between periods. One of the
ways of dealing with these problems is to remove or destroy the lining
(endometrium) of the womb (uterus). This is called endometrial ablation. It is done
when it is not possible to identify a specific, potentially treatable, cause for the heavy
bleeding such as the presence of polyps, which are non-cancerous growths that can
sometimes bleed a lot, or a hormone problem, which can also sometimes cause a lot
of bleeding. When a specific cause cannot be found, endometrial ablation is a very
good option to correct the problem.
119
The operation
It is possible that for a period of time before the operation (sometimes up to two
months) you will need to take medications (possibly in the form of injections) that
will decrease the thickness of the lining of the womb. This will make the operation
easier and will increase the chances of success.
The operation can be done as a day surgery case. This means that you can go home
the same day of the operation usually a few hours after it is completed. The
operation lasts between 30 and 45 minutes.
The operation is usually carried out under general anesthetic. This means that you
will be asleep and unconscious and you will not feel pain during the procedure.
The operation starts with a hysteroscopy which allows the surgeon to have a look in
the womb by using a special telescope which is connected to a TV monitor. The
telescope (and any other instruments that are needed during the operation) is
entered into the womb by passing it first through the vagina and then through the
cervix which is the entrance of the womb lying in the deep part of the vagina.
Although the modern telescopes used in such procedures are very thin, in most
cases, the surgeon will need to dilate (widen/open up) the cervix by using a special
device so that he can pass the telescope or other instruments into the womb. The
inside of the womb is a collapsed cavity and the surgeon needs to inflate it by using
a special liquid so that he can see everything clearly.
The lining of the womb can be destroyed by using many different techniques. The
most common one is by using the wire loop of an electrocautery device. This is a
device that burns the lining of the womb and at the same time stops any bleeding.
Another commonly used method is the insertion in the womb of a triangular balloon
which when inflated has the shape of the cavity of the womb. The balloon is inflated
120
with fluid which is then heated for several minutes and eventually destroys the lining
of the womb. Freezing techniques, microwaves or laser ablation have also been used
on a more experimental basis but there is no clear proof that they offer any
substantial advantages compared to the traditional methods.
Any alternatives?
If you leave things as they are the bleeding related to your periods, although not
directly life threatening, will continue to severely affect the quality of your life. The
only alternative to endometrial ablation is a hysterectomy which is an operation to
remove the womb. This obviously offers a definitive solution to the problem but is a
relatively big operation, and more difficult and complicated compared to endometrial
ablation. In most cases it is recommended that a patient has an endometrial ablation
first and if this doesn’t work to then consider a hysterectomy.
You have to remember that an ablation can affect your fertility (ability to stay
pregnant) and obviously it is not an operation you should have if you still want to
have children. In addition, you should not have the operation if there is any suspicion
that you might have cancer in the womb. In this situation you will clearly need more
radical/extensive treatment such as a hysterectomy.

a relative or friend who can come with you to the hospital, take you home, and look
after you for the first week after the operation. Sort out any tablets, medicines,
them to the hospital with you. On the ward, you may be checked for past illnesses
and have special tests to make sure that you are well prepared and can have the
operation as safely as possible. Please tell the doctors and nurses of any allergies to
After - in hospital
You will have a sanitary pad in place. The drugs given for a general anesthetic will
make you clumsy, slow and forgetful for about 24 hours. The nurses will help you
with everything you need until you can do things for yourself. Do not make any
important decisions, do not drive, do not use machinery at work or at home, do not
even boil a kettle during this time. Any pain will usually settle quickly after you have
been to the operating theatre. But you may be left with some tummy discomfort.
Take the painkillers you would normally use for painful periods. For about a week or
two you will experience slight bleeding similar to the kind you get at end of a period.
You should only use external pads for any loss. You can start taking the
contraceptive pill the day after the operation, even if you are bleeding. You can
bathe or shower as often as you wish. The nurses will advise about sick notes,
certificates, etc. Even though the ablation will most likely affect your ability to stay
pregnant there is still a very small possibility that you can get pregnant within a few
weeks of the procedure and you should use appropriate contraception if you do not
want to conceive. You can resume sex three weeks after the procedure, as long as
you are not experiencing any bleeding or discharge.
121
An endometrial ablation is a routine and safe procedure. Complications are rare, they
happen in about 1 to 2% of cases but they can sometimes be serious.
Very rarely, you can have a reaction to the liquid that is used to inflate the cavity of
the womb. This must be recognized promptly and can usually be controlled with
medication.
It is possible that after the procedure you can get an infection inside the womb.
Sometimes the infection spreads to the Fallopian tubes which connect your ovaries to
the womb or even to the rest of your pelvis (the lower part of your abdomen where
your womb is situated). If this happens you will need antibiotics to control the
infection and this might need to be done in the hospital if the infection is serious and
spreads outside the womb.
Finally, relatively rarely, the instruments used during the procedure can cause a hole
in the womb and may even damage other organs around the womb such as the
bowel and large blood vessels. If this happens you will need another operation to fix
the problem.
The operation is very often successful. Most studies show that 80 to 90% of women
are very pleased with the result. About half of them have no periods and the rest
experience only light bleeds. However, the same studies show that five years after
the operation, about one third of women will require another procedure for the same
problem and this second procedure is frequently a hysterectomy.
General advice
122
Epididymal Cyst Removal
What is it?
An epididymal cyst is a swelling containing watery liquid lying just above the testicle.
There may be more than one cyst present and they can occur above both testicles.
They are quite harmless.
The Operation
is made into the skin over the cyst. The cyst is removed and the cut is stitched up.
The cyst and the fluid will be examined in the laboratory. Your operation may be
done as a day case. This means that you come into hospital on the day of the
operation and go home the same day.
Any Alternatives
If you leave things as they are, the cyst will most probably over time get bigger.
Sometimes this takes years. You can afford to wait and see if you wish. The fluid
from the cyst can be drawn out using a needle, but the fluid will build up again in a
month or two. There is no injection treatment that works well.

123
them to the hospital with you.
as possible. . Please tell the doctors and nurses of any allergies to tablets, medicines
checks.
After - In Hospital
Most patients have local anesthetic injected into the wound, even if they have a
general anesthetic for the operation. This is done to try and reduce the pain that you
may experience after the operation. Usually the wound is almost pain-free. There
may be some discomfort on moving. Simple painkillers should easily control this
discomfort. If not, painkilling injections can be given. Ask for more if the pain is not
well controlled or if it gets uncomfortable. . A general anesthetic will make you slow,
decisions, drive a car, use machinery, or even boil a kettle during that time.
Some hospitals arrange a check-up about one month after you leave the hospital. By
that time the results of the examination of the cyst and the fluid should be available.
Others leave check-ups to the general practitioner. The nurses will advise about sick
After - At Home
After two to three hours on the ward, you should feel fit enough to go home. Make
sure you are going home by car with your relative or friend. once home, go to bed.
Take painkiller tablets (such as paracetamol) every six hours to control any pain. The
next morning you should be able to get out of bed quite easily despite some
discomfort. You will not do the wound any harm. The exercise is good for you.
The second day after the operation, you should be able to spend most of your time
out of bed in reasonable comfort. You should be able to walk 50 yards slowly. By the
end of a week the wound should be nearly pain-free. It is important that you pass
urine and empty your bladder within 6 to 12 hours of the operation. If you have
difficulty doing that , phone the hospital ward or your GP. The wound has a dressing
which may show some staining with old blood in the first 24 hours. Replace the
dressing if it gets dirty. You can take the dressing off after 48 hours. There is no
need for a dressing after this unless the wound is painful when rubbed by clothing.
The stitches in the skin will usually slip out after about 7 to 10 days.
gravity and fades to a yellow colour after two or three days. This is expected and you
should not worry about it. . There may be some swelling of the surrounding skin
which also improves in two to three days. After 7 to 10 days, slight crusts on the
wound will fall off. Occasionally minor match-head sized blebs (blisters) form on the
wound line, but these settle down after discharging a blob of yellow fluid for a day or
124
so. You can wash as soon as the dressing has been removed but try to keep the
wound area dry for a week. Soap and tap water are entirely adequate. Salted water
is not necessary.
You are likely to feel tired for one to two days. After one to two weeks you should be
able to return completely to your usual level of activity. After about two to three
days you can lift as much as you used to lift before the operation. You can drive as
soon as you can make an emergency stop without discomfort in the wound i.e. after
about two days. You can restart sexual relations within a week or so. You should be
able to return to a light job within three to four days and a heavy job within six to
seven days.
troublesome, particularly if the cyst is large. The swelling may take four to six weeks
to settle down. Putting on a scrotum support (special type of underwear that
elevates the scrotum) lessens the chances of getting swelling or, if you do get
swelling, can help to make you more comfortable. Infection is a rare problem and
settles down with antibiotics in a week or two. The area on top of the testis where
the cyst used to be might feel thickened. This will gradually get better but there is a
good chance that it will not disappear completely. This is expected and you should
not worry about it. In addition, after the operation the testis on the side of the
operation might end up a little higher compared to before the operation. This is also
something that you should not worry about. Aches and twinges may be felt in the
wound for up to six months. Occasionally there are numb patches in the skin around
the wound which get better after two to three months. Recurrence of the cysts
happen in about 5 in 100 cases.
Very rarely this operation can affect your fertility (your ability to make a woman
pregnant). This happens because the structures that carry the sperm from the testis
can be damaged during the operation. If fertility is still important to you, discuss the
possibility of this complication with your surgeon.
General Advice
The operation is a relatively minor one but can be irritatingly slow to become pain-
free if there has been swelling after the operation. We hope these notes will help you
125
Epidural
What is it?
The feeling of pain starts in the tiniest of nerve endings in the skin. The nerve fibres
join up to form nerves which run under the skin to the spine. In the spine, the
nerves form a thick rope called the spinal cord, which runs inside the bones of the
spine to the brain. If something presses on or irritates the nerve as it runs between
the bones of the spine to join the spinal cord, you will feel pain not so much in the
spine as in the skin where the nerve started. The bones of the spine (vertebrae) are
like a tower of 24 hollow bricks held together by rubbery plates called discs. The
spinal cord runs through the hollow centre of each vertebra. The spinal cord has a
special covering called the dura. It is quite common for the nerve endings from the
back of the thigh down to the foot to be pressed on by a disc bulging out between
two of the lower vertebrae. This causes pain down the back of the thigh, calf and
foot called sciatica and also some back pain.
The Operation
A mixture of two drugs is injected into your back. The injection goes around the
nerves just outside the dura of the spinal cord into the epidural space. Your legs will
be numb for a few hours after the injection because of one drug. After two or three
weeks, the second drug, a steroid, will take effect, and your pain should lessen. An
epidural injection gives long-lasting pain relief for some people. For others the
improvement is only temporary. The procedure is usually performed as a day case.
Any Alternatives
Other operations would not be helpful at this stage. Drugs have been disappointing.
There are no major disadvantages to having an epidural. If it does not work, you will
be no worse than you were before.
Before the procedure

126
you have a relative or friend who can come with you to the hospital, and take you
home after the procedure. Bring all your tablets and medicines with you to the
tests, to make sure that you are well prepared and that you can have the operation
as safely as possible.. Many hospitals now run special preadmission clinics, where
After - In Hospital
Your legs may be numb and weak. This lasts for a few hours only. Initially, your back
pain will be the same as before the injection. The injection site should not be painful.
The first hours after the procedure, the injection may make it difficult for you to pass
urine and empty your bladder. It is important that your bladder does not seize up
completely. If you cannot get the urine flowing properly after six hours, contact the
nurses or your doctor. The injection site will have a simple adhesive dressing over it.
You may remove this after 24 hours. You will be given an appointment to visit the
orthopaedic outpatient department about six weeks after you leave the hospital.
Some hospitals leave check-ups to the General Practitioner. The nurses will advise
After - At Home
You may return to work two or three days after your injection. The anti-inflammatory
steroid takes two or three weeks to work. Not everyone's pain improves. The
improvement is only temporary for some but long lasting for others.
This is a simple procedure. Complications happen very rarely. You can have some
minor bruising at the site of the injection or a small blood clot on top of you spine
which eventually dissolves. Infection is very rare and can be settled by taking
antibiotics for a few days
Extremely rarely, this procedure can cause damage to one of your nerves of your
spinal cord.
General Advice
The procedure is relatively minor. If it works you should be much more comfortable.
Epigastric Hernia Repair - Child
What is it?
A hernia is a weakness in the tummy wall. An epigastric hernia is a weak spot or gap
above the tummy button. The area of the hernia gets swollen because organs within
the tummy are pushing through the weak spot. It may get bigger or give pain.
Sometimes there is more than one hernia. The hernia is not any fault of the parents..
The Operation
Your child will have a general anesthetic, and will be asleep for the whole operation.
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A cut is made into the skin above the tummy button. Whatever organs are pushing
through the weak spot are placed back in the tummy and the weak spot or gap is
closed with strong stitches. The cut in the skin is then closed up. Usually you can
take your child home the same day.
Any Alternatives
If you leave things as they are, the hernia will get bigger and more uncomfortable.
Binding the hernia down or using trusses will not help. Keyhole operations are
experimental, and leave a scar not much smaller than the one being planned.
If the hernia is not repaired, the greatest danger to the child is the abdominal organs
getting trapped in the hernia. This usually happens after some excess physical
activity and it can be very painful. Even worse, the organs that get trapped in the
hernia can get strangulated, the blood supply to them can stop and they get necrotic
(die). This serious condition is called an incarcerated hernia. If this happens the child
must be taken to hospital urgently and an emergency operation will be needed to fix
the problem. If your child has a hernia, you should be alert to this potential situation
and seek medical advice urgently if you have any suspicions that your child is getting
rather uncomfortable in or around the area of the hernia.
For these reasons it is very important to proceed with the hernia repair before your
child experiences such problems.

Your child must have nothing to eat or drink for about six hours before the operation.
This means not even a sip of water. Your child's stomach needs to be empty so that
the anesthetic can be administered safely. If your child has a cold in the week before
admission to the hospital, please telephone the ward and let the ward sister know.
The operation will usually need to be put off. Your child has to get over the cold
before the operation can be done. By having an anesthetic the cold could turn into a
and your child will have the operation explained to you and you will be asked to fill in
where you and your child visit for an hour or two, a week or so before the operation
for these checks.
After - In Hospital
Your child will be sleepy after the operation and is likely to sleep for an hour or more
afterwards. The drugs given for a general anesthetic will make your child clumsy,
slow and forgetful for about 24 hours. This happens even if your child feels quite all
right. Do not leave your child on his or her own or let your child use anything sharp
or dangerous. Your child will probably not notice any particular pains. If necessary
your child can take a painkiller by mouth, such as paracetamol in liquid or tablet
form. By the end of one week the wound should be virtually pain-free. There may be
stitches or clips in the skin. Sometimes the wound is held together with the stitches
under the skin that dissolve and don’t need to be removed. . There may be some
swelling of the surrounding skin which improves in two to three days. This is
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expected and you should not worry about it.
After 7 to 10 days, slight crusts on the wound will fall off. Occasionally minor
matchhead sized blebs (blisters) form on the wound line. These settle down after
discharging a blob of yellow fluid for a day or so. You can wash your child but try to
keep the wound area dry until the stitches or clips come out or for about a week if
there only stitches under the skin. Baths or showers with ordinary soap and water
are all right. Salt water is not necessary. Some hospitals leave check-ups to the
After - At Home
Your child may need frequent sleeps for a day or two. Although it is usually difficult
to limit what he or she does, try to help your child avoid any excess physical activity
for four to six weeks after the operation, particularly if he or she is over five years
old. If your child goes to school he or she can return to lessons after about 10 days.
Your child can restart any sport in four to six weeks.
before the operation will make sure that he or she can have the operation in the
Complications are rare and seldom serious. If you think that something is wrong let
the doctors or the nurses know. There is often some swelling and even some redness
around the wound. These usually settle in three or four days. Infection is a rare
problem and settles down with antibiotics in a week or two. It is very rare for the
hernia to form again. The risk or recurrence is less than 1 in 100. This is more
common in children who have a wound infection after the operation or who don’t
avoid any excess physical activity for the first four to six weeks.
General Advice
These notes will help you and your child through the operation. They are a general
Eye Lift (Blepharoplasty)
What is it?
An eyelift operation, or Blepharoplasty, is the removal of excess skin, saggy muscle
and sometimes fat from the eyelids. It may be performed alone or as part of a face
lift procedure.
The Operation
The surgery can be performed under local or general anaesthesia. The surgeon
marks out the excess skin on the upper eyelid so that the final scar will tend to be
hidden when the eye is open. On the lower eyelid, the scar is very close underneath
the eyelashes and extends out onto a crease line. The type of surgery performed
depends on the exact underlying problems. The surgery is frequently performed as a
Day Case.
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Any Alternatives
There are no surgical alternatives for Blepharoplasty.

Pre-operative assessment by the surgeon is most important to achieve the best
results. Assessment will indicate where the problem is. Sometimes the problem
may be related to excess drooping of the eyebrows. This may need to be surgically
corrected. The older one gets the more tissue tends to sag and some of the tissue
on the eyelids may be related to laxity of the underlying ligaments as much as to the
overlying skin. This may need to be corrected at the time of surgery. It is also very
important to make sure that there is adequate tear production in the eye. Should
this not be the case, 'dry eyes' can occur following surgery, which can lead to
damage to the outer lining of the eyes. It is important to avoid smoking before the
surgery and to avoid taking Aspirin, or other medication, which makes you more
likely to bleed.
After - In Hospital
There will be stitches on the upper eyelid and just beneath the lashes of the lower
eyelid. There may also be some paper tapes in order to support the stitches. Ice
packs may be used over the eyes in order to decrease the amount of swelling and to
keep the eyelids comfortable. It is best to sleep propped up for forty-eight hours
following surgery as this is when most swelling tends to occur. The eye vision and
blood pressure will be checked following surgery. Ointment may also be placed in
the eyes to prevent them from drying out and becoming irritated.
After - At Home
As the surgery may be performed as a Day Case, you may be able to go home on
the same day as the surgery. There is likely to be bruising or swelling for two to
three weeks. This can be well hidden by sunglasses. It is also important to avoid
heavy lifting or bending for two to three weeks following surgery. It is advisable to
avoid any heavy activity or gym work for about one month after surgery. Sleeping
propped up at nighttime tends to help reduce swelling. The stitches from around the
eyes are usually removed between five and seven days following surgery.
Swelling persists for some weeks after the surgery. Very occasionally serious
complications can occur with eye lifts. It is very important to let the doctor know if
pain is experienced beyond that which one would expect. This can be an indication of
bleeding into the back of the eye. Occasionally wounds can get infected and lead to
infection in and around the eye. Inadequate removal of the tissue can also lead to
an unsatisfactory result. Drooping of the upper eyelid can also occur if the muscle
that lifts the upper eyelid is damaged during the surgery. People who wear contact
lenses may find that they are difficult to put in after the surgery.
Excess removal of fatty tissue can result in a hollow 'dead eye' appearance, which
does not look nice. Excision of too much skin can lead to an 'open eye'
appearance. This can be difficult to correct. Very very rarely loss of vision can
occur.
General Advice
Following eyelid surgery it is important to avoid any activities that involve bending
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stooping or straining. It is also important to avoid situations where foreign material
may get into the eyes.
Eyebrow Lift
What is it?
As the face ages, one of the sometimes noticeable problems is drooping of the
eyebrows. This may make excess upper eyelid skin even more noticeable. It is
important when being assessed for 'baggy eyelids' that the position of the eyebrows
is also noted. Occasionally it may be necessary to perform an eyebrow lift prior to,
or at the same time, as performing surgery to the eyelids.
The Operation
The operation of eyebrow lift can be performed either using open surgical techniques
or using endoscopic/telescopic surgery. The idea is to perform the surgery in the
hairline on the forehead where the scars are not seen. The surgery lifts the forehead
area up level just above the bone and allows repositioning of the eyebrows to a more
superior position. At the same time as repositioning the eyebrows, one of the
muscles which causes wrinkling to appear, between the eyebrows, can be removed
to decrease noticeable wrinkling in this area. The surgery, when it is performed
using an endoscopic technique produces small scars. If it is necessary to perform
the surgery by other methods there can be a significant scar behind the hairline
extending across the scalp. The operation can be performed under general
anaesthesia or under local anaesthesia with injections in and around the forehead
area.
Any Alternatives
There are no real alternatives to an eyebrow lift. Wrinkling of the forehead itself
may be improved by the use of Botox injections but this does not promote elevation
of the eyebrows and may cause further drooping of the eyebrows.

It would be important for your surgeon to assess your general medical condition
prior to surgery. It may be necessary to take advice from other doctors depending
on your weight, blood pressure and general overall health. The surgical procedure of
eyebrow lift is often undertaken with other techniques in order to rejuvenate the face
and may be part of a whole face lift/eye lift/nose reshaping procedure. The exact
type of surgery that would need to be performed would bee discussed with your
surgeon prior to the operation. I would be important not to be a smoker as this can
decrease the blood supply to the skin and cause problems with wound healing. It
would also be important to let your doctor know your medication and to avoid any
tablets that contain Aspirin or Aspirin-like derivatives.
After in Hospital
Following the surgery the extent of the bandaging will depend on how the surgery
has been performed and if it has been performed in conjunction with any other
procedures to make your face look younger.
If it has been performed using endoscopic techniques there will be small scars above
the hairline. There may also be small scars in the forehead area. You may have
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bandages pressed firmly over your forehead which can decrease the amount of
bleeding underneath the skin in the post-operative period.
If the surgery has been performed using a bigger scar, there is likely to be firm
bandaging over your scalp and forehead area. It is also likely that you will have
bruising and swelling particularly to your upper eyelid area and that there may be
altered sensation and decreased feeling over the forehead and scalp areas. This
unusual feeling is likely to improve as time progresses. Occasionally it may be
necessary to have drains underneath the scalp. The nurse will check you blood
pressure, pulse and temperature on a regular basis. It is also likely that you will be
asked to keep upright, avoid coughing, stooping and straining.
After at Home
The unusual sensation over the forehead and scalp area can persist for many weeks
following surgery and may feel numb and occasionally itchy. It is important to
remember to avoid any heavy lifting or straining activities. You should not smoke,
take alcohol or Aspirin for at least two weeks following surgery. Continuing to sleep
in a semi-upright position or with your head propped up with a number of pillows
helps to minimise swelling. On the third or fourth day following surgery, the hair can
be washed. Stitches are generally removed between four and seven days following
surgery depending on the type of sutures that have been used. Your surgeon may
use dissolving sutures and these do not require removal and often come out with
normal hair washing.
Complications
As with any surgical procedure, bleeding can occur. Drains may have been placed
underneath the skin following the surgery and these are usually sufficient to remove
any excess blood. It is most unusual to need to return to theatre having had a brow
lift performed. However as the face has a very good blood supply, bleeding can
occasionally occur.
The nerves which give sensation to the forehead and anterior scalp area, are very
close to the eyebrows. These occasionally can be bruised during surgery and you
may notice a decrease in sensation over the forehead and anterior scalp following
the surgery. However, the nerve damage occasionally can be permanent and in
those situations there can be an uncomfortable feeling on that area of the scalp
where there is no sensation. When performing a forehead lift occasionally the
hairline may be moved in a superior direction, depending on the amount of the
excess skin laxity. This then can result in a high forehead. Alteration in the hair
style making the hair fall forwards rather than backwards will help to disguise this.
If it is important that the hairline be kept at its originally position, it may be
necessary to put a scar immediately in front of the hair and perform the forehead lift
through this type of scar. However, this can leave a noticeable scar and most people
would prefer to have the scar hidden in the hair rather than in front of the hairline.
Undermining the hair bearing area of the scalp to perform the forehead lift can
occasionally interfere with the hair follicles and sometimes hair loss can occur. The
blood supply to the scalp and forehead area is very good but very occasionally if
infection happens, skin loss can occur and this can result in noticeable scarring.
It is important when doing the surgery to avoid lifting the eyebrows too far superior
as this can result in a startled expression. The height of the eyebrows would be
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discussed with the patient prior to surgery. It is likely that some muscle from
underneath the skin will have been removed at the time of surgery in order to try
and decrease some wrinkling of the forehead area following the operation. This may
result in some irregularities but these usually settle with time.
General Advice
The forehead lift may be part of a full attempt at rejuvenating the face. It is
important that the exact results and expectations should be discussed with your
surgeon prior to undergoing the operation. It is likely that a brow lift would last for
many years but as with other procedures to improve facial looks, recurrence of the
original problem can ensue.
Femoral Embolectomy
What is it?
The main artery running down your bad leg is blocked near the knee. The leg is
starved of blood. This causes pain, infection and even loss of the limb. The blockage
in the artery is because of a blood clot. This has formed in the artery, or has floated
down in the bloodstream from your heart or another blood vessel upstream. The
loose type of blood clot is called an embolus. Either way, it is essential to try and get
the blood clot out. Taking out the clot is called an embolectomy. If the clot came
from upstream, and the leg is healthy, the operation usually works very well. If not,
the artery may well clot up again, and the leg is at risk of getting worse. You may
need special tests and possibly bigger operations. As a first step, the embolectomy is
absolutely necessary to save your leg.
The Operation
You may have a general anesthetic and be asleep for the whole operation, or have
an injection in your back, (epidural) or groin and be heavily sedated. Either way you
will not remember anything about the operation. A cut is made into the skin in the
groin and thigh. Sometimes a cut is made on each side to catch any clot slipping into
the artery of the other leg. The artery is opened. Then a special plastic balloon is slid
down the artery. The clot is then pulled out through the opening in the artery. The
opening in the artery is stitched up. The surgeon checks the blood is flowing down
the artery once more. Finally the skin is stitched up. If the operation is not done
soon after the blocking (occlusion) of the artery it might be that the surgeon will
have to make a couple of cuts on the skin and the underling fat and supportive tissue
(fascia) on each side of your leg below the knee. The cuts are called fasciotomies.
This is done because the leg gets very swollen when the blood flows through it again
(perfusion) after a long time of non-perfusion. The swelling can compress the tissues
of the leg to the point that it will destroy them. The fasciotomies release the
pressure and allow the leg to recover. In most cases, the fasciotomies heal on their
own relatively quickly and the areas of the cuts are covered again with skin. You
should plan to leave the hospital about five to seven days after the operation
provided the leg is healthy. If you have fasciotomies you might need to stay longer.
Any Alternatives
If you do nothing, the problems you are having with your limb will surely get worse
and you will most certainly to lose your leg. Drugs and antibiotics by themselves will
not work. Another option is for the radiologists to pass a fine tube through the skin
into your bloked (occluded) artery and introduce a solution of blood thinners into the
artery to dissolve the clot. This might work for some selective cases but not
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everyone. Injections into the nerve in your back which controls the arteries will not
help. The doctors are aiming to save your leg by doing the planned operation.
Sometimes, if the leg is beyond recall, it is better to go ahead with an amputation
(removal of the part of the leg that doesn’t have proper blood supply). Sometimes a
more complex operation is needed to deal with a narrow artery.

You will have come to the hospital as an emergency. Check that you have a relative
or friend who can come with you to the hospital, take you home, and look after you
for the first week after the operation. Sort out any tablets, medicines, inhalers that
hospital with you.
as possible. Please tell the doctors and nurses of any allergies to tablets, medicines
an operation consent form.
After - In Hospital
You may have a fine, thin plastic drip tube in an arm vein connected to a plastic bag
wounds and possibly fine plastic drainage tubes in the nearby skin connected to
plastic containers. These drain any residual blood or other fluid from the area of the
operation. You may be given oxygen from a face mask for a few hours if you have
had chest problems in the past. The wound is a bit painful and you will be given
injections and later tablets to control this. Ask for more if the pain is not well
controlled or if it gets worse. A general anesthetic will make you slow, clumsy and
you are able to do things for yourself. Do not make important decisions during this
time.
You will be given blood thinners initially into one of your veins or with an injection
into your skin. These will be replaced gradually with blood thinner tablets that you
can take by mouth (orally). The blood thinners are given to prevent the artery from
getting clotted again.
You will most likely be able to get out of bed with the help of the nurses the day
after the operation despite some discomfort. You will not do the wound any harm,
and the exercise is very helpful for you. The second day after the operation you
should be able to spend an hour or two out of bed. By the end of four days you
should have little pain. It is important that you pass urine and empty your bladder
within 6 to 12 hours of the operation. If you cannot pass urine, let the doctors and
nurses know. They will take steps to correct the problem. Each wound has a dressing
which may show some staining with old blood in the first 24 hours. You can take the
dressings off after 48 hours. There is no need for a dressing after this unless the
wound is painful when rubbed by clothing. There may be stitches or clips in the skin.
The wounds may be held together with just stitches underneath the skin that are
dissolvable and do not need to be removed. Any plastic drainage tube is taken out
after about two days or so.
gravity and fades to a yellow colour after two to three days. This is expected and you
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will fall off. Occasionally minor matchhead sized blebs (blisters) form on the wound
line, but these settle down after discharging a blob of yellow fluid for a day or so.
You can wash as soon as the dressings have been removed but try to keep the
wound area dry until the stitches/clips come out. If there are only stitches under the
skin, try to keep the wound dry for a week after the operation. Soap and warm tap
water are entirely adequate. Salted water is not necessary. You can shower or bath
as often as you want.
If you have fasciotomies, they will be cleaned and redressed regularly and their
healing will be closely monitored. Try to keep them clean and dry while the healing is
in progress. You will be told when it is safe to wash the area of the fasciotomies.
You will be given an appointment to visit the outpatient department for a check-up
about one month after you leave the hospital. The nurses will advise about sick
After - At Home
You are likely to feel very tired and need to rest two or three times a day for two
weeks or more. You will gradually improve so that by the time two months have
passed you should be able to return completely to your usual level of activity. You
can drive as soon as you can make an emergency stop without discomfort in the
wound, i.e. after about three weeks. You can restart sexual relations within two or
three weeks when the wound is comfortable enough. You should be able to return to
a light job after about six weeks and any heavy job within 12 weeks.
the chances for such complications.
blood clot forming on top of your spine which can cause numbness or pins and
needles in your legs. The clot usually dissolves on its own and this solves the
problem. Extremely rarely, the injections can cause permanent damage to your
spine.
It is important to know that the chances of dying during or after a femoral

embolectomy can be up to 25% especially if you are elderly and you have a serious
cardiac disease.
that all is not well, please let the doctors and nurses know.
Sometimes there is some bleeding under the wounds which causes more severe
bruising. This usually settles down. It is possible to have more bleeding in the area of
the operation and this may require another operation to stop it. The fact that you are
going to be given blood thinners increases the chances of bleeding after the
operation.
Sometimes the blood in the artery clots. This usually needs a second operation to
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clear the blockage. The next steps to deal with this will be discussed with you.
two. Sometimes fluid builds up under the wounds. This settles down.
Overall there is a 2% chance that something will go wrong when the balloon is
passed into your artery to remove the clot:
• the balloon can go the wrong way and get into the wall of the artery
• an aneurysm (weak area of the wall of the artery that gradually gets bigger like a
balloon and might burst) can be created
• a communication between the artery and a nearby vein can be accidentally
created.
It might be possible to fix these conditions with an operation but it might also be
that they will result in you losing your leg.
As we said, if you have fasciotomies they will most likely heal on their own. There is
however a chance that the fasciotomies will need one or more further minor
operations to clean any unhealthy or necrotic (dying) tissue. If the fasciotomies don’t
heal satisfactorily you may need another operation to cover them with skin grafts
that are taken from another part of your body.
months.
This operation is generally quite successful if performed within six hours of the artery
becoming blocked (occluded). After this six-hour period, the chance of success are
reduced as time goes by.
General Advice
As with all operations involving the blood vessels this operation should not be
underestimated. Your recovery depends on the state of the other arteries in the legs,
but is usually relatively quick and good. You should never smoke after the operation.
Femoral Shaft Fracture - Internal Fixation
What is it?
Your thigh bone (femur....fee-mer) is broken. Fractured means broken. There is no
difference in severity between a fractured bone and a broken bone.
The Operation
is made in your buttock over the top end of the thigh bone. A steel rod (often called
a nail) is then passed down the inside of your thigh bone. It goes across the break
and holds your bone in the correct position. The surgeon may pass some screws
across the rod for added stability. The wound is then closed with stitches or clips.
There will probably be a fine plastic drainage tube coming out from the wound to
drain any residual blood from the operation. You will be in hospital four or five days
after the operation.
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Any Alternatives
If you leave things as they are with your leg in a traction splint, the thigh bone would
eventually heal. It might take three months of rest in bed to do so. There may be
shortening of the bone and the pieces may heal out of line. A plate of metal on the
outside of the bone is not strong enough. Some fractures, such as those at the lower
end of the thigh bone, are not suitable for nailing.

Arrangements will be made for you to have the operation within 24 hours or so of
the injury. You will have all the necessary tests to make sure that you are well
prepared and that you can have the operation as safely as possible.
After - In Hospital
Your leg will no longer be in a traction splint. The wound may be painful. You will be
given injections and later tablets to control this. Ask for more if the pain is getting
worse. . A general anesthetic will make you slow, clumsy and forgetful for about 24
things for yourself. Do not make important decisions during this time. The discomfort
of the operation can make it difficult to pass urine and empty the bladder. It is
important that your bladder does not seize up completely. If you cannot get the
urine flowing properly after six hours, contact the nurses or your doctor. The wound
will have a simple adhesive dressing on it. The nurses will usually remove the wound
drain one or two days after your operation. This doesn’t hurt. Your stitches or clips
will be taken out when you come to the outpatient clinic 10 to 12 days after the
operation. You will be asked to start getting out of bed the day after the operation.
As long as the fracture is firmly held by the nail, you should be able to walk, you will
need crutches for six weeks or so. You will be shown how to keep your ankle, knee
and hip joints mobile. Wash around the dressing for the first 10 days. You can wash
the wound area as soon as the dressing has been removed. Soap and warm tap
water are entirely adequate. Salted water is not necessary. You can shower or take a
bath as often as you like once the stitches are out. You will be given an appointment
to visit the orthopaedic outpatient department to have check-up X-rays. The nurses
After - At Home
You must not drive for six weeks after you leave hospital. You will not be able to
perform an emergency stop as quickly as normal before then. How soon you can
return to work depends on your job. If you sit whilst at work, you will be able to
return to work two or three weeks after your operation. This also depends on you
being able to get to work. If your job is manual you will be unable to work for at
least three months. You may swim gently as soon as the stitches have been taken
out. You may play light sports 12 weeks after your operation. You may not play
contact sports until you have been told that the break has soundly healed. When you
start playing, you will not be able to play for as long as normal. Your leg will ache at
the end of a game. Your leg will continue to improve for up to 12 months. The cross
screws may need to be removed after a few weeks. This is a minor procedure. This is
done as a day-case. If you are less than 40 years old, it is recommended that the
metal rod is removed. This will be at least 18 months following its insertion.
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You can develop a blood clot in one of your calf or thigh veins (deep vein thrombosis
-DVT). This can be very dangerous because it can travel to your lungs which can be
potentially lethal. You will be given medication (injection of blood thinners), as well
as compression stockings and foot pumps to protect you and minimise the risk of
DVT.
Rarely, you might have nerve or blood vessel damage after this operation and you
There is always a risk of delayed healing or even non-healing. The X-rays will show
these up and you will have further treatment to allow proper healing.
General Advice
The operation is a neither very simple nor very complicated but somewhere in
between. . You should end up much better off than if you did not have an operation.
Femoro-Femoral Bypass
What is it?
The main artery which carries blood to your bad leg is blocked near your tummy
button. The leg is starved of blood. This causes pain, infection and even loss of the
limb. The artery carrying blood to your other leg is not blocked. Some of the blood
from the good side can be led across to the bad side (bypass the problem) using a
new piece of artificial artery (vascular graft). The blood will then run down the leg
arteries below the blocked part. The pain and infection then get better. Your good leg
can easily spare some blood to go to the bad side.
The Operation
operation. Sometimes you may be numbed from the waist down with an injection in
your back or groin. A cut is made into the skin in the groin and thigh on each side.
The left and right arteries are found below any blockages. A new artificial artery of a
special plastic material is stitched in place to join the two arteries under the skin.
The cuts are then stitched up. If all goes well, you should plan to leave the hospital
about five to seven days after the operation.
Any Alternatives
Drugs and antibiotics by themselves will not work. Injections into the nerve in your
back which control the arteries will not help. Unblocking the artery with an X-ray
guided balloon or a laser will not work for you. An alternative to re-routing blood
from the other limb is a major operation on your tummy arteries or a medium
operation to channel blood from an artery just below your collar bone. For you they
are not as beneficial as getting a If you do nothing, the problems you are having with
your limb will surely get worse. blood supply from your other groin. The doctors are
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aiming to save your leg by doing the planned graft. Sometimes it is better and safer
to go ahead with an amputation than a graft.

and that you can have the operation as safely as possible. Please tell the doctors and
nurses of any allergies to tablets, medicines or dressings. You will have the operation
explained to you and will be asked to fill in an operation consent form. Many
few weeks or so before the operation for these checks.
After - In Hospital
the area of the operation. You may be give oxygen from a face mask for a few hours
if you have had chest problems in the past. The wounds are a bit painful and you will
be given injections and later tablets to control this. Ask for more if the pain is not
well controlled or if it gets worse. A general anesthetic will make you slow, clumsy
and forgetful for about 24 hours. The nurses will help you with everything you need
until you are able to do things for yourself. Do not make important decisions during
this time. You will most likely be able to get out of bed with the help of the nurses
the day after the operation despite some discomfort. You will not do the wound any
harm, and the exercise is very helpful for you. The second day after operation you
should be able to spend an hour or two out of bed. By the end of 4 days you should
have little pain. It is important that you pass urine and empty your bladder within 6
to 12 hours of the operation. If you cannot pass urine, let the doctors or nurses
know. Each wound has a dressing which may show some staining with old blood in
the first 24 hours. You can take the dressings off after 48 hours. There is no need for
a dressing after this unless the wound is painful when rubbed by clothing. There may
be stitches or clips in the skin. The wounds may be held together underneath the
skin with stitches that eventually dissolve and they don’t need to be removed. Any
plastic drainage tube is taken out after two days or so.
will fall off. Occasionally minor matchhead sized blebs (blisters) form on the wound
line, but these settle down after discharging a blob of yellow fluid for a day or so.
You can wash as soon as the dressing has been removed. Try to keep the wounds
dry until the stitches/clips come out which is usually 10 to 14 days after the
operation. If there only stitches under the skin, try to keep the wounds dry for a
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you leave the hospital. The nurses will advise about sick notes, certificates etc.
After - At Home
You are likely to feel very tired and need to rest two or three times a day for two
passed you should be able to return completely to your usual level of activity. You
can drive as soon as you can make an emergency stop without discomfort in the
wound, i.e. after about three weeks. You can restart sexual relations within two or
three weeks when the wound is comfortable enough. You should be able to return to
a light job after about six weeks and any heavy job within 12 weeks.
the chances for such complications.
spine.
that all is not well, please let the doctors and nurses know. Sometimes there is some
bleeding under the wounds which causes more severe bruising. This usually settles
down. However, there is a small chance of severe bleeding in the area of the
operation that might require another operation to stop it.
Sometimes the blood in the new artificial artery clots. This usually needs a second
operation to clear the blockage. Sometimes the arteries further down the leg cannot
take the extra flow of blood. The next steps to deal with this will be discussed with
you. The worst case scenario is that the a satisfactory blood supply to the leg cannot
be restored in which case you may need an amputation (removal of the diseased
part of the leg).
two. It is much more serious if the infection spreads into your bloodstream or if the
new artificial artery gets infected. If this is the case you will need antibiotics for
much longer and it may be that the new artificial artery has to be removed to allow
the infection to clear. Sometimes fluid builds up under the wounds. This settles down
with time.
There is a very small chance that you will experience steal syndrome in your “good”,
healthy. This is a feeling of pins and needles, numbness, coldness or even pain. This
happens because the new artificial artery “steals” or diverts more blood than your
healthy leg can afford to give to the diseased leg(s). The upper limb needs this blood
to maintain its circulation and function.
The problems that you experience in your healthy leg usually get better but there is
a chance that the artificial artery has to be removed to save the healthy leg and
prevent further problems.
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months.
The overall results of this operation are very good. Close to 75% of the new artificial
arteries of the femoro-femoral bypasses remain open five years after the operation
and patients experience a good quality of life.
General Advice
The operation is routine in many hospitals but as with all operations involving the
blood vessels it should not be underestimated. Your recovery depends on the state of
the other arteries in the legs, but is usually relatively quick and good. You should
never smoke after the operation because this causes the new artery to close up.
Femoro-Popliteal Bypass
What is it?
The main artery which carries blood down your leg is blocked just above the knee.
The calf, foot and toes are starved of blood. This causes pain and can lead to serious
infection and loss of the limb. The blocked part of the artery can be bypassed so that
blood flows properly again.
The Operation
You will have a general anesthetic, and will be asleep for the whole operation. One or
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two cuts are made in the skin down the inside of the thigh so that the artery above
and below the block can be seen. A bypass tube (vascular graft), made of vein (a
superficial vein that lies under the skin which is taken if possible from one of your
legs at the same time as the bypass operation) or a special plastic, is stitched into
the artery above and below the block. The blood then flows down the bypass towards
the toes. The skin wound(s) are then closed up. Usually after a week or so you will
feel fit enough to leave hospital provided there is someone to look after you and the
wounds are healing well.
Any Alternatives
If you do nothing your lower limb problems will surely get worse. An injection into
the nerve in your back that controls the artery will not help. The blocked artery is not
suitable for coring out using lasers or X-ray controlled balloons. Antibiotics and other
drugs will not help by themselves. An amputation is not something to have done
instead of the bypass operation. However, dead tissue may need to be trimmed
away after a bypass operation.

packets. Bring them to the hospital with you.
checks.
After - In Hospital
problems in the past. You will have a fine, thin plastic tube in an arm vein to give
you a transfusion of blood or salt solution. There may be some discomfort on moving
rather than severe pain. You will be given injections or tablets to control this as
required. Ask for more if the pain is not well controlled or if it gets worse. A general
anesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses
will help you with everything you need until you are able to do things for yourself. Do
not make important decisions during this time. You will most likely be able to get out
of bed with the help of the nurses the day after the operation despite some
you. The third day after the operation you should be able to spend most of your time
out of bed and in reasonable comfort. You should be able to walk slowly along the
corridor. By the end of one week the wound should be virtually pain-free. It is
important that you pass urine and empty your bladder within 6 to 12 hours after the
operation. If you cannot pass urine let the doctors and nurses know and steps will be
taken to correct the problem.
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be stitches or clips in the skin. The wound(s) may be held together underneath the
skin with stitches that are dissolvable and don’t need to be removed. There may be
some purple bruising around the wound which spreads downward by gravity and
fades to a yellow colour after two to three days. This is expected and you should not
worry about it. There may be some swelling of the surrounding skin which also
improves after two to three days. After 7 to 10 days, slight crusts on the wound will
fall off. Occasionally minor matchhead sized blebs (blisters) form on the wound line.
These settle down after discharging a blob of yellow fluid for a day or so. You can
wash as soon as the dressing has been removed. Try to keep the wound(s) area dry
until the stitches/clips come out which is usually 10 to 14 days after the operation. If
you just have stitches inside the wound(s), try to keep the wound(s) dry for a week.
Soap and tap water are entirely adequate. Salted water is not necessary. You will be
given an appointment to visit the outpatient department for a check-up about one
etc.
After - At Home
You will feel tired and need to rest two or three times a day for two weeks or more.
The wound is likely to be quite uncomfortable for a month or so. You should get back
to your normal activities within two months. If you have had infections, ulcers or loss
of skin, these parts may take two months or more to heal up. Sometimes further
operations are needed to trim them up. At first discomfort in the wound will prevent
you from harming yourself by lifting things that are too heavy. After one month you
can lift as much as you used to lift before the operation. There is no value in
attempting to speed the recovery of the wound by special exercises before the
month is out. You can drive as soon as you can make an emergency stop without
discomfort in the wound, i.e. after about 10 days. You can restart sexual relations
within a week or two, when the wound is comfortable enough. You should be able to
return to work within two months or so.
As with any operation that is done under general anesthetic, there is a risk of
and will reduce the chances for such complications.
that all is not well, please let the doctors and nurses know. Sometimes there is some
bleeding under the wounds which causes more severe bruising. This settles down.
However, there is a small chance of severe bleeding in the area of the operation that
might require another operation to stop it.
Sometimes the blood in the bypass tube clots. This usually needs a second operation
to clear the blockage. Sometimes the arteries further down on one or both legs
cannot take the extra flow of blood. The next steps to deal with this will be discussed
with you. The worst case scenario is where it has not been possible to restore
satisfactory blood supply to the leg in which case you may need an amputation
(removal of the diseased part of the leg).
143
two. It is much more serious if the infection spreads into your bloodstream or if you
have a plastic bypass tube that gets infected. If this is the case you will need
antibiotics for much longer and it may be that the plastic bypass tube has to be
removed to allow the infection to clear. Sometimes fluid builds up under the wounds.
This usually settles down after a while.
The wound sometimes gapes and is slow to heal. This gradually settles down.
months. The leg may be swollen for one to two months. This gradually gets better.
Late clotting of the graft can occur. You will be given treatment to prevent it and
advice to avoid long car and plane journeys without hourly exercise.
The overall results of this operation are very good. If the bypass tube is a vein. it
stays open in 75% of cases five years after the operation. If the bypass tube is made
of plastic it stays open in 55% of cases five years after the operation and patients
enjoy a good quality of life.
General Advice
The operation is routine in many hospitals. However, as with all operations in blood
vessels it should not be underestimated. You must not smoke, because vascular
graft failure is almost certain if you do. These notes should help you through your
doctors or nurses.
Fracture of Thigh Bone - Femur (in a child)
What is it?
Your child's thigh bone (femur) is broken. This is the long bone running from the hip
to the knee. Fractured means exactly the same as broken. There is no difference
between a fractured bone and a broken bone. Children's femur fractures heal up very
quickly, but may lead to shortening if the bone ends override. The bone ends may
heal at the wrong angle. The bone ends can usually be kept in line while they heal by
pulling on the leg (traction). Traction is made up of strings that run from your child's
leg, via pulleys, to weights at the end of the bed. X-rays are taken to check the
position of the bone ends and to show healing. The weights are changed as needed
to keep the bones properly lined up. In young children, sticky tape is used on the
skin to fix the traction to the leg (skin traction). Often the strings are led upwards for
traction.
In older children (10 to 14 years) skin traction cannot usually be used. Instead we
use skeletal traction. Your child would be given a general anesthetic and have a
metal pin passed through the leg below the knee. The traction strings are attached
to this pin. Your child is kept in traction until the bone begins to feel solid and there
are signs of healing on the X-ray. Occasionally the broken bone can be fixed by
passing two flexible metal rods up inside the bone. This is called intra-meddlary
nailing. The rods are usually removed once the bone has healed.
Children generally take one week for each year of their age to heal their breaks, up
to a maximum of 12 weeks. For example, a five year old child will be in hospital for
at least five weeks.
144
The Operation
Your child will have a general anesthetic, and will be completely asleep. A nick is
made in the skin on each side of the bone below the knee. A special steel pin is
pushed through the bone and is fitted to the traction strings. Then your child is
woken up. The operation takes about 20 minutes. There are no stitches in the skin.

A temporary skin traction and a splint are put on your child's leg. These will keep it
still whilst your child is waiting to have his or her operation. If you are staying in with
your child, you will be shown where you will sleep. Your child must have nothing to
eat or drink for about six hours before the operation. This means not even a sip of
water. Your child's stomach needs to be empty so that the anesthetic can be
administered safely. On the ward, your child will be checked for past illnesses and
may have special tests to make sure he or she is well prepared and can have the
operation as safely as possible.
After - In Hospital
Your child's leg should not hurt much after it has been put in traction. If it does, he
or she will be given medicine or tablets to ease the pain. Your child will be able to
drink again two to three hours after the operation provided he or she is not feeling
sick. Your child should be able to eat normally the next day. Children do not
generally need a lot of physiotherapy whilst in bed. Your child will need help getting
back on his or her feet. Your child will regain hip, knee and ankle movement on his
or her own. It may take two or three months for your child to regain full movement
of the leg. Your child will be in hospital for at least one week for every year of his or
her age (aged five years = five weeks). Your child will be given an appointment to
visit to the orthopaedic outpatient department after leaving the hospital. An X-ray
will be taken to check that the break is healing satisfactorily. If your child is of school
age, he or she will be given lessons by teachers on the ward. The traction pin in a
teenager is taken out on the ward. However, children are usually given a brief
general anesthetic in the operating theatre for this.
After - At Home
Your child will not be able to do sports until advised by the doctors. Your child may
swim as soon as he or she is out of bed. Your child's leg will continue to improve for
up to six months.
There is a small risk for minor infection in the area where the pins enter the skin but
this can be treated quickly with antibiotics. There is a much smaller risk (less than
1%) of infection deeper in the leg and on the bone especially close to the area of the
fracture. This will require antibiotics for a longer period. There is also a very small
chance that one of the blood vessels or the nerves of the leg can be damaged during
the operation and this might require another operation to fix the problem.
The bone may not heal in a perfect position. It may be a little bent at first. If bent,
the bone will become straighter as it grows. The younger the child, the more the
145
bone will straighten. This is known as remodelling. The growth of the thigh bone may
be upset. Surprisingly, the injured leg may end up a little longer than the other leg.
This is because fracturing the bone increases its blood supply. This in turn increases
the bone's growth.
If the healing of the fractured area is not as strong as expected (and this happens
rarely), your child will be more prone to have further fractures in the same bone in
the future.
Also rarely, the blood supply to a certain area of the bone can be affected because of
the fracture and the operating procedure and this can result in necrosis (death) of
the bone. If this happens, it is a serious complication and your surgeon will offer you
further advice.
General Advice
These notes should help your child through his or her recovery. They are a general
Fracture of Upper Arm - Humerus
What is it?
The bone between your child's shoulder and elbow is called the humerus. Your child's
humerus is broken just above the elbow. Fractured means the same as broken.
There is no difference in severity between fractured and broken bones. This fracture
is very common in children. The fractured pieces of the humerus in your child's
elbow are out of place. The break will heal without an operation, but the bone ends
will be out of line. The bone will grow crookedly and elbow movement will be poor.
The Operation
Your child will have a general anesthetic, and will be asleep for the whole operation.
One of the three operations described below will be performed. The decision depends
on what the surgeon finds when he examines the arm when your child is asleep. He
will be able to see the position of your child's humerus fracture with a special X-ray
machine in the operating theatre.
1. Manipulation under anesthetic (MUA). The surgeon will try to push the bone ends
back into a reasonable position (manipulation). He will try to keep the bones in their
correct position with a plaster cast.
2. Manipulation under anesthetic (MUA) and K-wiring. Sometimes the bones are
wobbly after manipulation. Without something being done, they would move out of
position. The surgeon puts one or two pins (K-wires) through the skin into the bones
to hold them in the correct position. He will remove the pins after about three weeks.
3. Open reduction and K-wiring. Occasionally one or two cuts have to be made into
the elbow in order to move the bones into their correct position. The cuts are made
on the inside and the outside of the elbow. Pins are then put into the bone to hold
the fragments in place. The pins are left protruding through the skin. The pins will be
removed after three weeks or so. The skin wound is then closed up with stitches.
Your child will be in hospital for one or two nights after the operation. A check X-ray
will be taken before your child goes home.
Any Alternatives
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Sometimes the lower end of the humerus is fractured, but the pieces are still nicely
in line. In this case an operation is not needed. If the bones are out of place, there is
no satisfactory alternative treatment.

Bring all your child's tablets and medicines with you to the hospital. On the ward,
your child may be checked for past illnesses and may have special tests to make
sure that he or she is well prepared and can have the operation as safely as possible.
You will be asked to fill in an operation consent form for your child.
After - In Hospital
There will be a sling on your child's arm called a collar and cuff. The arm will
probably be in a plaster cast. Your child's elbow should not hurt much after it has
been fixed. If it does, he or she will be given medicine or tablets to ease the pain. A
general anesthetic will make your child slow, clumsy and forgetful for about 24
hours. The nurses will support in helping your child until he or she feels better. If
there are stitches in the skin, they will probably be the type that dissolve by
themselves. If the stitches are the type that do not dissolve, they will be removed in
the outpatient department. Having stitches taken out does not hurt. The plaster cast
must not get wet. For the first three weeks, the collar and cuff must not be removed.
After the plaster cast and dressings have been removed you may wash the arm.
Soap and warm tap water are entirely adequate. Salted water is not necessary. Your
child will be given an appointment to visit the orthopaedic outpatient department
about a week after leaving hospital. An X-ray will be taken to check that the break is
healing. Your child will be seen again about three weeks after the operation to have
the plaster removed. If he or she has pins or non-dissolving stitches they will be
removed.
After - At Home
How soon your child can return to school depends on your child's age and the injury.
He or she will probably be off school for a minimum of two weeks, and will not be
able to do sports until there is good elbow movement after about six weeks. If pins
are inserted, they are left protruding through the skin. The pins will be removed after
about three weeks. A very young child will be admitted as a day case to have the
pins removed. In older children, the pins are removed in the clinic. They are simply
pulled out using stout pliers. This does not hurt. Your child's elbow will continue to
improve for up to six months.
There is a small risk for minor infection in the area where the pins enter the skin but
this can be treated quickly with antibiotics. There is a much smaller risk (less than
1%) of infection deeper in the arm and on the bone especially close to the area of
the fracture. This will require antibiotics for a longer period. There is also a very
small chance that one of the blood vessels or the nerves of the arm can be damaged
during the operation and this might require another operation to fix the problem.
The following complications are rare. The blood supply to the arm may be damaged
at the time of the fracture. This happens in no more than 5% of cases and can
147
damage the forearm muscles. The bones may move out of their good position and a
second manipulation may be required. The growth of the elbow may be disturbed.
If the healing of the fractured area is not as strong as expected (and this happens
rarely), your child will be more prone to have further fractures in the same bone in
the future.
Also rarely, the blood supply to a certain area of the bone can be affected because of
the fracture and the operating procedure and this can result in necrosis (death) of
the bone. If this happens, it is a serious complication and your surgeon will offer you
further advice.
General Advice
The operation is neither too simple not too complicated but somewhere in between.
It is best that your child has the operation. We hope these notes will help you
through you and your child through the operation. They are a general guide. They do
Full Face Lift
What is it?
A full face-lift, or Rhytidectomy, is an operation to improve the loose skin of the
neck, the jaw line, the deeper wrinkle lines, and the corners of the mouth. It may be
combined with other procedures to improve the fine wrinkles on the face and also
with blepharoplasty (baggy eyelids). These options should be discussed with the
surgeon at the initial consultation.
The Operation
There are a number of different techniques used to tighten the skin on the face. The
surgery is usually performed under general anaesthesia and may be aided by using
endoscopic surgical techniques.
Any Alternatives
Some improvement in the fine wrinkles of the face can be achieved temporarily by
skin hydration. Deep furrows and wrinkles may be helped by the use of Botox
injections, which paralyses the underlying muscles and prevents wrinkling of the
skin. However, the excess saggy skin will still be noticeable.

It is most important to give up smoking. This can have a serious effect on the blood
supply to the skin and cause areas of skin on the face to become black and scarred
following surgery. It is also useful to be at one's chosen weight or even somewhat
underweight, as weight loss subsequent to the surgery can allow further wrinkling to
occur. One should avoid taking Aspirin or Aspirin containing pain medication as this
can increase bleeding following surgery and cause blood clot formation underneath
the skin, and interfere with wound and skin healing. The operation itself takes
between two and three hours to perform and your surgeon would assess if you are fit
to undergo such a procedure.
After in Hospital
The surgery is performed through an incision that starts in the temporal hair area,
downwards in front of the ears, curving underneath the ear lobe, and then extends
148
up behind the ear sometimes into the hairline. Depending on the extent of surgery
performed you can be in hospital from one to three days. After you wake up it is
likely that you will have soft padding around your face and you may have drains. It is
also likely that there will be an intravenous drip to provide fluid. The nurses will
check your blood pressure, pulse and temperature on a regular basis and observe
the colour of the skin of your face. It will also be likely that you will be asked to
keep upright, avoid coughing, stooping and straining. If eyelid surgery has been
performed at the same time, your eyes may also be initially covered. Staying semi
upright also helps reduce the swelling and enables better observation by the nurses.
Maximum swelling tends to occur within forty-eight hours. To decrease the swelling
further, cold bandages or packs may occasionally be applied during the day. Pain
killer tablets or injections will be available. The drains and dressings are removed
prior to discharge to hospital and further dressings or scarf may be applied.
After at Home
You may have numbness on your face and neck for several weeks and this can
sometimes last longer. It is important again to avoid any bending or heavy lifting for
two weeks following surgery. You should not smoke, not take alcohol or Aspirin for
at least two weeks following surgery. Continuing to sleep upright at night will help to
decrease swelling of the face. On the third or fourth day following surgery you can
start washing your hair and blow-drying it gently. You should avoid stooping or
straining or bending over as this can cause a rushing of blood to the face, discomfort
and occasionally some minor bleeding. The sutures from around the ear are usually
removed between five and ten days following surgery depending on the extent of
surgery. Bruising may be obvious for two to three weeks following surgery.
Cosmetic make-up may be used but should avoid the suture line itself until it is well
healed some two to three weeks following surgery. Perming and hair colouring can
be used from four to six weeks, depending on the extent of the surgery. As with any
major surgery, you may feel tired for a few days after the operation and this can last
for two to three weeks. Serious physical or gym activity, aerobics are probably best
avoided for up to one month following surgery although one can do gentle exercises
such as swimming once the wounds are soundly healed. You may also notice, over a
period of time, numbness of the face and potentially some numbness of the ear,
particularly on the posterior aspect.
Complications
The blood supply to the face is very good. Because of this, wounds heal very well
but during any surgery bleeding can occur. Your surgeon is very careful to stop
bleeding at the time of surgery and drains are usually left in afterwards. If heavy
bleeding occurs following surgery underneath the skin, it is likely that you will need
to return to the operating theatre in order to have this controlled. Small episodes of
bleeding are likely to occur and this can result in areas of thickening underneath the
skin flaps. This will settle with time, particularly with gentle massage for a few
weeks following surgery. Infection is unusual but can occur and can cause problems
with wound healing. It is also important that surgery should not be performed if
there is evidence of any cold sore or Herpes at the time of surgery. The nerves of
facial expression are underneath the muscle layer of the face and these can very
occasionally be bruised or injured when doing face-lift surgery. This particularly
occurs with the nerve that goes to the side of the mouth and so can result in a
weakness here. It is unusual for this to occur and usually settles over a period of a
few months. Numbness of the ear may also be noted as the nerve that gives
sensation to the ear is quite close to the surface of the skin in the neck region.
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Although the blood supply to the skin is very good, in order to get a good result a
certain amount of tension has to be placed on the skin. This can sometimes interfere
with the circulation of the skin, particularly in smokers, and should the circulation be
badly affected some of the skin can become necrotic and die. This can result in
areas of skin loss and very occasionally skin grafting may be required. When the
surgery involves some of the hair-bearing scalp, hair thinning or hair loss may
occasionally occur. The scars in front of the ear are usually not that noticeable, but
scar spread can occur as time progresses. Occasionally if the wound does not heal
up satisfactorily underneath the earlobe, the earlobe itself may be pulled down and a
scar can become noticeable in this region. It may take two to three months for the
swelling and discomfort on the face to settle down entirely. You may also find it
comfortable to wear a light bandage at night-time to prevent your ears from bending
forward initially.
General Advice
A face-lift may be part of a number of procedures to try and rejuvenate the ageing
face. The type of face-lift procedure will depend on the individual, the excess skin
and the overall facial appearance. Significant weight loss can also precipitate a
problem with excess skin on the face.
Face-lift operations last for from five years upwards depending on the age at which it
is performed. It also depends on whether or not excess weight gain or weight loss
occurs subsequent to the surgery. It can be performed again. Best results are in
non-smokers.
Ganglion Excision - Foot
What is it?
You have a ganglion on your foot. A ganglion is a swelling that is filled with thick jelly
like material. They usually occur on the back of the wrist but they do occur near
other joints or near tendons (like in your case where it is in your foot). They usually
occur in young adults. It is not known why they occur. In children, ganglions usually
disappear without any treatment. This can also happen in adults.
The Operation
You can be given a local or a general anesthetic. The choice depends partly on which
you prefer, and partly on what your surgeon thinks is best. Having a general
anesthetic means that you will be completely asleep during the operation. Having a
local anesthetic means that you will be awake during the operation, but will not feel
any pain in your foot because the area of the operation will be numbed with an
injection. A cut is made in the skin that is at least as wide as the lump. The ganglion
is then removed. The skin wound is then closed up with stitches. By having the
operation on your foot you must realise that:
• You will have a scar instead of the ganglion.
• The ganglion will come back in 1 out of 5 patients.
• If you have pain in your foot, this may not be cured by removing your ganglion.
Any Alternatives
You could do nothing and wait to see if your ganglion disappears. The jelly in a
ganglion can be removed with a needle and syringe. This is called aspiration. This
cures 80% of patients. The ganglion re-fills in 20% of patients. Aspiration of your
ganglion is done in the outpatient department. The skin over your lump is cleaned
150
and numbed with a small local anesthetic injection. The surgeon will suck out as
much of the contents of your ganglion as possible with a large needle and syringe.
This does not hurt. A sticky plaster is put over the needle hole. You should remove
this plaster after six hours. If the hospital has tried curing your ganglion with a
needle and syringe and it has returned twice, probably the best plan is to have an
operation.

After - In Hospital
painkillers to take home. They should easily control this discomfort. After an hour or
two on the ward, you should feel fit enough to go home. Before you go, the hospital
will:
• Check the wound is comfortable.
• Check the wound is not bleeding.
• Check there is no swelling.
• Give you painkilling tablets to take home.
• Give you a follow-up appointment for 10 days' time or so for a check-up and stitch
removal.
• Give you a note to give to your General Practitioner.
• Give you a work certificate, sick note, etc.
• Check you have the ward telephone number.
After - At Home
Make sure a relative or friend can take you home. You should not be by yourself for
the first day after your operation. At home, rest. Your foot will be in a bulky bandage
when you go home. Your bandage will be taken off and your stitches taken out 10 to
12 days after the operation. You will not need a dressing on the wound after that.
Wash around the bandage for the first 10 days. You can wash the wound area as
soon as the dressing has been removed. Soap and warm tap water are entirely
adequate. Salted water is not necessary. You can shower or take a bath as often as
you like once the wound has healed. 24 hours after your operation, your foot should
not hurt much.. If you have severe pain, telephone the ward. If you cannot get
through to the ward, go straight away to the casualty department of the hospital.
You must move your toes regularly. You cannot drive whilst your foot is in the
bandage. How soon you can return to work depends on your job. If you can work
sitting down, you may be able to return to work two or three days after your
operation. This also depends on you being able to get to work. If your job is manual
you will be unable to work for three weeks. You may swim and play most sports once
your stitches are out. When you start playing, you will not be able to play for as long
151
as normal and your foot may ache at the end of a game.
As we mentioned, this operation is mostly carried out under local anesthetic.
If you have the operation under general anesthetic there is a very small risk for
Complications are rare and seldom serious. You can have a minor infection in the
area of the operation which can be settled by taking antibiotics for a few days. You
may also experience some bruising around the wound which will go away quickly.
The ganglion may come back in 1 out of 5 patients. The skin around the scar may be
permanently numb after your operation.
General Advice
The operation is a relatively minor one. You should end up better off after the
operation. We hope these notes will help you through your operation. They are a
Ganglion Excision - Wrist
What is it?
You have a ganglion on your wrist. A ganglion is a swelling that is filled with thick
jelly-like material. They typically occur on the back of the wrist but they can occur
near other joints or near tendons. They usually occur in young adults. It is not
known why they occur. In children, ganglions usually disappear without any
treatment. This can also occur in adults.
The Operation
you prefer, and partly on what your surgeon thinks is best. Having a general
anesthetic means that you will be completely asleep during the operation. Having a
local anesthetic means that you will be awake during the operation, but will not feel
any pain in your wrist. Most surgeons perform this operation under local anesthetic.
A cut is made in the skin that is at least as wide as the lump. The ganglion is then
removed. The skin wound is then closed up with stitches. A bandage is usually put
over the stitches. By having the operation on your wrist you must realise that:
• You will have a scar instead of the ganglion.
• The ganglion will come back in 1 out of 5 patients.
• If you have pain in your wrist, this may not be cured by removing your ganglion.
Any Alternatives
You could do nothing and wait to see if your ganglion disappears. The contents of a
ganglion can be removed with a needle and syringe. This is called aspiration. This
cures 80% of patients. The ganglion re-fills in 20% of patients. Aspiration of your
ganglion is done in the outpatient department. The skin over your lump is cleaned
and numbed with a small local anesthetic injection. The surgeon will suck out as
much of the contents of your ganglion as possible with a large needle and syringe.
This does not hurt. A sticky plaster is put over the needle hole. You should remove
152
this plaster after six hours. If the hospital has tried curing your ganglion with a
needle and syringe and it has returned twice, probably the best plan is to have an
operation.

before the operation for these checks. .
After - In Hospital
painkillers to take home. They should easily control this discomfort.
After - At Home
After an hour or two on the ward, you should feel fit enough to go home. Before you
go, the hospital will:
• Check the wound is comfortable.
• Check the wound is not bleeding.
• Check there is no swelling.
• Give you painkilling tablets to take home.
• Give you a follow-up appointment for ten days time or so for a check-up and stitch
removal.
• Give you a note to give to your General Practitioner.
• Give you a work certificate, sick note, etc.
• Check you have the ward telephone number Make sure a relative or friend can take
you home.
You should not be by yourself for the first day after your operation. At home, rest.
Your hand will be in a bulky bandage when you go home. Your arm will be in a sling
to reduce any swelling. Wear your sling for the first 24 hours after your operation.
Your bandage will be taken off and your stitches taken out about 10 days after the
operation. You will not need a dressing on the wound after that. You may remove the
sling to wash. Wash around the bandage for the first 10 days. You can wash the
wound area as soon as the dressing has been removed. Soap and warm tap water
are entirely adequate. Salted water is not necessary. You can shower or take a bath
as often as you like. Your hand should not hurt much 24 hours after your operation.
If you have severe pain, telephone the ward. If you cannot get through to the ward,
go straight away to the casualty department of the hospital.
You must move your fingers regularly. You cannot drive whilst your hand is in the
bandage. How soon you can return to work depends on your job. If you can work
one handed, you may be able to return to work two or three days after your
operation. This also depends on you being able to get to work. If your job is manual
you will be unable to work for two to three weeks. You may swim and play most
sports once your stitches are out. When you start playing, you will not be able to
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play for as long as normal and your wrist may ache at the end of a game.
As we mentioned, this operation is mostly carried out under local anesthetic.
Complications are rare and seldom serious. You can have a minor infection in the
area of the operation which can be settled by taking antibiotics for a few days. You
can also experience some bruising around the wound which will go away quickly. The
ganglion may come back in 1 out of 5 patients. The skin around the scar may be
permanently numb after your operation.
General Advice
The operation is a relatively minor. You should end up better off after the operation.
Gastroscopy
What is it?
A gastroscope is a bendy telescope about the diameter of a pen and about three feet
long. This passes very easily down the throat and beyond. Strictly speaking a
gastroscopy is just an examination of your stomach. But on the way, you are
examined from the back of your mouth right down the oesophagus, the tube which
runs inside your chest and connects the back of your mouth to your stomach. You
may also be examined beyond your stomach into the upper part of the gut called the
duodenum. Snippets of the lining of the stomach and other parts (biopsies) may be
taken to help find out what is causing your problem.
154
The Operation
First you will have your mouth and the back of your throat sprayed three or four
times to make the lining numb. The spray tastes of orange and is a little sour. Then
you have a fine, thin plastic tube put into a vein in your arm in case a sedative is
needed. You will be turned to lie on your left side. You will be given a plastic tooth
guard to bite on. Then the gastroscope is passed slowly down the back of your
tongue. It tickles and makes fizzing noises. You will be asked to swallow once or
twice to get the tube started on its journey down the back of your throat. You will be
able to breathe normally, but you will find it difficult to talk because of the tube. You
may feel your tummy swelling a little with wind as air is blown down the gastroscope
to get a good view. You may even burp loudly. This is expected. The swelling soon
passes off. Some people get a sickly feeling at one moment during the examination.
This passes quickly. As the gastroscope is taken out at the end of the examination, it
makes a noise in your mouth as it clears any secretions. You can always choose to
have a general anesthetic if you prefer.
Any Alternatives
It is important to know what is going on inside your stomach and the other parts of
your feeding (digestive) system. X-rays and scans are not the answer at this stage.
Doing nothing may mean that something important may be missed.

You will need to stop drinking and eating 12 hours before the examination. This will
make sure your stomach is empty for the examination. Check you have a relative or
friend who can come with you to the hospital and take you home. Bring all your
tablets and medicines with you to the hospital. On the ward, you may be checked for
and that you can have the procedure as safely as possible. . Many hospitals now run
After - In Hospital
You may feel drowsy afterwards. You may in fact not remember the gastroscopy at
all. You should not drink for one hour after the gastroscopy while your throat is
numb. After two hours you can eat and drink normally. You can leave hospital after
an hour or two provided someone goes with you. You may be given an appointment
to visit the outpatient department for the result of the examination. Often your
family doctor will handle the check up. Please ask the nurses about sick notes,
certificates etc.
After - At Home
You may feel tired for a day or so. The sedative will make you slow, clumsy and
machinery, or even boil a kettle during that time.
155
If you have this procedure under general anesthetic, there is a very small risk of
procedure will make sure that you can have the it in the safest possible way and will
bring the risk for such complications very close to zero.
The examination is virtually free from complications. There may be some soreness of
the throat for a day or so. Extremely rarely, especially if biopsies are taken, you can
have some prolonged bleeding from the area of the biopsies or even a hole in your
oesophagus or stomach that will require an operation to fix it.
General Advice
The examination is very quick and easy. We hope these notes will help you through
Grommet Insertion
What is it?
First of all, each ear is made up of three parts. There is the outer ear which you can
see, and which gathers the sound. Further in, the outer ear runs into the middle ear
on each side. Deeper still, there is an inner ear on each side. The sound goes down
the ear tube, which is part of the outer ear, into the middle ear on that side. The ear
drum stretches across the deepest part of the ear tube between the outer ear and
the middle ear. The drum is about a third of an inch (0.8cm) across. It is made of
thin skin, like the top of a real drum. The middle ear is an air space which connects
with the back of your nose. This is why your ear drums pop when you blow your
nose. Fluid has built up in the middle ear, because it cannot drain through to the
back of your nose. To start with, the fluid was thin and watery. Gradually, it has
become thick and sticky, like jelly. It is sometimes called "glue ear". This fluid stops
the ear drum letting the sound through properly. It is the cause of your hearing
difficulties. The fluid behind the ear drum may be also leading to infection in the
middle ear.
156
The Operation
You will have a general anesthetic and will be completely asleep. The surgeon will
shine a very fine microscope down your ear tube. He will make a tiny cut in the ear
drum (myringotomy). A very fine sucker will be placed through the hole in the
eardrum into the middle ear. The sucker will draw the fluid from behind the ear drum
like a miniature vacuum cleaner. He will then plug a tiny hollow plastic tube into the
hole in the ear drum. This tube is called a grommet. It is shaped like a cotton reel
with flanges that hold it in place in the ear drum. The grommet lets air pass from the
ear tube through the ear drum and into the middle ear. Any fluid in the middle ear
will now just dry up. Because you will be asleep, you will not feel any pain during the
operation. Your operation can be done as a day case. The surgeon can do both sides
at the same time if needed.
Any Alternatives
If you leave things as they are, the fluid will probably not drain away. The hearing
difficulties will continue. You may get serious middle ear infection. This can
eventually lead to more and more thickening of the ear drum as well as thickening of
the fluid in the middle ear and can cause an irreversible hearing loss. Tablets,
medicines, nose drops, and inhalers, will no longer help. Hearing aids are only a stop
gap. Drawing the fluid out with a fine needle has not helped. The fluid may have just
built up again. The fluid may be too thick for needling. You do not need to have your
tonsils or adenoids taken out.

After - In Hospital
There is very often no pain in the ear after a grommet operation. The nurses will give
you some medicine to take any discomfort away. With the grommet in place, the
fluid will clear from behind the ear drum within six to eight weeks. Once the fluid has
cleared, you should be able to hear normally. The grommet stays in the ear drum for
about a year. As the fluid problem gets better, the hole in the drum heals, and
squeezes the grommet out into the ear tube. The grommet then usually sticks to wax
157
in the ear tube. The doctor in the outpatient clinic can then easily take it out.
Sometimes the grommet has to be taken out with a small operation, if it does not
come out by itself. A general anesthetic will make you slow, clumsy and forgetful for
to do things for yourself. Do not make important decisions, drive a car, use
machinery, or even boil a kettle during this time. Hospitals usually arrange a check-
up about one month after you leave the hospital. The nurses will advise about sick
After - At Home
(1) Keep the ears dry. (2) Do not allow water to enter the ears when you are taking
a bath or washing your hair. Protect the ear by placing a piece of cotton wool rubbed
in Vaseline in the ear. (3) It is better not to go swimming while the grommet is in
place. The risk is that dirty swimming pool water will pass through the grommet and
cause a middle ear infection. This could make the grommet come out sooner than it
should. It is best to wait until the grommet has come out before swimming again.
You should not risk the need for more ear operations. (If you must go swimming,
plug the ear with cotton wool rubbed in Vaseline, and wear a swimming cap pulled
well down over the ears. Do not jump in, dive, or swim under water.) (4) You must
not have your ear syringed if you have a grommet. It would be very painful and
could cause serious infection in your middle ear. You should be fit to go back to work
the second day after your operation. You should be fit to drive one or two days after
the operation. It is perfectly safe to travel by air. Air can pass freely through the
grommet into the space behind the ear drum, so there will be no problems with
changes in pressure.
The operation is successful in about 70% of patients. The remaining 30% might need
the grommet re-inserted on one or more occasions.
If you follow the advice listed above, the grommet is unlikely to cause you any
problems. Occasionally people notice a popping or clicking in the ears. This is not
harmful and is expected and you should not worry about it.
You may notice some clear but lightly blood-stained fluid coming out of the ear for
the first two days after the operation. This is expected but if it continues for more
than two days and you get a runny ear (especially if the fluid coming out is thick,
yellow and/or green or smelly), it probably means that germs have passed through
the grommet and have caused an ear infection. You should go to your doctor who
will probably give you antibiotics. If the infection is not getting better, he will arrange
for you to be seen in the ENT outpatient clinic. In a few patients, the ear can be a bit
runny without anything serious being wrong. In addition, if you don’t have a runny
ear but you get a headache, a temperature or you become irritable, you should also
be alert and ask for medical advice because these symptoms can be an indication of
a developing infection.
There is a 2 to 3% chance that following the insertion and removal of the grommet
(especially after multiple insertions and removals as can be the case sometimes) the
ear drum will develop a hole that doesn’t heal well. Given time most of these holes
158
heal on their own but for some of them another operation is needed to close them..
General Advice
Grommet Removal
What is it?
The grommet in your ear drum has done its job. There is no more fluid behind the
ear drum in the middle ear. Your ear is now healthy again. Most grommets come out
on their own. Some grommets, like yours, are slow to come out. It needs to be taken
out with a little operation.
The Operation
You have a short general anesthetic and are completely asleep. The surgeon will
shine a very fine microscope into your ear tube. He will pull the grommet out of the
ear drum with a special instrument. Because you are asleep you will not feel any
pain during the operation. Your operation can be done as a day case. This means
that you come into hospital on the day of your operation and go home the same day.
When the grommet is out, there is a small hole left in the ear drum. This will usually
close up on its own. The surgeon will check your ear drum in the outpatient clinic, to
make sure that it has done this.
Any Alternatives
If you leave things as they are, the grommet may stay there for years. It could be
difficult to get out if you delay that long. All the time the grommet is in place, you
must not let water in your ears. You cannot safely go swimming or diving unless the
ears are very well protected with ear plugs and a tight bathing cap. You cannot have
your ears syringed to remove any wax. There is no rush to have the grommet taken
out. You would be better off without it.

few weeks or so before the operation for these checks. If you have a cold in the
week before your admission to the hospital, please telephone the ward and let the
ward sister know. The operation will usually be put off, and you are given time to get
better before being sent for again. You need to get over the cold before the
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After - In Hospital
There is very often no pain in the ear after removing a grommet. If you do have
some earache after the operation, the nurses will give you some medicine to take
the discomfort away. A general anesthetic may make you slow, clumsy and forgetful
for about 24 hours. The nurses will help you with everything you need until you are
able to do things for yourself. Do not make important decisions, drive a car, use
machinery, or even boil a kettle during that time. After three to four hours on the
ward you will be well enough to go home. Usually, the nurses like you to have
something to eat or drink before you leave. They will check that your ear is
comfortable and is not bleeding. Before you leave the ward, you will be given
arrangements for coming back to the ENT (ear, nose, and throat) outpatient clinic in
about six weeks' time. There, the doctors will check your ear drum has healed up.
After - At Home
Make sure you go home by car or taxi, with your relative or friend. You must not
drive yourself home. At home, take two painkilling tablets every six hours to control
any pain in your ear. It is important to keep your ear dry. Any water in your ear may
go through the hole in the ear drum and cause an infection. When taking a bath or a
shower, plug your ear with a piece of cotton wool rubbed in Vaseline. It is safer not
to go swimming until the surgeon has checked that the hole in the ear drum has
completely closed. If you go swimming, make sure that your ears are very well
protected by ear plugs and a tight bathing cap. You will be fit to return to work one
or two days after your operation. You will be fit to drive 1-2 days after your
operation. It is perfectly safe to travel by air. Air can pass freely through the hole in
your ear drum. There will be no problems with changes in pressure.
a very small risk that the ear may bleed when you get home. If this happens, come
back to the ward. There is also a very small possibility of an ear infection. If this
happens, you will notice some fluid coming out of the ear (with a bad infections this
can be thick, green and/or yellow and smelly) and you might have a headache or
temperature. The infection usually settles by taking antibiotics for a week or so.
In a small number of people (2 to 3% of cases), the small hole in the ear drum may
not close up after six weeks. Given more time, most of these close on their own
without any treatment. A few need to be closed with another operation.
The grommet insertion operation is successful for about 70% of patients who have it.
The remaining 30% may need a grommet re-inserted on one or more occasions
because the fluid builds up again at a later date.
General Advice
160
Hemorrhoid Injection
What is it?
Piles (haemorroids) mean different things to different people. In medical terms they
are the loose lining of the lowest part of the bowel. This lining can push out through
the back passage. They are one cause of bleeding, swelling, pain, discharge. More
often than not the doctors make a diagnosis of piles by ruling out all the other things
that can cause bleeding, swelling, etc. The piles are injected to stop the bleeding,
pain and discharge. If not, the cause may be something else. You will then need
different tests and treatment.
The Operation
You will not require any anesthetic. A very simple treatment of the piles is a set of
three injections into the lining tissue. This is uncomfortable for a few minutes but
soon gets better. First the surgeon discusses your symptoms and examines your
tummy. Then you turn onto your left side so that he can examine your bottom end.
He examines the inside of your rectum with a telescope to check that there is
nothing there except piles. This is uncomfortable, but not painful. Then he examines
your piles with a shorter telescope. Through this telescope he make the injections.
The injections consist of a special liquid that triggers the creation of scared tissue in
the area of the piles. This is aimed at stopping the bleeding and the other problems
related to the piles. It causes some spotting of blood for a day or two but then this
passes off. You will need to return to the hospital after about six weeks to check your
symptoms have gone. If you are still having trouble, the doctors may need to check
there is nothing else going on in the bowel and to see if you need more treatment for
the piles.
Any Alternatives
If you leave things as they are, your piles are likely to slowly get worse. Nipping off
161
the piles with special rubber bands is an alternative, but it often needs two or three
visits to the outpatient department for a course of treatment. Cutting off the piles
means a stay in hospital. You do not need this to be done at this stage..
After - At Home
You can go back to work straight away from the outpatient clinic. You will be checked
in six weeks or so to make sure that the injection has worked.
The piles may bleed again or continue to drop down. Because the area of the piles
contains many bugs, the injection can rarely cause an infection and that’s why you
will be given antibiotics to take for four to five days after the injection to prevent this
from happening. Even more rarely the needle used for the injection can accidentally
go through the bowel wall. This can potentially be very dangerous and an operation
will be needed to fix it.
General Advice
These notes will help you through your procedure. They are a general guide. They do
Hemorrhoidectomy
What is it?
Piles (hemorrhoids) are the loose lining of skin that bulges out through the ring
muscle which holds the back passage shut. They contain big blood vessels which can
bleed or clot up and cause pain. The loose skin can produce irritating tags.
Hemorrhoidectomy simply means removal of the hemorrhoids.
The Operation
You will probably have a general and be completely asleep. Sometimes you may be
given an injection in the back to numb the area. The ring muscle is stretched and the
piles are trimmed off. Usually after two or three days, when your bowels have
opened, you will feel fit enough to leave hospital provided there is someone to look
after you. The wound heals up within a week or two.
Any Alternatives
If you do nothing the piles will stay about as troublesome as they are now or get
worse. They will not get better. Instead of cutting off the piles, they can be frozen or
nipped off with rubber bands. Overall the best option is to have the piles cut out.

and may have special tests to make sure that you are ready and that you can have
the operation as safely as possible.. Many hospitals now run special preadmission
clinics, where you visit for an hour or two, a few weeks or so before the operation for
162
these checks.
After - In Hospital
injections or tablets to control this as required. Ask for more if the pain is not
controlled or if it gets worse. The second day after the operation you should be able
to spend most of your time out of bed and in reasonable comfort. You should be able
to walk slowly along the corridor. By the end of the first week the wound should be
virtually pain-free. A general anesthetic will make you slow, clumsy and forgetful for
to do things for yourself. Do not make important decisions during this time.
It is quite normal for the bowels not to open for a day or so after the operation. The
first time you open your bowels it may be a bit painful but this rapidly improves. You
may also see a small amount of blood mixed with your stool for a few days after the
operation. This eventually stops. Once your bowels have opened you can make plans
to go home. The discomfort of the operation can make it difficult to pass urine and
empty the bladder. It is important that your bladder does not seize up completely. If
you cannot get the urine flowing properly after six hours, contact the nurses or your
doctor. The wound may have a dressing held on with elasticated net pants. There
may be some staining with old blood during the first 12 hours. The dressing will be
removed the day after operation and will be replaced with a lighter one. There may
be black threads tied round the stumps of the piles. These will drop off by
themselves in two or three days. Do not pull them.
There are many different types of dressings for piles. Ask the nurses for details. You
can wash the wound area as soon as the dressing has been removed. Soap and tap
water are entirely adequate. Salted water is not necessary. You can bathe or shower
as often as you wish. Some hospitals arrange a check up about one month after you
leave hospital. Others leave check-ups to the general practitioner. The nurses will
After - At Home
You are likely to feel very tired and need to rest two to three times a day for a week
or more. You will gradually improve so that by the time a month has passed you will
be able to return completely to your usual level of activity. It will take a month
before your back passage feels normal again. You can drive as soon as you can make
an emergency stop without discomfort in the wound, i.e. after about 10 days. You
can restart sexual activities within a week or two, when the wound is comfortable
enough. You should be able to return to a light job after about one week and any
heavy job within two weeks.
Complications are rare and seldom serious. If you think that all is not well, let the
doctors or the nurses know. The wound is always a bit moist for a week or two.
There is likely to be a discharge of yellow matter and even some dark blood on the
dressings during this time. Opening your bowels becomes gradually easier
particularly if you take a laxative. DO NOT however take bran or a high-fibre diet
until the back passage is pain-free in case you end up with a blockage. Occasionally
163
after 7 to 10 days there is more bleeding. Contact your doctor straight away. Rarely,
you can have an infection in the wound area which is settled by taking antibiotics for
a few days. Occasionally you may notice difficulty controlling the wind or your stool
through your back passage. This improves after a day or two. If it doesn’t or if it gets
worse it is potentially an indication of the very rare complication of a sphincter injury
that took may have taken place during the operation. The sphincters are the muscles
that help you control your back passage and obviously if they have been damaged
you will partially or completely lose control of you back passage. This might require
an operation to fix it. The chance of the piles coming back again is less than 1 in 20.
Maintaining good bowel habits by using fibre and water in the diet and avoiding
straining can help a lot in preventing the recurrence of piles.
General Advice
In general the operation is much less painful and troublesome than friends and
acquaintances would lead you to believe. It will, however, be a month before the
wound settles down. We hope these notes will help you through your operation. They
Hemi-Colectomy - Left
What is it?
the waistline, up to the right ribs, loops across the upper part of the belly and passes
down the left side. There it runs backwards into the pelvis (the lower part of your
abdomen) as the back passage, where it is called the rectum. In your case, the
problem lies in the left side of the colon or upper rectum. The left side of the colon is
taken out, and the ends are joined up (anastomosed) whenever possible.
164
The Operation
is made in the skin in the middle lower part of your abdomen about 40cm (15
inches) long. The left side of the colon loop and the upper rectum are freed from the
inside of the tummy. The diseased part is cut out and usually the ends are joined
together. Sometimes it is safer if the ends are not joined together. Then the bowel
waste is channelled through the bowel which opens in the front of your tummy (a
colostomy), and you need to wear a bag. Usually the ends are joined up at a later
date. Sometimes the ends are joined up at the first operation, but a short-term
colostomy is made as well. This keeps the bowel waste away from the join while it is
healing up. You should plan to leave the hospital two weeks or so after the
operation. Very rarely, if the problem area is in the lower part of the rectum it may
be necessary to remove the back passage as well. You will be warned about this
before the operation.
Any Alternatives
medicines will not be helpful, neither will X-ray and laser treatment.

After - In Hospital
uncomfortable. You will have a dressing on your wound and a drainage tube nearby,
connected to another plastic bag. This drains any residual blood from the area of the
operation. You may have a colostomy. The wound is painful and you will be given
injections and, later, tablets to control this. Ask for more if the pain is not controlled
or gets worse. You will most likely be able to get out of bed with the help of the
nurse the day after operation despite some discomfort. You will not do the wound
any harm, and the exercise is very helpful for you. The second day after operation
165
you should be able to spend an hour or two out of bed. By the end of four days you
should have little pain. A general anesthetic will make you slow, clumsy and forgetful
able to do things for yourself. Do not make important decisions during this time.
You will probably have a fine drainage tube in the penis or front passage to drain the
urine from the bladder until you are able to get out of bed easily. You should be
eating and drinking normally after about four to six days. The wound will have a
dressing which may show some staining with old blood in the first 24 hours. There
may be stitches or clips in the skin. Sometimes seven or eight stitches are put across
the wound to add strength. Stitches and clips are removed after about 7 to 10 days.
The drain tube is removed after aboutfour days. You can shower or bath but try keep
the wound area dry until the stitches are out. If you have a colostomy, special
nurses will show you how to manage it. You will be given an appointment to visit the
outpatient department for a check-up about one month after you leave the hospital.
You will know the results of the examination of the bowel by then. The nurses will
After - At Home
You are likely to feel very tired and need to rest two or three times a day for a
month or more. You will gradually improve so that by the time three months have
passed you will be able to return completely to your usual level of activity. You can
i.e. after about three weeks. You can restart sexual relations within two or three 3
weeks when the wound is comfortable enough. Sometimes the operation will upset
the nerves which control sex in the male. This is more frequent (some studies show
in up to 50% of cases) if during the operation the surgeon believes that your back
passage (rectum) has to be removed. The surgeon can discuss this with you. You
should be able to return to a light job after about six weeks and any heavy job within
12 weeks.
Complications are unusual but are rapidly recognized and dealt with by the surgical
staff. If you think that all is not well, let the doctors or the nurses know. Chest
infections may arise, particularly in smokers. Getting out of bed as quickly as
possible, being as mobile as possible and co-operating with the physiotherapists to
clear the air passages is important in preventing the condition. Do not smoke.
food and water intake will continue through your vein tubing until you pass wind or
open your bowels. Sometimes there is some discharge from the drain by the wound.
This stops given time. Wound infection is sometimes seen. This happens relatively
more frequently in any bowel operation compared to other 'clean' operations such as
taking out your gallbladder and the reason is that the bowel has many bugs that can
cause an infection. The infection settles down with antibiotics in a week or two.
the problem.
166
One potential major complication is a leak from the area where the two parts of your
bowel were put back together. The chance of a leak is up to 15% and is more
frequent in patients whose wounds may take longer to heal, such as elderly people,
diabetics and patients suffering from cancer. If a leak happens you will stop eating
and drinking for several days until the bowel heals completely. In the meantime you
will be given all the food and water you need via a catheter in one of your veins. This
fixes the problem frequently but sometimes another operation is needed to control
the leak.
months. If you have a colostomy, you will be given help and advice from the stoma
nurses.
General Advice
back doing their normal duties within three months. We hope these notes will help
you through your operation. They are a general guide. They do not cover everything.
Hemi-Colectomy - Right
What is it?
The lower part of the bowel is called the colon. The colon starts just to the right of
the waistline and runs up under your ribs, across the tummy and down the left side
where it becomes the rectum. Your problem is in the right hand side of the colon.
The diseased part of the right colon and a small piece of the upper bowel have to be
taken out. The ends of the rest of the bowel are joined up inside the tummy.
The Operation
is made in the skin in the middle lower part of your abdomen 25cm (10 inches) long.
The right side of the colon and the lowest part of the small bowel are freed. The
diseased bowel is taken out. The cut ends of the small bowel and of the middle of the
colon are joined together. The cut is then closed up. You will not end up with a
colostomy or need to wear a bag to collect the bowel waste. You should plan to leave
hospital about 10 days after the operation.
Any Alternatives
medicine will not be helpful, neither will X-ray and laser treatment. Keyhole
operations to remove this part of the bowel are possible in very specialised centres.
Most centres perform the classic open operation with excellent results.

167
After - In Hospital
uncomfortable. You will have a dressing on your wound and perhaps a drainage tube
nearby, connected to another plastic bag. This drains any residual blood from the
area of the operation. The wound is painful and you will be given injections and later
tablets to control this. Ask for more if the pain is not controlled or gets worse. A
yourself. Do not make important decisions during this time. You will probably have a
fine drainage tube in the penis or front passage to drain the urine from the bladder
until you are able to get out of bed easily.
You should be eating and drinking normally after about four to six days. The wound
has a dressing which may show some staining with old blood in the first 24 hours.
There may be stitches or clips in the skin. Sometimes seven or eight stitches are put
across the wound to add strength. Stitches and clips are removed after about 7-10
days. The drain tube is removed after four days or so. You can wash as soon as the
dressing has been removed but try to keep the wound area dry until the stitches
come out. Soap and warm tap water are entirely adequate. Salted water is not
appointment to visit the outpatient department for a checkup about one week after
leaving hospital. The results from the laboratory about your colon condition should
be ready then. The nurses will advise about sick notes, certificates etc.
After - At Home
month or more. You will gradually improve so that by the time three months has
i.e. after about three weeks. You can restart sexual relations within two to three or
weeks when the wound is comfortable enough. You should be able to return to a
light job after about six weeks and any heavy job within 12 weeks.
Complications are relatively unusual but are rapidly recognized and dealt with by the
168
surgical staff. If you think that all is not well, let the doctors or the nurses know.
Chest infections may arise, particularly in smokers. Getting out of bed as quickly as
clear the air passages is important in preventing the condition. Do not smoke.
Occasionally the bowel is slow to start working again. This may take a week or more.
Your food and water intake will continue through your vein tubing until you pass
wind or open your bowels. Sometimes there is some discharge from the drain near
the wound. This stops given time. Wound infection is sometimes seen. This happens
relatively more frequently in any bowel operation compared to other 'clean'
operations such as taking out your gallbladder and the reason is that the bowel has
many bugs that can cause an infection. The infection settles down with antibiotics in
a week or two.
the problem.
frequent in patients whose wounds take longer to heal, such as elderly people,
often corrects the problem but sometimes another operation is needed to control the
leak.
months. Because of loss of some of the bowel you may need some vitamin
replacement. This will be discussed with you.
General Advice
normal duties within three months. We hope these notes will help you through your
doctors or nurses.
Hernia Repair - Epigastric
What is it?
A hernia is a weakness in the muscles which form the front of the body wall. Usually,
the bowel, and more rarely other organs, can push through this weak spot and
create a bulge in the area. In your case the hernia is in the gristle between your
breastbone and your tummy button. This is called the epigastrium. Sometimes there
are more than one. It is usually caused by the body wall being weak from birth.
Sometimes the body wall weakens with the passing of time. Sometimes the body is
overstrained by coughing, heavy work or sport, etc. Hernias are very common and
are easily treated. If left untreated they get bigger and cause pain. More
dangerously, the bowel can sometimes get trapped in the weak spot of the muscles.
This can cause a blockage of the bowel, which can eventually cause it to become
strangulated. An emergency operation is then required to deal with the problem.
169
The Operation
you prefer, and partly on what your anaesthetist and surgeon think is best. The vast
majority of operations for hernia repair are carried out under general anesthetic. In
some cases when the hernia is relatively small and your general medical condition
does not allow you to tolerate the stress of a general anesthetic, the operation can
be done under local anesthetic. Having a general anesthetic means that you will be
completely asleep during the operation. Having a local anesthetic means that you will
be awake during the operation, you will feel that something is being done at the area
of the operation but will not feel pain. A cut is made into the skin overlying the
hernia. The bulge is pushed back or is cut off. The weak part is mended/closed and
strengthened, usually with strong stitches. Another alternative is to patch the weak
spot with a piece of synthetic material. This is usually done when the tissues around
the weak spot are not strong enough to be stitched up together with strong stitches
or when the weak spot is so big that it is impossible to close it just by using stitches.
The synthetic patch is placed on top of the weak spot and is stitched to the healthy
tissues around it. Soon, a lot of scarred tissue develops above and under the patch
which makes it very strong and doesn’t allow the hernia to come back again. The cut
in the skin is then closed up.
Keyhole surgery for hernia repair is only carried out in some specialised centres and
for selective cases. There is no clear evidence at the moment that it offers a
significant advantage compared to the traditionally performed operations.
The operation can either be done as a daycase, which means that you come into
hospital on the day of the operation and go home the same day, or as an inpatient
case, which means spending one or two nights in hospital. Your doctor will have
discussed with you which operation you will be having.
Any Alternatives
Simply waiting and seeing if you have more trouble is not a good idea. The hernia
will always get worse. A support or a belt may be useful if the hernia is very big. It is
a good idea if you do not like the idea of an operation, or if you are not fit enough for
one. Keyhole operations for hernia repair are experimental.

as possible.. Please tell the doctors and nurses of any allergies to tablets, medicines
checks.
170
checks.
After - In Hospital
not make important decisions, drive a car, use machinery, or even boil a kettle
during this time. The nurses will help you with everything you need until you are able
to do things for yourself. Most patients have local anesthetic injected into the wound
(even if you have a general anesthetic for the operation) to minimise the pain after
the operation. Usually the wound is almost pain-free. There may be some discomfort
on moving. Painkilling tablets should easily control this discomfort. Painkilling
injections can be given. Ask for more if the pain is not well controlled or if it is
getting worse.
It is important that you pass urine and empty your bladder within six hours of the
operation. If you have difficulty, let the nurses know. The wound has a dressing
which may show some staining with old blood after 24 hours. You can take the
dressing off after 48 hours. There is no need for a dressing after this unless the
wound is painful when rubbed by clothing. You can leave the wound without
dressings after five days or so, when it is comfortable. There may be stitches or clips
in the skin. They are usually removed 10 to 14 days after the operation. The wound
may be held together with dissolvable stitches underneath the skin.
There may be some purple bruising around the wound which spreads downward by
should not worry. There may be some swelling of the surrounding skin which also
improves in two to three days. After 7 to 10 days, slight crusts on the wound will fall
off. Occasionally minor matchhead-sized blebs (blisters) form on the wound line.
These settle down after discharging a blob of yellow fluid for a day or so.
After - At Home
Make sure you are going home by car with your relative or friend. Go to bed. Take
two painkiller tablets every six hours to control any pain. The next morning you
should be able to get out of bed quite easily despite some discomfort. You will not do
the wound any harm. The exercise is good for you. The second day after the
operation, you should be able to spend most of your time out of bed in reasonable
comfort. You should be able to walk 50 yards slowly.
By the end of a week the wound should be nearly pain-free. You can wash but try to
keep the wound area dry until the stitches/clips come out. If there are only
dissolvable stitches under the skin, try to keep the wound dry for a week.. Soap and
warm tap water are entirely adequate. Salted water is not necessary. You can
shower or take a bath as often as you want. You are likely to feel very tired and need
rests two to three times a day for a week or more. You will gradually improve. By the
time a month has passed you will be able to return completely to your usual level of
activity. At first discomfort in the wound will prevent you from harming yourself by
lifting things that are too heavy. After one month you can lift as much as you used to
lift before you had the operation. There is no value in trying to speed the recovery of
the wound by special exercises before the month is out. You can drive as soon as
you can make an emergency stop without discomfort in the wound, i.e. after about
10 days. You can restart sexual relations within a week or two, when the wound is
comfortable enough. You should be able to return to a light job after about two
weeks and any heavy job within four to six weeks.
171
Complications are rare and seldom serious. If you think that all is not well, please let
the doctors and the nurses know.
Bruising and swelling may be troublesome, particularly if the hernia is large. The
swelling may take four to six weeks to settle down. Serious bleeding that might
require another operation to stop it happens in less than 1% of cases.
Infection happens in 1 to 2% of cases and usually settles down with antibiotics in a

week or two. The infection can cause more trouble in situations where the hernia was
repaired with a synthetic patch. The patch is a foreign body and if it gets infected it
makes it difficult to control the infection with the antibiotics. If this happens, you
may require antibiotics for a longer period of time and, very rarely, you might need
another operation to remove the patch. In this case, you will most probably need
another operation in the future to repair the hernia again.
Extremely rarely (1 in 2000 cases) the bowel or other organs of the abdomen can be
damaged during the operation and if this occurs you will need another operation to
fix the problem.
Aches and twinges may be felt in the wound for up to six months. About 1 to 2% of
patients experience some pain for longer than this (chronic incisional pain) and if this
happens the doctors will discuss with you the best way to deal with the problem.
Overall, the chances of the hernia coming back again is about 1 in 100. This can go
up to 2 to 3% if the hernia was very big or the patient’s tissues are not very healthy
and they are not healing well, for example if the patient is elderly or diabetic.
General Advice
their normal duties within one month. These notes will help you through your
doctors or nurses.
172
Hernia Repair - Femoral
What is it?
A hernia is a weakness in the muscles which form the front of the body wall. Usually,
the bowel or some fat, and more rarely other organs, can push through this weak
spot and create a bulge in the area. In your case the hernia is just below your groin.
It is usually caused by the body wall being weak from birth. Sometimes the body
wall weakens with the passing of time. Sometimes the body is overstrained by
coughing, heavy work or sport etc. Hernias are very common and are easily treated.
If left untreated they get bigger and cause pain. More dangerously, the bowel can
sometimes get trapped in the weak spot of the muscles. This can cause a blockage of
the bowel, which can eventually cause it to become strangulated. An emergency
operation is then required to deal with the problem.
The Operation
Most patients have a general anesthetic so that they are asleep during the operation.
The area below the groin is often numbed with local anesthetic to cut down the pain
you may experience when you wake up. However, it is also possible to have the area
below the groin numbed with a local anesthetic and have the whole operation under
local anesthetic. In this case, you will be awake during the operation and you will feel
that something is being done in the area of the operation but you will not feel pain.
The operation can be done under local anesthetic when the hernia is relatively small
and your general medical condition does not allow you to tolerate the stress of a
general anesthetic.
A cut is made into the skin overlying the hernia. The bulge is pushed back or is cut
off. The weak part is mended/closed and strengthened using strong stitches. Another
alternative is to patch the weak spot with a piece of synthetic material. This is
usually done when the tissues around the weak spot are not strong enough to be
173
stitched up together with strong stitches or when the weak spot is so big that it is
impossible to close it just by using stitches. The synthetic patch is placed on top of
the weak spot and is stitched to the healthy tissues around it. Soon, a lot of scarred
tissue develops above and under the patch which makes it very strong and doesn’t
allow the hernia to come back again. The cut in the skin is then closed up. The
operation takes about 40 minutes.
for selective cases. It is carried out under general anesthetic and there is no clear
evidence at the moment that it offers a significant advantage compared to the
traditionally performed operations.
You may well be able to have the operation on the day you come in and go home the
same day. You may need to stay in hospital for a day or two, if you are over 50,
having trouble passing urine, have other illnesses, or if you cannot manage at home.
Any Alternatives
will always get worse. There is a real risk of a blockage of the bowel if you delay
having an operation. A support or a belt will not be useful.

checks.
After - In Hospital
The nurses will help you with everything you need until you are able to things for
kettle during this time. The local anesthetic in your wound may make your leg give
way for 12 hours or so. Be especially careful when getting in or out of a car, when
climbing stairs, or when getting in or out of bed. There may be some discomfort on
moving rather than severe pain. You will be given injections or tablets to control this
as required. Ask for more if the pain is not well controlled or if it gets worse. You will
most likely be able to get out of bed the day after the operation despite some
you. The second day after the operation you should be able to walk 50 yards slowly.
By the end of one week the wound should be virtually pain-free. It is important that
174
you pass urine and empty your bladder within six hours of the operation. If you
cannot pass urine let the nurses know and steps will be taken to correct the problem.
be stitches or clips in the skin. They need to come out 10 to 14 days after the
operation. Sometimes there are stitches under the skin instead. These melt away
and they don’t need to be removed.
There may be some purple bruising around the wound which spreads downward by
should not worry. There may be some swelling of the surrounding skin which also
improves in two to three days. After 7 to 10 days, slight crusts on the wound will fall
off. Occasionally minor, matchhead-sized blebs (blisters) form on the wound line.
These settle down after discharging a blob of yellow fluid for a day or so. You can
wash, but try to keep the wound area dry until the stitches/clips come out. If you
only have stitches under the skin, try to keep the wound dry for a week. Soap and
shower or take a bath as often as you want. The nurses will talk to you about your
home arrangements so that a proper time for you to leave the hospital can be
arranged. Some hospitals arrange a check-up about one month after you leave the
hospital. Others leave check-ups to the general practitioner. The nurses will advise
about sick notes, certificates etc. Arrangements for removal of stitches or clips will
be made.
After - At Home
or more. You will gradually improve so that by the time three weeks have passed
you will be able to return completely to your usual level of activity. At first,
discomfort in the wound will prevent you from harming yourself by lifting things that
are too heavy. After three weeks you can lift as much as you used to lift before your
operation. There is no value in attempting to speed the recovery of the wound by
special exercises before the month is out. You can drive as soon as you can make an
emergency stop without discomfort in the wound, i.e. after about 10 days. You can
restart sexual relations within a week or two, when the wound is comfortable
enough. You should be able to return to a light job after about seven days, and any
heavy job within four to six weeks.
175
fix the problem.
patients experience some pain longer than this (chronic incisional pain) and if this
Overall, the chances of the hernia coming back again is about 3 to 5 in 100. The
chances of the hernia coming back are higher if the hernia was very big or the
patient’s tissues are not very healthy and they are not healing well, for example if
the patient is elderly or diabetic.
General Advice
their normal duties within one month. These notes will help you through your
doctors or nurses.
176
Hernia Repair - Inguinal
What is it?
A hernia is a weakness in the muscles of the front of the body wall. Usually, the
bowel or some fat, and more rarely other organs, can push through this weak spot
and create a bulge in the area. In your case the hernia is in the groin. Sometimes
they are in both groins. They can be caused by the body wall being weak from birth.
Sometimes the body wall weakens with the passing of time. Sometimes the body is
overstrained by coughing, heavy work or sport etc. Hernias are very common and
are easily treated. If left untreated, they get bigger and cause pain. More
dangerously, the bowel can sometimes get trapped in the weak spot of the muscles.
This can cause a blockage of the bowel, which can eventually cause it to become
strangulated. An emergency operation is then required to deal with the problem.
For children, please see "Child's inguinal hernia operation".
The Operation
The groin is often numbed with local anesthetic to cut down the pain you may
experience when you wake up. However, it is also possible to have the groin numbed
with a local anesthetic and have the whole operation under local anesthetic. In this
case, you will be awake during the operation and you will feel that something is
being done in the area of the operation but you will not feel pain. The operation can
be done under local anesthetic when the hernia is relatively small and your general
medical condition does not allow you to tolerate the stress of a general anesthetic.
177
A cut is made into the skin overlying the hernia. The bulge is pushed back or is cut
off. The weak part is mended/closed and strengthened using strong stitches. Another
alternative is to patch the weak spot with a piece of synthetic material. This is
usually done when the tissues around the weak spot are not strong enough to be
stitched up together with strong stitches or when the weak spot is so big that it is
impossible to close it just by using stitches. The synthetic patch is placed on top of
the weak spot and is stitched to the healthy tissues around it. Soon, a lot of scarred
tissue develops above and under the patch which makes it very strong and doesn’t
allow the hernia to come back again. The cut in the skin is then closed up. The
operation takes about 40 minutes.
If you have a hernia in each groin, they can usually both be mended at the same
time. Keyhole surgery for hernia repair is only carried out in some specialised centres
and for selective cases. It is carried out under general anesthetic and there is no
clear evidence at the moment that it offers a significant advantage compared to the
traditionally performed operations. Ask your surgeon to explain his own method.
same day. You may need to stay in hospital for a day or two, if you are over 50,
having trouble passing urine, have other illnesses, or if you cannot manage at home.
Any Alternatives
may get worse. A truss will usually hold the hernia back in place. It is useful as a
stop-gap until you have the operation. It is a good idea if you do not like the idea of
an operation, or if you are not fit enough for one.

Stop smoking and get your weight down. (See Healthy Living.) If you know that you
first week after the operation. Bring all your tablets and medicines with you to the
tests to make sure that you are well prepared and that you can have the operation
as safely as possible. Many hospitals now run special preadmission clinics, where you
visit for an hour or two, a few weeks or so before the operation for these checks.
After - In Hospital
There may be some discomfort on moving. Painkilling tablets should easily control
this discomfort. If not, you can have painkilling injections. By the end of one week
the wound should be just about pain-free. The local anesthetic in your wound may
make your leg give way for 12 hours or so. Be especially careful when getting in or
out of bed, or getting into a car. Ask a nurse to help you. A general anesthetic will
important decisions, drive a car, use machinery, or even boil a kettle during this
time. The discomfort of the operation can make it difficult to pass urine and empty
the bladder. It is important that your bladder does not seize up completely. If you
cannot get the urine flowing properly after six hours, contact the nurses or your
doctor. The wound may be closed with stitches or clips which need to be taken out
178
10 to 14 days after the operation. Sometimes there are stitches under the skin
instead. These melt away and they don’t need to be removed. A plaster on the
wound makes it more comfortable. You can wash, bathe, or shower but try to keep
the wound area dry until the stitches or clips are taken off. If you only have stitches
under the skin, try to keep the wound dry for a week. Soap and tap water are quite
all right. Salted water is not needed. Some hospitals arrange a check-up about one
month after you leave the hospital. Others leave check-ups to the general
practitioner. The nurses will advise about sick notes, certificates etc.
After - At Home
At first discomfort in the wound will prevent you from harming yourself by lifting
things that are too heavy. After one month you can lift as much as you used to lift
before the operation. There is no value in attempting to speed the recovery of the
wound by special exercises before the month is out. You can drive as soon as you
days. You may restart sexual relations within a week or two, when the wound is
weeks, and any heavy job within four to six weeks.

damaged during the operation and in if this occurs you will need another operation to
fix the problem.
patients experience some pain for longer than this (chronic incisional pain) and if this
patient’s tissues are not very healthy and they are not healing well, for example if
the patient is elderly or diabetic.
179
General Advice
Do leave yourself enough time to get over the operation. Practically all patients are
back to their normal duties within one month. We hope these notes will help you
Hernia Repair - Umbilical
What is it?
There is a weakness of the tummy button (umbilicus). Usually, the bowel or some
fat, and more rarely other organs, can push through the weak spot making it look
bulgy. This will most likely get bigger and become unsightly. Sometimes fat or bowel
gets caught in the hernia causing severe pain and illness and requires an emergency
operation to deal with the problem. For a child, please refer to "Hernia repair -
umbilical (Child)".
The Operation
you prefer, and partly on what your anaesthetist and surgeon think is best. The vast
majority of operations for hernia repair are carried out under general anesthetic. In
some cases when the hernia is relatively small and your general medical condition
does not allow you to tolerate the stress of a general anesthetic, the operation can
be done under local anesthetic. Having a general anesthetic means that you will be
be awake during the operation, you will feel that something is being done at the area
of the operation but will not feel pain.
A cut is made around the tummy button, which may have to be taken away. Any fat
or bowel in the hernia is pushed back or removed. The weakness is mended/closed
usually with strong stitches. Another alternative is to patch the weak spot with a
piece of synthetic material. This is usually done when the tissues around the weak
spot are not strong enough to be stitched up together with strong stitches or when
the weak spot is so big that it is impossible to close it with stitches alone. The
synthetic patch is placed on top of the weak spot and is stitched to the healthy
tissues around it. Soon, a lot of scarred tissue develops above and under the patch
and this makes it very strong and doesn’t allow the hernia to come back again. The
skin is then closed up. You may not have a tummy button after the operation
depending on the size of the hernia.
for selective cases only. There is no clear evidence at the moment that it offers a
significant advantage compared to the traditionally performed operations.
same day. You may need to stay in for a day or two, if you are over 50, having
trouble passing urine, have other illnesses, or if you cannot manage at home.
Any Alternatives
will always get worse. A truss will not usually hold the hernia back in place. It is
180
useful as a stop-gap until you have the operation. It is a good idea if you do not like
the idea of an operation, or if you are not fit enough for one.

Stop smoking and get your weight down. (See Healthy Living.) If you know that you
friend who can come with you to the hospital, take you home, and look after you for
the first week after the operation. Bring all your tablets and medicines with you to
the hospital. On the ward, you may be checked for past illnesses and may have
special tests to make sure that you are well prepared and that you can have the
operation as safely as possible. Many hospitals now run special preadmission clinics,
checks.
After - In Hospital
the wound should be just about pain-free. A general anesthetic will make you slow,
decisions, drive a car, use machinery, or even boil a kettle during that time. The
discomfort of the operation can make it difficult to pass urine and empty the bladder.
It is important that your bladder does not seize up completely. If you cannot get the
urine flowing properly after six hours, contact the nurses or your doctor. The wound
may be closed with stitches or clips which will need to be taken out about 10 to 14
days after the operation. Sometimes there are stitches under the skin instead. These
melt away and don’t need to be removed. A plaster on the wound makes it more
comfortable. You can wash, bathe, or shower as soon as the stitches or clips are
taken off. If you only have dissolvable stitches under the skin, try to keep the wound
area dry for a week. Soap and tap water are quite all right. Salted water is not
needed. Some hospitals arrange a check-up about one month after you leave the
hospital. Others leave check-ups to the general practitioner. The nurses will advise
After - At Home
before the operation. There is no value in attempting to speed the recovery of the
181

fix the problem.
Aches and twinges may be felt in the wound for up to six months. About 1 to 2 % of
patients experience some pain longer than that (chronic incisional pain) and if this
happens the doctors you discuss with you the best way to deal with the problem.
patient’s tissues are not very healthy and they are not healing well for example if the
patient is elderly or diabetic.
Complications are rare and seldom serious.
In the first 24 hours:

• look out for any bleeding coming through the dressings.
• look out for any swelling bigger than the original hernia.
• look out for difficulty emptying your bladder.
After the first 24 hours:

• bruising and swelling may be troublesome, particularly if the hernia was large. t
• the swelling may take four to six weeks to settle down.
• infection is a rare problem and settles down with antibiotics in a week or two.
After the first week:

• occasionally there are numb patches in the skin around the wound which get better
after two to three months.
• the risk of the hernia coming back is about 5 in 100 operations.
General Advice
back to their normal duties within one month. We hope these notes will help you
182
Hernia Repair - Umbilical (Child)
What is it?
There is a weakness in the tummy button or umbilicus. Normally this closes off at
birth or within the first two years. In your child's case the weakness is still there.
This causes a swelling a hernia. This happens because organs within the tummy are
pushing through the weak spot. The hernia may go away by itself especially if the
weak spot is less than 1cm (less than ½ an inch) wide at the time of birth, or it may
get bigger or give pain. It is not the fault of either parent.
The Operation
Your child will have a general anesthetic, and will be completely asleep. A cut is
made into the skin of the tummy button. Whatever organs are pushing through the
weak spot are placed back in the tummy and the weak spot or gap is closed with
strong stitches.. The cut in the skin is then closed up so that the tummy button looks
normal. The operation takes about 20 minutes.
Any Alternatives
Small hernias may be safely left alone. They disappear by the time the child is five or
six years old. There are no suitable supports or trusses for these hernias.
If a hernia that doesn’t close spontaneously is left alone there is chance that it will
get bigger and more uncomfortable.
If the hernia is not repaired the greatest danger to the child is the abdominal organs
getting trapped in the hernia. This usually happens after some excess physical
activity and it can be very painful. Even worse, the organs that get trapped in the
hernia can get strangulated, the blood supply to them can stop and they get necrotic
(die). This serious condition is called an incarcerated hernia. If this happens the child
must be taken to hospital urgently and an emergency operation will be needed to fix
the problem. If your child has a hernia, you should be alert to this potential situation
and seek medical advice urgently if you have any suspicions that your child is getting
rather uncomfortable in or around the area of the hernia.
For these reasons it is very important to proceed with the hernia repair before your
child experiences such problems.

admission to the hospital, please telephone the ward and let the ward sister know.
The operation will usually need to be put off. Your child has to get over the cold
before the operation can be done because by having an anesthetic the cold could
turn into a serious infection in the chest. Sort out any tablets, medicines, and
inhalers that your child is using. Keep them in their original boxes and packets. Bring
them to the hospital with you. On the ward, your child may be checked for past
illnesses and may have special tests to make sure that he or she is well prepared
and can have the operation as safely as possible.. Many hospitals now run special
preadmission clinics where you and your child visit for an hour or two, a week or so
before the operation for your child to have these checks.
After - In Hospital
Your child may not notice any particular pains. If necessary he or she can take
183
paracetamol liquid. By the end of one week the wound should be virtually pain-free.
Your child will be able to drink a couple of hours or so after the operation. He or she
should be able to eat normally the next day. Usually you can take your child home
on the day of the operation. You may be given an appointment to bring your child to
the outpatient department a month after leaving hospital for a check-up. Sometimes
the family doctor checks the wound.
After - At Home
to limit what he or she does, try to help your child avoid any excess physical activity
for four to six weeks after the operation especially if he or she is over five years old.
The wound is usually held together with stitches under the skin that dissolve and
don’t need to be removed. There may be stitches in the wound and these need to
come out a week or so after the operation. There may be some bruising of the
surrounding skin which will improve after about two or three days>. This is expected
and you should not worry about it. You can wash your child but try to keep the
wound area dry until the stitches come out or for about a week if there only stitches
under the skin. Salt water is not necessary. If your child goes to school, he or she
can return to lessons after about 10 days. Your child can restart any sport after
about four to six weeks.
Complications are rare and seldom serious. If you think that something is wrong let
the doctors or the nurses know. There is often some swelling and even some redness
around the wound. These usually settle in three or four days. Infection is a rare
problem and settles down with antibiotics in a week or two. It is very rare for the
hernia to form again. This is more common in children who have a wound infection
after the operation or who don’t avoid any excess physical activity for the first four to
six weeks.
General Advice
The operation can be a little painful for a day or two. Your child will need to try and
be patient. These notes should help you and your child through the operation. They
184
Hip Replacement
What is it?
You have developed arthritis in your hip. The surfaces of the ball-and-socket joint
between your thigh bone and pelvis bone are no longer smooth. The bones surfaces
are rough and the cartilage lining has worn away. As a result, your hip is painful and
stiff.
The Operation
You will have a general or spinal anesthetic. A cut about 10 inches long is made
along the side of your hip and thigh. The damaged bone ends are removed. These
are replaced with an artificial joint. The artificial hip consists of a ball on a stem, and
a socket. The stem is fixed into your thigh bone, and the new socket into the space
in your pelvis. The skin is then closed with stitches or clips. There are many different
types of artificial hips. Most have a metal ball in a plastic cup. Some are held in with
special bone cement, some are not. The surgeon will explain the type he or she
intends to use and the reasons for this choice. The aim of the operation is to stop the
pain in your hip. The range of movement in your hip may not improve very much,
but the pain should go. As a result you will be able to walk further and climb stairs
more easily. You should not have a new hip if you have angina (chest pains) or
shortness of breath that limit your walking more than your hip pain. You should not
have a hip replacement if you have a urinary infection. This may result in infection of
your new hip. Your urine will be checked. If it is infected, we will give you antibiotics
before your operation. The same applies to other infections. They have to be cleared
185
before you have your operation. You should not have a hip replacement if you are a
man with prostate problems. If you have poor urinary flow, it is better to have this
investigated and treated before your hip is replaced.
Any Alternatives
If you leave things as they are, the hip problem will probably get worse. Tablets and
avoiding the things that make the hip painful may be all you need. Physiotherapy will
not diminish the pain. Very rarely these days, the thigh bone can just be cut across
to change the pressures on your hip to relieve the pain. Usually a hip replacement is
better. If the pain in your hip interferes with your life and the X-rays show that the
joint is severely damaged, then you should have your hip replaced.

hospital's advice about taking the Pill or hormone replacement therapy (HRT.) Check
you have a relative or friend who can come with you to the hospital, take you home
before the operation for these checks..
After - In Hospital
You may have a fine plastic drainage tube coming out of the skin near the wound,
connected to a container. This is to drain any residual blood from the operation. Your
legs may be held apart by a special pillow. This is to prevent you from crossing your
legs, which may make the new ball slip out of the new socket and dislocate your new
hip. The wound may be painful. You will be given injections or tablets to control this.
Ask for more if the pain gets worse. The physiotherapist will tell you how to get out
of bed, rise from a chair, and teach you exercises and how to walk with walking aids.
The occupational therapist will show you how to do many daily tasks, such as
washing and dressing. For the first six weeks, you must be very careful not to do
things that may dislocate the new hip joint.
• Do not cross your legs, either in bed or when sitting.
• Do not bend your hip beyond a right angle.
• When in bed you may sit up, but you must not lean forwards, for example, to reach
your foot.
• You must not bend your knee up to put on socks or shoes.
• You must not sit on a low seat such as a toilet. You may be given a raised toilet
seat if necessary to take home.
• While in hospital, you must sleep on your back.
The wound will probably have a simple adhesive dressing over it. The nurses will pull
out your wound drain 24-48 hours after your operation. This does not hurt. Your
stitches or clips will be taken out about 12 days after the operation. You will be in
hospital for 7 to 10 days following your operation depending on your circumstances.
You may go home when you can walk safely with crutches or sticks. You will be given
an appointment to visit the orthopaedic outpatient department six weeks or so after
your operation. Please ask the nurses about sick notes, certificates etc.
186
After - At Home
arrange for friends or family to shop for you. Your hip will continue to improve for at
least six months. At home, it is advisable to sleep on your back for six weeks. If you
must sleep on your side, sleep on your operated side with a pillow between your
legs. Lie on the side that has been operated upon. You will not be able to drive for
six weeks after your operation. You will not be able to perform an emergency stop as
quickly as normal before then. How soon you can return to work depends on your
job. If you mainly sit at work, you may be able to return to work three to four weeks
after your operation. This also depends on your being able to get to work. You should
not do manual work after a total hip replacement.
complications related to your heart or your lungs. If you have the operation under a
spinal anesthetic, you also have a very small risk of having a blood clot or an injury
to you spinal cord (the bundle of nerves that runs from your brain to the lower area
of your back). Regardless of which type of anesthetic you are going to have, the
tests that you will have before the operation will make sure that you can have the
operation in the safest possible way and will bring the risk of such complications very
close to zero.
Complications occur in about 1 out of 20 operations. Wound infection sometimes

happens. You will be given antibiotics to try and prevent this. You can develop a
blood clot in the veins of your calf (deep vein thrombosis -DVT). A combination of
medicine (an injection of a blood thinner), special compression stockings or foot
pumps will be used to try to prevent this. The thigh bone can break while the
surgeons are trying to put in your artificial joint. This is rare. The exact treatment
depends on the nature of the break. Dislocation can occur, especially immediately
after your operation. Artificial joints last for many years. However they can become
loose and painful after years of use. A further operation may then be necessary.
General Advice
The operation is neither very simple nor very complicated but somewhere in
187
Hydrocele Operation - Adult
What is it?
A hydrocele is a pocket of watery liquid that has built up around your testicle.
Sometimes this is because the testicle is diseased. More often it is because the liquid
cannot drain into the circulation properly. In a child, the cause of the hydrocele, and
its treatment, are different. See "Hydrocele operation - child".
The Operation
Sometimes the operation can be done by an injection of local anesthetic in the back
which will numb the area from the waist down. A cut is made into the skin over the
hydrocele. The liquid is emptied out. Some of it will be checked for the possible
presence of bugs and some of it in order to exclude the presence of cancerous cells.
The testicle is examined. If it is all right, the double coverings of the testicle are
stitched up to stop the liquid building up again. If the testicle is diseased, it may be
necessary to remove it. This will be discussed with you before the operation. Finally,
the skin is stitched up. The operation is usually done as a day case. This means that
you come into hospital on the day of the operation and go home the same day. You
may need to stay in for a day or two, if you are over 50, having trouble passing
urine, have other illnesses, or if you cannot manage at home.
Any Alternatives
If you leave things as they are, the hydrocele will slowly get bigger. It will not be
certain why there has been a build up of fluid unless you have an operation. The fluid
188
can be drained out using a needle, but it builds up again in a month or two. There is
no injection treatment that works well.

after you for the first week after the operation. Bring all your tablets and medicines
with you to the hospital. On the ward, you may be checked for past illnesses and
may have special tests to make sure that you are well prepared and that you can
After - In Hospital
the wound should be just about pain-free. A general anesthetic will make you slow,
decisions, drive a car, use machinery, or even boil a kettle during this time. The
wound may be closed with stitches or paper strips, which need to be taken out by
the nurses about 7 to 10 days after the operation. Sometimes there are stitches
which are under the skin and which eventually melt away and don’t need to be
removed. You can wash, bathe, or shower as soon as the stitches or paper strips are
taken off. If you only have stitches in the skin try to keep the wound area dry for a
week. Soap and tap water are quite all right. Salted water is not needed. It is
important that you pass urine and empty your bladder within 6 to 12 hours of the
operation. If you have difficulty, ask the nurses. Some hospitals arrange a check-up
about one month after you leave hospital, especially if the testis was removed. The
results of the examination of the fluid around the testis will also be ready by then.
Others leave check-ups to the general practitioner. The nurses will advise about sick
After - At Home
At first, discomfort in the wound will prevent you from harming yourself by lifting
before your operation. There is no value in attempting to speed the recovery of the
healed. You should be able to return to a light job after about two weeks and any
heavy job within four weeks.
189
spine.
troublesome, particularly if the hydrocele was large. The swelling may be as large as
the hydrocele. The swelling may take four to six weeks to settle down. Close fitting
Jockey-type underpants are often helpful. Infection is a rare problem and settles
down with antibiotics in a week or two.
Another very rare complication is infertility (the inability to make a woman
pregnant). This happens because the structures that carry the sperm from the testes
can be damaged during this operation. If fertility is still important for you, then you
should discuss the possibility of this rare complication with your surgeon.
The chances of the hydrocele coming back again is less than 1 in 20.
General Advice
back to their normal duties within one month. These notes should help you through
Hydrocele Operation - Child

What is it?
There is a gathering of fluid around the testicle. This is called a hydrocele. The fluid
comes from the lining of the tummy and trickles down a narrow tube to lie around
the testicle. This tube can be either:
• completely closed (non-communicating hydrocele)
• or very narrow and not allow any organs from the tummy (the bowel most
commonly) to come through it
• or sometimes the tube is quite wide in part, so that the bowel or other organs can
bulge through, making a hernia.
It is something your child was born with, but it is not the parents' fault.
The Operation
Your child will have a general anesthetic, and will be completely asleep. A small cut
is made in the groin. The narrow tube is then identified, any organs – such as the
bowel - that are in the tube and causing a hernia are pushed back in the tummy and
the fluid around the testicle is emptied out. Some of the fluid is sent to the
laboratory for examination. The part of the tube towards the testicle is removed and
the part of it towards the tummy is tied (ligated) twice. Sometimes, when the hernia
is big, stitches are needed to close the gap in front of the tummy that allows the
narrow tube to come through the tummy wall towards the testicle and make the
hernia. The cut is closed up. Sometimes a second cut is made in the scrotum to fix
the testicle in its proper place. The operation takes about 20 minutes a side.
Any Alternatives
TIf your child has a non-communicating hydrocele, there is a very good chance that
it will go away by the time he is 12 months old. If this doesn’t happen by the age of
12 months then an operation is necessary. An operation is also necessary if the
hydrocele communicates with the tummy or if a hernia is present. Injections will not
190
work. If you leave things as they are, the build up of fluid may become large and
uncomfortable. Hormone treatment does not work. Trusses and supports are of no
value.

admission to hospital, please telephone the ward and let ward sister know. The
operation will usually need to be put off. Your child has to get over the cold before
the operation can be done because by having an anesthetic the cold could turn into a
Sort out any tablets, medicines, and inhalers that your child is using. Keep them in
sure that he is well prepared and can have the operation as safely as possible. Many
hospitals now run special preadmission clinics, where you and your child visit for an
hour or two, a week or so before the operation for your child to have these checks.
After - In Hospital
Your child may not notice any particular pains. If necessary he can take paracetamol
liquid. By the end of one week, the wound should be virtually pain-free. Your child
will be able to drink again about two to three hours after the operation. Your child
should be able to eat normally the next day. Usually you can take your child home
on the day of the operation. You may be given an appointment to bring your child to
the outpatient department a month or so after leaving hospital for a check-up. The
results of the examination of the fluid from around the testicle should be ready by
then. Sometimes the family doctor checks the wound instead.
After - At Home
to limit what he does, try to help your child avoid any excess physical activity for
four to six weeks after the operation especially if he is over five years old. The groin
wound is usually held together underneath the skin with stitches that eventually
dissolve and which don’t need to be removed. . There may be stitches in the wound,
which should melt away in about 7 to 10 days. It is rare for the stitches to need
taking out. There may be some bruising of the surrounding skin which will improve in
two to three days. This is expected and you or your child should not worry about it.
Your child can wash but should try to keep the wound area dry until the stitches melt
away or for about a week if there are only stitches under the skin. Salt water is not
necessary. If your child goes to school, he can return to lessons in 10 days or so.
Your child can restart any sport after about four to six weeks.
before the operation will make sure that he can have the operation in the safest
possible way and will bring the risk for such complications very close to zero.
Complications are rare and seldom serious. There is often some swelling and even
some redness around the wound. These settle in three or four days. Bleeding is very
rarely a problem and can usually be settled with some extra pressure on the wound
191
area. Extremely rarely, another operation may be needed to stop the bleeding.
Infection is a rare problem and settles down with antibiotics in a week or two.
Sometimes the stitches take a month or more to drop out of the wound. This can
happen and you or your child should not worry about it. Recurrence of the hydrocele
is very rare. Sometimes the testicle lies a little higher than before. Consult the
surgeon if either of these happen.
Two other extremely rare complications that can happen during this operation is
damage to the structures that carry the sperm from the testicle or damage to the
pipes (vessels) that feed the testicle with blood. This can have an affect either on
you child’s fertility in the future (his ability to father children) since one of his
testicles will not contribute sperm or can cause a significant damage or even necrosis
(death) of the testicle. You should discuss the possibility of those extremely rare
complications with your surgeon.
General Advice
These notes will help you and your child through the operation. They are a general
you have any queries or problems, please ask the doctors or nurses
Hysterectomy - Abdominal
What is it?
You are having trouble with your periods. They may be heavy, painful, or not
regular, or all three. The doctor has not been able to find any serious cause. At the
same time, he or she has not been able to find anything to help. If your womb is
taken out - hysterectomy , the problem is solved. This is done through a cut in the
tummy - an abdominal hysterectomy. At the same time, if the ovaries (the two small
glands that produce the eggs) are diseased, they can be taken out as well, with the
Fallopian tubes (which connect the ovaries with the womb). This is called a salpingo-
oophorectomy.
192
The Operation
You will have a general anesthetic and will be completely asleep. A cut is made in the
lower part of the tummy. This will usually be a "bikini" incision across the tummy,
just above the hair line. The uterus is taken out. If the ovaries are diseased, they are
best removed as well. The space fills in naturally. The wound, and the skin, and the
top of the vagina are closed up with stitches. There may be a fine plastic drainage
tube running from the wound. All tissue will be sent to the laboratory to be examined
under the microscope. You will be in hospital for about five days. If both ovaries are
removed, you may have menopausal problems such as hot flushes and dizzy spells.
You can stop them by taking hormone replacement therapy (HRT). This can be
started with a small pellet of HRT implanted under the skin. It may even help you get
over your operation quicker.
Any Alternatives
If you leave things as they are, the problems with your periods may go on for years.
Hormone drugs have not helped. The loss of blood could make you quite ill with
anaemia. The surgeon could just take out the lining of the womb - an endometrial
resection. This may just lessen the bleeding without stopping it. There may in fact be
a disease in your womb such as fibroids, making it safer if you have it all taken
away. Sometimes the womb can be taken out through the vagina. This is not a good
idea if the womb is very large, or is scarred by earlier operations on the tummy. A
new way of hysterectomy is using keyhole surgery to free off the body of the womb.
This is followed by bringing the womb out through the vagina. This can lead to a
shorter hospital stay if it goes well. If not, the tummy has to be opened as for an
abdominal hysterectomy.

packets. Bring them to hospital with you.
On the ward, you may be checked for past illnesses and may have special tests, to
checks.
After - In Hospital
The tummy wound may be painful. You may be given injections or tablets for the
pain. A general anesthetic will make you slow, clumsy and forgetful for about 24
hours. Do not make important decisions during that time. The nurses will help you
with everything you need until your are able to do things for yourself. You will have a
small, thin plastic tube (a drip) in an arm vein. This gives you salt and sugar and
water, and sometimes blood, for a day or so from a plastic bag on a stand. You will
have a sanitary pad in place. There will be slight bleeding like the end of a period. It
should be almost nil by the time you leave hospital. You should wear pads. You will
193
probably have a tube (a catheter) in the bladder for a few days. You will be able to
take a bath or shower as often as you want but try to keep the wound area dry for a
week. Any wound drain is usually removed the day after the operation.
You will have some blood and a urine tests a few days after your operation. These
will check you are not anaemic and have no urine infection. r. If you have had the
ovaries taken out, the HRT pellet will stop hot flushes for about six months. You can
decide about more HRT then. The nurses will advise about sick notes, certificates etc.
After - At Home
You will feel tired and need frequent rests for a month or so. There may be some
discharge from the vagina. There will be slight bleeding like the end of a period. It
should be almost nil by the time you leave hospital. Use pads. Do not use tampons
for six weeks. There are stitches in the top of the vagina. Sometimes the surface
knots of the stitches will appear on the pads with some bleeding after about two
weeks. This is quite normal. If the bleeding is heavy, contact the ward. You can drive
as soon as you can make an emergency stop without discomfort, generally after four
weeks or so. You will be able to start sexual relations before your six-week check if
you are comfortable and have no bleeding or discharge. You may be able to return to
a light job after about eight weeks, but you will not be able to cope with a busy job
until at least 12 weeks.
Most hysterectomies are without complication. Minor complications occur in up to 2%

of cases. Occasionally the bladder is slow to start working again. You may need the
catheter back in the bladder for a few days. Wound infection is sometimes seen. This
settles down with antibiotics in a week or two. Sometimes scarring in the vagina
makes intercourse difficult or uncomfortable. This usually settles down with time.
damage to your bladder, bowel and vessels and may require another operation to fix
them.
General Advice
194
Hysterectomy - Vaginal
What is it?
You are having trouble with the periods. They may be heavy, painful, or not regular,
or all three. The doctors have not been able to find any serious cause. At the same
time, they have not been able to find anything to help. If your womb is taken out
(hysterectomy), the problem is solved. This is done through a cut in the vagina (a
vaginal hysterectomy). At the same time, if the ovaries (the small glands that
produce the eggs) are diseased, they can be taken out as well, with the Fallopian
tubes (which connect the ovaries with the womb). This is called a salpingo-
oophorectomy. Rarely, the operation cannot be safely finished through the vagina.
This may be because the womb is too large, or fixed to other organs. It is then
necessary to make a cut in the tummy to free the womb and take it out from above.
The Operation
You will have a general anesthetic and will be completely asleep. A cut is made in the
upper part of the vagina. This will not leave any visible scar. The womb is taken out.
If the ovaries are diseased, they will need to be taken out as well. This will usually
require an abdominal incision (see Abdominal hysterectomy). The space fills in
naturally. The wound in the top of the vagina is then closed up. All tissue is sent to
the laboratory to be examined under the microscope. You will be in hospital for about
three days. If both ovaries are taken out, you may have menopausal problems such
as hot flushes and dizzy spells. You can stop them by taking hormone replacement
therapy (HRT). This can be started at the time of the hysterectomy. A small pellet of
HRT may be implanted under the skin. It may even help you get over your operation
quicker.
Any Alternatives
A new way of hysterectomy is using keyhole surgery to free off the body of the
womb. This is followed by bringing the womb out through the vagina. This can lead
to a 2-3 day hospital stay if it goes well. If not, the tummy has to be opened as for
an abdominal hysterectomy. Your gynaecologist will be able to advise you.

packets. Bring them to hospital with you.
ready for the operation. Please tell the doctors and nurses of any allergies to tablets,
After - In Hospital
You will probably have a small/thin plastic tube (a drip) in an arm vein. This gives
195
you salt and sugar and water, and sometimes blood, for a day or so from a plastic
bag on a stand. You may be given oxygen from a face mask for a few hours if you
have had chest problems in the past. There may be a gauze pack in the vagina to
absorb any ooze of blood. This is usually taken out the next day. You may have
some backache. You may be given injections or tablets by the nurses for the pain.
By the end of two days you should have little pain. A general anesthetic will make
you slow, clumsy and forgetful for about 24 hours. Do not make important decisions
during that time. The nurses will help you with everything you need until you can do
things for yourself. You will have some blood and urine tests in the first few days
after your operation. These will check you are not anaemic and have no infection in
the urine. If you have had the ovaries taken out, the HRT pellet will stop hot flushes
for about six months. You can decide about more HRT then. You may have a fine
tube (catheter) in the bladder to drain it for a day or so after the operation. The
wound in the top of the vagina is out of sight. There may be some discharge from
the vagina after the gauze is taken out. There will be slight bleeding like the end of a
period. It should be almost nil by the time you leave hospital. Use pads. Do not use
tampons for six weeks. There are stitches in the top of the vagina. Sometimes the
surface knots of the stitches will appear on the pads with some bleeding after about
two weeks. This is quite normal. If the bleeding is heavy, contact the ward.
You will be able to take a bath or shower as often as you wish. You do not need salt
water. Do not soak in the bath for more than 10 minutes. Try to keep the wound
area dry for a week.. You will be given an appointment for an Out Patient check up
about six weeks after you leave hospital. They will have the results of the tests on
the womb then. Some hospitals leave check -ups to the General Practitioner. The
nurses will advise about sick notes, certificates etc.
After - At Home
At home, you are likely to feel tired and need rest two or three times a day for three
to four weeks. You will gradually improve. After three months, you should be able to
make an emergency stop without discomfort, generally after six weeks. You will be
able to start sexual relations before your six-week check, if you are comfortable and
have no bleeding or discharge. You may be able to return to a light job after about
eight weeks, but you will not be able to cope with a busy job until at least 12 weeks.
Most hysterectomies are without complication. Minor complications happen in up to

2% of cases. Chest infections may arise, particularly in smokers. Do not smoke.
Occasionally the bladder is slow to start working again. This requires patience. You
may need the catheter back in the bladder for a few days. Wound infection is
sometimes seen. This settles down with antibiotics in a week or two. Aches and
twinges may be felt in the wound for up to six months. Sometimes there are numb
patches in the skin around the wound which get better after two to three months.
Sometimes scarring in the vagina makes intercourse difficult or uncomfortable. This
usually settles down with time.
196
damage to your bladder, bowel and vessels and may require another operation to fix
them.
General Advice
Hysteroscopy
What is it?
A hysteroscopy is a procedure that allows a surgeon to have a look in the uterus
(womb) by using a special telescope. The telescope (and any other instruments that
are needed during the operation) is entered into the womb by passing it first through
the vagina and then through the cervix, which is the entrance of the womb lying in
the deep part of the vagina. A hysteroscopy is most commonly indicated for women
who experience heavy bleeding during their periods; prolonged periods; bleeding
between periods; or bleeding after their periods have stopped (menopause). It is
also indicated in situations where a woman experiences difficulty conceiving, has had
the stress of multiple miscarriages or when there is a suspicion that there is a growth
(a tumour) in the womb.
When a hysteroscopy is performed to detect the cause of a problem it is called a

diagnostic hysteroscopy. When the hysteroscopy includes one or more procedures
that aim to clarify or solve a problem it is called an operative hysteroscopy.
The operation
Both a diagnostic and a operative hysteroscopy can be done as day surgery cases.
This means that you can go home the same day of the operation, usually a few hours
197
after it is completed.
A hysteroscopy is usually performed under general anesthetic. This means that you
will be asleep and unconscious and you will not feel pain during the procedure.
Sometimes, simple diagnostic hysteroscopies can be tolerated where the
anaesthetist gives only some sedative medication (which makes you very sleepy but
not unconscious) in combination with a local anesthetic injection that blocks the
nerves that are close to the area of the operation.
Although the modern telescopes used in hysteroscopies are very thin, in most cases
the surgeon will need to dilate (widen/open up) the cervix by using a special device
so that the telescope or other instruments can be passed into the womb. The inside
of the womb is a collapsed cavity and the surgeon will need to inflate it by using
special gas or liquid so that everything can be seen properly.
In an operative hysteroscopy, following the initial observation, the surgeon will take
one or more samples (biopsies) of the lining of the womb or even gently scrape and
suction the lining of the womb (curettage) and send it for examination under a
microscope in a laboratory so that the cause of the problem that lead to the
hysteroscopy can be identified.
Any alternatives?
A hysteroscopy is clearly the best option for finding the cause of your problem. Other
tests, including various scans of the womb, will not help and can’t give a definitive
answer to the problem.

and may have special tests to make sure that you are well prepared and you can
have the operation as safely as possible. Please tell the doctors and nurses of any
After - in hospital
even boil a kettle during this time. Any pain will usually settle quickly after you have
been to the operating theatre. But you may be left with some tummy discomfort.
Take the painkillers you would normally use for painful periods. For about a week
you will experience slight bleeding similar to the kind you get at end of a period,
especially if you had an operative hysteroscopy. Only use external pads for any loss.
You can start taking the contraceptive pill the day after the operation, even if you
are bleeding. You can bathe or shower as often as you wish. The nurses will advise
198
about sick notes, certificates, etc. If you had a hysteroscopy with scraping and
evacuation of the lining of the womb, pregnancy can happen within weeks of the
procedure and you must use appropriate contraception, if you do not want to
conceive. You can resume sex three weeks after the procedure as long as you are
not experiencing any bleeding or discharge.
Both the diagnostic and the operative hysteroscopies are routine and safe
procedures. Complications are rare, they happen in 0.05% to 1% of cases and they
are more common in operative hysteroscopies.
Very rarely you can have a reaction to the gas or liquid that is used to inflate the
cavity of the womb. This must be recognized promptly and can usually be controlled
with medication.
More than expected bleeding happens in 0.25% of cases. This can be stopped with
medication that causes a spasm of small bleeding vessels (blood pipes) of the womb
or it might require another operation. In this situation, the options for stopping the
bleeding are: a) packing of the cavity of the womb that stops the bleeding by
applying pressure to the bleeding vessels, b) tying off of some of the large vessels
that supply the womb with blood and c) extremely rarely, removal of the womb
(hysterectomy).
Infection inside the womb can occur in about 0.7% of cases. Sometimes the infection
expands to the Fallopian tubes which connect your ovaries to the womb. The
infection can also spread to the rest of your pelvis (the lower part of your abdomen
where your womb is placed). If this happens you will need antibiotics to control the
infection and this might need to be done in the hospital if the infection is serious and
spreads outside the womb.
Finally, in 0.7% to 0.8% of difficult operative hysteroscopies (like for example in

women who had many similar procedures in the past), the instruments can cause a
hole in the womb and they can even damage other organs around the womb such as
the bowel and large blood vessels. In this case you will need another operation to fix
the problem.
General advice
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Knee Arthroscopy
What is it?
The surgeon needs to look inside your knee to find out exactly what is causing your
problem.
• You may have a tear of one of your cartilages. These are half moon shaped pieces
of gristle cushioning the bones in the knee.
• You may have torn one of the ligaments within your knee joint. These are strong
bands of gristle holding the bone ends together inside the joint.
• You may have a loose piece of bone in your knee joint.
• You may have arthritis in part of your knee.
The Operation
arthroscope is a telescope about as wide as a pen, connected to a television. The
surgeon will insert the arthroscope through one or two tiny cuts (about half an inch
1.2cm) around your knee. He will use it to look at the inside of your knee. This
operation is called an arthroscopy. If you have torn a cartilage, he will remove the
torn part using fine instruments inserted through small cuts. Occasionally he has to
make a bigger cut to remove the cartilage. This would be about three inches (7.2cm)
long. If you have torn a ligament within the knee, he will not replace it during this
operation. He will discuss the possible treatments with you after your arthroscopy. If
he finds a loose bone fragment, he will remove it through the small cuts. If you have
arthritis, he can see how severe it is. He will wash out the knee with salt water. This
often improves your symptoms for some months. The cuts will be closed with paper
tapes or stitches. The operation can either be done as a day case, which means that
you come into hospital on the day of the operation and go home the same day, or as
an inpatient case, which means spending one night in hospital. Your surgeon will
discuss with you which way you will be having the operation.
200
Any Alternatives
If you leave things as they are, the knee problem will probably get worse. More X-
rays and scans will not help. Arthroscopy is the only way to give a direct view of the
inside of the joint.

Stop smoking and get your weight down if you are overweight. (See Healthy Living.)
Bring all your tablets and medicines with you to the hospital. On the ward, you may
be checked for past illnesses and may have special tests, to make sure that you are
well prepared and that you can have the operation as safely as possible.. Many
After - In Hospital
You will have a bandage on your knee. Usually the wound is pain-free but you may
feel some discomfort and your knee may feel a bit stiff. This will quickly get better.
You will be given painkillers to take home. They should easily control this discomfort.
kettle during this time. The cuts will be held closed with paper tapes or stitches.
There will usually be simple adhesive dressings or a crepe bandage over the tapes.
You may take the bandages, dressings and the tapes off 10 to 12 days or so after
the operation. Wash around the dressing for the first 10 days. You can wash the
as often as you like once the wound has healed. You will be given an appointment to
visit the orthopaedic outpatient department 10 days or more after your operation.
After - At Home
You will not be able to drive for two weeks after your operation. You will not be able
to perform an emergency stop as quickly as normal before then. How soon you can
return to work depends on your job. If you mainly sit at work, you may be able to
return to work one week after your operation. This also depends on you being able to
get to work. If your job is manual you will be unable to work for two or three weeks.
You may swim and play most sports three weeks after your operation. When you
start playing, you will not be able to play for as long as normal. Your knee may ache
at the end of a game. You will gradually improve.
Complications are rare and seldom serious. Bleeding into the joint and infection of
the joint may rarely happen after the arthroscopy. Sometimes a repeat operation is
needed to remove a damaged cartilage. If there is arthritis, the operation may do no
more than confirm this, without making the knee better.
More serious complications happen very rarely. You can develop a blood clot in one
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of your calf veins (deep vein thrombosis - DVT). This can be very dangerous because
it can travel to your lungs which can be potentially lethal. You will be given
medication (injection of blood thinners), and this in combination with the use of
compression stockings and foot pumps, will protect you and help minimise the risk of
DVT. In addition, during the operation further damage to the knee joint or damage
to the nerves and blood vessels of the area can happen and this may require another
operation to deal with the problem.
General Advice
The operation is a minor one. You should end up much better off after the operation.
Knee Replacement
What is it?
You have developed arthritis in your knee. The surfaces of your joint are no longer
smooth. The bones ends are rough and the cartilage lining has worn away. As a
result, your knee is painful and stiff.
The Operation
You will have a general or spinal anesthetic. A cut is made about 8 inches (19.2 cm)
long down the front of your knee. The damaged surfaces of the lower end of your
thigh bone and the upper end of your shin bone are removed. These are replaced
with an artificial joint. The artificial knee is made from metal and plastic. There are
many different types of artificial knees. Some are held in with special bone cement,
some are not. The surgeon will explain the type he intends to use, and the reasons
for his choice. The skin is then closed up with stitches or clips. You will be in hospital
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for 7 to 10 days following your operation. You may go home when you can walk
safely with crutches or sticks. The main aim of the operation is to stop the pain in
your knee.
After your operation, you should be able to bend your knee from fully straight to a
right angle. As a result you will be able to walk further and climb stairs more easily.
If you have become knock-kneed as a result of your arthritis, the surgeon will try to
straighten your leg with the knee replacement. You should not undergo knee
replacement if you have angina (chest pains) or shortness of breath that limit your
walking more than your knee pain. You should not have a knee replacement if you
have a urinary infection. This may result in infection of your new knee. Your urine
will be tested. If it is infected, you will be given antibiotics before your operation. The
same applies for any other infection, it has to be cleared before you have your
operation. You should not have a knee replacement if you are a man with prostate
problems. If you have poor urinary flow, it is better to have this investigated and
treated before your knee is replaced.
Any Alternatives
If you leave things as they are, the knee will slowly get worse. Steroid injections into
your knee will not help the pain in the long term. If the pain in your knee interferes
with your life and the X-rays show that the joint is severely damaged, then you
should have your knee replaced.

and look after you for the first week after the operation.
be checked for past illnesses and may have special tests, to make sure that you are
ready and that you can have the operation as safely as possible.. You will be asked
to fill in an operation consent form. Many hospitals now run special preadmission
clinics, where you visit for an hour or two, a few weeks or so before the operation for
these checks.
After - In Hospital
Your knee will be wrapped in a bulky bandage. There may be a fine plastic drainage
tube running from the wound. This is to drain any residual blood from the operation.
You may have a knee support on your leg to keep it still when you are not doing
your exercises. The wound may be painful. You will be given injections or tablets to
control this. Ask for more if the pain gets worse. A general anesthetic will make you
slow, clumsy and forgetful for about 24 hours. The nurses will help you with
everything you need until you are able to do things for yourself. Do not make
important decisions during this time.
The physiotherapist will teach you important exercises and you will learn to walk
using walking aids. The occupational therapist will show you how to do many daily
tasks, such as dressing and washing. The physiotherapist may arrange for you to
have therapy as an outpatient. The discomfort of the operation can make it difficult
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to pass urine and empty the bladder. It is important that your bladder does not seize
up completely. If you cannot get the urine flowing properly after six hours, contact
the nurses or your doctor. The wound will have a simple adhesive dressing over it.
The nurses will pull out your wound drain a day or two after your operation. This
does not hurt. Your stitches will be taken out 10 to 12 days after the operation.
Wash around the dressing for the first 10 days. You can wash the wound area as
soon as the dressing has been removed. Soap and warm tap water are entirely
adequate. Salted water is not necessary. You can shower or take a bath once the
wound has healed. You will be given an appointment to visit the orthopaedic
outpatient department about six weeks after your operation. The nurses will advise
After - At Home
When you go home, you will be able to move around the house and manage stairs. It
is very important that you continue the exercises shown to you. You will not be able
to go shopping for the first few weeks after you go home. Please make arrangements
for friends or family to shop for you. Your knee will continue to improve for at least
six months. Some people say that it takes this long for your new knee to feel part of
you. You must not drive for two months after you leave hospital. You will not be able
to perform an emergency stop as quickly as normal before then. How soon you can
return to work depends on your job. If you can get to work without driving yourself
or by using public transport you may be able to return to work six weeks after your
operation. You should not do manual work after a total knee replacement.
Complications occur in about 5 out of 100 operations. Wound infection sometimes

happens. You will be given antibiotics to try and prevent this. You can develop a
blood clot in the veins of your calf (deep vein thrombosis -DVT). A combination of
medicine (injection of blood thinners), special compression stockings and foot pumps
will be used to try and prevent this.
Very rarely, more serious complications can occur during the operation such as
further damage to the knee joint or damage to the nerves and blood vessels in or
around the area of the operation and this may require another operation to deal with
the problem.
Artificial joints last for many years. However they can become loose and painful after
years of use. A further operation may then be necessary.
General Advice
The operation is a neither very simple nor too difficult but somewhere in between.
Overall will be much better off with a new knee joint. We hope these notes will help
204
Laparoscopy
What is it?
You are having pains or swellings which point to the womb, ovaries, or tubes. A look
inside your tummy and pelvis (the lower part of your abdomen where your womb,
ovaries and tubes are located) is needed to see what is going on.
The Operation
You will have a general anesthetic and be completely asleep. A small cut is made in
the skin just below your tummy button. A narrow telescope called a laparoscope is
passed through the tummy wall, and your tummy is inflated with carbon dioxide gas.
This gives the surgeon a good view of the inside of your pelvis. He may also pass
other instruments into the tummy through one or two other cuts. These will help him
to get a better view. He may pass a fine instrument through the vagina and into the
womb to help him move the pelvic parts around as he looks for the problem. A
scraping of the lining of the womb is often taken at the same time. Finally, a stitch is
put into each skin wound. The operation usually takes about 20 minutes. It can
usually be done as a day case. This means you come into hospital on the day of the
operation and go home the same day providing that everything is fine with you and
you recover from the , which usually takes three to four hours. Usually a laparoscopy
tells the surgeon if there is anything wrong. Treatment with tablets may be all you
need. Sometimes the surgeon can operate using special instruments passed down
the laparoscope tubing. This may be just taking a snippet of unhealthy tissue - a
biopsy. Sometimes he can take out all the diseased part. If not a bigger operation
will need to be planned at a later date. Quite often a laparoscopy will reveal that the
womb, ovaries, and tubes are in good order.
Any Alternatives
If you leave things as they are, you may not get any better. The doctors may be
missing something important if you delay. Drugs and medicines will not help. It is
not a good idea to have treatment if the doctors do not know what is going on. You
have already had scans and X-rays and the doctors have looked at them very
carefully and believe that only a laparoscopy can help to identify the problem.
Further scans and X-rays will not help at this stage. You do not need to have a
bigger operation to find the cause of your problem.
205
may have special tests to prepare you so that you can have the operation as safely
as possible. . Please tell the doctors and nurses of any allergies to tablets, medicines
checks.
After - In Hospital
You will have a sanitary pad in place. You may have some discomfort in the tummy
and shoulders caused by the gas inside the tummy. Tell the nurse if this is troubling
you. You can be given an injection to help. After this, mild painkillers should be all
you need. After three or four hours on the ward, you should feel fit enough to go
home. You should be prepared to stay overnight, in case you are still not
comfortable. A general anesthetic will make you slow, clumsy and forgetful for about
24 hours. While you are in the hospital, the nurses will help you with everything you
need until you can do things for yourself. Once you go home , do not make
important decisions, drive a car, use machinery, or even boil a kettle during for those
first 24 hours. You will be given a Follow Up Appointment for two weeks or so, and a
note will be sent to your General Practitioner. The hospital will have the results for
you when you go to the Out Patients Department. Some hospitals leave check-ups to
the General Practitioner. The nurses will advise about sick notes, certificates etc.
After - At Home
Make sure you are going home by car with your relative or friend. At home, go to
bed and rest for at least six hours. Sometimes there may be some bruising in the
tummy, but this will settle after a week or so. You can shower and bath but try to
keep the area of the wound(s) dry for a week. You can take the dressing off the
wound after three days. The hospital will arrange for the stitch to be taken out, if this
is a non-absorbable suture. There may be slight bleeding from the vagina, like the
end of a period. It will last for a few days. Only use external pads for any loss. Do
not use tampons. You can usually go back to normal activity and work after a week.
Avoid heavy exercise for a week. You can have sex after your next natural period if
you feel comfortable enough.
All operations have some risks of complications. However, laparoscopy is a very

common and safe operation. Very rarely bleeding can happen during the operation.
Even more rarely, the bowel or other organs inside the abdomen can be damaged by
the instruments. In either case, the surgeon can deal with the problem straight away
206
through a bigger wound. Sometimes, there is some infection in the tummy button
area after the operation. This settles down with antibiotics. For simple laparoscopies
when the surgeon is just having a look in the abdomen, complications occur in 1-2%
of cases. In more complicated procedures (such as when the surgeon takes small
samples of unhealthy tissue-biopsies for tests) complications can occur in up to 5%
of cases.
General Advice
Laparoscopy and Dye
What is it?
You are having difficulty getting pregnant. In order for you to be able to get
pregnant, your ovaries that produce the eggs must be healthy and the same applies
to the Fallopian tubes that allow the eggs to travel from your ovaries to the womb
where they can get fertilised. Since you have problems getting pregnant, there may
be a blockage in the Fallopian tubes or damage around the ovaries. The ovaries may
not be quite right. The surgeon needs to look inside your tummy and pelvis (the
lower part of your abdomen where your womb, tubes and ovaries are placed) to
identify the problem. The doctor injects some dye up the cervix into the womb. He
can see if the dye flows along the Fallopian tubes and around the ovaries. He may
see other things that are making pregnancy difficult. He is mainly seeing and testing,
but sometimes he can deal with minor problems during the operation. Unblocking the
tubes usually means a bigger operation later. If you need special treatment to get
pregnant later, the surgeon needs to know if the tubes are blocked or not at this
stage.
The Operation
the skin just below your tummy button. A narrow telescope called a laparoscope is
passed through the tummy wall, and your tummy is inflated with some carbon
dioxide gas. This gives the surgeon a good view of the inside of your pelvis. He may
also pass other instruments into the tummy through one or two other cuts. These
will help him to get a better view. He passes a fine instrument through the vagina
and into the womb. Then he injects dye up the instrument into the womb. The
laparoscope is used to see if the dye comes out of the Fallopian tubes near the
ovaries. Finally, a stitch is put into each skin wound. The operation usually takes
about 20 minutes. It can often be done as a day case. This means you come into
hospital on the day of the operation and go home the same day.
Any Alternatives
If you leave things as they are, you may get pregnant. But not if there is a blockage,
The surgeon may not be able to find something simple and easy to fix, if you do not
have the test. Drugs and medicines will not help at this stage. Doing the dye test
with X-rays instead of an operation is not as reliable.

207
packets. Bring them to hospital with you. On the ward, you may be checked for past
that you can have the operation as safely as possible.. Tell the doctors and nurses of
any allergies to tablets, medicines or dressings. You will have the operation
After - In Hospital
You will have a sanitary pad in place. You may have some discomfort in the tummy
and shoulders caused by the gas inside the tummy. Tell the nurse if this is troubling
you. You can be given an injection to help. After this, mild painkillers such as aspirin
or paracetamol should be all you need. After three or four hours on the ward, you
should feel fit enough to go home. You should be prepared to stay overnight, in case
you are still uncomfortable at the end of the day. A general anesthetic will make you
important decisions, drive a car, use machinery, or even boil a kettle during that
time. You will be given a Follow Up Appointment for two weeks or so, and a note will
be sent to your General Practitioner. The hospital will have the results for you when
you go to the Out Patients Department. Some hospitals leave check-ups to the
General Practitioner. The nurses will advise about sick notes, certificates etc.
After - At Home
Make sure you are going home by car with your relative or friend. At home, go to
bed and rest for at least six hours. Sometimes there may be some bruising in the
tummy, but this will settle after a week or so. Take the dressing off the wound while
in the bath or shower after three days. You can shower and bath but try to keep the
area of the wound(s) for a week. The hospital will arrange for the stitch to be taken
out. There may be slight bleeding from the vagina, like the end of a period. It will
last for a few days. Only use external pads for any loss. Do not use tampons. You
can usually go back to normal activity and work after a week. Avoid heavy exercise
for a week. You can have sex after your next natural period if you feel comfortable
enough.
All operations have some risks. However, laparoscopy is a very common and
relatively safe operation. Complications occur in 1-2% of cases. Very rarely bleeding
can happen during the operation. Even more rarely, the bowel can be damaged by
the instruments. In either case, the surgeon can deal with the problem straight away
through a bigger wound. Sometimes, there is some infection in the tummy button
area after the operation. This settles down with antibiotics.
Finally, very rarely, you can develop an allergic reaction to the dye. The anaesthetist
208
will ask you before the operation for any allergic reactions that you had in the past to
establish whether you have an increased risk for such reactions. Even if you have not
had similar problems in the past you can still have a reaction to the dye and the
anaesthetist will give you medications to control it.

General Advice
Laryngoscopy and Biopsy
What is it?
There is something wrong with your voice or throat. The problem lies in your larynx
or voice box. The larynx fits inside your Adam's apple at the top of your windpipe.
Inside your larynx, the vocal cords make your voice. They are not really cords. They
look more like the sliding doors at the entrance to a supermarket. They fit across the
top of your wind pipe. If the cords are held open by the muscles in your larynx, air
will pass in and out of your windpipe for normal, quiet breathing. If the cords are
pulled nearly shut by the muscles as you breathe out, the edges of the cords vibrate.
This makes a sound - your voice. If the cords are completely shut, as you breathe
out, and then you open the cords suddenly, this is a cough. If the cords are lumpy
and do not fit together well, your voice and your cough will be weak. You have
probably had an examination with a mirror looking down your throat in the
outpatient department. This is called an indirect laryngoscopy. This did not give all
the information that was needed. The surgeon now needs to have a closer look inside
your larynx to find out exactly what is wrong. Usual indications for laryngoscopy are
voice problems (such as weak or hoarse voice), unexplained throat pain, difficulties
in swallowing, injuries in the area of the voice box or suspicion that there is a lump
or a foreign body in the voice box.
209
The Operation
You have a general anesthetic and are completely asleep. Because you are relaxed
when you are asleep, the surgeon can pass a telescope through your mouth and into
the top of your voice box. He is then able to examine the inside of the voice box very
carefully. While you are asleep, he passes a special telescope called a laryngoscope
into your larynx. The operation is called a laryngoscopy. Sometimes the surgeon
shines a microscope through the telescope to help him see the vocal cords better.
This is called a microlaryngoscopy. If the surgeon sees any swellings inside the voice
box, he can take a sample of tissue (a biopsy) from inside the larynx at the same
time. This is done with a very small cutting instrument. The biopsy is examined in
the laboratory to find out what it is. Because only a very small piece of tissue has
been removed, it is not necessary to use any stitches. The wound will heal up very
quickly. If the surgeon takes a biopsy from one of the vocal cords, you will need to
rest your voice for 10 days after the operation, while the vocal cord heals up. This
means no speaking at all for 10 days. Instead you will have to write things down.
When the surgeon sees you after your operation he will tell you whether he has
taken any biopsies from the vocal cord, and whether you need to rest your voice or
not. Sometimes a swelling inside the voice box can be removed with a laser.
Any Alternatives
If you leave things as they are, the doctors will not know what is going on in your
larynx. You may miss out on having early treatment which would be extremely
important to have if a lump in your cords proved to be cancer. It is a bad idea to
start any treatment, if it is not known for certain what is wrong. X-rays and scans
may show a lump but will not tell the doctors what type of lump it is. The best way is
for the surgeon to look inside the voice box and check it thoroughly using a
laryngoscope.

and look after you for the first couple of days after the operation. Sort out any
tablets, medicines, inhalers that you are using. Keep them in their original boxes and
nurses of any allergies to tablets, medicines or dressings. Because the surgeon uses
a telescope inside your mouth, it is important that you tell him before the operation
if you have any loose teeth, dental crowns or bridges, and any stiffness or problems
with your neck. You will have the operation explained to you and will be asked to fill
in an operation consent form. Many hospitals now run special preadmission clinics,
checks. If you have a cold in the week before your admission to hospital, please
telephone the ward and let the ward sister know. The operation is usually put off,
and you are given time to get better before being sent for again. You will need to get
over the cold before the operation can be done because by having an anesthetic the
cold could turn into a serious infection in the chest.
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After - In Hospital
You may be given oxygen from a face mask for a few hours if you have had any
chest problems in the past. You will have a slightly sore throat when you wake up.
This is where the telescopes have been rubbing inside. The sore throat will only last
a day or so. Painkilling tablets should easily control this discomfort. Ask for more if
the soreness is not well controlled or if it is getting worse. If the surgeon has
removed any tissue from your vocal cords the nurses will remind you that you must
not speak. You will be given a pencil and paper to write things down instead. A
general anesthetic may make you slow, clumsy and forgetful for about 24 hours. The
kettle during this time. The day after the operation, the doctors will see you and
make sure that your throat is comfortable. You will then be able to go home. Before
you leave the ward you will be given an appointment to come back to the ENT (ear,
nose and throat) outpatient clinic to see the surgeon again. If you have had any
biopsies taken the surgeon will have the results of these when he sees you in the
clinic. If the surgeon wants you to have voice therapy you will be given an
appointment to attend the speech therapy department. The nurses will advise about
After - At Home
Take two painkilling tablets every six hours to control any sore throat. Remember if
you have been advised to rest your voice this means no speaking for 10 days. You
will be fit to drive again when you get home. You should be fit to go back to work
after 48 hours.
Provided the advice given above is followed you are unlikely to have any problems. If
you have had a biopsy taken from inside the voice box, you may cough up a small
amount of fresh blood during the first 24 hours. If you continue to cough up lots of
fresh blood at home, come back to the ward. If you have had a biopsy taken from
the vocal cord, there is a small risk that the scarring on the cord will change your
voice slightly as it heals up. The chances of this happening are very slight.
There is a small risk of infection at the area of the operation especially if a biopsy
was taken. If you develop increasing pain in the throat, a headache or a
temperature, it probably means that an infection is developing and you will need
medical attention promptly. Taking antibiotics for a week or two usually solves the
problem.
The most dangerous, although very rare, complication after a laryngoscopy is the
development of spasm or swelling in the area of the voice box that can seriously
affect or completely stop breathing. This is a very serious condition and it can require
another operation to deal with the problem. Although this usually happens while you
are still in the hospital, there is a very small chance that it will happen in the early
days after your discharge from the hospital especially if you develop an infection in
the area of the operation. Therefore, you must be alert and if you are experiencing
211
breathing problems, you should come back to the ward or to the nearest Accident
and Emergency Department urgently and preferably with the help of a relative or a
friend.
General Advice
Laser treatment for diabetic retinopathy
What is it?
Diabetic retinopathy is a complication of diabetes and it can seriously affect vision
and lead to blindness. Diabetic retinopathy is the leading cause of blindness for
people who are between 20 and 65 years old. Diabetics are 25 times more likely to
become blind than any other member of the population.
Poorly controlled diabetes can cause many problems. One of these is thickening of
the wall of small blood vessels (small pipes that feed various parts of the body with
blood) and subsequently the narrowing of their lumen (the internal space of the
pipes through which the blood flows). Because of this narrowing, which can
sometimes result in a complete blockage, not enough blood gets to certain parts of
the body and this obviously affects the function of certain organs. One of the areas
where this problem becomes very obvious is the retina. The retina is the lining at the
back of the eye. It is here that the light/image is converted into nerve waves/signals,
which then 'travel' through the nerves to a certain area of the brain so that you can
finally see the light/image. The retina has two layers that are attached (stuck) to
each other. The centre of the retina is called the macula and this is involved in
providing detailed/precise vision.
There two types of diabetic retinopathy.

1. The non-proliferative/background type, which is the milder form that appears in
the early stages of retinopathy.
2. The proliferative more severe type that appears as the condition progresses.
In non-proliferative retinopathy the affected small vessels have a lot of small bulky
areas (aneurysms) which can burst and cause bleeding within the retina or within the
vitreous (the 'jelly ball' that occupies the centre of the eye). These small bleeds can
212
obviously affect vision especially if they cover the macula or they spread into the
vitreous.
In proliferative retinopathy, the retina develops many small new vessels to
compensate for the reduction of the blood supply by the original vessels which have
been narrowed because of the diabetes. Unfortunately, the proliferation/development
of new vessels is done in a disorganised way and they can sometimes even cover the
macula. These new vessels are also very frail, they burst and bleed and the blood
spreads into the retina or the vitreous and affects vision. In addition, the presence of
the new vessels and the multiple bleeds from them can lead to the development of
many bands of scarred tissue which can pull on the retina and detach/separate its
two layers (retinal detachment). Retinal detachment is an emergency condition and
can have a detrimental effect on vision.
In most patients diabetic retinopathy, even if it is advanced, is not associated with

many symptoms. This is why it is very important for a diabetic patient to have
regular eye tests to monitor the progress of the disease and plan appropriate
treatment. When symptoms appear (floaters and flashes in the field of vision, and
partial or total loss of vision, or pain) it usually means that the disease has
progressed dramatically and treatment may not be very effective.
The operation
The operation can be done as a day surgery procedure, which means that you can go
home on the same day of the operation.
Initially, the pupil (the small round transparent part in the centre of the iris which is
the coloured part in front of the eye) is dilated (made wider) by using some special
eye drops. Following that, the eye is numbed with eye drops that contain local
anesthetic. Sometimes, an extra injection into the side of the eye is needed to make
the procedure totally painless and comfortable. A contact lens is placed on the eye.
The patient sits and faces the laser machine. The laser light passes through the
contact lens and the pupil in the eye and is directed in a very accurate way to the
many small vessels that have created the problem. During the procedure you may be
asked to turn your eyes to look in different directions so that the laser light can be
applied to different areas of the retina.
The laser light works in two ways.
1. It scars the vessels that have a tendency to bleed and so prevents any further
bleeding.
2. It destroys substances in the retina that help/stimulate the massive disorganised
proliferation of small vessels in the surface of the retina.
It is estimated that 2,500 to 3,000 tiny burns are needed to treat an eye with
proliferative retinopathy. For this treatment to be completed you will most likely
need more that one laser sessions.
Sometimes, when there is a lot of bleeding in the vitreous it can become 'cloudy',
which affects vision and also doesn’t allow the laser light to get through to the retina.
In this situation, the surgeon may need to perform a more complicated procedure.
He may have to make a small cut on the side of the eye to remove the vitreous
(vitrectomy), and replace it with some special liquid and carry out laser treatment at
the same time. This procedure can still be done as a day surgery case.
If due to diabetic retinopathy you experience the relatively rare acute problem of
retinal detachment, you will need an urgent procedure to put the layers of the retina
back together.
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Any alternatives?
There is no cure for diabetic retinopathy. Laser treatment is the only way to stop the
progression of the disease particularly when it has reached the proliferative stage.
However, it has been proven that very tight proper control of your blood sugars,
effective control of your blood pressure and stopping smoking can substantially delay
the progress of the disease and also contribute to a better outcome after laser
treatment.

Stop smoking and get your weight down of you are overweight. (See Healthly
Living). If you know that you have problems with your blood pressure, your heart or
After - in hospital
Following laser treatment, most patients experience some minor discomfort in the
eye which can be easily controlled by taking tablets. Your vision might be blurry for a
few hours and the operated eye can be sensitive to light. If you had a vitrectomy,
your eye may well be red and you might have some pain. If this happens, you will be
given tablets or an injection to control any pain or discomfort. You can wash, bathe,
or shower normally after the operation, but you must not get water in your eye for a
month, especially if you had a vitrectomy. If you have your hair washed, have it
month. You will normally be able to go home on the day of your operation. You will
be given a supply of eye drops, and be shown how to put them in your eye. These
are used to prevent infection and swelling in the eye. You will be given an
appointment for the outpatient department for a check-up one to two weeks after
you leave hospital. The nurses will advise about sick notes, certificates, etc.
After- at home
Following laser treatment it is advisable to wear sunglasses until your eyes are no
longer sensitive to light. If you had a vitrectomy, your eye will be covered by a pad
and a protective plastic shield. This is to stop you touching your eye, especially when
you are half asleep. Sometimes it takes a few days for the eye to settle down and
the patient to experience improved vision. You MUST wear the eye shield to protect
the operated eye at night, or if you sleep during the day. You will be told in the
outpatient clinic when you can stop using the shield (normally about one month).
During the daytime you can use any glasses you were using before the operation. If
you wear contact lenses, do not put one in the operated side for eight weeks. Plan to
go back to light work after one to two weeks, and a more heavy/manual job after
about three months.
You must be very careful with driving in the early stages after the procedure because
your sight may not be as good as you think it is. Ask the doctor whether your sight is
good enough to drive. If in doubt, don't drive.
Complications after the operation are not common but they can be problematic.
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Following laser treatment it is possible that you will experience:
• some decrease in you peripheral or even your central vision
• a decrease in your colour vision or your night vision. This is usually a temporary
problem but, rarely, can become permanent.
Following a vitrectomy, there is a small risk of bleeding at the back of the eye. This
can cause pain and affect your vision. This usually settles by itself but it might need
another operation to fix it. The eye may also become infected. Drops of antibiotics
and of anti-swelling medications will be needed to treat the infection. Rarely, the
surgical manipulations during a vitrectomy can be the cause of a retinal detachment.
In this situation you will need another urgent operation to put the two layers of the
retina back together.
Overall, the results of laser treatment are very good. Although it cannot improve
vision, studies show that it can stop further progress of diabetic retinopathy and loss
of vision in about 80% of patients.
General advice
LASIK surgery for myopia
What is it?
LASIK (laser assisted in-situ keratomileusis) surgery is an operation that is done to
correct nearsightedness (myopia) by using laser light.
The cornea is the clear/transparent film in the front of the eye that lies just in front of the
coloured part which is the iris. The cornea allows light to enter the eye and also refracts/bends
the light and focuses it at the back of the eye which is the photosensitive area called the
retina. If there is a problem with the shape of the cornea, the light focuses in front of and not
exactly on the retina and this doesn’t allow you to clearly see objects that are away from you.
In LASIK surgery, the cornea is properly reshaped by the laser to allow the light to focus on
the retina. LASIK surgery can be used for people with mild, moderate or severe myopia. It's
not indicated for people who:
• are aged less than 18 years.
• have not had stable vision for at least one year.
• have any other diseases of the cornea.
Although nearsightedness is the main indication for LASIK surgery, it has also been used to a
much lesser degree for the correction of hypermetropia and astigmatism. In hypermetropia
(farsightedness) the cornea focuses the light behind the retina, while in astigmatism the light
has a split focus which results in blurred vision.
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The operation
The operation takes about 30 minutes and is carried out as a day surgery case,
which means that you will go home on the same day of the operation.
The operation takes place in a room that has the Laser system. You will be on a
special chair that is similar to a dentist's chair. You will be lying on your back and
your eye will be numbed with some anesthetic eye drops. A special device is used to
keep the eyelids open. A microscopic knife will be used to cut a small flap in the
centre of the cornea. The cut is not complete; a small bridge of tissue is left to keep
it in contact with the rest of the cornea. The flap is then lifted and folded back. Via
this opening the laser light can get through to the inner aspect of the cornea. The
laser system will then be positioned close to your eye and the laser light will be
directed towards the inner aspect of your cornea. The laser light vaporises the tissue
of the inner aspect of the cornea and reshapes the cornea in such a way that after
the operation it will focus the light on the retina allowing you to clearly see objects
that are away from you. The amount of laser light/energy that will enter your eye
and the way it will reshape the cornea is controlled by a computer which is very
accurate. After the laser treatment the flap of the cornea is put back in place but it is
not stitched. A pad/shield will be placed over the eye at the end of the procedure to
protect it.
Any alternatives?
This is an entirely elective procedure that is being done to help you to get rid of the
inconvenience of wearing spectacles/glasses or contact lenses. You don’t have to
have LASIK surgery and therefore, you need to have a very detailed discussion with
your ophthalmologist before you decide to have the procedure.

If you are using contact lenses, you need to stop wearing them three to four weeks
before the operation and use glasses instead. This is because contact lenses affect
the shape of the cornea and it needs three to four weeks to revert to its natural
shape. If the cornea does not have its natural shape before the operation, the laser
cannot reshape it accurately and effectively to provide a successful result.
After - in hospital
Most patients experience little pain or discomfort after LASIK surgery but may have
some minor swelling of the eye. You may be given tablets to control the pain or
discomfort. Your eye may also itch or produce tears. Don’t rub it! You can wash,
bathe, or shower normally after the operation, but you must not get water in your
eye for a month. If you have your hair washed, have it done with your head leaning
backwards. Do not use makeup on your eyelids for one month. You will be given a
supply of eye drops and be shown how to put them in your eye. The drops are used
to prevent infection.
You will be given an appointment for the outpatient department for your first check-
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up one to two days after your operation. From then on you will have regular
appointments (the frequency depends on your progress) for six months after your
operation. The nurses will advise about sick notes, certificates, etc. You are advised
to have somebody with you to drive you home.
After- at home Even if everything is well during your first visit as an outpatient one
to two days after your operation, you will continue to have your eye covered by a
pad and a protective plastic shield. This is to stop you touching your eye, especially
when you are asleep. You MUST wear the eye shield to protect the operated eye at
night, or if you sleep during the day. You will be told in the outpatient clinic when
you can stop using the shield (normally about one month). During the day you can
use any glasses you were using before the operation. Sun glasses are a good idea to
protect your eyes from the glare. You must not use contact lenses.
After the operation any activity that can jolt the eye must be avoided. Contact sports
must be avoided after LASIK surgery for at least four to six weeks. Plan to go back to
light work in about two to three weeks, and a more heavy/manual job after about
three to four months.
Initially, your vision might be blurry for the first few days after the operation but it
will gradually improve. It usually takes three to six months to experience the
maximum improvement and stability of your vision.
You must be very careful with driving because your sight may not be as good as you
think it is. Ask the doctor whether your sight is good enough to drive. If in doubt,
don't drive.
Complications occur in 1 to 5% of cases. The eye may become infected in the area of
the operation. Drops of antibiotics and of anti-swelling medication may be needed to
treat the infection. You may also experience the problem of dry eye which can cause
irritation, redness and discomfort. This is treated by using eye drops that help to
keep the area wet until the symptoms go away.
The dislocation of the flap after the operation can be a problem which has to be
treated promptly with another operation to put it back in place before it affects
vision. Sometimes, while the cut around the flap is healing, a lot of scarred tissue
can develop and this can blur your vision. You may need further laser treatment or
another operation to deal with this problem, but this is not always successful.
LASIK surgery can sometimes under-correct or over-correct the problem of myopia
or, rarely, can make it worse. In this situation you may require further laser
treatment but there is a chance that the result will not be successful.
LASIK surgery significantly improves the vision of 80 to 90% of people with less than
6 diopters (a unit used to measure how well a person sees - the more the diopters
the worse the vision) of myopia. The procedure results in significantly better vision in
30 to 60% of people with 6 to 12 diopters of myopia.
General advice
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Liposuction
What is it?
Liposuction is the removal of fatty tissue from underneath the skin using small
incisions and metal cannulas. It can also be called 'body contouring, lipoplasty or
liposculpture'. It tends to work best for treating localised areas of fat that have not
responded to diet. In some situations ultrasound treatment may also be used in
order to assist dissolving the fat prior to removing it by suction.
The Operation
Small areas of liposuction can be carried out under local anaesthesia. For bigger
areas the procedure is performed under a general anesthetic. The area of the body
which has the excess fat is usually marked out prior to surgery to identify those
areas that are most prominent. During surgery, small incisions are made. Some
fluid is then introduced into and around the fat in order to assist removal of the fat.
The fat is then sucked out. Extreme care is taken not to damage the overlying skin
or underlying important structures like nerves and blood vessels. The small incisions
are closed with dissolving stitches. The surgery is usually performed as a Day Case.
After the operation, it is likely that the patient will need to wear an elasticated
garment in order to help control the swelling and improve the overall shape.
Liposuction may also be used in conjunction with other procedures such as a face-
lift, in order to provide better definition of certain areas (e.g. under the chin).
Any Alternatives
Ultrasonic assisted liposuction can also be used. The ultrasound causes the fat to
break up into smaller particles. The operation however, takes longer to do than the
ordinary liposuction method.
Liposuction removes fat cells and though these fat cells cannot come back again,
continued weight gain will remove the benefits of previous liposuction. It is
important to realise that liposuction is not a treatment for obesity. A properly
controlled diet and exercise regime can produce significant weight loss.
Before the Surgery

It is important in your pre-operative assessment to be aware of the quality of your
skin prior to surgery. To have good results, one needs to have skin that has
elasticity. Removal of the fat without skin elasticity can end up with wrinkly excess
skin. In some situations it may be more appropriate to perform surgical excision of
the skin and fat, for example tummy tuck.
After - In Hospital
There is likely to be some pain and discomfort in and around the are where the fat
has been removed. Local anesthetic is frequently given so this may alleviate the
immediate postoperative pain. It is also important to wear an elasticated garment to
provide compression to the area where the fat has been removed. This is helpful in
order to minimise swelling and improve the final result. Simple painkillers, such as
Paracetamol, usually alleviate discomfort after surgery. There will be swelling,
bruising and discoloration of the skin. In most situations this settles down without
specific treatment or can be helped by the use of massaging around the area.
After - At Home
It is important to continue to wear the elasticated garment for six weeks. Following
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this time it may also be useful to maintain gentle compression over the area. If the
liposuction has been performed around the hips, use a pair of cycle or Lycra shorts
(or equivalent). For other sites, other alternatives can be discussed with your
surgeon. Swelling can persist for several months after treatment. There may be
persistent numbness over the treated area.
The complications specifically with sucking out fat include residual irregularities,
areas that are lumpy, areas of tenderness, insufficient removal of fatty tissue and
wrinkling of the skin in the post operative phase. If liposuction is performed too
close to the surface of the skin, ridging of the area can be noted and this can
persist. Very occasionally damage can occur to the skin itself which can produce
scab formation leading to scar formation. Bleeding can occur underneath the skin
that can lead to clot formation and further potential for irregularities. Large amounts
of fatty tissue can be removed using liposuction but it is important, in those
situations, that controlled replacement of fluid is performed. There have been
occasional incidences of heart and lung problems related to excess fat aspiration and
intravenous fluid replacement. There can be abnormalities, unusual sensations
where large amounts of fat have been removed but this tends to improve as time
passes.
General advice
Return to normal activities depends on how much fatty tissue has been removed and
to what extent there is continued soreness and problems.
If liposuction is performed as part of a major surgical procedure like a tummy tuck or

a breast reduction, it may take many weeks before the patient can return to work.
However, with small areas of liposuction to improve contour defects, the patient may
be able to return to work very rapidly, depending on whether the surgery is
performed under general or local anesthesia.
Those with experience should only perform liposuction as significant distortion

following inappropriate use can occur.
Lower Face Lift
What is it?
A lower face-lift is an operation to improve the loose skin of the neck, the jaw line,
the deeper wrinkle lines, and the corners of the mouth.
The Operation
There are a number of different techniques used to tighten the skin on the face. The
surgery is usually performed under general anesthesia and may be aided by using
endoscopic surgical techniques.
Any Alternatives
Some improvement in the fine wrinkles of the face can be achieved temporarily by
skin hydration. Deep furrows and wrinkles may be helped by the use of Botox
injections, which paralyses the underlying muscles and prevents wrinkling of the
skin. However, the excess saggy skin will still be noticeable.
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It is most important to give up smoking. This can have a serious effect on the blood
supply to the skin and cause areas of skin on the face to become black and scarred
following surgery. It is also useful to be at one's chosen weight or even somewhat
underweight, as weight loss subsequent to the surgery can allow further wrinkling to
occur. One should avoid taking Aspirin or Aspirin containing pain medication as this
can increase bleeding following surgery and cause blood clot formation underneath
the skin, and interfere with wound and skin healing. The operation itself takes about
two hours to perform and your surgeon would assess if you are fit to undergo such a
procedure.
After in Hospital
Depending on the extent of surgery performed you can be in hospital from one to
three days. After you wake up it is likely that you will have soft padding around your
face and you may have drains. It is also likely that there will be an intravenous drip
to provide fluid. The nurses will check your blood pressure, pulse and temperature
on a regular basis and observe the color of the skin of your face. It will also be likely
that you will be asked to keep upright, avoid coughing, stooping and straining.
Staying semi upright helps reduce the swelling and enables better observation by the
nurses. Maximum swelling tends to occur within forty-eight hours. To decrease the
swelling further, cold bandages or packs may occasionally be applied during the day.
Pain killer tablets or injections will be available. The drains and dressings are
removed prior to discharge to hospital and further dressings or scarf may be applied.
After at Home
You may have numbness on your face and neck for several weeks and this can
sometimes last longer. It is important again to avoid any bending or heavy lifting for
two weeks following surgery. You should not smoke, not take alcohol or Aspirin for
at least two weeks following surgery. Continuing to sleep upright at night will help to
decrease swelling of the face. . You should avoid stooping or straining or bending
over as this can cause a rushing of blood to the face, discomfort and occasionally
some minor bleeding. The sutures are usually removed between five and ten days
following surgery depending on the extent of surgery. Bruising may be obvious for
two to three weeks following surgery.
Cosmetic make-up may be used but should avoid the suture line itself until it is well
healed some two to three weeks following surgery. As with any major surgery, you
may feel tired for a few days after the operation and this can last for two to three
weeks. Serious physical or gym activity, aerobics are probably best avoided for up
to one month following surgery although one can do gentle exercises such as
swimming once the wounds are soundly healed.
Complications
The blood supply to the face is very good. Because of this, wounds heal very well
but during any surgery bleeding can occur. Your surgeon is very careful to stop
bleeding at the time of surgery and drains are usually left in afterwards. If heavy
bleeding occurs following surgery underneath the skin, it is likely that you will need
to return to the operating theatre in order to have this controlled. Small episodes of
bleeding are likely to occur and this can result in areas of thickening underneath the
skin flaps. This will settle with time, particularly with gentle massage for a few
weeks following surgery. Infection is unusual but can occur and can cause problems
with wound healing. It is also important that surgery should not be performed if
there is evidence of any cold sore or Herpes at the time of surgery. The nerves of
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facial expression are underneath the muscle layer of the face and these can very
occasionally be bruised or injured when doing face-lift surgery. This particularly
occurs with the nerve that goes to the side of the mouth and so can result in a
weakness here. It is unusual for this to occur and usually settles over a period of a
few months. Numbness of the ear may also be noted as the nerve that gives
sensation to the ear is quite close to the surface of the skin in the neck region.
Although the blood supply to the skin is very good, in order to get a good result a
certain amount of tension has to be placed on the skin. This can sometimes interfere
with the circulation of the skin, particularly in smokers, and should the circulation be
badly affected some of the skin can become necrotic and die. This can result in
areas of skin loss and very occasionally skin grafting may be required.
General Advice
A face-lift may be part of a number of procedures to try and rejuvenate the ageing
face. The type of face-lift procedure will depend on the individual, the excess skin
and the overall facial appearance. Significant weight loss can also precipitate a
problem with excess skin on the face.
Face-lift operations last for from five years upwards depending on the age at which it
is performed. It also depends on whether or not excess weight gain or weight loss
occurs subsequent to the surgery. It can be performed again. Best results are in
non-smokers.
Lumps and Bumps and Skin Lesions - Removal
What is it?
You have a lump or a mark or a blemish which is causing trouble or worry. There are
three good reasons for having the piece taken out. First you will be freed from the
symptoms. Second, it will no longer be there to worry you. Third, we can examine
the piece under a microscope to find out exactly what it is.
The Operation
You can be given a local or a general anesthetic. The choice depends on what your
surgeon thinks is best. Having a general anesthetic means that you will be
be awake during the operation, but will not be able to feel anything in the part of
your body that is being operated on. The piece is cut out using an incision which is
planned to leave the best possible scar afterwards. Whenever possible this means
using natural skin lines and creases. Hair may need to be shaved away. The wound
is then closed, usually with stitches. You can leave the hospital the same day usually.
Any Alternatives
If you leave things as they are, the problem remains. It may get worse. Injections,
lasers, cautery, and drug treatment will not be as good as surgery. You do not need
to have anything more than this small operation at this stage.

a relative or friend who can come with you to hospital and take you home. Bring all
221
your tablets and medicines with you to hospital. On the ward, you may be checked
for past illnesses and may have special tests, ready for the operation. Many hospitals
After - In Hospital
If you have had a general anesthetic you will come round within 15 minutes. A
general anesthetic will make you slow, clumsy and forgetful for about 24 hours. Do
during that time. If you have had only a local anesthetic you will be completely
awake and alert throughout. Local anesthetic will wear off after an hour or two, so
the wound gradually gets uncomfortable. Take Aspirin or Paracetamol early to
control any pain. Feeling in the wound may come back quicker after a general
anesthetic so that you should be ready to take painkillers inside an hour. The nurses
will give you a supply of painkillers. The wound should be just about pain-free within
a day or so. The wound may have stitches which need to be removed or stitches
which melt away. There may be a dressing or no dressing. You will be told about the
arrangements for your own wound. There may be some purple bruising around the
wound which spreads downwards by gravity and fades to a yellow color after 2 to 3
days. It is not important. There may be some swelling of the surrounding skin which
also improves in 2 to 3 days. You can wash the wound area as soon as the dressing
has been removed. Soap and warm tap water are entirely adequate. Salted water is
not necessary. You can shower or bathe as often as you want. Some hospitals
arrange a check up about a week after you leave hospital. Others leave check-ups to
the General Practitioner. You will be given the results from the laboratory microscope
tests. The nurses will advise about sick notes, certificates etc.
and surgical staff. If you think that all is not well, ask the nurses or doctors. Bleeding
may show up as swelling under the skin or by blood coming through the dressing.
This may happen in the first 12 hours. Get advice from your doctor straight away.
two. The wound is not strong enough to take blows or rough treatment for 2 to 3
weeks. Be careful with it during this time. Occasionally there are numb patches in
the skin around the wound which get better after 2 to 3 months. The wound may
take up to a year to really soften and fade. Rarely there is thickening in the wound
that lasts longer.
General Advice
The operation is a minor one and the results are very good. We hope these notes will
help you through your operation. They are a general guide. They do not cover
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Mastectomy
What is it?
Mastectomy means removal of a breast. At the same time some or all the glands in
the arm pit may well be taken out. The end result is smooth skin across half the
chest with a scar across it.
The Operation
You will be given a general anesthetic and be completely asleep during the
operation. The operation takes about 60 minutes.
Any Alternatives
Leaving things as they are would mean that the problem in the breast will get worse.
Simply taking out the diseased part and using x-ray treatment for the rest of the
breast is not for you. This is because a safe margin of healthy breast tissue can not
be achieved, or the background tissue is not stable, or you are not happy with the
idea. X-ray treatment on its own would not be as good in your case. Neither would
drug treatment on its own. Coring out the breast tissue would not give a safe
margin. Re-building the breast with an implant at the time of mastectomy is often
risky from the point of view of healing.

doctor to check that these are under control. Check you have a relative or friend who
can come with you to hospital, take you home, and look after you for the first week
after the operation. Bring all your tablets and medicines with you to hospital. On the
ward, you may be checked for past illnesses and may have special tests, ready for
the operation. Many hospitals now run special preadmission clinics, where you visit
for an hour or two, a few weeks or so before the operation for these checks. You
should already have met the Breast Specialist Nurse. She will continue to help you
during and after your hospital stay.
223
After - In Hospital
You will be able to drink within an hour or two of the operation provided you are not
feeling sick. The wound has a dressing which may show some staining with old blood
in the first 24 hours. The dressing will be exchanged for a clean one which stays until
the drain tubes are removed after 4 to 5 days. You will probably have a drip tube in
an arm vein and also one or two fine plastic drainage tubes in the skin near the
wound. There is some discomfort on moving rather than severe pain. You will be
given injections or tablets to control this as required. Ask for more if the pain is still
unpleasant.
You will be expected to get out of bed the day after the operation, despite the
you. The second day after the operation you should be able to spend most of your
time out of bed and in reasonable comfort. You should be able to walk slowly along
the corridor. By the end of one week the wound should be virtually pain free. There
will probably be stitches or clips in the skin. They will be taken out in 7 days or so.
Sometimes the wound is held together underneath the skin with stitches that just
melt away and do not need further attention. The drain tubes are removed in 4 to 5
days depending on the amount of drainage. Do not be disappointed if the drainage
actually increases after 3 days or so. You can wash the wound area as soon as the
dressing has been removed. Soap and tap water are entirely adequate. Salted water
is not necessary.
The wound gradually improves for one to two months after the operation. You may
be fitted with a soft sponge filling for your bra to give you some shape until a more
permanent filling can be fitted when the wound has settled down. A check up will be
arranged for a week or so after you leave hospital. The results from the examination
of the breast tissue will be available then. You will be informed about deciding on any
further treatment. The nurses will advise about sick notes, certificates etc.
After - At Home
more. You will need to continue arm and shoulder exercises to prevent getting a stiff
shoulder. You will gradually improve so that by the time a month or so has passed
10 days. You can safely wear a seat belt. You can restart sexual relations within a
month or so, when the wound is comfortable. You should be able to return to a light
job after about 4 weeks and a heavier job within 8 weeks.
Complications are seldom serious. If you think that all is not well, please ask the
nurses or doctors. Bruising may be troublesome. Occasionally some old blood
collects under the wound, but this can easily be removed with a needle in the two or
three weeks after you leave hospital. Occasionally the wound edge does not heal well
in places. This settles down, but may take 3 or more weeks to do so. Infection is a
rare problem and settles down with antibiotics in a week or two. Aches and twinges
may be quite troublesome in the wound, shoulder and arm for up to 6 months.
Occasionally there is a numb patch in the skin of the armpit and down the inside of
the upper arm. This patch slowly lessens in size but may always be present. There
may be some swelling of the arm.
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General Advice
The mastectomy operation is much less of an undertaking than was the rule 10 or
more years ago. Patients are usually surprised how little discomfort there is.
However it may take a year or two before they feel comfortable about having had a
mastectomy. Details of further treatment, including possible rebuilding of the breast,
will be discussed with you and your surgeon. These notes should help you through
Mastectomy - Male Subcutaneous
What is it?
Everyone has some breast tissue. In males this normally does not grow. However, in
your case this tissue has started to grow. It is commoner in young men. It does not
mean that you are having a sex change. It can be very embarrassing, but it is not
serious.
The Operation
surgeon normally makes a cut around part of the nipple. He takes out the breast
tissue. The overlying skin and nipple stay there. The cut is stitched up. Afterwards
the chest looks pretty normal for a male. The operation can either be done as a day
case, which means that you come into hospital on the day of the operation and go
home the same day, or as an in-patient case, which means spending one or two
nights in hospital. Your surgeon will have discussed with you which operation you will
be having.
Any Alternatives
You can leave things as they are. In your case the breast will stay more or less the
same, probably for years. There is no good drug treatment. X-ray treatment is not a
good idea.

your family doctor to check that these are under control. Check you have a relative
or friend who can come with you to hospital, take you home, and look after you for
are using. Keep them in their original boxes and packets. Bring them to hospital with
you.
an operation consent form. Many hospitals now run special pre-admission clinics,
checks.
After - In Hospital
Some patients feel a bit sick for up to 24 hours after the operation, but this passes
off. You will be given some treatment for sickness if necessary. You may be given
225
oxygen from a face mask for a few hours if you have had chest problems in the past.
You may have a drip tube in an arm vein and also one or two fine plastic drainage
tubes in the skin near the wound. These last tubes are each connected to a plastic
vacuum container. You will find these vacuum containers lying near you under the
sheets. A general anesthetic will make you slow, clumsy and forgetful for about 24
hours. Do not make important decisions, drive a car, use machinery, or even boil a
kettle during that time.
injections or tablets to control this as required. By the end of one week the wound
should be virtually pain-free. The wound has a dressing which may show some
staining with old blood in the first 24 hours. The dressing will be exchanged for a
clean one which stays until the drain tubes are removed after 1 to 3 days. There are
no stitches in the skin. The wound is held together underneath the skin and does not
need further attention. There may be some purple bruising around the wound which
spreads downwards by gravity. It fades to a yellow colour after 2 to 3 days. It is not
important.
days. The wound gradually improves for one to two months after the operation. You
can wash the wound area as soon as the dressing has been removed. Soap and tap
water are entirely adequate. Salted water is not necessary. You can shower and take
baths as often as you want. The nurses will talk to you about your home
arrangements so that a proper time for you to leave hospital can be arranged. Some
hospitals arrange a check up about one month after you leave hospital. Others leave
certificates etc.
Complications are minimal and seldom serious. If you think that all is not well,
please ask the nurses or doctors. Bruising may be troublesome. Occasionally some
old blood collects under the wound, but this can easily be removed. Occasionally the
wound edge and nipple do not heal well in places. This always settles down but may
take 2 or 3 weeks to do so. Infection is a rare problem and settles down with
antibiotics in a week or two. There may be some numbness around the nipple. This
gets better over a month or more.
There may be some flatness of the chest, but this improves over 6 months or so.
General Advice
The operation can be quite an undertaking if there is more than an egg-cup sized
amount of breast tissue. Overall, patients are very pleased with the final result.
These notes will help you through your operation. They are a general guide. They do
226
Maxillary Antral - Sinus Washout
What is it?
The cheek bone or maxilla is hollow. This keeps the bones of the face nice and light.
The space inside any face bone is called a sinus. The sinus in the maxilla is
sometimes called the antrum and is very large. The bone between the sinus and the
inside of the nose is thin like an egg shell. The sinus in the cheek bone has a little
drain hole which leads into the upper part of the inside of your nose. Normally the
hole lets in air. Infection may drain from the sinus into your nose. This hole often
gets blocked if the sinus becomes infected. Sometimes just some swelling of the
lining of the nose during a cold will block the hole. It causes unpleasant pains in the
cheekbones and sometimes upper toothache - "sinus trouble". Usually antibiotics and
sprays will control the infection and let the hole unblock itself. In your case, you
keep having blockages despite this treatment. Your sinus needs to be washed out to
get rid of the infection. This should give the tissues a chance to heal properly.
The Operation
You will have a general anesthetic and be completely asleep. A fine metal tube will
be pushed into the nose and through the thin bone of the maxilla into the sinus.
Salty water will be flushed through the tube into the sinus. The salty water will come
out of the little drain hole in the sinus, and drain into the nose. Any pus or infected
fluid will come out as well. A specimen of the infected fluid will be taken so that it
can be examined so that the bugs causing the infection can be identified and then
227
the rest washed away. The metal tube will then be taken out. The inside of the nose
usually heals very quickly. There is no need for any stitches. If the little hole in the
sinus is blocked by infection, or if the infection is very bad, the surgeon will make a
bigger hole into the sinus to help drain the infection away. Because you are asleep,
you will not feel any pain at all during the operation. Your operation can be done as a
day case. This means that you come into hospital on the day of your operation, and
go home the same day.
Any Alternatives
If you leave things as they are, you will get more and more sinus trouble. The
infection can damage the lining of the sinuses so that they never get back to normal.
Rarely, very serious infections can happen. More antibiotics, sprays, and other drugs
will not help at this stage. Sometimes there is another cause for the sinus trouble. It
is necessary to find out about this. In your case, the operation is the best way
forward.

and look after you for the first day after the operation. Sort out any tablets,
telephone the ward and let the ward sister know. The operation will usually be put
off, and you will be given time to get better before being sent for again. You will
need to get over the cold before the operation can be done because by having an
anesthetic the cold could turn into a serious infection in the chest.
After - In Hospital
chest problems in the past. Your nose may feel a little sore after the operation.
Painkilling tablets should easily control this discomfort. Ask for more if the pain is not
well controlled or if it gets worse. After three to four hours on the ward you should
feel fit enough to go home. Before you leave, the nurses will check that your nose is
comfortable and is not bleeding. If you have been given antibiotics, you will be told
how often to take the tablets, and how many days you will need to use them for. If
you have been given nasal drops, you will be told how to use the drops, and for how
long. A general anesthetic may make you slow, clumsy and forgetful for about 24
things for yourself. Do not make important decisions, drive a car, use machinery, or
even boil a kettle during this time. If the surgeon needs to see you again and check
on your progress, the nurse will give you an appointment for the ENT (ear, nose, and
throat) outpatient clinic. The nurses will advise about sick notes, certificates etc.
228
After - At Home
Make sure you are going home by car or taxi, with your relative or friend. You must
not drive yourself home. At home, take two painkilling tablets every six hours to
control any pain or discomfort. If you are to use antibiotics or nasal drops, follow the
instructions you have been given on the ward very carefully. Do not blow your nose
for the first 48 hours after the operation. Take it easy for the rest of the day. Do not
do anything too energetic in case this starts the nose bleeding. You will be fit to go
back to work one or two days after your operation. You will be fit to drive 24 hours
after your operation. You should not swim until the lining of the sinus is fully healed.
This will take two months or so. Avoid diving for three months. Flying in an ordinary
passenger aircraft should be all right after a month. Ask the surgeon if you wish to
fly in an unpressurised aircraft.
complications related to your heart and the lungs. The tests that you will have before
a small risk that the nose may bleed when you get home. If this is just a spot or two
you should not worry. If the nose continues to bleed for more than an hour, come
back to the ward.
There is a small risk of infection at the area of the operation. If you develop
increasing pain in the cheek bone or the nose, a headache or a temperature, it
probably means that an infection is developing and you will need medical attention
promptly. Taking antibiotics for a week or two usually solves the problem.
General Advice
Myringotomy
What is it?
Each ear is made up of three parts. There is the outer ear which you can see, and
which gathers the sound. Further in, the outer ear joins the middle ear on each side
of the head which contains the ear drum. Deeper still, there is an inner ear on each
side. The sound goes down the ear tube, which is part of the outer ear, into the
middle ear on that side. The ear drum stretches across the deepest part of the ear
tube between the outer ear and the middle ear and vibrates. The drum is about a
third of an inch (8mm¬) across. It is made of thin skin, like the top of a real drum.
The middle ear is an air space which connects with the back of your nose. This is why
your ear drums pop when you blow your nose. The surgeon has looked into your
outer ear and at your ear drum with a special telescope. He can see some fluid
behind the ear drum. The fluid has built up in the middle ear. To start with, the fluid
was thin and watery. Gradually, it has become thick and sticky, like jelly. It is
sometimes called "glue ear". This fluid stops the ear drum letting the sound through
229
properly. It is the cause of your hearing difficulties. The fluid behind the ear drum
may also lead to infection in the middle ear.
The Operation
You will have a general anesthetic and will be completely asleep. The surgeon will
shine a very fine microscope into your ear. He will make a tiny cut in the ear drum (a
myringotomy). A very fine sucker will be placed through the hole in the eardrum into
the middle ear. The sucker will be used to draw the fluid from behind the ear drum
like a miniature vacuum cleaner. This may be all that is needed at this stage. This
operation is "diagnostic", meaning, finding out what is wrong. Some of the fluid that
is sucked out will be examined in the laboratory to see if it contains any bugs that
need to be treated with antibiotics. If the fluid is very thick, the surgeon plugs a tiny
hollow plastic tube into the hole in the ear drum. This tube is called a grommet. It is
shaped like a cotton reel with flanges that hold it in place in the ear drum. The
grommet lets air pass from the ear tube through the ear drum and into the middle
ear. Any fluid in the middle ear will now just dry up. Because you will be asleep, you
will not feel any pain during the operation. Your operation can be done as a day
case. This means that you come into hospital on the day of your operation, and go
home the same day. Both sides can be done at the same time if needed.
Any Alternatives
If you leave things as they are, the fluid will probably not drain away. Your hearing
problems will continue. You may get serious middle ear infections. This can
eventually lead to more and more thickening of the ear drum as well as thickening of
the fluid in the middle ear and can cause irreversible hearing loss. Tablets,
medicines, nose drops, and inhalers, will no longer help. Hearing aids will help your
230
hearing but will not get rid of the fluid. You do not need to have your tonsils or
adenoids taken out. The best way forward for you, is to have the planned operation.

for an hour or two, a few weeks or so before the operation for these checks. If you
have a cold in the week before your admission to hospital, please telephone the ward
and let the ward sister know. The operation is usually put off, and you are given time
to get better before being sent for again. You will have to get over the cold before
After - In Hospital
There is very often no pain in the ear after simple removal of the fluid or insertion of
a grommet. After three to four hours on the ward you will be well enough to go
home. A general anesthetic may make you slow, clumsy and forgetful for about 24
hours. The nurses will help you with everything you need until you can do things for
kettle during that time. You will be given arrangements about a visit to the ENT (ear,
nose, and throat) outpatient clinic for the doctors to check the grommets and your
hearing. The nurses will advise about sick notes, certificates etc.
After - At Home
Take two painkiller tablets every six hours to control any earache or discomfort. If
the fluid has not built up again after the simple drainage, you should be able to hear
normally. If the fluid comes back, you may need a grommet. With a grommet in
place, the fluid will clear quickly from behind the ear drum. The grommet stays in the
ear drum for about a year. As the fluid problem gets better, the hole in the drum
heals, and squeezes the grommet out into the ear tube. The grommet then usually
sticks to wax in the ear tube. The doctor in the out patient clinic will easily be able to
take it out. Sometimes the grommet has to be taken out with a small operation, if it
does not come out by itself. Keep the ears dry. Do not allow water to enter the ears
when you are taking a bath or washing your hair. Protect the ear by placing a piece
of cotton wool rubbed in Vaseline in the ear. It is better not to go swimming while
the grommet is in place. If you want to swim use the cotton wool ear plug and a
swimming cap. You must not have your ear syringed if you have a grommet. It is
perfectly safe to travel by air.
231
If you follow the advice listed above, problems are unlikely. Occasionally people
notice a popping or clicking in the ears. This is not harmful, it is expected and you
should not worry about it.
You may notice some clear but lightly blood-stained fluid coming out of the ear for
the first two days after the operation. This is expected but if it continues for more
than two days and you get a runny ear (especially if the fluid coming out is thick,
yellow and/or green or smelly), it most probably means that you have got an ear
infection. You should go to your doctor who will probably give antibiotics to help clear
the infection. If the infection is not getting better, he will arrange for you to be seen
in the ENT outpatient clinic. In a few patients, the ear can be a bit runny without
anything serious being wrong. In addition, if you don’t have a runny ear but you get
a headache, a temperature or you become irritable, you should also be alert and ask
for medical advice because these symptoms can be an indication of a developing
infection.
When the grommet comes out, there will be a tiny scar left on the ear drum. This is
not anything to worry about. It will not make any difference to your hearing. In a
small number of people (2 to 3% of cases), the small hole in the eardrum does not
seal up quickly when the grommet comes out and may need to be closed with
another operation.
General Advice
Nasal Polyp Removal
What is it?
Polyps are swollen skin, lining the inside of the large air spaces that exist in the
bones of the face (the sinuses) or of your nose. They look like small bunches of
grapes. They exist in 1 to 4% of people and they are two to four times more
frequent in males compared to females. Sometimes polyps are caused by allergy or
infection. The polyps in your nose are stopping you from breathing easily through
your nose. The polyps sometimes block the sinuses in the bones of the face. They
make sinus infections more common. In some people, polyps block the part of the
nose which helps us to smell. Unfortunately, when this happens, the sense of smell
may not to come back after the polyps have been removed. If the polyps are taken
out, you will be able to breathe more easily through your nose. You should have less
trouble with sinus infections.
232
The Operation
You will have a general anesthetic and be completely asleep. The operation will be
carried out inside the nose. There will be no cuts on the outside of the nose. There
will be no change in the shape of your nose. Small instruments will be used inside
the nose to take out each polyp which is then sent to the laboratory to be examined
under a microscope. The surgeon will wash out your sinuses to remove any infection
that may be trapped inside by the polyps. If there is any bleeding, the surgeon will
put cotton gauze (a pack) soaked in Vaseline inside your nose to stop the bleeding,
or he may use a dressing like sponge rubber. Sometimes if the nose is very narrow
inside, the surgeon may leave plastic splints inside the nose to stop the tissues
sticking together when they heal up. Because you are asleep you will not feel any
pain at all during the operation. You will probably be fit to go home the day after
your operation.
Any Alternatives
If you leave things as they are, the polyps will always get worse. Some tablets and
nasal sprays shrink polyps a little. The polyps will always get bigger once the tablets
or sprays are stopped. The only way to get rid of polyps is with an operation.

233
and look after you for the first couple of days after the operation. Sort out any
tablets, medicines, inhalers that you are using. Keep them in their original boxes and
week before your admission to hospital, please telephone the ward and let the ward
sister know. The operation will usually put off, and you will be given time to get
better before being sent for again. You will need to get over the cold before the
After - In Hospital
chest problems in the past. There is usually some pain and discomfort around the
nose after this operation. With packing inside your nose, you will have to breathe
through your mouth. This will make your mouth feel dry. Take frequent drinks to
keep it moist. You may find that the nasal packing will make your eyes water or give
you a headache. Ask for painkillers if the pain is not well controlled or if it gets
worse. A general anesthetic may make you slow, clumsy and forgetful for about 24
things for yourself. Do not make important decisions during this time. The next day,
when the nurses take the packing from your nose, there will be a little bleeding. This
usually stops very quickly. Splints are usually left in place for about two weeks. You
will probably be able to go home later the same day. The nurses will check that your
nose is comfortable and is not bleeding. You will be given some cream to use inside
your nose, together with some nose drops and advice about steam inhalations.
Before you leave the ward, you will be given an appointment to attend the ENT (ear,
nose, and throat) outpatient clinic for a check-up by the surgeon. The results of the
examination of the polyp(s) will be ready by then. The nurses will advise you about
After - At Home
Take two painkilling tablets every six hours to control any pain or discomfort in your
nose. The nose will feel blocked for 7 to 10 days after your operation, but will
gradually improve. Do not blow your nose until two days after you get home, and
then start off by blowing it VERY GENTLY. To begin with, you will see blood staining
in your handkerchief. Most of this will be old blood from your operation, but there
may be a little fresh bleeding as well. If possible, try to avoid catching a cold during
your first week at home. If you do get a cold you should see your general
practitioner for some antibiotics. Take it easy at home. Do not do anything too
energetic during the first few days in case this makes your nose bleed. If you usually
do hard physical exercise such as weight training, jogging, keep fit classes, etc. you
will be fit enough to return to these activities about two to three weeks after your
operation. Any earlier, and there is a risk that you will make your nose bleed. Avoid
smoky atmospheres such as pubs and clubs, because cigarette smoke will irritate the
inside of the nose. Do not forget to use the cream, steam inhalations and nasal
drops. You will be fit to drive as soon as you leave the hospital. You should be able
234
to go back to work one week after your operation. Avoid swimming and diving until
you have seen the surgeon in the clinic.
complications related to your heart and the lungs. The tests that you will have before
If there is a lot of bleeding during your operation, the surgeon may leave the packs
inside your nose for an extra day. If there is a lot of bleeding after the packs are
removed, then the surgeon will put them back in, either with a local or a general
anesthetic. Sometimes in people with narrow nasal passages, the sides of the nose
may stick together as they heal with bands of scarred tissue which are called
adhesions. The adhesions can often be freed by the surgeon when he sees you in the
outpatient clinic. In some people, polyps can come back again. This may happen
within a year, or may occur several years later. It is impossible to say whether your
polyps will come back again, only time will tell. As long as you follow the advice
above, you are unlikely to have any problems when you get home. There is a small
risk that your nose may bleed. If this is just a spot or two you should not worry. If
your nose bleeds for more than an hour, come back to the ward.
probably means that an infection is developing and you will need medical attention
promptly. Taking antibiotics for a week or two usually solves the problem.
General Advice
235
Nephrectomy - Kidney removal
What is it?
You have two kidneys, which help to make urine. They lie deep in your back just in
front of your lowest ribs. One of your kidneys is diseased and needs to be taken out.
After your operation, the other kidney will make enough urine for your needs.
The Operation
is made in your skin either in your tummy or in your back depending on your
236
particular kidney disease. The surgeon will discuss the details with you. The kidney is
taken out after tying off important blood vessels (the arteries that give blood to it
and the veins that drain blood from it) and urine tubes (ureters) that drain the urine.
The skin wound is then stitched up. You should plan to be in hospital for 10 days.
You may well be home before this.
Leaving things as they are will mean that your kidney problem will just get worse.
For kidney stones shock wave treatment is usually a good way of getting stones out
of the kidney, but in your case this will not help. For cystic kidneys, there are ways
of draining the kidney using keyhole operations, but again these are not the best
ways to solve your problem. Taking out the kidney with a keyhole surgical procedure
is not always possible and it takes place only in some highly specialised centres. It
would not be suitable for your kidney. You do not need a kidney transplant as your
remaining kidney can produce the quantity and quality of urine that you need on
daily basis so that you will be entirely healthy.

checks. You will have a fine soft plastic tube passed into your bladder before the
operation. For females this may be done on the ward. For males it is done when
asleep in the theatre.
After - In Hospital
Although you will be conscious a minute or two after the operation ends, you are
unlikely to remember anything until you are back in your bed on the ward. Some
patients feel a bit sick for up to 24 hours after operation, but this passes off. You will
be given some treatment for sickness if necessary. You will have a fine, thin drip
tube in an arm vein connected to a plastic bag on a stand containing a salt solution
or blood. There will probably be a fine plastic tube coming out near the skin wound
(this is to drain any residual blood or other fluid from the area of the operation) and
possibly a fine plastic tube in your nose to drain your stomach. You may be given
yourself. Do not make important decisions during this time. The wound is painful and
237
after operation despite some discomfort. You will not do the wound any harm, and
the exercise is very helpful for you. The second day after operation you should be
able to spend an hour or two out of bed. By the end of four days you should have
little pain. The tube in your bladder may drain bloodstained urine for a day or two.
The tube will be taken out once the urine clears. After that it is important that you
pass urine and empty your bladder normally. If you have difficulty the doctors and
nurses will be pleased to sort the problem out. The wound has a dressing which may
show some staining with old blood in the first 24 hours. The dressing will be removed
and the wound will be sprayed with a cellulose varnish similar to nail varnish. You
can take the dressing off after 48 hours. There is no need for a dressing after this
unless the wound is painful when rubbed by clothing. There may be stitches or clips
in the skin. Sometimes, the wound is held together with stitches underneath the skin
that you can’t see and which eventually get dissolved. The thin plastic drain tube is
removed when it stops draining - usually after 48 hours.
There may be some purple bruising around the wound which spreads downwards
with gravity and fades to a yellow color after two to three days. This is expected and
you should not worry about it.
There may be some swelling of the surrounding skin which also improves in two to
three days. After 7 to 10 days, slight crusts on the wound will fall off. Occasionally
minor match head-sized blebs (blisters) form on the wound line, but these settle
down after discharging a blob of yellow fluid for a day or so. You can wash as soon
as the dressing has been removed but try to keep the wound area dry until the
stitches/clips come out. If there only stitches in the inside of the wound try to keep
the wound dry for a week after the operation. Soap and tap water are entirely
adequate. Salted water is not necessary. You will be given an appointment to visit
the outpatient department for a check-up. The nurses will advise about sick notes,
certificates etc.
After - At Home
You are likely to feel very tired and need to rest two or three times a day for three
i.e. after about three weeks. You can restart sexual relations within two or three
weeks when the wound is comfortable enough. You should be able to return to a
light job after about eight weeks and any heavy job within 12 weeks.
Complications are relatively unusual but are rapidly recognized and dealt with by the
surgical staff. If you think that all is not well, please let the doctors and nurses know.
Bruising of the wound can be troublesome but most of the time settles. There is a
2% chance of an infection of the wound which can be settled by taking antibiotics for
a week or two 1-2 week.
The drainage tube near the wound may drain old blood for up to a week. This
drainage settles down. Very rarely, it doesn’t settle down or gets worse in the first
few hours/days after the operation. This means that some damage has occurred
238
during the operation in one of your blood vessels or other organs of your abdomen
and you will most likely need another operation to fix the problem.
physiotherapists to clear the air passages is important in preventing a chest
infection.
months.
they regain their normal stamina. However, virtually all patients are back doing their
normal duties within three months. These notes will help you through your
doctors or nurses.
Nephrolithotomy - Removal of Kidney stone
What is it?
There are one or more stones in your kidney. Stones cause pain, infection or
bleeding, and can damage the kidney. The stone(s) need to be taken out. This
operation is called a nephrolithotomy. You have two kidneys. They lie deep in your
back on either side of your spine, in front of the lowest rib on each side. The kidneys
make urine which passes down a tube (ureter) on each side to the bladder just below
your tummy button. The stones usually lie where the ureter joins the kidney and can
be taken out through an opening in the top of the ureter. Sometimes the kidney is so
badly damaged by the stone(s) that it needs to be taken out as well. Sometimes just
part of the kidney is taken out with the stone(s) to help the urine drain out of the
kidney better. You will have enough kidney tissue after the operation to make urine
properly.
239
The Operation
is made in the skin over your kidney, usually round the back in the line of your
lowest rib. Sometimes the cut is made in the front of the tummy, especially when the
kidney is to be taken out. The stone(s) are taken out, with or without the kidney.
The wound is stitched up. Usually within 10 days you will feel fit enough to leave
hospital provided there is someone to look after you.
Any Alternatives
Leaving things as they are means that your problem will get worse. Usually the
stones can be broken up with shock wave treatment or taken out using keyhole
instruments. In your case these ways are not suitable. Dissolving these stones is not
a the correct procedure for you.

make sure that you are well prepared and that you can have this operation as safely
checks. Before the operation, a tube (catheter) may be passed into the bladder to
check the urine flow. In females this is done on the ward. In males this is usually
done when the patient is asleep in theatre.
After - In Hospital
You may feel a bit sick for up to 24 hours after operation, but this passes off. You
will be given some treatment for sickness if necessary. You may be given oxygen
from a face mask for a few hours if you have had chest problems in the past. You will
have a drain tube coming out of the skin near the wound. This is to drain any
residual blood or other fluid form the area of the operation. It usually comes out two
to three days after the operation; as soon as it is not draining any more. You will
have a fine, thin plastic tube (drip) in an arm vein giving you blood or salt solutions.
yourself. Do not make important decisions during this time. There may be some
discomfort on moving rather than severe pain. You will be given injections or tablets
to control this as required. Ask for more if the pain is not well controlled or if it gets
worse.
should be able to spend most of your time out of bed and in reasonable comfort. By
240
the end of one week the wound should be virtually pain-free. You may have some
blood in the urine catheter for a day or two after the operation. Once this clears and
you are able to get out of bed easily, the catheter will be taken out. It is important
that you pass urine properly after the catheter is out. The doctors and nurses will
check this. If you still cannot pass urine let the doctors and nurses know and steps
will be taken to correct the problem. The wound has a dressing which may show
some staining with old blood in the first 24 hours. The dressing will be removed and
the wound will be sprayed with a cellulose varnish similar to nail varnish. You can
take the dressing off after 48 hours. There is no need for a dressing after this unless
the wound is painful when rubbed by clothing. There may be stitches or clips in the
skin. The wound may be held together with stitches underneath the skin that you
can’t see and which eventually dissolve.
There may be some purple bruising around the wound which may spread downward
by gravity and fade to a yellow color after two to three days. This is expected and
you should not worry about it. There may be some swelling of the surrounding skin
which will also improve in two to three days. After 7 to 10 days, slight crusts on the
wound will fall off. The cellulose varnish will peel off. Occasionally minor match head-
sized blebs (blisters) form on the wound line, but these settle down after discharging
a blob of yellow fluid for a day or so. You can wash as soon as the dressing has been
removed but try to keep the wound area dry until the stitches/clips come out. If
there are only stitches underneath the skin, try to keep the wound dry for a week
after the operation.. Soap and warm tap water are entirely adequate. Salted water is
not necessary. You can shower or take a bath as often as you want. The nurses will
After - At Home
You are likely to feel very tired and need to rest two or three times a day for two to
three weeks. You will steadily get better so that by the time two months have passed
you should be able to get back to your usual activities. At first discomfort in the
wound will prevent you from harming yourself by lifting things that are too heavy.
After two months you can lift as much as you used to lift before your operation.
There is no value in attempting to speed the recovery of the wound by special
exercises before this. You can drive as soon as you can make an emergency stop
without discomfort in the wound i.e. after about three weeks. You can restart sexual
relations within three weeks or so, when the wound is comfortable enough. You
should be able to return to a light job after about one month and any heavy job
within two months.
Complications are relatively rare. If you think that all is not well, please let the
doctors and the nurses know. Bruising and swelling may be troublesome. The
swelling may take four to six weeks to settle down. A wound infection happens in 1-
2% of cases and settles down with antibiotics in a week or two.
drainage settles down. Very rarely, it doesn’t settle down or gets worse in the first
few hours/days after the operation. This means that some damage has occurred
241
during the operation in one of your blood vessels or other organs of your abdomen
and you will most likely need another operation to fix the problem.
infection.
months.
Sometimes (2-3% of cases) there is a leak of urine through the wound or from the
drain site. This settles down within a week or so. Very rarely, you will need another
operation to fix this problem. Sometimes stones reform. This will be discussed with
you.
General Advice
their normal duties within two months. These notes will help you through your
doctors or nurses.
Nose Augmentation - Tiplasty
What is it?
Nasal augmentation / tiplasty is reshaping of the nose to achieve a natural
appearance. The problem may have been present from birth or have been the result
of trauma or previous surgery.
The Operation
The operation is usually performed under general anesthesia. Depending on the
exact type of surgery to be performed, it may be necessary to take some spare
cartilage from the ear in order to build up areas of the nose that may be deficient.
The operation will last between one to two hours depending on the extent of surgery
to be performed.
Any Alternatives
Some minor deformities of the nose may be helped by injections beneath the skin
(subcutaneous) but more lasting results require surgery. Some of the nasal bridge
problems may be disguised by wearing glasses but no external prosthesis will
adequately disguise nasal deformities.

Your surgeon will assess the type of surgery that needs to be performed and will give
advice about your pre-operative medication. It is useful to avoid smoking and stop
taking any Aspirin or tablets containing Aspirin. This helps to prevent bleeding during
and after surgery. Your surgeon will assess if there is problems with the internal area
of the nose. It may be necessary to remove some of the middle cartilage of the nose
at the time of surgery to improve the airway. This is called a Septoplasty.
After the Operation
242
You are likely to have a protective splint over your nose, which will stay on for
between a week and ten days. If it has been necessary to take cartilage or skin from
your ear, you may also have a bandage around your ear. You may well have a
blocked nose because of the surgery and also because of the use of packs in the
nostrils, which may be required to support the new shape of the nose. If the surgery
is to the tip of the nose only, packs may not be required. If the surgery is of a
delicate nature, not involving the bones, an external plaster splint may also not be
required. After the surgery the nurse will take your pulse, blood pressure and
temperature and check that there is no excessive bleeding. It is likely that your face
will be bruised afterwards and you may develop black eyes. The bruising will take
two to three weeks to resolve. If you have packs they are usually removed twenty-
four hours following surgery at which time minor amounts of bleeding can occur.
Pain killing tablets are usually sufficient but injections may very occasionally be
required. You will be nursed in a semi-upright position and should avoid stooping,
straining, bending and coughing if possible. You should also not blow your nose after
surgery as this can cause bleeding. Gentle sniffing is usually enough to clear the
airways. You will probably notice however that there is swelling inside and you may
have a feeling of a blocked nose for two to three weeks following surgery. In some
situations it can take longer to resolve.
After at Home
Depending on the exact amount of surgery that was required, the type of protective
bandaging over the nose may vary from a plaster type splint to only some paper
stitches. Again depending on the extent of surgery that was required on the inside of
the nose, the nose may be blocked. This can last for two to three weeks following
surgery. Your doctor will have advised you on how to avoid doing activties which can
cause exertions such as stooping, straining or bending for a few weeks following
surgery.
Complications
Surgery for Tiplasty or nose augmentation should be avoided in people who a have a
cough, colds or have evidence of infection in and around the nose at the time of the
surgery. Bleeding does occur during surgery but this is usually stopped on return to
the ward. Occasionally it can occur again while the patient is in hospital and this may
necessitate a return to theatre. Should any infection intervene at the time following
surgery this is another cause of bleeding. This tends to occur between seven and ten
days following surgery. It necessitate packing of the nose and very occasionally a
return to theatre. Due to the narrowness of the nasal passageways, swelling after
surgery causes them to become even narrow. This can cause some difficulty with
breathing which can take a few months to settle. Removal of some of the cartilage in
the centre of the nose may be performed at the time of Tiplasty in order to improve
the nasal airways. Examination of the nose prior to surgery would indicate whether
this was necessary. This would be discussed with your surgeon prior to the
operation.
Minor irregularities over the tip of the nose can occur following Tiplasty type
procedures. These may become apparent and in a small number of cases, need
surgical correction at a later date. This can be performed when the swelling following
surgery has returned to normal. These minor irregularities may be less noticeable in
those who have thick-skinned noses. Some patients also find that they may have an
altered smell after the surgery.
243
General Advice
Depending on the extent of surgery the swelling after augmentation / Tiplasty
depends on the extent of the surgical procedure. Surgery to the tip of the nose itself
may produce minimal swelling. However extensive surgery involving the bones of the
nose may produce significant swelling, cause bruising to last for a few weeks
following surgery. The exact end result can depend on the quality of the tissue and
occasionally there are minor irregularities underneath the skin that may become
apparent when the swelling resolves. On occasion these irregularities may benefit
from re-operation.
Nose Reshaping - Rhinoplasty
What is it?
Rhinoplasty is the surgical treatment for reshaping of the nose. Depending on the
exact problem it can involve the removal of bone cartilage, a reshaping of the bridge
of the nose, and reshaping and altering the tip of the nose.
The Operation
The surgery is usually performed under general anesthetic but can be performed
under local anaesthesia and heavy sedation. The surgical scars may be either inside
the roof of the nose or at the central strut of the base of the nose. The surgical scar,
if it is placed externally, is occasionally visible and is particularly useful in noses
where there has been trauma or where previous surgery has been performed.
Any Alternatives
In noses where there are minor irregularities these may occasionally be corrected by
subcutaneous injections. However these may not be permanent and surgical
correction is often the only way of obtaining a lasting result.
Before the Operation.

The patient should be in good general medical health and avoid smoking, Aspirin or
Aspirin containing medication. Surgery should be postponed if there is any
evidence of infection in the nose, throat or sinuses. In your pre-operative
consultation your doctor will discuss your general medical health, what medications
you may be taking and if these have any bearing on the surgery. It is also likely that
one would wish your blood pressure to be normal.
After in Hospital
You are likely to have a plaster over your nose to protect the surgery that has been
performed. Depending on the necessity of surgery inside the nose itself, there may
be packs up each nostril. This initially may cause difficulty with breathing and a
sense of being gagged.
If there are no packs up the nose, there still may be residual swelling and this may
also cause some difficulty breathing through the nose. In normal breathing, most
people breath through their nose by preference and this inability to breathe through
the nose may be initially upsetting. If packs are in place, some minor bleeding may
occur when they are removed, usually twenty-four hours after surgery. There is
often minor bleeding following the surgery anyway. While in hospital your blood
pressure, pulse and temperature will be checked and pain killing tablets or injections
given. The surgery itself does not tend to produce bad pain. It is important after
244
the surgery not to blow your nose as this can cause significant bleeding.
Occasionally if one needs to clear the nose, it is necessary to gently sniff. It is also
likely that there will be significant bruising and swelling around the face and the
patient may end up with black eyes. On return to the ward you will also be nursed in
an upright position.
After at Home
Bruising following the surgery can last for two to three weeks. You may also find
that your nose is blocked off and on, particularly in the first few weeks following
surgery. This can take some time to settle down. It is important to avoid bending,
stooping and straining in order not to start the nose bleeding. Paracetamol is usually
adequate for pain relief. You should avoid taking Aspirin or tablets containing Aspirin
as these can promote bleeding. It is probably best to avoid people with coughs and
colds for the first few weeks following surgery. The protective plaster dressing is
usually taken off between one and two weeks following surgery. It is likely that your
nose will continue to remain swollen although it should have achieved a satisfactory
shape and size. You will also probably notice that there is some numbness over the
skin of the nose and this can persist for some time. You can return to work after a
few days but it may be too obvious with the plaster dressing and many people tend
to wait until the plaster has been removed and the bruising has settled before
returning to non-strenuous work. It is advisable to avoid any heavy activity such as
gym work, strenuous lifting, or straining for one month following surgery.
Surgery for Rhinoplasty correction should be avoided in people who have a cough,
colds or have evidence of infection in and around the nose at the time of the
surgery. Bleeding does occur during surgery but this is usually stopped on return to
the ward. Occasionally it can occur again while the patient is in hospital and this
may necessitate a return to theatre. Infection at any time following surgery is
another cause of bleeding and tends to occur between seven and ten days post-
operatively. It may necessitate packing of the nose and very occasionally a return to
theatre. Due to the narrowness of the nasal passageways swelling after surgery
causes them to become even narrower. This can cause some difficulty with
breathing which can take a few months to settle. Removal of some of the cartilage
in the centre of the nose may be performed at the time of Rhinoplasty in order to
improve nasal airways. This however would be discussed with your surgeon prior to
the operation. Examination of the nose prior to surgery would indicate whether this
was necessary. Minor irregularities over the tip of the nose can occur following
Rhinoplasty type procedures. These may be apparent and in a small number of
cases and need surgical correction at a later date. This can be performed when the
swelling following surgery has returned to normal. These minor irregularities may be
less noticeable in those who have thick-skinned noses. Some patients also find that
they may have an altered smell after the surgery.
General Advice
It is important for the surgeon to understand what problems the patient is having. It
may not be possible to achieve the exact results that the patient expects. It may
also be very important to point out to the patient the relationship of the nose to the
rest of the face and that to surgically alter a nose in some situations can leave the
face significantly out of balance. It is also important that the patient would be aware
that scars on the external part of the nose are occasionally necessary, particularly if
there are large nostrils or if secondary surgery needs to be performed.
245
Orchidopexy -Bringing down a testicle
What is it?
In the time before a male baby is born, the growing testicles have to travel from just
below the ribs at the back, to their proper place in the scrotum. Sometimes one or
both testicles do not get down as far as they should. Most often they lodge in the
groins. Sometimes they are higher. Then they are called undescended or
maldescended testicles. It is not the fault of either parent.
The Operation
Your child will have a general anesthetic, and will be completely asleep. A cut is
made overlying the groin. There is sometimes a small hernia (weak spot or gap in
the muscles in the front of the tummy) just next to the testicle which is fixed and
then closed with stitches. The testicle is found. Its artery and vein (the pipes that
give and drain blood respectively) and connecting tubes are freed off as much as
possible. This will make them long enough to allow the testicle to sit in the scrotum
without any tension. A second cut is made in the scrotum and some space is created
under the skin and the supporting tissues of the skin. . The testicle is then fixed with
stitches in the scrotum in its proper place. The skin is then stitched up in both
places. The operation takes about 20 minutes a side.
Any Alternatives
If you leave things as they are, the testicle will not come down any further. It can
get damaged by being in the wrong place. There may be a problem with your child
fathering children in the future. Hormone treatment does not work. Sometimes it is
best to wait for a few months until your child is bigger. This makes the testicle easier
to free and the anesthetic is easier to administer. If the surgeon cannot find the
testicle, a special examination inside your child's tummy will need to be done at a
later date to help locate it. If the testicle will not come down far enough at the first
attempt, a second operation at a later date will be needed. Some surgeons stitch the
testis and the skin of the scrotum to the side of the thigh. This is hardly ever needed.

admission to hospital, please telephone the ward and let ward sister know. The
operation will usually needs to be put off. Your child has to get over the cold before
Sort out any tablets, medicines, and inhalers that your child is using. Keep them in
sure that he is well prepared and that your child can have the operation as safely as
possible. Many hospitals now run special preadmission clinics, where you and your
child visit for an hour or two, a week or so before the operation for your child to have
these checks.
After - In Hospital
Your child may not notice any particular pains. If necessary he can take paracetamol
246
liquid. By the end of one week the wound should be virtually pain-free. Your child will
be able to drink again two to three 2-3 hours after the operation. He should be able
to eat normally the next day. Usually you can take your child home on the day after
the operation. You may be given an appointment to bring your child to the outpatient
department a month after leaving hospital for a check-up. Sometimes the family
doctor checks the wound.
After - At Home
to limit what he does, try to help your child avoid any excess physical activity for
four to six weeks after the operation. The groin wound is usually held together with
stitches underneath the skin that dissolve and don’t need to be removed. There may
be stitches in the groin wound and in the little wound in the scrotum. These stitches
should melt away after 7 to 10 days. It is rare for the stitches to need taking out.
There may be some bruising of the surrounding skin which improves in two to three
days. This is expected and you and your child should not worry about it. Your child
can wash after the operation but try to keep the wound area dry until the stitches
melt away or for about a week if there only stitches under the skin. Salt water is not
necessary. If your child goes to school, he can return to lessons after about 10 days.
He can restart any sport in four to six weeks.
before the operation will make sure that he can have the operation in the safest
possible way and will bring the risk for such complications very close to zero.
There is often some swelling and even some redness around the wound. These
usually settle in three or four days. Bleeding is very rarely a problem and gets
settled with some extra pressure on the wound area. Extremely rarely, another
operation may be needed to stop the bleeding. Infection in the wound area is a rare
problem and settles down with antibiotics in a week or two. The same is true for
some swelling of the testicle, which happens rarely and is usually settled by taking
antibiotics for a week or two. Sometimes the stitches take a month or more to drop
out of the wound. This happens and you and your child should not worry about it.
In about 10% of cases, one or both testicles cannot be brought down into the
scrotum or the testicle draws back up into the groin again. Another operation is
necessary to fix this problem. In 5% of cases, there may be some shrinkage of the
testicle after the operation or, very rarely, the testicle can become necrotic (dying).
This happens because the blood supply to the testicle can be partly or completely
damaged during the operation. The surgeon will discuss these problems with you and
your child if they happen.
Another rare complication that can happen during this operation is damage to the
structures that carry the sperm from the testicle. This can have an affect on your
child’s fertility in the future (his ability to father children) since one of his testicles
will not contribute sperm. You should discuss the possibility of this rare complication
with your surgeon.
One important thing to keep in mind is that children with undescended or

maldescended testicles have a higher risk (some studies show as much as 10 times
higher) of developing testicular cancer compared with children who don’t have this
247
problem. This risk is the same for the testicle(s) that needs to be brought down as
well as for the testicle that is in the correct place. The orchidopexy does not reduce
the chances of cancer developing but allows for both testicles to be examined easily,
properly and regularly to detect any developing tumour as early as possible.
General Advice
The operation can be a little painful for a week or two. You and your child will need
to be patient. These notes should help you and your child through his operation.
nurses.
Parotid Gland Removal - Parotidectomy
What is it?
The parotid is a gland which makes saliva to wet the food in your mouth. It is shaped
like a wedge and fits behind the back of your jawbone just in front of your ear. The
saliva runs from the parotid gland along a tube which opens into your mouth near
your back teeth. The nerve to all your face muscles runs through the parotid gland
and the nerve to the skin of your ear runs past the back of the parotid. If a swelling
grows in the parotid gland, that part of the parotid has to be removed.
The Operation
You will have a general anesthetic, and will be asleep for the whole operation. An S-
shaped cut is made down the skin crease in front of your ear, under your ear lobe,
and down on to the side of your neck. The swelling together with some of the parotid
gland is cut out. A small plastic tube is placedin the wound called a drain. this is
connected to a small bottle and stops blood collecting under the skin. The skin is
closed up. The wound is designed to heal leaving only a faint scar.
Any Alternatives
If you do nothing the problem in your parotid will slowly get worse. The bigger the
swelling the more difficult it is to take out safely and the greater the risk of nerve
damage. Sometimes the parotid problem needs extra treatment. The swelling needs
to be taken out to find out if this is needed. Treating the swelling with x-rays or
drugs on their own is not as good as an operation.

hospital with you.
248
checks.
After - In Hospital
Some patients feel a bit sick for up to 24 hours after operation, but this passes off.
You will be given some treatment for sickness if necessary. You may be given
A general anesthetic may make you slow, clumsy and forgetful for about 24 hours.
Do not make important decisions during that time. There is usually some discomfort
on moving rather than severe pain. You will be given injections or tablets to control
this as required.
By the end of one week the wound should be virtually pain-free. Any drain tubes are
removed after 2 or 3 days. The wound dressing may show some staining with old
blood in the first 24 hours. The dressing will be removed and the wound will be
sprayed with a cellulose varnish similar to nail varnish. There is no need for a
dressing after this. The wound is held together with metal clips and does not need
further attention. Some surgeons use a stitch deep under the skin which cannot be
seen, others use a glue for skin. There may be some purple bruising around the
wound which spreads downwards by gravity and fades to a yellow color after 2 to 3
days. It is not important.
days. After 7 to 10 days, small crusts on the wound will fall off. The cellulose varnish
will peel off and can be assisted with nail varnish remover. Any clips or stitches are
rived after 5-7 days. You will be told when to come back to the ward for this. You
can bathe, shower or shampoo normally after 10 days. The nurses will talk to you
about your home arrangements so that a proper time for you to leave hospital can
be arranged. Some hospitals arrange a check up about one month after you leave
After - At Home
You may feel rather tired for a week or so. You will gradually improve over the next
2 weeks. You can drive as soon as you leave hospital. You should be able to go back
to work within 10 days.
Most people have some numbness of the ear. This gets better over 2 to 3 months
but may always be there slightly. Straight after the operation about 1 in 10 patients
notices some weakness of the side of the mouth or some difficulty in closing the eye
properly. This is caused by stretching or bruising of nerve fibres. Recovery takes an
average of 2-4 months. Infection is an unusual problem and settles down with
antibiotics in a week or two. Rarely there may be a little discharge of saliva through
the wound for a week or two. This always gets better. Sometimes the skin over the
temple sweats during a meal. This is rarely troublesome, but can be treated. The
swelling in the parotid will be examined under a microscope to find out the exact
type. Sometimes x-ray treatment is needed after the operation. The results and any
further treatment will be discussed with you. Occasionally swellings come back on
the operated side or even appear on the opposite side. You will be examined from
time to time after the operation to check for this.
General Advice
The operation should not be underestimated, but the wound usually heals well, and
the long-term results are good. These notes will help you through your operation.
249
nurses.
Penis Frenuloplasty
What is it?
The problem lies in the foreskin. The foreskin is the sleeve of loose skin which covers
the bulb end of the penis (the glans). One end of the sleeve grows from the base of
the glans. The other end lies freely over the glans to protect it. Sometimes the
foreskin is very tightly fixed to the under surface of the penis, This can cause
discomfort on intercourse.
The Operation
You will have a general anesthetic and will be asleep for the whole operation. The
tight band is lengthened with a small operation. The operation can be done as a day
case, meaning that you come into hospital on the day of the operation and go home
the same day, or a non-day case, where you will spend two nights or so in hospital.
Any Alternatives
If you leave things as they are the problems may well get worse. Stretching the band
does not work. A formal circumcision to remove the whole of the foreskin is not
needed.

a relative or friend who can come with you to hospital, take you home, and look after
you for the first week after the operation. Bring all your tablets and medicines with
you to hospital.
After - In Hospital
There is some discomfort rather than severe pain. You will be given injections or
tablets to control this as required. Ask for more if the pain is still unpleasant. By the
end of one week the wound should be virtually pain-free. You will be able to get out
of bed after an hour or two despite the discomfort. A general anesthetic will make
you slow, clumsy and forgetful for about 24 hours. Do not make important decisions,
drive a car, use machinery, or even boil a kettle during that time.
You should feel fit enough to go home after an hour or two on the ward. The wound
has a moist dressing which can be removed after 12 hours or so. You may be
wearing net elastic pants to hold the dressing in place. There are stitches in the
wound which soften and drop out after 7 days or so. There may be some purple
bruising around the wound which spreads downwards by gravity and fades to a
yellow color after 2 or 3 days. It is not important.
There may be some swelling of the surrounding skin which also improves in 2 or 3
250
days. After 7 to 10 days crusts on the wound will drop off. Occasionally minor match
head sized blebs form on the wound line. These settle down after discharging a blob
of yellow fluid for a day or so. You can wash the wound area as soon as the dressing
has been removed. Soap and tap water are entirely adequate. Salted water is not
necessary. You can shower or take a bath as often as you want. Wear a dressing to
keep your underpants clean. Please ask the nurses about sick notes, certificates etc.
After - At Home
You are likely to feel a little sore for a week or so. By the time 2 weeks have passed
you can make an emergency stop without discomfort i.e. after about 3 days. You can
start sexual relations within 2 to 3 weeks, when the wound is comfortable enough.
You should be able to return to a light job after a week or so and a heavy job within
2 weeks.
ask the nurses or doctors. You may get painful erections in the first 2 or 3 days.
These can be controlled with painkillers. Infection is a rare problem and settles down
with antibiotics in a week or two. Aches and twinges may be felt for up to 2 months.
General Advice
Pilonidal Sinus
What is it?
A pilonidal sinus means a nest of hairs under the skin over the tailbone. Hairs pass
inwards through the little holes (sinuses) in the skin. Germs build up among the
hairs, causing pain, swelling and discharge. Sometimes the sinuses like these form
near old scars or between the fingers.
The Operation
The aim is to get rid of the hairs and close off the space under the skin. The
problems are to get good healing and to stop the pilonidal sinus coming back. There
are many operations for this, ranging from very small operations to major plastic
surgery operations. In all methods the tissue is taken out. The differences are in the
ways of getting the space healed up properly. One way is to let nature fill in the
space with scar tissue. Another is to stitch up the space and let the wound heal. You
would usually have a general anesthetic and be completely asleep. For a small
operation, numbing the skin with a local anesthetic injection may be all that is
needed. The skin with the sinuses is cut out. The space with its hairs is either
cleaned out or is cut out. The space may be left open to fill in from inside to leave a
widish scar. Alternatively the space is stitched up to heal with a narrow scar. Bigger
operations are designed to move the scars away from the midline. Ask your surgeon
which way he finds best. Most operations mean a day or two in hospital. The small
operations with local anesthesia are usually as day visits to hospital.
Any Alternatives
251
If you leave things as they are, the trouble will remain. It may get better on its own
by the time you are 40 years old or so. Burning the deeper tissue with a phenol
treatment is an alternative. It does not necessarily lead to better healing than the
small operation.

checks.
After - In Hospital
If you have had only a local anesthetic you will be completely awake and alert
throughout. Local anesthetic will wear off after an hour or two, so the wound
gradually gets uncomfortable. Take painkillers early to control any pain. Feeling in
the wound may come back quicker after a general anesthetic so that you should be
ready to take painkillers inside an hour. The wound should be just about pain-free
within a day or so. A general anesthetic will make you slow, clumsy and forgetful for
about 24 hours. Do not make important decisions, drive a car, use machinery, or
even boil a kettle during that time. The wound will have a dressing. This may be held
on by elastic net pants. Sometimes the space in the wound is packed with a an oily
dressing or a special silicone sponge. Usually the nurses on the ward and the district
nurses arrange to change the dressings as needed and to take out the stitches.
Sometimes the wound is examined and cleaned in the out-patient department. The
arrangements will be explained to you. The nurses will advise about sick notes,
certificates etc.
After - At Home
The advice below applies to a patient who has had a small operation under local
anesthesia. You should lie on the dressings for one hour or so before going home. If
there is any bleeding, add extra dressings and lie on them. If the bleeding continues
at home, come back to the ward. You will be given a supply of dressings and an Out
Patient appointment. The next day: Soak in a bath of warm water without salt for 30
minutes, and pull out all the dressings. Place a new dressing over the wound, held in
place by underpants. Each day: Remove the dressing, have a bath and apply a new
dressing. There may be a bloody discharge for a day or two, but the discharge will
then become yellow. To prevent the condition coming back, you should attend the
Out Patient clinic or your surgery each week until the wound has healed. You can
wash the wound area as soon as the dressing has been removed. Soap and warm
tap water are entirely adequate. Salted water is not necessary. You can shower or
bathe as often as you want. After a local anesthetic you can drive straight away.
After a general anesthetic you should wait 24 hours before driving. You should be
able to go back to work within 24 hours after the minor operation with out stitches. A
larger operation with stitches usually means two weeks off a light job and perhaps
four weeks off a heavy job. Avoid sport until the wound has fully healed. This will be
after three or four weeks after stitching, and six or seven weeks if the space has to
fill in with scar tissue.
252
and surgical staff. If you think that all is not well, ask the nurses or doctors. Bleeding
may show up as blood coming through the dressing. This may happen in the first 12
hours. Contact the ward if this happens. Wound infection is sometimes seen. This
settles down with antibiotics in a week or two. Slow healing can happen. You can
help this by very careful washing three times a day. Do not miss your follow up
treatment. The pilonidal sinus can sometimes come back. This will need a repeat
operation.
General Advice
The operation is a minor one and the results are good. The chance of more trouble is
about one in ten. We hope these notes will help you through your operation. They
Posterior Repair - Prolapse Operation
What is it?
The vagina and the back passage - rectum are no longer held up properly. The
rectum is dropping down onto the back of the vagina, making a weakness or bulge.
The bulge is called a prolapse. A prolapsed rectum is called a rectocele. The
prolapsed rectum may not empty properly when you want. The prolapse makes you
feel uncomfortable in the vagina. The prolapse happens if the supports to the vagina
and rectum stretch during pregnancy, and do not get back to normal afterwards.
This may not show up until after the menopause. Having a heavy job, having a
chronic cough, or being overweight will all bring on a prolapse earlier. An operation
will tighten up the supports to the rectum, and take away the bulge in the vagina.
253
The Operation
You will have a general anesthetic and be completely asleep. A small cut is made
through the lining of the back - posterior of the vagina. The supports to the rectum
are shortened with stitches and the bulging part of the vagina cut away. This repairs
the weakness. The wound in the vagina is then stitched up. You need to be in
hospital for about six days.
Any Alternatives
If you leave things as they are, the prolapse will slowly get bigger. Your discomfort
and difficulty opening the bowels will worsen. The bulge may even drop through the
vulva and start to bleed. At your stage, special exercise to the muscles of the pelvis
have not helped. A prolapse is not a serious/life-threatening condition but it can
seriously affect the quality of your life. . Your best way forward is to have the
operation. The operation is relatively easy to perform and is successful most of the
time.

lungs, ask your family doctor to check that these are under control. If you are past
the menopause, your vagina may be short of female hormone (estrogen). You may
heal better if you have some hormone replacement treatment (HRT). You may be
started on this before your operation using tablets, patches, or a vaginal cream. This
will be for a month or two to cover the operation only. You don’t need to decide at
this stage about having long-term HRT. Check that you have a relative or friend who
can come with you to the hospital, take you home, and look after you for the first
week after the operation. Sort out any tablets, medicines, inhalers that you are
using. Keep them in their original boxes and packets. Bring them to hospital with
to prepare you so that you can have the operation as safely as possible. . Please tell
the doctors and the nurses of any allergies to tablets, medicines or dressings. You
will have the operation explained to you and will be asked to fill in an operation
After - In Hospital
You will have a small/thin plastic tube (a drip) in an arm vein. This gives you salt and
sugar and water, and sometimes blood, for a day or so from a plastic bag on a stand.
problems in the past. You will have a sanitary pad in place. The wound may be
painful. You will be given painkilling injections or tablets for this. On the second day
you should be able to spend an hour or two out of bed. By the end of four days you
should have little pain. A general anesthetic will make you slow, clumsy and forgetful
for about 24 hours. Do not make important decisions during that time. The nurses
will help you with everything you need until you can do things for yourself.
You will have some blood and urine tests in the first few days after your operation.
These will check you are not anemic and have no infection in the urine. You may
have a fine tube - catheter in the your bladder . This drains urine from your bladder
into a collection bag at your bedside. It is usually taken out two days after your
operation. You will then pass urine normally. The catheter will makes you feel as
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though you need to pass urine. This is a false alarm. If you do not have a catheter,
you need to pass urine within six hours after the operation. If you have any
difficulty, tell the nurses. There are stitches in the skin wound in the vagina. The
parts of the stitches under the skin will melt away by themselves. The surface knots
of the stitches will appear on the pads after about two weeks. This is quite normal.
You should wear pads as dressings. Do not use tampons for six weeks. There will be
slight bleeding like the end of a period. It should be almost nil by the time you leave
the hospital. There may be a little bleeding again after about two weeks when the
knots free off. This is nothing to worry about. If it is heavy, contact the ward.
You will be able to take a bath or shower as often as you wish. You do not need salt
water. Do not soak in the bath for more than 10 minutes. Gently dry the wound area
afterwards. You will be given an appointment for an Out Patient check up about six
weeks after you leave hospital. The nurses will advise about sick notes, certificates
etc.
After - At Home
At home, you are likely to feel tired and need rest two or three times a day for a for
three to four weeks. You will gradually improve. After three months, you should be
able to return completely to your usual level of activity. You can drive as soon as you
can make an emergency stop without discomfort, generally after three weeks. You
can start sexual relations before you return for the six-week check, if you feel
comfortable enough, and you have no blood loss. You should be able to return to a
light job after about six weeks. Leave a very heavy or busy job until 12 weeks.
Most vaginal repairs are without complication. Problems are being looked for by the
medical and nursing staff. If you think that all is not well, please ask the nurses or
doctors.
Minor complications occur in 3-4% of cases. Chest infections may arise, particularly
in smokers. Work with the physiotherapists to clear the air passages to prevent this.
Do not smoke. Sometimes the bladder is slow to start working again. Be patient.
Sometimes the catheter needs to go back into the bladder for a few days. Wound
infection is sometimes seen. This settles down with antibiotics in a week or two.
Aches and twinges may be felt in the vaginal area for up to three months.
More serious complications such as severe bleeding, damage to your bowel by the
operation, or a creation of a passage between your vagina and the bowel (fistula) are
rare (1-2% of cases) and may require another operation to fix them.
General Advice
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Prostatectomy
What is it?
The prostate gland is a thick ring of muscle and gristle which lies between the outlet
of the bladder and the penis. It is rather like the bung in the outlet of a homemade
wine bottle, holding the outflow tube in place. It lies deeply behind the bone in the
front of the pelvis (which is the lower part of your abdomen). It makes the fluid that
carries sperm. Sometimes the centre of the prostate ring becomes narrow because of
overgrowth or scarring. This causes difficulty in passing urine, and back-pressure
effects on the bladder and kidneys.
The Operation
The centre of the prostate ring is widened by coring out the tissue using an
instrument passed up the penis. The removed tissue is send to the laboratory for
examination. Sometimes the tissue is taken out by opening up the bladder through a
cut just below the tummy button. Most patients have a general anesthetic, so that
they are asleep during the operation. It is quite common however, for patients to be
numbed from the waist down with an injection in the back. If this is the case you will
be awake during the operation, but feel no pain. The operation takes about 40 to 60
minutes.
Any Alternatives
If you just have a little slowness of the stream of urine and are getting up at night
once or twice, simply waiting and seeing if you have more trouble is a reasonable
idea. If you find your life is being upset by the prostate, then treatment is sensible.
256
Drug treatment may be helpful in the short term, but there may be side-effects. A
complete blockage definitely needs treatment, at first with a drainage tube
(catheter) through the penis or through the lower tummy wall, followed usually with
a coring out through the penis. Keeping the way through the prostate clear using
short indwelling tubes is experimental. An open operation through the tummy is
needed in about 10% of cases. The main indication for this is a very large prostate
(more than 60 to 80g) which is very difficult to take it out by passing the instrument
through the penis because this can take a very long time and is associated with an
increased risk of complications after the operation. Two other much less common
indications for removing your prostate with an open operation are a bladder
condition such as large bladder stones or a blowout on the bladder wall. Sometimes
a permanent catheter with a collecting bag for urine strapped to the leg is the best
plan if an operation would be very risky.

lungs, ask your family doctor to check that these are under control. Bring all your
tablets and medicines with you to the hospital. On the ward, you may be checked for
and that you can have the operation as safely as possible. Many hospitals now run
After - In Hospital
There will be a catheter in your penis connected to a urine bag. Usually the catheter
has a continuous stream of salt solution running through to keep it from blocking.
The urine will be bloodstained for the first two or three days. If you have had the
operation on your tummy, there will be a fine, plastic drainage tube coming out near
the wound. This is to drain any residual blood or other fluid from the area of the
operation. This usually comes out two to three days after the operation. It is
uncomfortable having a catheter in the penis. It can give a strong feeling of wanting
to pass urine. This passes off. The tummy wound is not very painful, but you can
have injections or tablets to control any pain and discomfort. Ask for more painkillers
if the pain is not well controlled or if it gets worse. When the urine has cleared, the
catheter will be taken out. You should then pass urine freely. If you have the open
operation, stitches or clips in the wound will be taken out after 7 to 10 days.
Sometimes the catheter has to be flushed through by the nurses or doctors to free
any blood clot. This is not painful. Most hospitals arrange a check-up about one
month after you leave hospital. Others leave check-ups to the general practitioner.
After - At Home
things that are too heavy. After a tummy operation you should be able to return to a
light job after about four weeks and a heavy one after about eight weeks. After a
coring operation - halve these times. You may restart sexual relations within a week
or two, when the wound is comfortable enough. You may find that at intercourse no
liquid comes, and that afterwards you notice milky fluid in the urine. This can happen
in up to 80% of cases and is because the widened prostate ring allows the sperm to
pass up into the bladder instead of down into the penis. You may be sterile. Some
men (5-10%) find that they cannot have sex as well after the operation as before it.
At the follow-up appointment you will be given the results of examination of the
257
prostate under the microscope. Sometimes further treatment with tablets is needed.
This will be discussed with you.
If you have an anesthetic injection in the back, there is a very small chance of blood
clot forming on top of your spine which can cause a feeling of numbness or pins and
needles in your legs. The clot usually dissolves on its own and this solves the
problem. Extremely rarely, the injections can cause permanent damage to your
spine.
nursing staff will deal with this. There is a 5% chance that you may require a blood
transfusion because of the blood loss.
physiotherapists to clear the air passages is important in preventing chest infections.
of the catheter, there may be difficulty passing any urine at all. It may mean
replacing the catheter for three days or more. Sometimes after removal of the
catheter there is some dribbling or moistness from the penis after passing urine. This
improves with time and the improvement can continue gradually for up to three
months. However, there is about a 1% chance that you may experience mild to
moderate urine incontinence in the long term. Ask the surgeon for advice if it is
troublesome.
the condition usually settles down.
There is a 10-15% chance that the prostate ring becomes narrow again over months
or years. Seek medical advice in this case and most likely you will need another
General Advice
The operation gives good results. Patients are usually surprised how quickly they get
better. However, there are many technical points in the operation and they vary
from patient to patient. The surgical and nursing staff will be pleased to explain what
is happening in your particular case. These notes should help you through your
and surgeons vary a little.
258
Radius and Ulna Fracture - Internal Fixation
What is it?
Your forearm is made up of two long bones that sit side by side. The inside bone is
called the ulna, and the outside bone is called the radius. You have broken both
bones. A fracture means just the same as a break. The bone ends are out of line and
may be overlapping. Without an operation, the bones would heal, but not in their
correct position. You would not be able to turn your hand from palm up to palm
down.
The Operation
surgeon makes two cuts. One will be on the side of your forearm, in line with your
little finger, where the ulna is just under the skin. The other will be on the underside
of the arm (the palm side). He will move the bone ends into their correct position
and then fix them with steel plates and screws. This is called 'open reduction and
internal fixation'. There may be a fine plastic drainage tube running from the wound.
This is to drain any residual blood form the operation. The skin wound is then closed
up with stitches. You will be in hospital one or two nights after the operation.
Any Alternatives
If you leave things as they are, the bones will not heal in the correct position. A
plaster cast will not hold the bone ends in the correct position properly. Fixing the
steel plates onto the bones is better than using steel pins attached to a frame
outside the arm (External Fixation).

nurses know about your general health, past illnesses, and drug treatment. You will
have all the necessary tests to make sure that you are well prepared and that you
can have the operation as safely as possible.
the injury.
After - In Hospital
You will have a dressing on your arm, and your arm will be in a sling. You will not
need to be in a plaster cast. Your arm will be raised to reduce any swelling. It will
either be on pillows or held up in a foam support. The wound may be painful. You will
be given injections and later tablets to control this. Ask for more if the pain getts
worse. A general anesthetic will make you slow, clumsy and forgetful for about 24
things for yourself. Do not make important decisions, drive a car, use machinery, or
even boil a kettle during this time. The wounds will have simple adhesive dressings
over them. The nurses will pull out your wound drain after 24 to 48 hours. Your
stitches will be taken out 10 to 12 days after the operation. You may remove your
sling to wash. Wash around the dressings for the first 10 days. You can wash the
as often as you like. Discomfort in the arm will stop you doing too much. Take things
easily for the first month. Keep your finger, wrist, elbow and shoulder joints working.
You will be given an appointment to visit the orthopedic outpatient department for a
check-up about one month after you leave hospital. There you will have an
259
examination and more X-rays to check the bones are healing properly. The nurses
After - At Home
You cannot drive while your arm hurts. You cannot drive until you can move your
arm freely. Therefore you may not be able to drive for six weeks after your
operation. How soon you can return to work depends on your job. If your work is
light, you may be able to return to work three or four weeks after the operation. This
also depends on you being able to get to work. If your job is manual, you will be
unable to work for two or three months. You may swim and play most sports six
weeks after your operation, as your break should have healed by this time. When
you start playing, you will not be able to play for as long as normal. Your arm will
ache at the end of a game. Your arm will continue to improve for at least six months.
The plates and screws do not have to be removed. The plate on the underneath bone
may be uncomfortable and can be removed. If you indulge in high level contact
sports, it may be best to remove the plates. This is to avoid breaks where the plate
is fixed to the bone. This is because these second breaks are more difficult to fix. If
the metalwork is to be removed, this will not be for at least 18 months after your
operation. The risk of serious injury to a nerve is much higher when taking out the
metal plates than putting them in. This is because your nerves may be embedded in
scar tissue from the first operation. This makes them more difficult to see and avoid.
There are several important nerves which run in the region of your operation. One or
more of these nerves can be bruised during your operation. This would make your
hand temporarily weak and numb. It is very rare for a nerve to be permanently
damaged. Very rarely, damage to the blood vessels in or aound the area of the
operation and bleeding can occur and might require another operation to deal with
the problem.
The operations is successful most of the time. On rare occasions a fracture may not
heal. If this occurs you will need another operation.
General Advice
The operation is a neither very simple nor too difficult but somewhere in between.
You will end up much better than if you do not have it. We hope these notes will help
260
Removal of chalazion
What is it?
Chalazion (which is the Greek word for hailstone) is a lump that develops in the
eyelids (more commonly the upper one). The chalazion is otherwise called
meibomian cyst. The meibomian glands are very small organs that lie in the back
surface of the eyelids (the one towards the eye ball) and they produce an oily fluid
which is part of the tears. The meibomian glands have a small duct/pipe that drains
the oily fluid they produce. When this duct gets blocked, the oily fluid cannot be
drained and it accumulates causing the gland to get bigger and bigger. It is a very
common condition that affects both sexes equally. It is more common in adults than
children. People who develop a chalazion have a tendency to have more in the
future. Poor hygiene of the eyelids and local infection are factors that can cause
blockage of the draining duct of a meibomian gland and lead to the development of a
chalazion.
A chalazion grows over a period of a few weeks and usually doesn’t cause pain or
any other problems. Rarely, it can become enlarged and can press on the eye ball
and affect the vision. If a chalazion gets infected it can become red, swollen and
painful.
The operation.
The operation can be done as a day surgery procedure, which means that you can go
home on the same day of the operation. The operation is performed under local
anesthetic, which is applied with a small injection into the eyelid. Sometimes an
anesthetic cream is also applied locally to minimize the discomfort from the injection.
261
When the chalazion is relatively small, it can be removed through a small cut at the
back of the eyelid. The eyelid is lifted so that the surgeon has access to the back
surface of it and a small cut (about 3mm) is made just on top of the chalazion. The
lump is then removed and pressure is applied for a few minutes to stop any oozing of
blood that may occur because of the operation. There is no need for stitches and
since the cut is at the back of the eyelid, it doesn’t show and the cosmetic result is
excellent. If the chalazion is large and pushes on the skin of the eyelid then it is
usually removed via a small cut in front of the eyelid through the skin. The cut is
again about 3mm and is on top of the chalazion. After removal of the lump the
application of pressure locally stops any oozing of blood in the area. The cut on the
skin of the eyelid is closed with very fine (hardly visible) stitches which provide a
very good cosmetic result when they are removed, usually five to seven days later.
The removed chalazion is usually sent to the laboratory to be examined under a
microscope because very rarely it can harbor cancer.
Any alternatives?
The application of warm compresses on the eyelid (four to six times a day for 10 to
15 minutes each time) in combination with very gentle massage of the eyelid that
has the chalazion, can lead many times to spontaneous opening of the blocked duct
of the meibomian gland which allows the oily fluid to drain and cures the chalazion.
If there is infection in the area of the chalazion, the application of local antibiotic
ointment for five to seven days can cure the infection, reduce the swelling in the
area and subsequently allow the duct of the meibomian gland to open up and drain
the accumulated oily fluid.
In some cases, the injection of anti-swelling medications (such as the steroids) in the
area near the chalazion can reduce the local swelling caused by the presence of the
chalazion and eventually helps the duct of the meibomian gland to open.
Those conservative treatments are effective in many cases. However, when the
chalazion doesn’t respond to this kind of conservative treatment, or when it is too
large, or when it comes back many times despite initial successful conservative
treatment, surgery is the only appropriate treatment.

After - in hospital
Following removal of a chalazion, most patients experience some very minor
discomfort in the eye which can be easily controlled by taking medication. You can
wash, bathe, or shower normally after the operation, but you must not get water in
your eye for 7 to 10 days. If you have your hair washed, have it done with your head
leaning backwards. Do not use makeup on your eyelids for one month. You will
normally be able to go home on the day of your operation. You will be given a supply
of eye drops, and shown how to put them in your eye. These are used to prevent
262
infection and swelling in the eye. If you have stitches on the skin of your eyelid, they
will be removed five to seven days after the operation. You will be given an
appointment for the outpatient department for a check-up three to four weeks after
you leave hospital. The results of the examination of the chalazion under the
microscope will be available by then. The nurses will advise about sick notes,
certificates, etc.
After- at home
Your eye will be covered by a pad and a protective plastic shield. This applies gentle
pressure on the eye to prevent any local small leakage of blood after the operation.
This can be removed six to eight hours after the operation. You can start driving the
day after the operation. You can use any glasses you were using before the
operation as soon as the pad is removed. If you wear contact lenses, do not put one
in the operated side for eight weeks. Plan to go back to light work in one to two
days, and a more heavy/manual job in 7 to 10 days.
The removal of a chalazion is a straightforward and safe procedure. Complications
are rare and seldom serious. Some minor bleeding can occur in the area of the
operation and this usually stops with the application of gentle pressure. Extremely
rarely, you will need another operation to fix the problem. Also rarely, the area of
the operation can become infected. If this happens you will need treatment with
antibiotic eye drops and, possibly, antibiotic tablets. The worst problems following
removal of chalazion occur when the removal is incomplete. In this case the area of
the chalazion becomes scarred and lumpy and can sometimes cause significant
discomfort in the eye. In this very rare situation you will need another operation to
remove the remnants of the chalazion and the scarred tissue around it.
Overall, the results of the operation for removal of a chalazion are excellent.
However, even if the surgery was a success, another chalazion can appear (people
who have had a chalazion have higher chances of experiencing the same problem in
the future) and in this case you may need another operation to remove it.
General advice
Retained Tooth - Root
What is it?
The root of a tooth is that part embedded in the upper or lower jaw bone. There are
up to four roots to a tooth. Roots need to be removed if they are causing mouth
infections, are causing pain, and if it is no longer possible to repair them or make
them infection-free. The same applies to a tooth that has stayed in the jaw bone
without growing out properly - an unerupted or impacted tooth. Roots or teeth may
start causing trouble in the gum after lying dormant for many years. This often
occurs when a patient has worn a denture over the gum in this region for some time.
263
The Operation
You will have a local anesthetic, a local anesthetic with some sedation or a general
anesthetic. When you have a local anesthetic, the area of the operation is numbed
with an anesthetic injection. You will not feel any pain but you will be awake and
conscious. The sedation is sometimes added to the local anesthetic to help you relax
and allow you to go through the operation. If you are sedated, you will be conscious
during the operation, but will not be aware of what is going on. Finally, if you have a
general anesthetic you will be completely asleep during the operation and you will
not feel any pain. The decision about the type of anesthetic will be discussed
between you and your surgeon. Although operations of this type can be done safely
and comfortably just with local anesthetic, it is better to have some sedation or a
general anesthetic if it is anticipated that the operation will be difficult, for example,
when you have a tooth that hasn’t erupted at all and lies deep in your gum.
The roots and/or teeth are removed from inside the mouth. Often only special
forceps are all that are needed. The gum may need to be cut slightly to make access
to the teeth/roots easier. A small amount of bone may have to be taken away to
loosen the tooth/root. The tooth/root may need to be cut into one or more pieces to
help its removal. The gum will be stitched after the tooth is removed, often with
stitches that melt away in 7 to 10 days. Most patients will be sent home on the day
of the operation. If you have just a local anesthetic you will normally go home two to
three hours after the operation.
Any Alternatives
If you leave things as they are, the problem remains. There are no satisfactory
alternatives.
264
If you are having a general anesthetic, stop smoking and get your weight down if
you are overweight. (See Healthy Living). If you know that you have problems with
your blood pressure, your heart, or your lungs, ask your family doctor to check that
these are under control. Check the hospital's advice about taking the Pill or hormone
replacement therapy (HRT). Check you have a relative or friend who can come with
you to the hospital, take you home, and look after you for the first week after the
operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in
Please tell the nurses of any allergies to tablets, medicines or dressings. You will
have the operation explained to you and will be asked to fill in an operation consent
form. Many hospitals now run special preadmission clinics, where you visit for an
hour or two, a few weeks or so before the operation for these checks.
After - In Hospital
Your mouth will feel bruised and swollen. Your jaw will be slightly stiff and usually
there is some mild to moderate discomfort. Your cheeks may swell a little with slight
bruising of the skin. Painkillers will be given to help with any discomfort. The
swelling, bruising and stiffness of the jaw will disappear over a week to 10 days. A
same is true for sedation but to a lesser degree. The nurses will help you with
time. The stitches which may have been put in usually dissolve but, you are normally
asked to attend a short outpatient visit to check healing about two weeks after your
operation. The stitches may be removed if required. An after-surgery X-ray may be
taken at that visit. Occasionally further visits may be arranged to monitor your
progress. Some hospitals arrange a hospital check-up. Others leave check-ups to
your usual dentist. The nurses will advise about sick notes, certificates etc.
After - At Home
You may be given a small 'take home drug pack' containing an antiseptic
mouthwash, some painkillers and some antibiotics. Please note that antibiotics can
make the contraceptive pill less effective. Take other precautions against pregnancy
while taking the antibiotics and for about a week after finishing the antibiotics. It
may be hard to chew normally for a while so you should eat a softer diet and initially
avoid very spicy and vinegary foods. A little extra daily fibre in the form of porridge
or bran cereals often helps to prevent constipation whilst your diet is temporarily
altered. It is important to keep your mouth cleaner than normal to prevent infection
of your wounds. A warm salt water mouth bath, three times a day (a pinch of salt to
half a pint of warm water), used for one minute each side of the mouth after tooth-
brushing often helps soothe the mouth. The antiseptic mouthwash given to you
should also be used after the salt water for one minute. You should finish the full
course of antibiotics and only take painkillers as directed. You will be aware of the
hole(s) left after removal of your teeth/roots for several weeks, but the bone and
gum will reshape and after six months it will be hard to tell you have had surgery
there at all. You may feel quite tired for one to two weeks after your operation. You
should be able to go back to work in a day or so.
265
Complications are rare. Bleeding after the operation occurs rarely and usually stops
when the surgeon applies some pressure with a sponge on the area of the operation.
Extremely rarely, you will need another operation to stop the bleeding.
If you experience increasing pain at the area of the operation, you feel that is getting
more swollen and you have a temperature, it most probably means that the
antibiotics that you were given to prevent an infection were not adequate and that
the area of the operation has become infected. This happens relatively rarely and
taking antibiotics (most likely different to the ones you were given to prevent the
infection) for another week or two usually solves the problem. In a very small
number of patients the infection can be very bad and lead to a collection of infected
fluid or pus (abscess) at the area of the operation. In this situation you will need
another operation to drain the infected fluid or pus.
Following the removal of an impacted tooth, you have 5 to 10% chance of

experiencing a problem called a “dry socket”. This happens because following the
removal of the tooth a clot was not formed in the area or socket where the tooth
used to be or it did form but was then dislodged. This can be painful, and often
causes foul bad breath and it is something you usually experience four to five days
after the operation. The socket needs to be packed with some medicated gauze for a
few days to relief the symptoms until the healing process progresses and starts to fill
the socket. The gauze needs to be changed every other day and most patients don’t
need more than two to three changes until they feel much better and packing of the
socket is no longer required. It is believed that patients who smoke or women who
use contraceptive pills experience this problem more frequently. Although a “dry
socket” can be very annoying, with proper care it settles completely, relatively
quickly.
The lower roots or teeth may run very close to a nerve running to the tongue and lip.
There is a separate nerve on each side. The nerve(s) may be affected by bruising
and swelling around the wound(s). This may cause some numbness of the lower lip
and tongue on one or both sides. Normal feeling usually returns rapidly but may
exceptionally last a week or two. Rarely the numbness does not get better.
General Advice
any queries or problems, please ask the doctors or nurses
Retrograde Pyelogram
What is it?
The tests you have had so far point to your water-works (urinary system) as the
266
The Operation
You can have a general anesthetic or you can be numbed from the waist down with
an injection in the back. The choice depends partly on which you prefer, and partly
on what your surgeon or anesthetist thinks is best. Having a general anesthetic
means that you will be completely asleep during the operation. Having an injection in
the back means that you will be awake during the operation, but will not be able to
feel any pain from the waist down.
If you are awake for the operation, you will have your legs held up in stirrups. A
nurse will chat to you during the operation.
planned. Finally all the equipment is taken out. After the operation, it is sometimes
Any Alternatives
this route is usually all that is needed. Sometimes a drug treatment washed into the
267
bladder is very helpful. X-ray treatment is usually held in reserve. If you do nothing
you will not find out what the trouble is. Also you will not get the benefit of early
treatment by this route which in certain situations, such as a developing cancer, it is
absolutely vital to get a diagnosis and start treatment as early as possible. The
problem will steadily get worse.

you are using. Keep them in their original boxes and packets. Bring them to hospital
with you.
as possible. Please tell the nurses of any allergies to tablets, medicines or dressings,
especially to iodine or post X-ray injections. You will have the operation explained to
After - In Hospital
You may have a fine tube (catheter) passing into the bladder through the front
passage. This is so that urine can drain into a collecting bag. This can feel
uncomfortable. Sometimes the catheter needs to be flushed out to keep the urine
flowing properly.
problems in the past. There is slight discomfort where the instruments have been.
You will not normally need painkillers. The feeling goes away after a day or two. A
kettle during this time.
If there is no catheter, you should be able to pass urine before you leave the
hospital. If you cannot pass urine, let the doctors and nurses know. If there is a
catheter, the urine drains out automatically. The catheter will be taken out when the
urine is clear and when it is safe to do so. After that you will be checked to see that
you are passing urine properly. It is a good idea to drink an extra pint of water in
addition to what you normally drink each day. Do this for a week after the operation.
This will help to clean the urine. You will be given an appointment for the outpatient
department, or you will get a date for any repeat operation. Some hospitals arrange
a check-up about one month after you leave hospital. Others leave check-ups to the
After - At Home
268
If you have an anesthetic injection in the back, there is a very small chance of blood
clot forming on top of your spine which can lead to a feeling of numbness or pins and
needles in your legs. Most of the time the clot dissolves on its own and this solves
spine.
Complications are unusual, but are rapidly recognized and dealt with by the surgical
and nursing staff. If you think that all is not well, please let the doctors and the
nurses know.
physiotherapists to clear the air passages is important in preventing chest infections.
Sometimes you can have an infection which is either localised in your urine stream
or gets into the bloodstream. You will be given antibiotics to treat the infection.
the telescope or the other instruments used during the operation can create a hole
General Advice
nurses.
Salpingo-oophorectomy - Ectopic Pregnancy
What is it?
The doctors think you have a pregnancy in a Fallopian tube or in an ovary. This is
called an ectopic pregnancy, meaning "not in the right place". An ectopic pregnancy
will not live. It can cause you life-threatening internal bleeding. It may have
happened because of scarring from earlier infection in or around the tubes. Blood
tests and scans will be of some help in finding out what is going on. The only certain
way is to look inside your tummy. A special narrow telescope - a laparoscope is used.
An ectopic pregnancy may be able to be dealt with through the laparoscope. The
ectopic pregnancy may be able to be taken out without removing the tube and
ovary. This is called a salpingostomy. If not, the tube has to be taken out and
possibly the ovary as well - salpingectomy or salpingo-oophorectomy .
269
The Operation
the skin just below your tummy button. The laparoscope is inserted through the
tummy wall, and your tummy is inflated with some carbon dioxide gas. This gives
the surgeon a good view of the inside of your pelvis (the lower part of your abdomen
where your womb, tubes and ovaries are placed). He may also pass other
instruments into the tummy through one or two other cuts. These will help him to
get a better view and let him do the operation. He will check that there is in fact an
ectopic pregnancy. He will deal with the problem by removing the pregnancy and any
tissues attached to it. Finally, a stitch is put into each skin wound. It usually takes
about 45 minutes. If the surgeon cannot manage to do the operation through a
laparoscope, he will need to make a bigger cut (4-6 inches/ 10-15 cms) in your
tummy. Whichever operation is done, only 50% of women become pregnant again.
And there is a 1 in 10 chance of any future pregnancy being ectopic.
Any Alternatives
If you leave things as they are, you will be in great danger of life threatening blood
loss. Drugs and medicines will not help. You must not delay.

All preparations need to be done very fast. The most important thing is for you to get
to hospital as soon as possible. Check you have a relative or friend who can come
with you to the hospital, take you home, and look after you for the first week after
the operation. Sort out any tablets, medicines, inhalers that you are using. Keep
them in their original boxes and packets. Bring them to the hospital with you. On the
ward, you will be checked for past illnesses and will have special tests to prepare you
so that you have the operation as safely as possible.. Please tell the doctors and
explained to you and will be asked to fill in an operation consent form. Bleeding from
the vagina will not put off the operation.
After - In Hospital
There may be a fine plastic drain coming out of your tummy. This will drain out any
blood from inside the pelvis. This is usually removed 12 to 24 hours after the
operation. You will have a small/thin plastic tube (a drip) in an arm vein. This gives
you salt and sugar and water, and sometimes blood, for a day or so from a plastic
270
bag on a stand. You may be given oxygen from a face mask for a few hours if you
have had chest problems in the past. You will have a sanitary pad in place. You may
have some discomfort in the tummy and shoulders caused by the gas inside the
tummy. Injections will help. After this, mild painkillers should be all you need. There
may be slight vaginal bleeding or a dark-stained discharge. This should stop after a
few days. Your next period may not appear on time. Only use external pads for any
bleeding. Do not use tampons for six weeks. Some blood tests will be done to check
you are not anemic. A general anesthetic will make you slow, clumsy and forgetful
for about 24 hours. Do not make important decisions during that time. The nurses
will help you with everything you need until you can do things for yourself. Most
likely you will have a catheter in your bladder that allows the urine to drain freely
into a collecting bag. This catheter is removed 24 hours after the operation. When
the catheter is removed, the discomfort of the operation can make it difficult to pass
urine and empty the bladder. . If you cannot get the urine flowing properly after six
hours, contact the nurses or your doctor. You will be able to take a bath or shower
as often as you want but try to keep the wound(s) dry for one week. You will be
given an appointment for an Out Patient check up a week or so after you have left
hospital. The result of the examination of the tissue will be ready then. The nurses
After - At Home
You may feel very tired for two to three days. You will be back to normal after three
weeks or so. Make sure you are going home by car with your relative or friend. At
home, go to bed and rest for at least six hours. You can usually go back to normal
activity and work after a week. Avoid heavy exercise for three weeks. You can get
back to driving after three days. You can resume sexual relations as soon as you feel
comfortable enough. You will need to discuss contraception and future pregnancy
with your partner and your doctor. If you wish, you can try for a pregnancy two
months after the operation. You should be able to return to a light job after about
two weeks, but you may not be able to cope with a very busy job for up to six
weeks.
complications related to your heart or you lungs. This is slightly increased in an
operation like this because everything is happening very quickly and also because if
you have any ongoing bleeding because of the ectopic pregnancy, you are not in the
best possible shape before the operation. However, the tests that you will have
before the operation will make sure that you can have the operation in the safest
possible way and will bring the risk of such complications very close to zero.
Ectopic pregnancy is a serious condition. Blood transfusion is sometimes needed. If
you have lost a lot of blood, you may need to stay much longer in hospital. If the
pregnancy can be removed through the laparoscope, you will recover more quickly.
The chances of complications after the operation are overall 3-4% and occur more
frequently when there is difficulty in removing the pregnancy. Minor complications
include small bruising or an infection of the wound that can be cured by taking
antibiotics for a few days. More serious complications include ongoing bleeding or
damage to one of the organs in the abdomen and may require another operation to
deal with them,
You are likely to feel very sad following the loss of your pregnancy. Support from the
miscarriage group may help you and your partner cope.
271
General Advice
Shoulder Arthroscopy
What is it?
The surgeon needs to look inside your shoulder to find out exactly what is causing
your symptoms. In some people, he is looking for signs that the shoulder has been
coming out of joint. In others, he is trying to see the condition of the tendons (strong
bands of tissue that attach the muscles to the bones) that are above the shoulder
joint. He will be using an arthroscope.
The Operation
arthroscope is a telescope about as wide as a pen, connected to a television. The
operation is called an arthroscopy. The surgeon will insert the arthroscope through
one or two tiny half inch (about 1 cm) cuts around your shoulder. He will use it to
look at the inside of your shoulder and the tendons over the shoulder. The cuts will
be closed with stitches, clips, or paper tapes. You will be in hospital one night or so
Any Alternatives
272
If you leave things as they are, the cause of the shoulder problem will remain
unclear. More X-rays and scans will not help at the moment. Arthroscopy is the only
way to get a direct view of the inside of the joint and the tendons above the joint.

After - In Hospital
Your arm will be in a sling. The shoulder may be a little sore. If it is, you will be
given injections or tablets to control this. Ask for more if the pain is getting worse.
Your shoulder might also be a bit stiff. This will get better quickly. A general
during this time. The cuts may be held closed with paper tapes, stitches or clips.
There will be simple adhesive dressings over the tapes. You may take the dressings
and the tapes off 10 days after the operation. Arrangements will be made for your to
have your stitches or clips taken out after 10 days or so. Wash around the dressings
for the first 10 days. You can wash the wound area as soon as the dressing has been
necessary. You can shower or take a bath as often as you like. You will be given an
appointment to visit the orthopaedic outpatient department about one week after
you leave hospital. Some hospitals arrange a check-up about one month after you
leave hospital. Others leave check-ups to the General Practitioner. The nurses will
After - At Home
You cannot drive whilst your arm is in a sling. If you were driving before the
arthroscopy you will be able to drive within a few days of leaving hospital. How soon
you can return to work depends on your job. If you are working now, you should be
able to return to work 7 to 10 days after your operation.
Complications following arthroscopy are very rare. Occasionally the surgeon is unable
to see all that he would wish. Sometimes arthroscopy does not come up with any
answers. Very rarely there is bleeding inside the joint, or some infection that can be
settled by taking antibiotics for a few days. Very rarely more serious complications
can happen like further damage to the joint or damage to the nerves or blood
273
vessels in or around the area of the operation and you might need another operation
to deal with the problem.
General Advice
The operation is a minor one. It should help to find out what is wrong with your
shoulder. We hope these notes will help you through your operation. They are a
Septoplasty
What is it?
The nasal septum is the partition inside the nose made of cartilage (gristle) 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 is bent over. You may feel that
your nose is blocked or may have headaches and pain in the face. You may have
sinus (the space inside any face bone) infections and even ear problems.
Straightening out the septum will help you to breathe through your nose more
easily, and lessen problems with your sinuses and ears.
The Operation
You will have a general anesthetic and be completely asleep. A small cut will be
made in the skin over the septum inside the nose. The surgeon will then straighten
out the cartilage and move it back into the middle of the nose. Further back, the
274
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 put into the nose to keep
everything straight and stop any bleeding. Because you will be asleep you will not
feel any pain at all during the operation. 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.
Any Alternatives
Using tablets, nasal sprays or nasal drops may unblock the nose a little. The
blockage will always get worse again when you stop the treatment. Using nasal
drops for a long time may eventually make the blockage worse. These treatments
are not as good as an operation.

and look after you for the first few days after the operation. Sort out any tablets,
off, and you will be given time to get better before being sent for again. You need to
get over your cold before you have your operation because by the general anesthetic
the cold could turn into a serious chest infection.
After - In Hospital
chest problems in the past. Usually the nose will be a little sore and uncomfortable
after this operation. While the packing is in your nose you will have to breathe
through your mouth, and this will make your mouth feel dry. Taking frequent drinks
will help to keep it moist. You may find that the nasal packing makes your eyes
water or gives you a headache. If you do get a headache or your nose feels sore, the
nurses will give you an injection or tablets to help relieve this. Ask for more if the
pain is not well controlled or if it gets worse.. A general anesthetic may make you
important decisions during this time. The next day there may be some swelling
around the nose. This always improves quickly after the packs and splints have been
removed. You may notice some numbness in the middle of your upper lip or the tip
of your nose. This always gets better but may take several weeks. You will be able to
get up and about and have a warm bath. On the second day after your operation,
275
when the nurses remove the packing and splints from your nose there may be a little
bleeding which usually stops very quickly. You will probably be able to go home later
on in the day, usually in the early evening. Before your leave the ward you will be
given an appointment to come back to the ENT (ear, nose and throat) outpatient
clinic to see the surgeon again and have your nose checked. The nurses will advise
After - At Home
At home, take two painkilling tablets every six hours to control any pain or
discomfort. You may be advised to use an antiseptic cream, nose drops and steam
inhalations. As the inside of the nose gradually opens up you will find that you can
breathe more easily through the nose each day. If your nose runs you can wipe it,
but do not blow your nose until two days after you get home, and then start off by
blowing VERY GENTLY. To begin with you will see blood staining in your
handkerchief, most of this will be old blood from your operation, but there may be a
little fresh bleeding as well. This is expected and you should not worry about it..
Take it easy when you get home. Avoid hard physical exercise as this may make the
nose bleed. Try and avoid smoky atmospheres such as pubs and clubs for the first
couple of weeks. If possible try and avoid catching a cold within your first week at
home. If you do get a cold you should see your GP for a course of antibiotics. It will
be five or six weeks before the swelling inside the nose has completely gone and you
get the full benefit of the operation. You should be fit to return to work about two
weeks after your operation. You should be fit to drive one to days days after you
leave the hospital.
If there is a lot of bleeding during your operation, the surgeon may decide to leave
the nasal packs and splints inside your nose for an extra day. If there is a lot of
bleeding after the packs have been removed, then the surgeon will put them back in,
either with a local or general anesthetic. The chances of this happening are very
slight. Provided the advice given above is followed you are unlikely to have any
problems when you get home. There is a small risk that the nose may bleed when
you get home. If this is just a spot or two, you should not worry. If the nose
continues to bleed, come back to the ward.
There is also a small chance that the area of the operation inside you nose will get
infected. If you get a runny nose (especially if the fluid coming out is bloodstained,
thick, yellow or green or smelly), a temperature or increasing pain in your nose, your
face or your head, it most probably means that an infection is developing and you
will need prompt medical attention. The infection is usually settled by taking
antibiotics for a week or two.
Very rarely following this operation you can develop a hole in your nasal septum,
your face appearance might change or the septum can bend again. If you develop
these problems you will most probably need another operation to deal with them.
General Advice
276
Shoulder Tendon Repair - Rotator Cuff
What is it?
A tendon is a strong cord which joins a muscle to a bone. It enables the bone to
move when the muscle contracts. The rotator (row-tay-tor) cuff is the group of
tendons over the top of the shoulder joint that make your arm move. One of your
tendons is torn. This is probably as a result of the tendon rubbing against the bone
above. Having a torn rotator cuff gives you pain when you use your arm. You may
not be able to do certain things, such as lift your arm above shoulder height.
The Operation
is made over the front of the shoulder in the line of a bra-strap. Some of the
overlying bone is removed. This gives more room for the tendons. The tear in the
tendons is repaired with stitches. The skin wound is then closed with stitches. There
may be a fine plastic drainage tube running from the wound. This is to drain any
residual blood from the operation. You will be in hospital one or two nights after the
operation.
277
Any Alternatives
Without an operation, both the pain and weakness will persist. Sometimes the
overlying bone is removed, but the cuff is not repaired. This improves the pain, but
the weakness remains. In your case, the best plan is to try and repair the torn
tendon as well as remove the bony overhang.

and may have special tests, to make sure that you are well prepared and that you
can have the operation as safely as possible. . Many hospitals now run special
After - In Hospital
Your arm will be in a sling that also has a waist strap. This is to stop you moving
your shoulder - which would hurt. The wound may be painful. You will be given
injections or tablets to control this. Ask for more if the pain gets worse. A general
not make important decisions during this time. The wound will have a simple
adhesive dressing over it. Your wound drain will be removed after 24 to 48hours..
Your stitches will be taken out 10 to 12 days after the operation. The physiotherapist
will advise you and teach you the exercises that you are permitted to do at this
stage. You may remove your sling to wash. Wash around the dressing for the first 10
days. You can wash the wound area as soon as the dressing has been removed.
Soap and warm tap water are entirely adequate. Salted water is not necessary. You
can shower or take a bath as often as you like. You will be given an appointment to
visit the orthopedic outpatient department about one month after you leave hospital.
After - At Home
You cannot drive whilst your arm is in a sling. You will not have free movement of
your arm for several weeks after the sling has been removed. Physiotherapy will be
arranged for you. Therefore you will not be able to drive for about three months.
How soon you can return to work depends on your job. If you can work one handed,
you may be able to return to work about two weeks after the operation. This also
depends on you being able to get to work. You will be able to perform light work
after about three months. If you perform heavy manual work, you will be off work
for 6 to 12 months. You can start to swim and play non-contact sports about three
months after your operation. You must not play contact sports for at least six
months. When you re-start sport, you will not be able to play for as long as normal.
Your shoulder will ache and be stiff at the end of a game. Your shoulder may
continue to improve for up to 18 months.
278
Wound infection sometimes occurs. You will be given antibiotics to prevent this. Very
rarely, more serious complications can occur, such as further damage to the joint or
damage to the nerves or blood vessels in or around the area of the operation and
you might need another operation to deal with the problem.
Although this operation is successful most of the time, it is not always possible to
repair a large tear. If this is the case, the overhanging bone is still removed. This will
relieve the pain. The repaired tendons may come apart again. The shoulder may
stiffen slightly.
General Advice
The operation is neither very simple nor too difficult but somewhere in between. You
should end up much better off than before it. We hope these notes will help you
through your operation. They area general guide. They do not cover everything.
Sigmoid-Colectomy
What is it?
the waistline, up to the right ribs, loops across the upper part of the belly and passes
down the left side. There it runs backwards into the pelvis as the back passage,
where it is called the rectum. In your case, the problem lies in the left side of the
colon or upper rectum. The left side of the colon is taken out, and the ends are
joined up whenever possible.
279
The Operation
is made in the skin in the middle lower part of the abdomen about 40cm (15 inches)
long. The left side of the colon loop and the upper rectum are freed from the inside
of the tummy. The diseased part is cut out and usually the ends are joined together.
Sometimes it is safer if the ends are not joined together. Then the bowel waste is
channelled through the bowel which opens in the front of your tummy (a colostomy),
and you need to wear a bag. Usually the ends are joined up at a later date.
Sometimes the ends are joined up at the first operation, but a short-term colostomy
is made as well. This keeps the bowel waste away from the join while it is healing
up. You should plan to leave hospital two weeks after the operation. Very rarely, if
the problem area is in the lower part of the rectum, at operation, the back passage
may need to be removed as well. You would be warned about this before the
operation.
Any Alternatives
medicines will not be helpful, neither will X-ray and laser treatment.

280
After - In Hospital
uncomfortable. You will have a dressing on your wound and a drainage tube nearby,
connected to another plastic bag. This is to drain any residual blood from the area of
the operation. You may have a colostomy. The wound is painful and you will be given
injections and, later, tablets to control this. Ask for more if the pain is not controlled
or is getting worse. You will most likely be able to get out of bed with the help of the
nurses the day after the operation despite some discomfort. You will not do the
wound any harm, and the exercise is very helpful for you. The second day after
operation you should be able to spend an hour or two out of bed. By the end of four
days you should have little pain. A general anesthetic will make you slow, clumsy
this time. You will probably have a fine drainage tube in the penis or front passage to
drain the urine from the bladder until you are able to get out of bed easily. You
should be eating and drinking normally after about four days. The wound will have a
dressing which may show some staining with old blood in the first 24 hours. There
may be stitches or clips in the skin. Sometimes seven or eight stitches are put across
the wound to add strength. Stitches and clips are removed after about 7 to 10 days.
The drain tube is removed after four days or so. You can shower and bath as
frequently as you want but try to keep the wound area dry until the stitches come
out. If you have a colostomy, special nurses will show you how to manage it. You will
be given an appointment to visit the outpatient department for a check-up about one
month after you leave hospital. You will know the results of the examination of the
bowel by then. The nurses will advise about sick notes, certificates etc.
After - At Home
month or more. You will gradually improve so that by the time three months have
i.e. after about three weeks. You can restart sexual relations within two or three
weeks when the wound is comfortable enough. Sometimes the operation will upset
the nerves which control sex in the male. This is more frequent (some studies show
in up to 50% of cases) if during the operation the surgeon believes that your back
passage (rectum) has to be removed. The surgeon will discuss this with you. You
should be able to return to a light job after about six weeks and any heavy job within
12 weeks.
281
staff. If you think that all is not well, let the doctors or the nurses know. Chest
infections may arise, particularly in smokers. Getting out of bed as quickly as
clear the air passages is important in preventing infection. Do not smoke.
food and water intake will continue through your vein tubing until you pass wind or
open your bowels. Sometimes there is some discharge from the drain by the wound.
Wound infection is sometimes seen. This happens relatively more frequently in any
bowel operation compared to other 'clean' operations such as taking out your
gallbladder and the reason is that the bowel has many bugs that can cause an
infection. The infection settles down with antibiotics in a week of two.
the problem.
frequent in patients whose wounds take longer to heal such as elderly people,
often corrects the problem but sometimes another operation is needed to control the
leak.
months. If you have a colostomy, you will be given help and advice from the stoma
nurses.
General Advice
back doing their normal duties within three months. We hope these notes will help
Sinus Washout
What is it?
The cheek bone or maxilla is hollow. This keeps the bones of the face nice and light.
The space inside any face bone is called a sinus. We sometimes call the sinus in the
maxilla the antrum. The bone between the sinus and the inside of the nose is thin
like egg shell. The sinus in the cheek bone has a little drain hole which leads into the
upper part of the inside of your child's nose. Normally the hole lets in air. Infection
may drain from the sinus into your child's nose. This hole often gets blocked if the
sinus becomes infected. Sometimes just some swelling of the lining of the nose
during a cold will block the hole. It causes unpleasant pains in the cheekbones and
sometimes upper toothache - "sinus trouble". Usually antibiotics and sprays will
control the infection and let the hole unblock itself. In your child's case, blockages
are happening despite this treatment. It is necessary to wash out the sinus to get rid
of the infection. This should give the tissues a chance to heal properly.
282
The Operation
Your child will have a general anesthetic and be completely asleep. A fine metal tube
is placed in the nose and through the thin bone of the maxilla into the sinus. Salty
water is flushed through the tube into the sinus. The salty water comes out of the
little drain hole into the nose. Any pus or infected fluid will come out as well. A
specimen of the infected fluid is taken to be examined so that the bugs causing the
infection can be identified and then the rest is washed away. The metal tube is then
taken out. The inside of the nose heals very quickly. There is no need for any
stitches. If the little hole in the sinus is blocked by infection, or if the infection is very
bad, the surgeon will make a bigger hole into the sinus to help drain the infection
away. Because your child is asleep, he or she will not feel any pain at all during the
operation. The operation can be done as a day case. This means that your child
comes into hospital on the day of the operation, and goes home the same day.
Any Alternatives
If you leave things as they are, your child will get more and more sinus trouble. The
infection can damage the lining of the sinuses so that they never get back to normal.
Rarely, very serious infections can happen. More antibiotics, sprays, and other drugs
will not help at this stage. Sometimes there is another cause for the sinus trouble. It
is necessary to find out about this by washing out the sinus.

will have the operation explained to you and will be asked to fill in an operation
consent form. Many hospitals now run special preadmission clinics, where you and
your child visit for an hour or two, a week or so before the operation for these
checks. If your child has a cold in the week before his or her admission to the
hospital, please telephone the ward and let the ward sister know. Usually the
operation will be put off. Your child is given time to get better before sending for him
or her again. Your child needs to get over the cold before the operation can be done
because by having an anesthetic the cold could turn into a serious infection in the
chest.
After - In Hospital
Usually there is a little soreness of the nose after this operation. Paracetamol
suspension should easily control this discomfort. A general anesthetic may make
your child slow, clumsy and forgetful for about 24 hours. The nurses will support you
to help your child until he or she feels better. If the surgeon needs to see your child
again and check on his or her progress, the nurse will give you an appointment for
the outpatient clinic about one month after you leave the hospital. Sometimes the
check-ups are carried out by your own general practitioner.
After - At Home
After three to four hours on the ward, your child should feel fit enough to go home.
Before you leave, the nurses will check that your child's nose is comfortable and is
not bleeding. If your child has been given antibiotics, you will be told how often to
take the medicine, and how many days you will need to use it. If your child has been
283
given nasal drops, you will be told how to use the drops, and for how long. Use
paracetamol suspension every six hours to control any discomfort in the nose. Follow
the instructions you were given on the ward carefully. Do not let your child blow his
or her nose for the first 48 hours after the operation. Your child should take it easy
for the rest of the day. Do not let your child do anything too energetic in case this
starts a nosebleed. Your child should be able to go back to school after two days.
Your child should not go swimming or diving until the nose has healed, usually after
about two weeks.
There is a small risk that the nose may bleed when you get home. You and your child
should not be concerned with a spot or two of blood. If the nose bleeds for more
than about an hour, bring your child back to the ward.
There is a small risk of infection at the area of the operation. If your child develops
probably means that an infection is developing and he or she will need medical
attention promptly. Taking antibiotics for a week or two usually solves the problem.
General Advice
Spinal Stenosis Operation
What is it?
The problem lies in the nerves which run from your legs to your spine. They are
being squashed by the bones and ligaments (strong bands of tissue that keep the
bones together) of your spine. Stenosis means narrowing of the channels in the
spine where the nerves run. The pressure on the nerves here makes it feel as if the
pain is coming from your legs especially when you walk. You may also have had, and
still have, some back pain. Usually only one or two of the bones of the spine
(vertebrae) are affected.
The Operation
is made about three inches (7.2cm) long in your lower back. Part of the vertebrae
and the ligament that is squashing your nerves are removed. This takes the pressure
off the nerve in your back. The skin wound is then closed up with stitches or clips.
You will be in hospital for 7 to 10 days after the operation. In the past, the whole of
an arch of bone on the vertebrae, the lamina , was always removed. The operation
was therefore called a laminectomy. Nowadays very little of this bone is removed.
The operation is now called a nerve root decompression.
Any Alternatives
284
If you leave things as they are, the pain will continue. It may get worse. Injections
into the spine will not help. The aim of the operation is to cure your leg pain and it is
successful in doing this in about 70-80% of cases. Your back pain may remain
unchanged after the operation. If your back pain is more of a problem than your leg
pain, you should not have the operation. You should have the operation if:
• your leg pain is worse than your back pain.
• you have had leg pain for several months that is not getting better.
• your leg pain is interfering with your life.
• you have had a special scan that shows that your nerves are squashed.
If you have all of the above you should have an operation.

After - In Hospital
for more if the pain is gets worse. A general anesthetic will make you slow, clumsy
that time. The discomfort of the operation can make it difficult to pass urine and
empty the bladder. It is important that your bladder does not seize up completely. If
you cannot get the urine flowing properly after six hours, contact the nurses or your
doctor. The wound will have a simple adhesive dressing over it. Your stitches or clips
will be taken 10 to 12 days after the operation. You will not need a dressing on the
wound after that. Wash around the dressing for the first 10 days. You can wash the
as often as you like. You will be given an appointment to visit the orthopedic
outpatient department six weeks or so after your operation. The physiotherapist will
advise you and assist you to become mobile after the operation. The nurses will
After - At Home
You should not drive for six weeks. For three months after your operation you should
not drive for longer than half an hour at a time. If your job entails mainly walking
with no lifting, you may return to work after four weeks. If you mainly sit at work,
you may return after six weeks. If your job involves heavy work or a lot of driving,
you may return to lighter duties after 12 weeks. If your job involves very heavy
manual work, you may have to change to a lighter job. You may swim six weeks
after your operation. You may restart non-contact sports three months after your
operation. When you start playing, you will not be able to play for as long as normal
and your back will ache at the end of a game. If all goes well, you should be free of
your leg pain within a week or two of the operation. Do not be tempted to do too
285
much too soon. Your back will continue to improve for up to one year.
A nerve in your back may be bruised during the operation. This temporarily stops it
working, making part of your leg numb and slightly weak. It is very rare (1 in a
1000) for a nerve to be permanently damaged. There is a 1 in 10,000 chance of
bowel or bladder incontinence after this operation. Wound infection sometimes
happens. You will be given antibiotics to try and prevent this. People fear that if the
surgeon's knife slips they will be paralyzed. This is extremely unusual as the
operation is performed away from the lower end of the spinal cord.
General Advice
Spleen Removal - Splenectomy
What is it?
Splenectomy means an operation to take out your spleen. A spleen is about the size
and shape of a person's fist. It is tucked under the ribs on the left. It filters the blood
of impurities and helps the body fight infections. Sometimes the spleen filters too
much of the blood causing bruising, bleeding and anemia. Sometimes it causes pain
if it swells up. Sometimes it splits after an injury and bleeds very seriously. It then
needs to be taken out.
The Operation
is made in the skin between your breast bone and your tummy button. The spleen is
taken out. The cut in the skin is then closed up. You will need some treatment for a
year or more to ward off infections. Plan to go home 7 days after the operation. That
is, unless there is a need for you to go back to a medical ward for extra treatment
from the hematology specialist. You will be told about this at the time. You will need
to take antibiotics and have vaccinations for a year after the operation.
Any Alternatives
If you do nothing the problem with your spleen will usually get worse. A bleeding
spleen is usually life threatening and needs to be taken out. Bruises and smaller
tears stop bleeding, so that the spleen does not need to be taken out. If the spleen is
damaging the blood in your case, drug treatment or x-ray treatment are of no
benefit. The benefits of having your spleen taken out outweigh the finer problems of
living without one.

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hospital with you.
checks.
After - In Hospital
Some patients feel a bit sick for up to 24 hours after operation, but this passes off.
You will be given some treatment for sickness if necessary. You will have a drain
tube in an arm vein. There will probably be a fine plastic tube coming out near the
skin wound. There will possibly be a fine plastic tube in your nose to drain your
stomach. You may be given oxygen from a face mask for a few hours if you have
had chest problems in the past. A general anesthetic will make you slow, clumsy and
forgetful for about 24 hours. Do not make important decisions during that time.
The wound is painful and you will be given injections and later tablets to control this.
Ask for more if the pain is still unpleasant. You will be expected to get out of bed the
day after operation despite the discomfort. You will not do the wound any harm, and
the exercise is very helpful for you. The second day after the operation you should
be able to spend an hour or two out of bed. By the end of 4 days you should have
little pain. The wound has a dressing which may show some staining with old blood
in the first 24 hours. The dressing will be removed and the wound will be sprayed
with a cellulose varnish similar to nail varnish. There is no need for a dressing after
this unless the wound is painful when rubbed by clothing. There are no stitches in
the skin. The wound is held together underneath the skin and does not need further
attention. The thin plastic drain tube is removed when it stops draining - usually
after 48 hours. There may be some purple bruising around the wound which spreads
important.
days. After 7 to 10 days, slight crusts on the wound will fall off. The cellulose varnish
will peel off and can be assisted with nail varnish remover. Occasionally minor match
head sized blebs form on the wound line. These settle down after discharging a blob
of yellow fluid for a day or so. You can wash the wound area as soon as the dressing
has been removed. Soap and tap water are entirely adequate. Salted water is not
necessary. The nurses will talk to you about your home arrangements so that a
proper time for you to leave hospital can be arranged. Some hospitals arrange a
check up about one month after leaving hospital. Others leave check-ups to the
General Practitioner. The nurses will advise about sick notes, certificates etc. You
may need to see the Hematology specialist after your operation. This will be
arranged.
After - At Home
287
comfortable enough. You should be able to return to a light job after about 4 weeks,
and any heavy job within 8 weeks.
and surgical staff. Chest infections may arise, particularly in smokers. Co-operation
with the physiotherapists to clear the air passages is important in preventing the
condition. Do not smoke. Wound infection is a rare problem and settles down with
antibiotics in a week or two. Aches and twinges may be felt in the wound for up to 6
months. Occasionally there are numb patches in the skin around the wound which
get better after 2 to 3 months. In the longer term there is a risk of you getting
infections readily. We will arrange for you to take antibiotics for a year or longer just
in case. You may need antibiotics and booster injections to prevent this. The
hematologist or your GP will advise you.
General Advice
they regain their normal stamina. However, virtually all patients are back doing their
normal duties within 2 months. These notes will help you through your operation.
nurses.
Stapedectomy
What is it?
Each ear is made up of three parts. There is the outer ear which you can see, and
which gathers the sound. Further in, the outer ear joins the middle ear on each side
of the head which contains the ear drum. Deeper still, there is an inner ear on each
side. The sound vibration goes down the ear tube, which is part of the outer ear, into
the middle ear on that side. The ear drum stretches across the deepest part of the
ear tube between the outer ear and the middle ear and vibrates. The drum is about a
third of an inch (8mm) across. It is made of thin skin, like the top of a real drum.
The vibration of the ear drum is transferred to three very small bones which are just
behind it in the middle ear. These three bones fit together like levers and transfer
the vibration to the fluid of the inner ear so that you can hear. The last of these
small bones (the one closest to the inner ear) is the stapes. . Your hearing difficulty
is because there is growth of bone on the stapes which makes it inflexible and stuck
to the other small bones. Because of this, the vibration does not get transferred to
the inner ear and you can’t hear well. This disease is called otosclerosis from the
Greek words oto which means ear and sclerosis which means hardening. By
replacing the damaged bone and joining the bones together again, your hearing
should improve.
288
The Operation
You will have a general anesthetic and be completely asleep. The surgeon will shine
a microscope into your ear, and the operation will be carried out inside the ear
passage using very fine instruments. A cut will be made round the ear drum which is
then lifted up. The surgeon will remove the top part of the stapes bone and replace it
with a "plastic" bone. When the bones have been joined together again, the ear
drum will be put back in place, and a dressing soaked in antibiotic solution will be
placed in the ear passage. Sometimes the surgeon will make a small cut in the edge
289
of the ear lobe and use some of the fat from inside to help seal up the inside of the
ear. The cut is closed up with stitches. Because you are asleep you will not feel any
pain during the operation. You will be in the hospital for four or five days depending
upon your progress.
Any Alternatives
Apart from this operation, the only other way to help you with your hearing is for you
to use a hearing aid.

and that you can have the operation as safely as possible.. Please tell the doctors
two, a few weeks or so before the operation for these checks. If you have a cold in
the week before your admission to hospital, please telephone the ward and let the
get better before being sent for again. You will need to get over your cold before you
have your operation because by having a general anesthetic the cold could turn into
a serious chest infection.
After - In Hospital
Your ear will be a little sore after the operation. There may be some discomfort in
your ear when opening and closing your mouth, or if you lie on the ear. You will be
given an injection or tablets to control this discomfort. Ask for more if the pain is not
well controlled or if it gets worse.. A general anesthetic may make you slow, clumsy
this time. You must not blow your nose, and you must not stifle any sneezing.
Blowing your nose or trying to stop a sneeze will increase the pressure underneath
the ear drum, and could push the new "bone" out of place. You will be on bed rest,
lying flat with no pillow for the first 24 hours after the operation. The next day you
will be given one pillow and so on until you are comfortable sitting up. You may have
some dizziness for the first 24 hours after the operation, but this is not very
common. Medicine can be given to stop the dizziness. You may notice a strange
squelching, buzzing or popping noise in your ear. This is usually due to the dressing
in the ear, it is expected and you should not worry about it.. Some soreness or
stiffness when opening your mouth is common after ear operations. You must be
careful when taking a shower and washing your hair that you do not get the ear wet.
The dressing in the ear passage must stay in place undisturbed for about 10 days.
You will be given an appointment to come back to the ENT (ear, nose and throat)
outpatient clinic about 10 days after the operation, when the surgeon will remove the
dressing from the ear passage. The surgeon will examine your ear carefully and test
your hearing and will tell you whether the operation has been successful. The nurses
290
After - At Home
Take two painkiller tablets every six hours to control any pain or discomfort. To
begin with avoid any sudden jarring movements such as running down stairs. Be
sure to keep the ear dry and do not go swimming. You may feel rather tired for a
week or so, but this will steadily improve. You should be able to go back to work
after a couple of weeks. If you have a dusty job you should take precautions against
getting dust or dirt in the ear. You will be advised about this. Providing you have no
dizziness you can drive as soon as you are fit to leave the hospital.
Provided the advice given above is followed, you are unlikely to have any problems.
There is a small risk that the ear may bleed when you get home. If this happens
come back to the ward. If possible try and avoid catching a cold in the first month or
so after your operation. Try and avoid contact with friends or relatives who have
colds. If you catch a cold you should go to your doctor for antibiotics as there is a
risk that a cold could lead to an ear infection. If the ear becomes very painful, or you
experience some continuous discharge from the ear which is bloodstained, yellow or
green, thick or smelly, or if you get a temperature or bad headache, it most probably
means that the ear is infected and you should return to the ward. The infection is
usually settled by taking antibiotics for a couple of weeks.
Rarely, a nerve that runs in the middle ear can be stretched during this operation
and this can result in lack of taste or a metallic taste on the tongue on the side of the
operation. This usually gets better as time goes by.
There are four very uncommon but very serious complications following this
operation even if surgically it is done in the best possible way:
• complete deafness of the operated ear
• permanent dizziness
• permanent ringing or buzzing noise on the operated ear
• paralysis of your face muscles on the side of the operation.
If you get any of these complications your doctors will discuss further treatment
options with you.
About 90% of patients experience a significant hearing improvement after this
operation whereas 8% experience some improvement but not as good as expected.
Finally, hearing in 1 to 2% of patients gets worse after a stapedectomy.
General Advice
291
Sterilization
What is it?
The Fallopian tubes allow eggs to travel from the ovaries to the womb where they
can be fertilized. Sterilization is done by blocking the Fallopian tubes by putting a
special metal clip across each one, or by taking out a short length of each one and
closing off the ends with a stitch. The ovaries and womb still work normally so that
the periods come just as before. The eggs, the size of a pinhead, will die in the pelvis
after a few days and are cleared away by special cells. Sterilization is the most
reliable form of contraception for women. There is a very small chance of a
pregnancy in the tube between the clip and its ovary end. The special clip that the
surgeon uses is the best one to stop this happening. It is very difficult, expensive
and unreliable to try to join the clipped ends of the tubes up again. Bear in mind that
nowadays 1 in 3 marriages break up. Also, if you have children that are under one
year old, they do not have such a strong hold on life as older children. It may be
wise to wait until you are quite certain that sterilization is for you. DO NOT MAKE A
HASTY DECISION ABOUT STERILISATION. You will be sterile as soon as the
operation is done. You must make sure you are not already pregnant before the
operation. There is no way of the surgeon telling if you are pregnant by looking at
the womb during the operation.
If you are taking the oral contraceptive pill, carry on and finish the packet you are
using right past the time of your operation. If you have a coil (IUCD), this is best
kept in until after the period following your sterilization. It will stop any fertilized egg
already in the tube, settling in the womb. Your coil can be taken out when the
sterilization is done if you use condoms. You must use them from the period before,
to the period after the operation. This will stop fertilization of any egg during this
time. If you think your contraception may have failed, tell the doctor when you are in
hospital. In itself, sterilization is free from side effects. However, stopping using the
pill, or having a coil taken out, may upset the periods for a month or two. Also long-
term use of the Pill may have made the periods lighter. Sterilization does not prevent
you having the period problems that can crop up as you get older. At the time of
your operation, the surgeon may see fibroids or other things that can lead to period
problems after the sterilization.
292
The Operation
You will have a general anesthetic and be completely asleep. The keyhole method is
the most common. A small cut is made in the skin just below your tummy button. A
narrow telescope called a laparoscope is passed through the tummy wall, and your
tummy is inflated with some carbon dioxide gas. The two clips are put on the
Fallopian tubes using a fine instrument which is passed in the tummy through a
second keyhole which is close to the one used for the telescope. Finally, a stitch may
be put into each skin wound. It usually takes about 15 minutes. It is dangerous to
use the keyhole method if there are many scars inside from other operations. Also
the laparoscopy is not safe if you have been pregnant very recently. The womb is in
the way, and all the tissues bleed. If this is the case, small cut is made in the lower
part of your tummy. The Fallopian tubes are blocked by taking out a short length of
each one and closing off the ends with a stitch. The operation can usually be done as
a day case.
Any Alternatives
By this stage, you will surely have tried and ruled out the Pill, the coil, condoms, and
injection treatment. Waiting until the youngest child is over one year old is often a
sensible plan. Sterilization of the male partner - vasectomy is worth thinking about.
It is more reliable than female sterilization. It can be done with just local anesthetic
to numb the skin. It takes about three months to work. It is very difficult and
expensive to join the ends up again, with about 1 in 3 chance of success. Some men
do just not like the idea of a vasectomy. You need to decide with your partner on the
best way for you to go ahead.

may have special tests to make sure that you are well prepared and you can have
the operation as safely as possible. . Please tell the doctors and nurses of any
After - In Hospital
If you have had the keyhole operation you may have a sanitary pad in place. You
may have some discomfort in the tummy and shoulders caused by the gas inside the
tummy. After three or four hours on the ward, you should feel fit enough to go
home. A general anesthetic will make you slow, clumsy and forgetful for about 24
hours. The nurses will help you with everything you need until you can do things for
kettle during that time. A note will be sent to your General Practitioner. You should
not need any check up. If you feel that all is not well, telephone the ward. The
293
After - At Home
Make sure you are going home by car with your relative or friend. At home, rest for
at least six hours. Take the dressing off the wound while in the bath or shower after
three days and although you can shower or bath try to keep the wound(s) dry for a
week. You will be advised about the stitches. There may be slight bleeding from the
vagina, like the end of a period. It will last for a few days. Only use external pads for
any loss. Do not use tampons. You can usually go back to normal activity and work
after a week. Avoid heavy exercise for a week. You can have sex after your next
natural period if you feel comfortable enough.
All operations have some risks. Laparoscopy is a very common and safe operation.
However, complications can occur in 1-2% of cases. Very rarely bleeding can occur
during the operation. Even more rarely, the bowel can be damaged by the
instruments. In either case, the problem can be dealt with straight away through a
bigger wound. Sometimes, there is some infection in the tummy button area after
the operation. This settles down with antibiotics.
General Advice
Submucous Resection - SMR
What is it?
The nasal septum is the partition inside the nose made of cartilage (gristle) 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 is bent over. You feel that your
nose is blocked or may have headaches and pain in the face. You may have sinus
(the space inside any face bone) infection and even ear problems. Removing a small
piece of cartilage from inside the septum will straighten it out. This should help you
to breathe through your nose more easily, and lessen problems with your sinuses
and ears.
294
The Operation
You will have a general anesthetic and be completely asleep. A small cut will be
made in the skin over the septum inside the nostril. The surgeon will then 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. Because you are asleep you will not
feel any pain at all during the operation. 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.
Any Alternatives
Using tablets, nasal sprays or nasal drops may unblock the nose a little. The
blockage will always get worse again when you stop the treatment. Using nasal
drops for a long time may eventually make the blockage worse. These treatments
are not as good as an operation.

get better before being sent for again. You need to get over your cold before you
have your operation because by having a general anesthetic the cold could turn into
a serious chest infection.
After - In Hospital
chest problems in the past. Usually the nose is a little sore and uncomfortable after
this operation. While the packing is in your nose you will have to breathe through
your mouth, and this will make your mouth feel dry. Taking frequent drinks will help
to keep it moist. You may find that the nasal packing makes your eyes water or gives
you a headache. If you do get a headache or your nose feels sore, the nurses will
give you an injection or tablets to help relieve this. Ask for more if the pain is not
well controlled or if it gets worse. . A general anesthetic may make you slow, clumsy
that time. The next day there may be some swelling around the nose. This always
improves quickly after the packs and splints have been removed. You may notice
295
some numbness in the middle of your upper lip or the tip of your nose. This always
gets better but may take several weeks. You will be able to get up and about and
have a warm bath. On the second day after your operation, when the nurses remove
the packing and splints from your nose there may be a little bleeding which usually
stops very quickly. You will probably be able to go home later on in the day, usually
in the early evening. Before your leave the ward you will be given an appointment to
come back to the ENT (ear, nose and throat) outpatient clinic to see the surgeon
again and have your nose checked. The nurses will advise about sick notes,
certificates etc.
After - At Home
At home, take two painkilling tablets every six hours to control any pain or
discomfort. You may be advised to use an antiseptic cream, nose drops and steam
inhalations. As the inside of the nose gradually opens up you will find that you can
breathe more easily through the nose each day. If your nose runs you can wipe it,
but do not blow your nose until two days after you get home, and then start off by
blowing VERY GENTLY. To begin with, you will see blood staining in your
handkerchief, most of this will be old blood from your operation, but there may be a
little fresh bleeding as well. This is expected and you should not worry about it..
Take it easy when you get home. Avoid hard physical exercise as this may make the
nose bleed. Try and avoid smoky atmospheres such as pubs and clubs for the first
couple of weeks. If possible try and avoid catching a cold within your first week at
home. If you do get a cold you should see your GP for a course of antibiotics. It will
be five or six weeks before the swelling inside the nose has completely gone and you
get the full benefit of the operation. You should be fit to return to work about two
weeks after your operation. You should be fit to drive one to two days after you
leave the hospital.
the nasal packs and splints inside your nose for an extra day. If there is a lot of
bleeding after the packs have been removed, the surgeon will put them back in,
either with a local or general anesthetic. The chances of this happening are very
slight. Provided the advice given above is followed you are unlikely to have any
problems when you get home. There is a small risk that the nose may bleed when
you get home. If this is just a spot or two you should not worry. If the nose
continues to bleed, come back to the ward.
Very rarely following this operation you can develop a hole in your nasal septum,
your face appearance might change or the septum can bend again. If you develop
these problems you will most probably need another operation to deal with them.
296
General Advice
Surgery for retinal detachment
What is it?
Detachment of the retina is one of the most serious emergency eye conditions. The
retina is the lining at the back of the eye. It is here that the light/image is converted
into nerve waves/signals which 'travel' through the nerves to the brain and finally
help you to realize or see the light/image. The retina has two layers which are
attached (stuck) to each other. A retinal detachment occurs when the two layers
become separated (detached) in one or more areas. This is an emergency condition
which can result in loss of sight from the affected eye.
The incidence of retinal detachment in the general population is about 0.3%. The
incidence increases with age and reaches a maximum for people who are 50 to 60
years old. Patients with severe myopia (short sight) have a 5% chance of developing
a retinal detachment while patients who have a cataract operation (an operation
done to replace the lens in front of the eye when it gets cloudy and affects the vision
with a new synthetic lens) have a 1% chance of developing the condition. Overall,
severe myopia is the cause of 40 to 50% of retinal detachments. A cataract
operation is the cause in 30-35% of cases. Trauma of the eye is the cause of the
detachment in 15 to 20% of cases. Patients who have had retinal detachment in one
eye have about a 15% chance of developing one in the other eye.
There are three causes of retinal detachment.

1. Development of holes in the inner layer of the retina which can happen either
spontaneously due to degeneration (aging) of the tissue or due to trauma (called
rhegmatogenous retinal detachment).
2. Traction on the inner layer of the retina due to contraction of fibrous bands of
tissue that have developed between the inner layer of the retina and the vitreous
which is the 'jelly ball' that occupies the centre of the eyeball. This happens more
frequently in diabetic patients.
3. Development of a fluid collection between the two layers of the retina. This can
occur because of trauma, infectious/inflammatory (swelling) processes in the
297
affected area or increased pressure close to the retina due to the development of a
tumor which forces fluid between the two retinal layers.
One of the most common symptoms you experience when you have retinal
detachment is a sudden increase in the number of floaters (small dots or strings) you
see in your field of vision. Although you can experience something like this as you
get older without having any significant underlying problem, the sudden appearance
of a 'shower of floaters' is usually an indication of a retinal detachment. Another very
common symptom is the sudden appearance of light flashes in your field of vision.
Some patients often describe the presence of a 'curtain' which is pulled over their
field of vision and it means that the detachment has started (as it usually does) from
the periphery of the retina. If the detachment involves the centre of the retina (the
macula which produces detailed vision), then the vision problems are much more
serious and the problem much more urgent. Pain is not necessarily present in retinal
detachment but when it is, it is usually when trauma is the cause of the detachment.
The operation
Most patients have the eye numbed with a local anesthetic. Very rarely, a patient
might need to be put to sleep with a general anesthetic to allow him/her to have this
operation comfortably. If you have a local anesthetic, you will be awake during the
operation, but will feel no pain and will not see anything, because the injection stops
the eye working. In most cases you will stay in hospital for no more than 24 hours
Most operations for retinal detachment last between one and two hours depending
on the extent of the retinal damage.
There are three types of surgery for retinal detachment.

1. The scleral buckling operation. Initially the surgeon will identify the areas of the
retinal breaks. The next step is to drain any fluid that has accumulated between the
two retinal layers. The retinal breaks are then closed by scarring the retina either
with extreme cold with a cryoprobe or with light from a laser. After that, the surgeon
will apply a ring/buckle made of silicone sponge or solid silicone around the sclera
which is the outer layer of the eyeball. This is stitched onto the sclera and is
positioned in such a way that it pushes in/buckles the sclera towards the centre of
the eye. This results in pushing back together again the two detached layers of the
retina.
2. Pneumatic retinopexy. This procedure uses an air bubble to put back together the
two layers of the retina (pneumatic from the ancient Greek word pneuma which
means air and retinopexy from the words retina and the Greek word pexy which
means to stick together). During this operation the surgeon injects an air bubble into
the middle of the eyeball. The head of the patient is positioned in such a way that
the bubble lies on the inner layer of the retina and pushes the inner layer onto the
outer layer so that the two layers are attached again. By applying pressure on the
two layers the bubble also squeezes out any fluid that has accumulated between the
two layers and allows the surgeon to close the breaks by scaring the retina with a
cryoprobe or laser (as described in the scleral buckling operation). The air bubble will
usually remain for about a week. During which time you need to avoid putting your
head in certain positions, such us lying flat on your back because this can push the
bubble to the front of the eye and prevent it from applying pressure on the retina.
The eye gradually absorbs the air bubble.
3. Vitrectomy. During this operation the surgeon first removes the jelly ball
(vitreous) from the centre of the eye. This technique is used in difficult and
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complicated cases of retinal detachment. The removal of the vitreous allows more
space for the surgical maneuvers that are needed to repair severe damage to the
retina. At the end of the operation the vitreous is replaced with silicone oil.
Any alternatives?
There are no alternatives to surgery for retinal detachment. It is a condition that
requires immediate surgical attention and intervention. Any delay reduces
significantly the chances of successful repair.

be checked for past illnesses and may have special tests to make sure that you are
well prepared and that you can have the operation as safely as possible.
After - in hospital
Most patients experience little pain after an operation for retinal detachment but may
have some swelling of the eye. You may be given tablets or an injection to control
any pain or discomfort. You can wash, bathe, or shower normally after the operation,
but you must not get water in your eye for a month. If you have your hair washed,
have it done with your head leaning backwards. Do not use makeup on your eyelids
for one month. You will normally be able to go home within 24 hours of your
operation. You will be given a supply of eye drops, and shown how to put them in
your eye. You will be given an appointment for the outpatient department for a
check up one to two weeks after you leave hospital. The nurses will advise about sick
notes, certificates, etc.
After- at home
touching your eye, especially when you are half asleep. Sometimes it takes a few
days after the operation for the eye to settle down and the patient to see an
improvement in vision. You MUST wear the eye shield to protect the affected eye at
night, or if you sleep during the day. You will be told in the outpatient clinic when
you can stop using the shield (normally about one month). During the day you can
use any glasses you were using before the operation. Sunglasses are a good idea to
protect your eyes from the glare. If you wear contact lenses, do not put one in the
operated eye for eight weeks. Plan to go back to light work in about one to two
weeks, and a more heavy/manual job in about three months.
If you had the pneumatic retinopexy operation you will be strongly advised to avoid
air travel for at least three to four weeks. This is because the change in altitude
during the flight can make the air bubble much bigger and this can cause serious
problems in your eye.
You must be very careful when driving in the early stages after the operation
because your sight may not be as good as you think it is. Ask the doctor whether
your sight is good enough to drive. If in doubt, don't drive.
In the rare case that you have this operation under general anesthetic, there is a
very small risk of complications related to your heart and lungs. The tests that you
Complications are not common but can be problematic.
Bleeding in the eye can cause pain and affect your vision. This usually settles by
itself but sometimes you will need surgery to fix the problem. The eye may also get
299
infected. Drops of antibiotics and anti-swelling medication such as steroids will be
needed to treat the infection.
One of the most common problems after an operation for retinal detachment is the
development of further scarring of the retina. The bands of tissue which can develop
because of the scarring can retract and cause a new detachment. In this situation, a
vitrectomy to create space for surgical maneuvers and another extensive operation
to fix the new detachment may be needed.
Another complication after retinal detachment surgery (especially after scleral
buckling) is the detachment of the choroid, the middle layer of tissue that lies
between the sclera and the retina. Choroid detachments usually heal on their own
within one to two weeks without further intervention.
The presence of a scleral buckle can increase the fluid pressure inside the eye and
change the shape of the eye or affect the muscles that control eye movements. All
these can clearly affect your vision and adjustments may be needed to ensure that
any changes in your vision are corrected. Very rarely, the buckle can also become
infected and, if the infection is not responding to antibiotic treatment it may need to
be removed.
The operation for correction of retinal detachment is successful in about 85% of
cases. Sometimes a second operation may be needed to improve the result of the
first operation. The operation is more successful if the detachment is localized in the
periphery of the retina and the central part of the retina (macula) is not affected. If
the macula is affected, it is much more difficult to fix the problem and the risks of
impaired vision after the operation are much higher.
General advice
Tendon Repair - Achilles Tendon
What is it?
move when the muscle contracts. Your Achilles tendon joins the bottom of your calf
muscle to your heel, at the back of your ankle. It enables you to point your foot
down and raise your heel. In this case, your Achilles tendon is torn - or ruptured.
This typically occurs in men in their forties or fifties whilst playing sports such as
squash or badminton. Without treatment you will never be able to bend your foot
down with any strength. You would then find going up-stairs difficult. You would be
unable to stand on tip-toes.
The Operation
You will have a general anesthetic, and will be asleep for the whole operation. A
vertical cut is made down the back of your heel. The ends of your ruptured tendon
are brought together. They are then held together with stitches to help your tendon
to heal. The skin wound is then closed up with stitches. You will be in hospital three
to four days after your operation. You can go home when you can walk safely with
crutches. You will be in a plaster for approximately six weeks.
Any Alternatives
If you come to the hospital within 24 hours of your injury you can be treated in a
plaster cast without an operation. You are put in a plaster with your foot pointing
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down (like a ballet dancer). This relaxes the tendon and allows it to heal. If you are
not seen straight after rupturing your tendon you will probably need to have an
operation on your ruptured tendon.

After - In Hospital
Your leg will be in a plaster cast from your knee to your toes. Your foot will be
pointing down to relax your newly repaired tendon. Your heel may be painful. You
will be given injections and later tablets to control this. Do not press on the plaster
for 48 hours. Ask for more painkillers if the pain is getting worse. A general
not make important decisions during this time. Your plaster will be changed and your
stitches will be removed 10 to 12 days after your operation. Do not get your plaster
cast wet. Most hospitals arrange an appointment at the orthopedic outpatient
department 10 days or so after your operation. The nurses will advise about sick
After - At Home
When you go home, you will be able to move around the house and manage stairs
with crutches. You will not be able to go shopping for the first few weeks after you
go home. Make arrangements for friends or family to shop for you. Your ankle will
continue to improve for up to six months. Do not let the plaster cast get wet. Do not
cut or bang the plaster. Do not put anything down the inside of the plaster (eg
coins). Do not use anything to scratch under the plaster. Come back to the hospital
if:
• you have pins and needles or numbness in your toes
• you cannot move your toes
• your toes go blue
• your toes become very swollen or if you have severe pain.
If you are experiencing one or more of these it could be an indication of a problem

with the nerves or the blood vessels in or around the area of surgery or of an
infection. In this case you should return to the hospital urgently.
Come back to see the plaster technician if the plaster cracks or is getting loose.
Physiotherapy will be arranged once the plaster is removed. You will not be able to
drive for up to two months after you leave hospital. You will not be able to perform
an emergency stop as quickly as normal before then. How soon you can return to
work depends on your job. If you mainly sit at work, you may be able to return to
work three weeks after the operation. This also depends on you being able to get to
work. If your job involves a lot of walking, you will be unable to work for two or
three months. You may swim gently as soon as the plaster cast has been removed.
You may begin to play most sports when you are able to stand on tip-toe. When you
re-start sport, you will not be able to play for as long as normal. Your ankle will ache
at the end of a game.
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More serious complications like damage to the blood vessels or the nerves in or
around the area of the operation happen rarely and you might need another
operation to fix them. Occasionally (in about 3 out of a 100 cases) the tendon
ruptures again. If this occurs you will need another operation.
General Advice
Having had one Achilles tendon rupture, you have an increased risk of your other
tendon rupturing. If you begin to have pain in your other heel, do not continue with
high risk activities such as squash, football etc. You should discuss this with your
doctors and think about possibly limiting your involvement in high risk sports having
had one Achilles tendon rupture. We hope these notes will help you through your
doctors or nurses.
Tendon Repair - Extensor
What is it?
move when the muscle contracts. The tendons that straighten your fingers run over
the back of your wrist and hand. Two tendons run to the index and little fingers.
There is only one tendon to each of your other fingers. The tendons to one or more
of your fingers have torn - or ruptured. This gives you a dropped finger or fingers.
Your tendons may have ruptured as a result of rheumatoid arthritis or due to the
tendons rubbing on a rough piece of bone.
The Operation
is made on the back of your wrist. The surgeon may need to make an extra cut on
the back of your hand. This is so he can find the ends of your torn tendon. Unlike a
tendon that has been cut with a knife, the surgeon cannot join the frayed ends of the
tendon together again. He may join the end of the ruptured tendon to its intact
neighbor. Alternatively he may use one of the "spare" tendons from your index or
little finger and stitch it to the end of your ruptured tendon. If several tendons have
ruptured, he may do a combination of both techniques. The tendons are sewn
together with fine stitches. The skin wound is then closed up with stitches. You will
be in hospital two or three days after the operation.
Any Alternatives
If you leave things as they are, you will not be able to straighten your finger. Plaster
casts and splints will not help on their own.
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After - In Hospital
Your arm will be in a plaster cast from below the elbow to the fingers. Do not press
on the plaster for 48 hours. The wound may be painful. You will be given injections
or tablets to control this. Ask for more if the pain gets worse. The tendons are
repaired with fine stitches. These stitches are not very strong. Too much force too
early will pull the tendon ends apart. The tendons must slide in their sheaths while
they heal. If they stay still while they heal, the tendons will never slide again. The
exercises that you do after your operation are a vital part of your recovery. The
physiotherapist will show you what exercises to do. A general anesthetic will make
you slow, clumsy and forgetful for about 24 hours. The nurses will help you with
important decisions during that time. Your skin stitches will be taken out when you
come to the outpatient clinic 10 days or so after the operation. You will not need a
dressing on the wound after that. You will need a plaster cast or splint on the front of
your hand for four weeks after your operation. Wash around the plaster for the first
10 days. You can wash the wound area when the dressing has been removed. Soap
and warm tap water are entirely adequate. Salted water is not necessary. You can
shower or take a bath as often as you like. The hospitals will arrange a check up
about 10 days or so after you leave hospital. The nurses will advise about sick notes,
certificates etc.
After - At Home
Do not let the plaster cast get wet. Do not cut or bang the plaster. Do not put
anything down the inside of the plaster (e.g coins). Do not use anything to scratch
under the plaster. Come back to the hospital if:
• you have pins and needles or numbness in your fingers.
• you cannot move your fingers.
• your fingers go blue.
• your fingers become very swollen.
If you are experiencing one or more of these it could be an indication of a problem

with the nerves or the blood vessels in or around the area of the operation or of an
infection. In this case you should return to the hospital urgently.
Come back to see the plaster technician if the plaster cracks, becomes softer is
getting loose. You must not drive whilst your arm is in a plaster cast. You should not
drive for six weeks after the operation to allow your tendons to heal fully. How soon
you can return to work depends on your job. If you can work one handed, you may
be able to return to work two weeks after the operation. This also depends on you
being able to get to work. If your job is manual you will be unable to work for three
303
or four months. You may swim six weeks after your operation. You may play most
sports 10 weeks after your operation. When you start playing, you will not be able to
play for as long as normal and your hand will ache at the end of a game. Your finger
movements and strength will continue to improve for up to six months.
this. More serious complications like damage to the blood vessels or the nerves in or
operation to fix them. The tendon is at its weakest two weeks after it has been
repaired. Occasionally, the tendon repair can come apart. If this occurs, you will
suddenly be unable to straighten your finger. Go straight to the casualty department
and you will be re-admitted for a second repair.
General Advice
between. Your co-operation and hard work after the operation are vital in order to
achieve a good result. If all goes well you should end up much better off after the
operation. We hope these notes will help you through your operation. They are a
Tendon Repair - Flexor
What is it?
move when the muscle contracts. There are two tendons that run on the palm side in
each finger. One tendon goes to your finger tip and bends the end joint. The other
goes to the middle bone and bends the first finger joint. The tendons run in a narrow
tunnel. One or both of your tendons are cut. If your tendons do not get repaired, you
will not be able to bend your finger.
The Operation
cut in your finger is lengthened. The surgeon may need to make an extra cut in your
palm. This is so he can find the ends of your cut tendon. The tendons are sewn
together with fine stitches. If one of the nerves that allows you to have feeling in
your finger has been cut, it will be repaired. The skin wound is then closed up with
stitches. You will be in hospital three or four days after the operation.
Any Alternatives
If you leave things as they are, the tendons will not heal properly. You will lose a lot
of the use of your finger.

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After - In Hospital
Your arm will be in a plaster cast from below the elbow to the finger tips. The wound
may be painful. You will be given injections or tablets to control this. Ask for more if
the pain gets worse. A general anesthetic will make you slow, clumsy and forgetful
able to do things for yourself. Do not make important decisions during this time. The
tendons are repaired with fine stitches. These stitches are not very strong. Too much
force too early will pull the tendon ends apart. The tendons must continue to slide in
their tunnel while they heal. If they stay still while they heal, the tendons stick to the
walls of the tunnel and never slide again. Too little movement of the healing tendon
will stop the tendon sliding in its tunnel.
The exercises that you do after your operation are a vital part of your recovery. The
physiotherapist will show you what exercises to do. If your cut is only in the palm,
you begin exercises on the first day after your operation. If your cut is in your finger,
you begin exercises on the second day after your operation. Your stitches will be
taken out when you come to the outpatient clinic 10 to 12 days after the operation.
You will not need a dressing on the wound after that. You will need a plaster cast or
splint on the back of your hand for about six weeks after your operation. Wash
around the plaster for the first 10 days. You can wash the wound area as soon as the
water is not necessary. You can shower or take a bath as often as you like. The
After - At Home
Looking after a plaster cast:
• Do not press on the plaster for 48 hours.
• Do not let the plaster cast get wet.
• Do not cut or bang the plaster.
• Do not put anything down the inside of the plaster (eg coins).
• Do not use anything to scratch under the plaster.
Come back to the hospital if:

• you have pins and needles or numbness in your fingers.
• you cannot move your fingers.
• your fingers go blue.
• your fingers become very swollen.
If you are experiencing one or more of these problems it could be an indication of a

problem with the nerves or the blood vessels in or around the area of the operation
or of an infection. In this case you need to return to the hospital urgently.
Come back to see the plaster technician if the plaster cracks ,becomes soft or is
getting loose.
You must not drive whilst your arm is in a plaster cast. You should not drive for
about 10 weeks after the operation to allow your tendons to heal fully. How soon you
can return to work depends on your job. If you can work one handed, you may be
able to return to work two weeks after the operation. This also depends on you being
305
able to get to work. If your job is manual you will be unable to work for three or four
months.
You may swim six weeks after your operation. You may play most sports 10 weeks
after your operation. When you start playing, you will not be able to play for as long
as normal. Your hand will ache at the end of a game. Your finger movements and
strength will continue to improve for up to six months. If you have had repair of a
cut nerve, you should begin to have some feeling in your finger about six weeks after
your operation. You may go through a period of up to six months when the finger is
extra sensitive. This passes. The sense of touch in your finger will improve for up to
three years. The feeling will never be normal, it will be different.
this. More serious complications like damage to the blood vessels or the nerves in or
operation to fix them. The tendon is at its weakest two weeks after it has been
repaired. Occasionally, the tendon repair can come apart. If this occurs, you will
suddenly be unable to bend your finger. Go straight to the casualty department and
you will be re-admitted for a second repair. The nerve may not heal. This leaves part
of your finger permanently numb.
General Advice
The operation is neither very simple nor too difficult but somewhere in between. Your
co-operation and hard work after the operation are vital in order to achieve a good
result. If all goes well you should end up much better off after the operation. We
hope these notes will help you through your operation. They are a general guide.
Termination of Pregnancy
What is it?
For very good reasons, it is in your best interests to have the pregnancy stopped.
This is clearly a very difficult and distressing decision for you. Your visit to the
hospital will be made as smooth as possible. The womb needs to be cleared out with
a small operation. This will make sure that all the pregnancy tissues have left the
womb.
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The Operation
You will have a general anesthetic and will be completely asleep. Special instruments
are passed into the womb through the vagina. The inside of the womb is gently
suctioned and scraped to clear out pregnancy tissue. Usually the operation can be
done as a day case. This means you come into hospital on the day of the termination
and go home the same day.
Any Alternatives
Not really. You have decided that you do not wish to have the baby. You do not wish
to have the baby adopted. Medical termination of pregnancy may be an alternative
procedure offered.

have the operation as safely as possible. . Please tell the doctors and nurses of any
After - In Hospital
even boil a kettle during this time. Any pain quickly settles after you have been to
the operating theatre. But you may be left with some tummy discomfort. Take the
painkillers you would use for painful periods. There will be slight bleeding like the
end of a period lasting for about a week. Only use external pads for any loss. You
can start taking the contraceptive pill the day after the operation, even if you are
bleeding. You can bathe or shower as often as you wish. The nurses will advise about
sick notes, certificates etc. If your blood group test shows that you are Rhesus
negative, you will need a special injection before you go home. This will stop
problems with blood transfusions and with pregnancies in the future. Pregnancy can
happen within weeks of a termination. You must use proper contraception, if you do
not want this to happen. You can have sex three weeks after the termination, as long
as you are not having any bleeding or discharge.
Sometimes the bleeding is very heavy with clots. Other times the bleeding does not
stop in a week. Phone the ward if you are worried. More serious complications occur
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in less than 1% of cases and include: a) severe blood loss that will require
transfusion, b) damage to the vagina or the womb by the instruments used to
terminate the pregnancy which may require an operation to fix and c) an infection of
the womb that will require you to come back to the hospital and be given
antibiotics). Termination of pregnancy is a very distressing experience. It is very
likely that you will have great sadness and regret. It may well be weeks or months
before you feel back to normal. Having someone close during this time will help see
you through. Rarely, in probably less than 1% of cases, a termination may cut down
the chance of having a baby in the future. Overall you have to keep in mind that the
more weeks you are pregnant the higher the chances of complications after
termination.

General Advice
Thyroidectomy
What is it?
The thyroid is an H-shaped gland. It lies just in front of the windpipe in the neck. It
is about 3 inches across. It makes the hormone thyroxin. Thyroxin passes into the
blood stream to keep the body active. If the gland makes too much thyroxin, the
body gets overactive and the heart can be strained. If the gland swells, it presses on
the windpipe and other parts of the neck. It may cause an ugly swelling in the front
of your neck. When this happens, the gland, or parts of it, need to be removed.
The Operation
The operation will be performed under general anesthetic which means that you will
be put to sleep. You will be unconscious and you will not feel pain during the
operation. A cut is made across the front of your neck. Some or all of the thyroid is
taken out. Usually enough thyroid is left to supply your needs for thyroxin.
Sometimes this is not possible, but you can easily take tablets of thyroxin to top up
your supplies. Great care is taken to avoid damaging the nerves that control your
voice. The surgeon also avoids the nearby glands (parathyroid glands) that control
your blood calcium salts. The cut in the skin is closed so that it heals with a barely
visible scar. Plan to go home four days after your operation.
Any Alternatives
If you leave things as they are, the thyroid problem will remain. For an overactive
gland, drug treatment will not work very well, or may cause a bad reaction in you.
Pressure effects are likely to get worse. Any swelling will get more unsightly. When
the thyroid, or parts of it, are removed, they are sent for examination under the
microscope to make sure that they don’t harbor a cancerous tumor. If you don’t
have the operation, the possibility of a missed tumor remains. Drawing fluid out of a
swelling gives relief only for a week or two. X-ray and laser treatment do not work.

308
hospital. On the ward you may be checked for past illnesses and may have special
tests, ready for the operation. Many hospitals now run special pre-admission clinics
checks.
After - In Hospital
The wound may be mildly to moderately uncomfortable and you may have
discomfort in your neck. Swallowing may be uncomfortable. You will be given
injections or pills for the pain. After three days you should have little pain. The
wound will have a dressing which may show some staining with old blood in the first
24 hours. A thin plastic drain tube is placed in the area where the thyroid used to be
to drain any residual blood or other fluid from the area of the operation. The drain is
removed when it stops draining - usually after 48 hours. There may be some purple
bruising around the wound which spreads downwards by gravity and fades to a
yellow color after two to three days. This is expected and you should not be worried
about it. There may be some swelling of the surrounding skin which also improves
after about two to three days. The wound is usually closed with stitches under the
skin. These stitches dissolve over time and result in a very neat scar. Sometimes,
the skin can be closed with metal clips or stitches which are removed three days
after the operation and are replaced with small pieces of sticky paper tape to allow a
better cosmetic result for the wound. Regardless of the way the wound is closed, you
can wash it 7 to 10 days after the operation. If you have pieces of sticky paper tape
on the wound they will peal off when you start washing. Soap and tap water are
entirely adequate. Salted water is not necessary. You can wash or bathe the rest of
your body normally. You will be given details about a check-up and the results of the
tests two weeks after the operation.
After - At Home
or more. You will gradually improve so that after about a month you will be able to
make an emergency stop without hurting your neck, i.e after about two weeks. You
can restart sexual relations within two to three weeks when the wound is
and nursing staff. If you think that all is not well, please let the doctors and nurses
know.
Occasionally the wound swells due to a build-up of blood in the neck in the 24 hours
after operation. The blood that builds up under the wound is drained through the
drain tube that you will have in your neck. If you have some bleeding, you may need
a blood transfusion (giving you blood by placing a fine thin plastic tube in one of your
veins). Usually the bleeding stops. Rarely (in less then 0.5% of cases) you may need
309
to go back to the operating theatre to stop the bleeding. This happens on the rare
occasions when the blood builds up very quickly. Sometimes, it can even put
pressure on your windpipe and eventually obstruct it and cause very serious
problems with breathing.
Rarely, (in about 3 to 4% of cases) the voice is a little hoarse after the operation due
to pulling on the nerves to the voice box. Very rarely (in less than 1% of cases) this
becomes permanent. The surgeon will discuss this with you.
Sometimes the calcium in your blood falls below normal in the hours and days after
the operation. This can give you a tingling feeling in your fingers or your lips. Most
patients experience this problem 24 to 72 hours after the operation. After the
removal of a large thyroid, about 20% of patients will need a calcium supplement to
get the concentration of calcium in the blood back to normal levels. Eventually,
everything will return to normal and these patients will no longer require additional
calcium. However, in about 3% of cases this becomes a permanent problem and
these patients will need calcium for the rest of their lives.
A very rare complication after a thyroidectomy is the development of what is called a

lymphatic fistula. This happens when a pipe (thoracic duct) close to the thyroid is
damaged during the operation causing the development of a fistula (a
communication or channel) between the thoracic duct and the skin. The fistula allows
continuous drainage of the lymph through the skin. The drainage sometimes stops
but in some circumstances it can be a permanent problem for which you will need
further treatment.
Another very rare complication during or after a thyroidectomy is the development of

a 'thyroid storm'. This happens because during or after the operation any remnants
of thyroid tissue can become over-reactive causing problems like a very fast heart
rate and very high temperature. The 'storm' needs to be recognized and dealt with
promptly with the right medication because it can otherwise be lethal.
Checks will be made on your blood thyroxin and other chemicals in the months and
years after the operation. Sometimes long-term treatment is needed. Chest
infections may arise, particularly in smokers. Do not smoke. Wound infection is a
rare problem and settles down with antibiotics in a week or two. Aches and twinges
may be felt in the wound for up to six months. Occasionally there are numb patches
in the skin around the wound which get better after two to three months. Very
rarely, the thyroid becomes overactive again. This can be checked in the outpatient
clinic. Rarely, extra treatment is needed.
General Advice
The operation is well tolerated. Some patients, however, are surprised that they
recover more slowly than expected but you should be back doing your normal duties
within a month. We hope these notes will help you through your operation. They are
a general guide. They do not cover everything. Also, all hospitals and surgeons vary
a little. If you have any queries or problems, please ask the doctors or nurses.
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Toe Fusion - Arthodesis
What is it?
Your toe is out of shape. It is called a hammer toe. The first joint of your toe sticks
out. It usually makes finding comfortable shoes difficult. The top of your toe may be
red and sore.
The Operation
You will have a general anesthetic, and will be asleep for the whole operation. Your
toe will be straightened. This is done by removing the joint of the toe. This is either
called fusion of the toe, or arthrodesis. A cut is made over the top of your abnormal
joint. The surfaces of the joint are then removed. The toe may be held in its correct
position with a stout wire. This is known as a K-wire. This passes down from the end
of the toe and across the joint to be fused. The skin is then closed up with stitches.
After your operation, you will not be able to bend the toe joint.
Any Alternatives
Most people try pads from the chemists or the chiropodists before seeing an
orthopedic surgeon. If the pads have not helped, probably the best plan is to
permanently straighten your toe.

After - In Hospital
Your toe may be painful. You will be given injections or tablets to control this. Ask for
more if the gets worse. A general anesthetic will make you slow, clumsy and
you are able to do things for yourself. Do not make important decisions during this
time. You will be able to walk around with the help of crutches. The wound will have
simple adhesive dressings over it. Your stitches will be taken out about two weeks
after your operation. About 1 cm (less than half an inch) of the wire is left sticking
out of the end of your toe. This is so it can be removed in the clinic six weeks or so
after your operation. You do not need an anesthetic to have your wire removed.
Surprisingly this does not hurt. Wash around the dressing for the first 10 days. You
can wash the wound area as soon as the dressing has been removed. Soap and
shower or take a bath as often as you like. You will be given an appointment to visit
the orthopedic outpatient department two weeks or so after your operation. The
311
After - At Home
make arrangements for friends or family to shop for you. Your toe will continue to
improve for at least six months. You must not drive until your toe is completely
comfortable. You are unlikely to drive for at least four weeks after your operation.
How soon you can return to work depends on your job. If you can get to work
without driving yourself or by using public transport you may be able to return to
work six weeks after your operation. You should not do manual work until your toe is
solidly fused.
The wound or the wire can become infected. You will be given antibiotics to try and
prevent this. If the wire becomes infected, it will be removed.
There is more than a 90% chance that the toe fusion operation will be successful.
However, there is always a chance that the bones may not fuse. If this occurs, a
further operation may be necessary
General Advice
The operation is relatively minor. Overall you will be much better off having your toe
straightened. We hope these notes will help you through your operation. They are a
Toe Nail Removal
What is it?
Your toenail can cause trouble in two main ways. First, it can make the skin fold at
the side and become very swollen and red (in growing toenail). Second, it can
become very thick, curved and painful. Both these conditions can be treated by an
operation.
312
The Operation
The toe is made numb with an injection of local anesthetic into its base. Then, for an
in growing toenail, a sliver of the nail and of the nail bed is cut out on each side that
is tender and swollen. The nail is then always a little narrower. The skin fold settles
down. For a thick curved nail, the whole nail and all the nail bed are cut out so that
instead of a nail there is just skin. You should be able to go home within one hour of
the operation.
Any Alternatives
If you leave things as they are the trouble with your toenail will stay about the same.
Antibiotics can be helpful, especially when the area that is swollen and painful is
infected. However, if you don’t have any other treatment, the infection might very
well come back . Taking off the nail and letting it re-grow does not give good results.
Killing the nail bed with Phenol is sometimes used. Taking away the whole nail bed is
needed only if the whole nail is diseased.

Check you have a relative or friend who can come with you to the hospital, take you
home, and look after you for the first week after the operation. Bring all your tablets
and medicines with you to the hospital. On the ward, you may be checked for past
before the operation for these checks. For the operation, you will be lying on an
operating table. The anesthetic injection will be given into your toe. This is
uncomfortable, but the feeling soon wears off. Your toe will be cleaned with
antiseptic, and sterile towels will be draped around it. A tight band will be clipped
around your toe to prevent bleeding. The operation is performed. This takes about
15 minutes per toe. The toe is covered with a dressing and a bandage to apply
gentle pressure on the wound and to prevent any bleeding
After - In Hospital
There is no feeling in the toe for an hour or so. After this you may need painkillers
such as paracetamol, to control any pain. This gradually improves after a day or so.
You should be able to eat and drink normally. The wound has a dressing which
should not be removed for one week. You will need shoes with a large area for your
toes to accommodate the bandages, or shoes with no toes. Keep the dressing dry
and as clean as possible. There may be stitches in the skin. Wash around the
dressing to avoid wetting it. Some hospitals arrange a check-up about two weeks
after you leave hospital. Others leave check-ups to the General Practitioner. The
After - At Home
You will be uncomfortable for a day or two and will be a little hampered by the
dressings and the tender toe. You can drive as soon as it its comfortable to do so.
You should be able to return to a light job within 24 hours and a heavy job within
three weeks.
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Complications are rare and seldom serious. If you think that all is not well, ask the
nurses or doctors. Bleeding in the first 12 hours may be troublesome. Apply pressure
with a bandage on the toe wound and contact your doctor straight away. Pain in the
toe that cannot be controlled with simple painkillers, or pain that is bad enough to
keep you awake, means you should contact a doctor. The wound is tender and
delicate for a week or so after the dressings are taken off. This rapidly gets better.
There is also a very small chance of infection, which can be controlled by taking
antibiotics for a few days. The chance of the nail trouble coming back is about 1 in
20.
General Advice
The operation is a little uncomfortable, but should rapidly heal. We hope these notes
will help you through your operation. They are a general guide. They do not cover
Tongue Tie Operation
What is it?
A tongue tie is a web of skin that holds the tip of the tongue down to the floor of the
mouth. This sometimes causes talking or eating difficulty. It is not the fault of either
parent. The tongue tie is called ankyloglosia from the Greek words ankylo which
means difficulty in moving and glosa which means tongue. It happens in about 3 to
4% of children and is more frequent in boys compared with girls (some studies show
that it is twice as common in boys than girls).
The Operation
Leavings things as they are does no harm. You may find that your child's talking
problems get better within the next few months. If not, cutting the tongue tie is all
that is needed. Bigger operations with stitches are no better. There are no drug
treatments or creams for tongue tie.
Any Alternatives
admission to hospital, please telephone the ward and let the ward sister know. The
operation will usually need to be put off. Your child has to get over the cold before
serious infection in the chest. Sort out any tablets, medicines, and inhalers that your
child is using. Keep them in their original boxes and packets. Bring them to the
hospital with you. On the ward, your child may be checked for past illnesses and may
have special tests to make sure that he or she is well prepared and can have the
operation as safely as possible.. Many hospitals now run special preadmission clinics,
for your child to have these checks.

Your child must have nothing to eat or drink for about 4 hours before the operation.
This means not even a sip of water. Your child's stomach needs to be empty for a
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safe anesthetic. If your child has a cold in the week before admission to hospital,
please telephone the ward and let
Sister know. The operation usually needs to be put off. Your child has to get over the
cold before the operation is done. Sort out any tablets, medicines, and inhalers that
your child is using. Keep them in their original boxes and packets. Bring them to
hospital with you. On the ward, your child may be checked for past illnesses and may
have special tests, ready for the operation. Many hospitals now run special
preadmission clinics, where you visit for an hour or two, a week or so before the
operation for your child to have these checks.
After - In Hospital
Your child may have a little oozing of blood from the cut. It is not painful. Your child
will be able to drink again about two to three 2-3 hours after the operation. He or
she should be able to eat normally the next day. Usually you can take your child
home on the day of the operation. You may be given an appointment to bring your
child to the outpatient department a month after leaving the hospital for a check-up.
Sometimes the family doctor checks the operation.
After - At Home
There is very little to the operation. Your child can clean his or her teeth as long as
care is taken not to brush under the tongue. If your child goes to school, he or she
can return to lessons in a couple of days. Any sport can restart in a week or so.
Complications are rare and seldom serious. There may be a little swelling under the
tongue for a day or two. Rarely, the area of the operation can be infected but this
settles quickly with antibiotics. There may be minor spotting of blood after a week.
This will settle down. Very rarely, there may be some bleeding in the area of the
operation that might require another small operation to stop it.
General Advice
This is basically a simple and safe operation.. Very rarely the tongue tie comes back.
These notes should help you and your child through the operation. They are a
Tonsillectomy (Adult)
What is it?
The tonsils are made of special tissues which fight infection. There are lots of other
areas in the head and neck and throughout the body made of this tissue, so even
without the tonsils the body can still fight infection. If the tonsils are becoming
infected very often (tonsillitis), making you ill and having to take time off work, it is
best to remove them.
The Operation
You will have a general anesthetic and be completely asleep. The surgeon removes
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the tonsils through the mouth and stops any bleeding. A special instrument called
diathermia (a Greek word which means by applying heat) is usually used which can
free the tonsils and at the same time can stop the bleeding by applying a wave of
heat on the small blood vessels. Because you are completely asleep you will not feel
any pain during your operation. Provided that you are eating and drinking normally,
and there is no sign of any infection, you will be fit to go home one or two days after
your operation.
Any Alternatives
There are no tablets or medicines that will stop you from getting tonsillitis.
Antibiotics can help to make the tonsillitis get better. If the tonsils are becoming
infected frequently, antibiotics may not work very well. The only way to stop you
getting tonsillitis is to remove the tonsils.

and that you can have the operation as safely as possible.
for an hour or two, a few weeks or so before the operation for these checks. If you
have a cold or tonsillitis in the week before your admission to hospital, please
off, and you will be given time to get better before being sent for again. You will
need to get over the cold or the tonsillitis before you have the operation because by
having an anesthetic, the cold or the tonsillitis could turn into a serious chest
infection.
After - In Hospital
chest problems in the past. To start with you will have a sore throat and some
stiffness of your jaws. You may also find that you have a mild earache. The nurses
will give you medicine or an injection to help with the soreness. Ask for more if the
pain is not well controlled or if it gets worse. A general anesthetic may make you
important decisions during this time. It is very important for you to eat and chew
solid, soft food (normal meals not just drinks), as soon as possible after your
operation. Some ice cream is an ideal first meal after this operation because it's soft
and offers comfort for the sore throat. It will be a bit difficult initially to have solid
food but actually makes your sore throat go away more quickly. Solid, chewed food
going down your throat will keep it clean and help it to heal up. If you do not eat and
chew normal food, but only take drinks, your throat will become sore with the risk of
infection, and bleeding, all of which will prolong your stay in hospital. Before leaving
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the ward you may be given an appointment to come back to the ENT (ear, nose and
throat) outpatient clinic for a check-up. Some hospitals leave check-ups to the
After - At Home
Take painkilling tablets every six hours to control any sore throat. Eating and
chewing solid, soft food is just as important at home. Crisps, corn flakes, toast and
similar sharp or hard food should be avoided for the first week. You should be fit to
return to work 10 days after your operation. You will be fit to drive one or two days
after your operation.
Provided the advice given above is followed you are unlikely to have any problems.
There is a small risk (2 to 3% of cases) of bleeding from the place where the tonsils
have been removed. This can happen within a few hours after the operation. Usually
this stops by applying some pressure with a special sponge through the mouth on
the area where the tonsils used to be. Very rarely, a further operation may be
necessary to stop the bleeding. Bleeding can also occur after a week or so. This is
usually due to infection caused by not eating. If this happens you must come back
into hospital for this to be treated, but another operation is not usually necessary.
increasing pain in the throat or the ears, a headache or a temperature, it probably
means that an infection is developing and you will need medical attention promptly.
Taking antibiotics for a week or two usually solves the problem.
General Advice
Tonsillectomy and Adenoidectomy - Child
What is it?
You can see your child's tonsils in the back of the throat. They look like a strawberry
on each side. You cannot see the adenoids, because they are hidden above and
behind the floppy part of the roof of the mouth. They look like tonsils, but are in the
back of the nose. They are close to the little tubes in the back of the nose which
connect to the ears. The tonsils and adenoids are like the glands you get in the neck
with a sore throat. They swell up to fight infection. Usually the swelling settles down
after the infection passes. Sometimes, after many attacks of infection, the tonsils
and adenoids do not shrink down properly. Antibiotics do not work very well on the
thickened tissue. Your child will have more attacks of tonsillitis (infection of the
tonsils). Each attack will last longer and be worse as time goes by. Your child's
adenoids are blocking the back of the nose. This makes breathing through the nose
difficult. They can also block the tubes in the back of the nose that connect to the
ears. Blockage here can cause earache and deafness. Taking out the tonsils and
317
adenoids will stop these nose and ear problems. After taking out the tonsils and
adenoids, there is plenty of gland tissue elsewhere in the head and neck, and
throughout the body, to fight infection. Tablets or medicines will not make the tonsils
and adenoids get smaller or go away.
The Operation
Your child will have a general anesthetic and will be completely asleep. Special
instruments are passed into the mouth. The tonsils and adenoids are freed off and
taken away. Any bleeding is then stopped. A special instrument called diathermia (a
Greek word which means by applying heat) is usually used to free the tonsils and
adenoids and at the same time can stop bleeding by applying a wave of heat on the
small blood vessels. There are no cuts in the skin. Because your child will be
completely asleep, he or she will not feel any pain at all during the operation. Your
child can go home if eating well and if there is no infection. This is usually on the first
or second day after the operation.
Any Alternatives
Usually tonsils and adenoids shrink away on their own when a child reaches the age
of 12 or 13. Waiting this long is not a happy prospect for a child. It can lead to life-
long hearing difficulties.

Sort out any tablets, medicines or inhalers that your child is using. Keep them in
sure that he or she is well prepared and can have the operation as safely as possible.
You and your child will have the operation explained to you and will be asked to fill in
for these checks. If your child has a cold in the week before admission to hospital,
please telephone the ward and let the ward sister know. Usually the operation will
have to be put off. Your child needs to get over the cold before the operation can be
done because by having an anesthetic the cold could turn into a serious infection in
the chest. Because the surgeon will be working inside your child's mouth, you must
tell him if your child has any loose teeth.
After - In Hospital
To start with your child will have a sore throat and some stiffness of the jaw. You
may also find that he or she has some mild earache. This often happens after this
operation. It does not mean there is anything wrong with the ears. It quickly goes
away and is not something you should worry about. The nurses will give your child
some medicine to help with the soreness. A general anesthetic may make your child
slow, clumsy or forgetful for about 24 hours. The nurses will help you to support
your child until he or she feels better. It is very important for your child to eat and
chew soft, but solid food, as soon as possible after the operation. This means normal
meals, not just drinks. Some ice-cream is an ideal first meal after this operation
since its soft and offers comfort for the sore throat. It will be a bit difficult initially to
have solid food, but actually makes the soreness in the throat go away more quickly.
Solid, chewed food going down the throat will keep it clean, and help it to heal up. If
your child does not eat but only takes drinks, the throat will become sour. There will
be a risk of infection and bleeding. These will hold up your child's home-coming. The
doctors may wish to see your child in the ENT (ear, nose and throat) outpatient
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clinic. You will be given an appointment card for this. Some hospitals arrange a
check-up about one month after your child leaves the hospital. Others leave check-
ups to the general practitioner.
After - At Home
Use a medicine such as paracetamol suspension to settle any sore throat. If possible
try and prevent your child catching a cold or cough within the first week at home.
Avoid having friends round to play if they have a cold. For the same reason your
child should stay off nursery or school for a week after the operation. If your child
does develop a cold, you should see your general practitioner for a course of
antibiotics. Eating and chewing solid food is just as important at home. Avoid sharp
and hard food such as crisps, corn flakes, and toast for the first week. Your child
should not go swimming until the wounds have healed. This will usually be after
about three weeks.
Sometimes (in less than 1% of cases) the surgeon has to control oozing of blood
from the adenoid area. This means tucking a length of gauze into the nose for 24
hours or so. When the surgeon is certain that the bleeding has stopped, the gauze is
taken out. A second very short operation will be needed to do this.
There is a very small chance (no more than 6 in a 1000) that when the adenoids are
removed the area close to where they used to be is not closing properly and this can
affect your child’s speech. In the majority of cases this can improve with speech
therapy and only in a few cases is an operation needed to fix the problem.
There is a small risk (2 to 3% of cases) of bleeding from where the tonsils have been
taken away. This can happen within a few hours of the operation. Usually this stops
by applying some pressure with a special sponge through the mouth on the area
where the tonsils used to be. Very rarely a second operation may be needed to stop
the bleeding. Bleeding can also occur a week or so after the operation. This is usually
due to an infection caused by not eating properly. If this happens, bring your child
straight back to the ward for treatment. Another operation is not usually needed.
For both the tonsillectomy and the adenoidectomy there is a small risk of infection at
the area of the operation. If your child develops increasing pain in the throat or the
ears, a headache or a temperature, it probably means that an infection is developing
and he or she will need medical attention promptly. Taking antibiotics for a week or
two usually solves the problem.
General Advice
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Trabeculectomy for open angle glaucoma
What is it?
The term glaucoma means increased fluid pressure in the front part of the eye. It is
a condition that affects about 1% of the population and is much more common in
people who are over 50 years old. Trabeculectomy is an operation that is performed
to allow free drainage of this fluid.
The front part of the eye has two chambers. The first one is the space between the
cornea (the transparent 'film' in the centre of the eye) and the iris which is the
colored, rounded part behind it. The open centre of the iris is the pupil. The second
chamber is just behind the first and is the space between the back surface of the iris
and the lens of the eye.
The side 'walls' of the second chamber consists of a special type of tissue called the
ciliary’s body. The ciliary’s body produces a clear fluid which is called aqueous
humor. This fluid is very nutritious for the tissues of the front part of the eye and it
also prevents them from becoming dry, which can affect vision.
After its production by the ciliary’s body, the aqueous humor fills the second
chamber and it then passes through the pupil and fills the first chamber. On the side
of the first chamber (in the area where the cornea joins the iris) there is special
network of channels that is called the trabecular meshwork. The aqueous humor is
drained through these channels out of the eye. This continuous production and
drainage of the aqueous humor allows only a small amount of fluid to be under low
pressure in the front part of the eye at any given time. If there is problem with the
drainage of the fluid, this causes it to accumulate in the two chambers and, as
expected, causes an increase in pressure (glaucoma). The increased pressure is
transferred to the back of the eye and eventually affects the nerves of the eye and
over time this can lead to blindness. The most common type of glaucoma (the one
that you have) is when the angle/corner between the cornea and the iris is still open
but the trabecular meshwork channels are thickened and narrowed and don't allow
free drainage of the aqueous humor. The small cut in the trabecular meshwork that
allows free drainage of the aqueous humour to treat the open angle glaucoma is
called trabeculectomy.
The other much less frequent type of glaucoma is closed angle glaucoma where the
angle between the cornea and the iris closes (sometimes acutely) and the pressure
of the aqueous humour increases rapidly. This is a relatively rare acute condition that
requires special emergency treatment.
Most patients with open angle glaucoma don’t experience specific symptoms. The
disease is usually diagnosed during routine examination of the eye. It is therefore
important to have a proper routine eye examination especially for people who are
over 50 years old and even more so for people who have family members who have
the disease since it is a problem that 'runs' in families.
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The operation
In most patients the operation is performed by having the eye numbed with a local
anesthetic injection. Very rarely a patient might need to be put to sleep with a
general anesthetic to allow him or her to have this operation comfortably. If you
have a local anesthetic, you will be awake during the operation, but will feel no pain
and will not see anything, because the injection stops the eye working and you will
be able to go home the same day of the operation (day surgery case). If you have
the operation under general anesthetic, you may need to stay in hospital for up to 24
hours after the operation.
The operation takes about an hour. The surgeon starts by making a very small cut
on the conjunctiva and the sclera. The sclera is the white part of the eye around the
iris and the conjunctiva is the clear thin covering just on top of the sclera. The cut is
made on the upper part of the eye just at the margin between the sclera and the iris
(the white and the colored part respectively) and is done in a way that creates a very
small flap ('trapdoor'). The trabecular meshwork that lies just under this area is cut
and removed. The cut on the conjunctiva and the sclera is left open. This allows the
aqueous humour to drain freely out of they eye through the removed area of the
trabecular meshwork and through the flap on the conjunctiva and sclera. As the fluid
continues to drain through the flap it creates a small bubble in the area which is
called a bleb. At the end of the operation it is common to inject substances into the
area of surgery to delay the healing process. These help to decrease the chances of
scar tissue developing which can eventually block the flap and stop the drainage of
fluid. In some cases, where it is thought the flap may not stay open, usually because
of previous eye surgery and scarring, a tiny silicone tube is placed in the cut created
on the conjunctiva and the sclera to form a permanent channel that will allow the
free drainage of the aqueous humor.
Any alternatives?
The initial treatment of glaucoma is usually with special eye drops that aim to reduce
the production of the aqueous humor or help its drainage. If these do not work an
alternative is laser trabeculoplasty. The laser light destroys part of the thickened wall
of the channels of the trabecular meshwork and makes them wider allowing the
aqueous humor to drain more freely. The benefits of this treatment last between two
and five years. If the eye drops or the laser treatment fails then surgery is the only
option. Some studies show that laser treatment can reduce the success rate of future
surgery and that is why some hospitals prefer to go straight to surgery if the eye
drops fail.
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Stop smoking and get your weight down, if you are overweight. (See Healthy Living).
After - in hospital
Most patients have little pain after a trabeculectomy and sometimes experience
some minor swelling of the eye. You may be given tablets to control any pain and
discomfort. You can wash, bathe, or shower normally after the operation, but you
must not get water in your eye for a month. If you have your hair washed, have it
month. You will be given a supply of eye drops, and shown how to put them in your
eye. These are to reduce swelling and the risks of infection. You will be given an
appointment for the outpatient department for a check-up the day after your
operation. This is to make sure that the flap is open and the fluid is draining from the
eye. If all is going well, you will have another follow-up in the next 7 to 14 days. The
nurses will advise about sick notes, certificates, etc. You are advised to arrange for
somebody to accompany you when you leave hospital.
After- at home
touching your eye, especially when you are half asleep. Sometimes it takes a few
days for a patient to see well, as it takes some time for the eye to settle down after
the operation. You MUST wear the eye shield to protect the operated eye at night, or
if you sleep during the day. You will be told in the outpatient clinic when you can
stop using the shield (usually about one month). During the day you can use any
glasses you were using before the operation. Sunglasses are a good idea to protect
your eyes from the glare. If you wear contact lenses, do not put one in the operated
side for eight weeks.
After the operation any activity that can jolt the eye must be avoided. Bending,
heavy lifting or straining can suddenly increase the pressure in the eye and cause a
problem with your vision. For the same reason, if you have problems with
constipation, you need to take laxatives after the operation to avoid any strain when
you try to pass stools. Plan to go back to light work in one to two weeks, and a more
heavy or manual job in three months.
You must be very careful with driving in the early stages because your sight may not
be as good as you think it is. Ask whether your sight is good enough to drive. If in
doubt, don't drive.
In the rare case where the operation is performed under general anesthetic, there is
a very small risk of complications related to your heart and lungs. The tests that you
Bleeding in the eye can cause pain and affect your vision. Usually this settles by
itself but, very rarely, you will need surgery to fix the problem. The eye may also get
322
infected in the area of the operation. Drops of antibiotics and anti-swelling
medications may be needed to treat the infection. The chances of infection are
higher if a silicone tube is placed in the eye to allow drainage of the aqueous humor.
Sometimes, because of the opening in the conjunctiva and the sclera, the infection
can spread inside the eye and cause a much more serious problem for which you will
need to be in hospital for more extensive antibiotic treatment.
After the operation you might experience some blurring of your vision which can last
for a few weeks. In most cases, this gets better over time. If it doesn’t, the doctors
will advise you about further treatment. The operation of trabeculectomy increases
the chances of a cataract (the lens of the eye behind the iris becoming cloudy and
affecting your vision) or it can make an existing cataract worse. In this situation you
might need another operation to replace the cloudy lens with a new synthetic one.
The long-term results of trabeculectomy can be affected by many factors. In general,
following a trabeculectomy, 50% of patients will have a significant drop in their eye
pressure and they will not need medication to reduce eye pressure. This can last
from one to many years. Another 40% of patients will also experience a similar drop
in eye pressure but only if they take medication to reduce eye pressure after the
operation. The most common cause of failure of trabeculectomy is the development
of scarred tissue in the area of the flap which eventually closes it and doesn’t allow
the free drainage of aqueous humour. In this situation another operation might be
needed to create a new opening.
General advice
Turbinates of Nose - Excision
What is it?
The turbinates are three small ridges that run deep inside each nostril. They jut out
into the nose spaces. They help to warm and moisten the air you breathe in through
your nose. You have a swelling on one of the turbinates. To find out what it is, the
surgeon needs to take away the swelling and look at it under a microscope. He can
then tell whether you need any more treatment.
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The Operation
You will have a general anesthetic and be completely asleep. The surgeon will take
out the swelling on the turbinate from inside the nose and send this to the laboratory
for examination to identify the cause of it. The surgeon will use a fine knife, or a
laser. There will be no cuts on the outside of the nose. There will be no change to the
shape of your nose after the operation. At the end of the operation, the surgeon will
put gauze packs soaked in Vaseline inside your nose to stop any bleeding. The
nurses will take out the packs on the ward the next day. If there is no further
bleeding, you will probably be able to go home three to four hours later. Because you
will be asleep you will not feel any pain at all during the operation.
Any Alternatives
If you leave things as they are, the swelling will not go away. It may easily get
bigger, block your nose, and be more difficult to treat. X-rays and scans will not tell
the doctors what the swelling is. It is not sensible to start treatment without knowing
what is wrong. Tablets, nose drops, or nose sprays do not usually work. The best
way forward is for the swelling to be taken out and the tissue examined under the
microscope.

324
and look after you for the first day or so after the operation. Sort out any tablets,
medicines, or inhalers that you are using. Keep them in their original boxes and
get better before being sent for again. You will need to get over your cold before you
can have your operation because by having a general anesthetic the cold could turn
into a serious chest infection.
After - In Hospital
chest problems in the past. Usually the nose is a little sore and uncomfortable after
this operation. While the packing is in your nose you will have to breathe through
your mouth, and this will make your mouth feel dry. Taking frequent drinks will help
to keep it moist. You may find that the nasal packing makes your eyes water or gives
you a headache. If you do get a headache or your nose feels sore, the nurses will
give you an injection or tablets to help relieve this. Ask for more if the pain is not
well controlled or if it gets worse.. A general anesthetic may make you slow, clumsy
or forgetful for about 24 hours. The nurses will help you with everything you need
this time. The next day there may be some swelling around the nose. This always
improves quickly after the packs have been removed. You will be able to get up and
about and have a warm bath. When the nurses remove the packing from your nose
there may be a little bleeding which usually stops very quickly. You will probably be
able to go home later on in the day. Before your leave the ward you will be given an
appointment to come back to the ENT (ear, nose and throat) outpatient clinic to see
the surgeon again and have your nose checked. You will get the result of the
examination of the swelling. Sometimes the check-ups will be done by your general
practitioner. The nurses will advise about sick notes, certificates etc.
After - At Home
At home, take painkilling tablets every six hours to control any pain or discomfort.
You may be advised to use an antiseptic cream, nose drops and steam inhalations.
As the inside of the nose gradually opens up you will find that you can breathe more
easily through the nose each day. If your nose runs you can wipe it, but do not blow
your nose until two days after you get home, and then start off by blowing VERY
GENTLY. To begin with you will see blood staining in your handkerchief. Most of this
will be old blood from your operation, but there may be a little fresh bleeding as well.
This is expected and you should not worry about it. . Take it easy when you get
home. Avoid hard physical exercise as this may make the nose bleed. Try and avoid
smoky atmospheres such as pubs and clubs for the first couple of weeks. If possible
try and avoid catching a cold within your first week at home. If you do get a cold you
should see your general practitioner for a course of antibiotics. It will be five or six
weeks before the swelling inside the nose has completely gone and you get the full
325
benefit of the operation. You should be fit to return to work about two weeks after
your operation. You should be fit to drive one or two days after you leave the
hospital.
the nasal packs inside your nose for an extra day. If there is a lot of bleeding after
the packs are removed, then the surgeon will put them back in, either with a local or
general anesthetic. The chances of this happening are very slight. Provided the
advice given above is followed you are unlikely to have any problems when you get
home. There is a small risk that the nose may bleed when you get home. If this is
just a spot or two it is not important. If the nose continues to bleed, come back to
the ward or contact your GP.
Very rarely following this operation you can develop a hole in your nasal septum. If
this happens you will most probably need another operation to correct the problem.
General Advice
Tympanoplasty - Myringoplasty (Adult)

What is it?
Each ear is made up of 3 parts. There is the outer ear which you can see, and which
gathers the sound. Further in, the outer ear joins the middle ear on each side of the
head. Deeper still, there is an inner ear on each side. The sound goes down the ear
tube, which is part of the outer ear, into the middle ear on that side. The ear drum
stretches across the deepest part of the ear tube between the outer ear and the
middle ear. The drum is about 8 mm (a third of an inch) across. It is made of thin
skin like the top of a real drum. Your ear drum has a hole in it, which doctors call a
perforation. Germs may go through the hole and cause an ear infection, particularly
if you get water in the ear whilst hair washing, taking a shower or swimming. The
hole in the ear drum will stop it from vibrating normally, and this may cut down your
hearing. Sealing up the hole in the ear drum should prevent you getting so many ear
infections, and may improve the hearing. Just how much hearing improvement
depends where in the drum the hole is, and how big it is.
326
The Operation
You have a general anesthetic and are completely asleep. A cut will be made in the
skin above your ear. From inside this cut the surgeon will take a small, thin piece of
tissue. This tissue is called a graft, and the surgeon will use it to seal up the hole in
your ear drum. The surgeon will shine a microscope inside your ear, and the rest of
the operation is carried out through the ear passage. Using very, very small
instruments, the ear drum is lifted up and the graft is put underneath the ear drum
and spread out to seal up the hole. A small amount of some sticky-spongy
dissolvable material is placed on each side of the graft (in the ear tube and the
middle ear) to support the graft until it heals and seals up the hole. This material will
just melt away in a few weeks. A dressing soaked in antibiotic drops will then be put
into the ear passage, and stays in place for about three weeks whilst the graft and
ear drum are healing up. Cotton-wool padding is placed over the ear and held in
place with a bandage. Because you are asleep you will not feel any pain during the
operation. You will be in the hospital for one or two days depending upon your
progress.
Any Alternatives
Sometimes holes in the ear drum heal themselves. In your case this has not
happened. Drops or tablets will not make the hole close up. If the hole is left open
you risk getting more ear infections every time you get water in the ear.

327
and look after you for the first few days after the operation. Sort out any tablets,
medicines or inhalers that you are using. Keep them in their original boxes and
week before your admission to hospital, please telephone the ward and let the ward
sister know. The operation will usually be put off, and you will be given time to get
better before being sent for again. You will have to get over the cold before the
After - In Hospital
chest problems in the past. Your ear will be a little sore after the operation. There
may be some discomfort in your ear when opening and closing your mouth, or if you
lie on the ear. You will be given an injection or tablets to control this discomfort. Ask
for more if the pain is not well controlled or if it gets worse. A general anesthetic
may make you slow, clumsy and forgetful for about 24 hours. The nurses will help
you with everything you need until you are able to do things for yourself. Do not
make important decisions during this time. You must not blow your nose, and you
must not stifle any sneezing. You may have some dizziness for the first 24 hours
after the operation, but this is not very common. Medicine can be given to stop the
dizziness. You may notice a strange squelching, buzzing or popping noise in your
ear. This is usually due to the dressing in the ear, it is expected and you should not
worry about it. The noises usually stop when the dressing is removed. Some
soreness or stiffness when opening your mouth is common after ear operations. It
usually stops within one or two weeks. The stitches above your ear need to stay in
for seven days. You must be careful when taking a shower and washing your hair not
to get the ear or the wound above it wet. You will probably be given a time to return
to the ward a week after your operation, for the stitches to be removed. You will be
given an appointment card to come back to the ENT (ear, nose and throat)
outpatient clinic about three weeks after the operation, when the surgeon will
remove the dressing from the ear passage. He will examine your ear carefully and
tell you whether the operation has been successful. The nurses will advise about sick
After - At Home
Take two painkilling tablets every six hours to control any pain or discomfort. Be
sure to keep the ear dry and do not go swimming. You should also avoid flying until
the doctor confirms that the graft has successfully closed the hole. This is because
changes in the ear pressure especially during take off and landing can push the graft
out of place. You may feel rather tired for a week or so, but this will steadily
improve. You should be able to go back to work after 10 days, but you must keep
your ear dry. It will be better for somebody to drive you home after the operation or
for you to take a taxi.
328
Provided the advice given above is followed, you are unlikely to have any problems.
There is a small risk that the ear may bleed when you get home. If this happens
come back to the ward. If possible try and avoid catching a cold in the first month or
so after your operation. Try and avoid contact with friends or relatives who have
colds. If you catch a cold you should go to your doctor for antibiotics as there is a
risk that a cold could lead to an ear infection which would destroy the graft while it is
healing. If the ear becomes very painful, or if you develop a temperature or a
headache it may mean that the ear is infected and you should return to the ward. A
continuous discharge form the ear (especially if it is thick, green and/or yellow or
smelly) is also a significant indication of an infection and you will need immediate
medical attention. If you get an ear infection, you will need antibiotics for a week or
two to control it. Remember any infection in the early stages after the operation will
destroy the graft.
A rare complication is damage during the operation of a small nerve that runs behind
the ear drum. If this happens, you will experience some loss of taste and/or
numbness on the side of the tongue. This usually gets much better with time in most
cases.
Overall the success rate of this operation is about 90%. If your ear drum is badly
scarred from previous infections this will lower the success rate of the operation.
General Advice
Ureterolithotomy - Dormia Basket
What is it?
There is a stone in the tubing, in the ureter, that runs from your kidney to your
bladder. You have two kidneys, a left and a right one. They are each about the size
of a fist. They lie deep in your back on each side of your spine, in front of the lowest
rib on each side. They make the urine which passes down the ureter on each side to
the bladder just below your navel. Stones from the kidney can pass down the ureter
causing pain, blood in the urine, infection, or can block the ureter causing pressure
on the kidney. Often the stones pass right through by themselves. In your case,
however, the stone has stuck in the ureter. It needs to be taken out with an
operation.
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The Operation
You will have a general anesthetic, and will be asleep for the whole operation.
Sometimes the stone in the ureter can be pulled out by a special telescope passed up
into your bladder through the normal urine passage. Otherwise a cut has to be made
into the skin. The stone is then taken out through an opening in the side of the
ureter. The wound is then stitched up. If the stone can be removed with the special
telescope, you should be able to leave hospital within 24 hours. Otherwise you
should allow seven days or so in hospital.
Any Alternatives
Waiting and seeing if the stone will pass is a good idea if the stone is less than one
third of an inch long. This has not happened in your case. Breaking up the stone with
shock-wave treatment often works very well. If it has not worked, an operation is
needed to find out why and deal with the problem. Drug and diet treatment are
useful to stop more stones forming. They are not very helpful in dissolving stones
which are already there.

about taking the Pill or hormone replacement therapy (HRT). Check you have a
relative or friend who can come with you to the hospital, take you home, and look
them to the hospital with you.
330
checks.
After - In Hospital
If you have had the stone taken out with the special telescope, you will not have a
cut in the skin nor any extra drainage tubes. If a cut was needed, you will have a
drain tube coming out of the skin near the wound. This is to drain any residual blood
or other fluid from the area of the operation and is usually removed one to two days
after the operation. You may have a fine, thin plastic tube (drip) in an arm vein
giving you blood or salt solutions. You will have a fine plastic tube (catheter) coming
out of the front passage or penis to drain urine out of the bladder. A general
not make important decisions during this time. If you have only had the special
instrument, there is only some soreness in the front passage or penis. If you have
had a cut, there is some discomfort on moving rather than severe pain. You will be
given injections or tablets to control this as required. Ask for more if the pain is not
well controlled or if it is getting worse.
should be able to spend most of your time out of bed and in reasonable comfort. By
the end of one week the wound should be virtually pain free. If you have only had
the special instrument, and as long as you are not feeling sick, you will be able to
start drinking within two to three hours of the operation. The next day you should be
able to manage small helpings of normal food. If you have had the bigger operation,
you will be able to start taking drinks once your tummy is soft. This is after about 24
hours. By the end of 48 hours you should be starting to eat more solid food. The arm
drip tube will be taken out once you are drinking freely. You may have some blood in
the urine catheter for a day or two. Once this clears and you are able to get out of
bed easily the catheter will be taken out. It is important that you pass urine properly
after the catheter is out and also after the special instrument has been used. The
doctors and nurses will check this.
If you had the operation through a skin cut, the wound may have stitches or clips or
may be held together with just stitches underneath the skin. You can wash as soon
as the dressing has been removed but try to keep the wound area dry until the
stitches/clips come out. If there are only stitches underneath the skin, try to keep
the wound dry for a week. Soap and warm tap water are entirely adequate. Salted
water is not necessary. You can shower or take a bath as often as you want. The
nurses will talk to you about your home arrangements so that a proper time for you
to leave hospital can be arranged. Some hospitals arrange a check-up about one
month after leaving hospital. Others leave check-ups to the general practitioner. The
After - At Home
After the open operation, you are likely to feel very tired and need to rest two to
three times a day for a week or more. You will gradually improve so that by the time
a month has passed you will be able to return completely to your usual level of
activity. After the special instrument procedure you should be back to normal duties
331
inside a week. At first discomfort in the wound will prevent you from harming
yourself by lifting things that are too heavy. After two months you can lift as much
as you used to lift before the operation.. There is no value in attempting to speed the
recovery of the wound with special exercises before this. You can drive as soon as
three weeks. You can restart sexual relations within three weeks or so, when the
wound is comfortable enough. You should be able to return to a light job after about
one month and any heavy job within two months.
For both types of operations, complications are relatively rare. If you think that all is
not well, please ask the doctors and the nurses.
infection.
Sometimes there is blood in the urine. If the doctors expect this, a catheter is
Sometimes you can have an infection which is either localised in your urinestream or
gets into the bloodstream. You will be given antibiotics to treat the infection.
If you have the open operation

Bruising and swelling may be troublesome. The swelling may take four to six weeks
to settle down. A wound infection happens in 1 to 2% of cases and settles down with
antibiotics in a week or two.
drainage settles down. Very rarely, it doesn’t settle or gets worse in the first few
hours/days after the operation. This means that damage has occurred during the
operation in one of your blood vessels or other organs of your abdomen and you will
most likely need another operation to fix the problem.
months.
Sometimes (2 to 3% of cases) there is a leak of urine through the wound or from the
drain site. This settles down within a week or so. Very rarely, you will need another
operation to fix this problem.
If you have the operation with the telescope

Extremely rarely the telescope or the other instruments used during the operation
can create a hole (perforation) or an extensive scratch in the lining of the urethra
(the tube that connects your bladder with your penis or the area in the front of your
vagina), the bladder or the ureter. This problem is usually corrected by putting a
catheter back in for one to two weeks to decompress the bladder and drain the urine
332
until the hole or the scratch has healed. In addition, if the problem is in the ureter, a
fine, thin plastic tube (stent) is placed in the ureter to allow the free drainage of the
urine until the hole or the scratch has healed. You won’t feel the presence of the
stent and it is removed using the telescope in after about six to eight weeks. Only in
extreme circumstances will you need another operation to fix the problem.
Sometimes stones reform. This will be discussed with you. Sometimes the special
instruments cannot get the stone out and you will eventually need the open
operation to get the stone out. This possibility will be discussed with you.
General Advice
their normal duties within two months after the open operation, but within 1 week
after the telescopic operation. These notes will help you through your operation.
nurses.
333
Urethroscopy
What is it?
The tests you have had so far point to the water-works below the bladder as the
The Operation
You can be given a general anesthetic or you can be numbed from the waist down
with an injection in the back. The choice depends partly on which you prefer, and
partly on what your surgeon or anesthetist thinks is best. Having a general
anesthetic means that you will be completely asleep during the operation. Having an
injection in the back means that you will be awake during the operation, but will not
be able to feel any pain from the waist down. If the surgeon believes that he just
needs to have a thorough look at your urethra (the tube that connects your bladder
with you penis or the area in the front of your vagina) and or possibly your bladder
and needs to take two to three pieces of tissue (biopsies) from the lining of the
urethra or the bladder to clarify the problem, you might not need a general
anesthetic or an anesthetic injection in the back. As an alternative, the surgeon can
flush some anesthetic jelly into your urethra so that you will have only a minimal
334
discomfort when he passes the telescope up into you. If you are awake for the
operation, you will have your legs held up in stirrups. A nurse will chat to you during
the operation.
planned. Finally all the equipment is taken out. Sometimes, after the operation, it is
Any Alternatives
this route is usually all that is needed. Sometimes a drug treatment washed into the
bladder is very helpful. X-ray treatment is usually held in reserve. If you do nothing
you will not find out what the trouble is. The problem will steadily get worse. Also
you will not get the benefit of early treatment and this can be extremely important
particularly if it is something like a developing cancer which if diagnosed at an early
stage could be treated.

your lungs, ask your family doctor to check that these are under control. Check that
hospital with you.
checks.
After - In Hospital
You may have a fine, rubber tube (catheter) passing into the bladder through the
front passage. This is to help you to pass urine freely which can be a bit difficult after
an operation like this. Sometimes the catheter needs to be flushed out to keep the
urine flowing properly You may be given oxygen from a face mask for a few hours if
you have had chest problems in the past. There may be some slight discomfort
where the instruments have been. You will not normally need painkillers. The feeling
335
goes away after a day or two. However, if you feel that you can’t tolerate the
discomfort, you can ask for help. Painkiller tablets can usually help but very rarely
you will need an injection. A general anesthetic will make you slow, clumsy and
you are able to do things for yourself. Do not make important decisions, drive a car,
use machinery, or even boil a kettle during this time.
If there is no catheter, you should be able to pass urine before you leave hospital. If
you cannot pass urine, let the doctors and the nurses know. If there is a catheter,
the urine drains out automatically. The catheter will be taken out when the urine is
clear and when it is safe to do so. After that you will be checked to see that you are
passing urine properly. It is a good idea to drink an extra pint of water each day
more than you usually do. Do this for a week after the operation. This will help to
clean the urine.
You will be given an appointment for the outpatient department, or you will get a
date for any repeat operation. Some hospitals arrange a check-up about one month
after you leave hospital. By then the results of the biopsies should be ready. Others
leave check-ups to the general practitioner. The nurses will advise about sick notes,
certificates etc.
After - At Home
You may feel tired for a day or two after the operation. You should not drive for 24
hours after the anesthetic. You can start sexual relations within two to three days of
the operation as long as you feel comfortable. You should be able to go back to work
one to two days after leaving hospital.
pins and needles in your legs. Most of time the clot dissolves on its own and this
your spine.
Complications are rare. If you think that all is not well, please let the doctors or the
nurses know. Chest infections may arise, particularly in smokers. Do not smoke.
Getting out of bed as quickly as possible, being as mobile as possible and co-
operating with the physiotherapists to clear the air passages is important in
preventing a chest infection.
Sometimes you can have infection which is either localized in your urine stream or
gets into the bloodstream. You will be given antibiotics to treat the infection.
336
the telescope or the other instruments used during the operation can create a hole
General Advice
nurses.
Vaginal and Vulval Warts - Removal
What is it?
You have warts around the opening of the vagina - the vulva. There may also be
some inside the vagina or around the back passage (rectum). They are an infection.
They are caused by a virus which is a type of very tiny germ. They usually pass from
one person to another during sex. They can be a sign of other disease passed during
sex. The warts can be taken away with a small operation. Your partner should also
check for warts, and if necessary, have treatment.
The Operation
You will have a general anesthetic , and be completely asleep during the operation.
337
The warts are burned away using a special electric current. The operation takes
about 20 minutes. You should be able to have the operation on the day you come
into hospital, and go home the same day.
Any Alternatives
If you leave things as they are, the warts will get bigger. They can become very
painful. Special ointments will only deal with small patches of warts. Your best way
forward is to have this little operation.

have the operation as safely as possible. . Many hospitals now run special
After - In Hospital
You will have a sanitary pad in place. The vulva will feel very tender for a week or
more afterwards. Take painkillers to ease the pain. Take baths three times a day to
keep the vulva clean and to help healing. There may be slight bleeding from the
vulva or vagina for the first three or four days. Only use external pads for this. You
need to pass urine before you leave the ward. If you have any difficulty, tell the
nurses. You can wash the wound area as soon as you wish. Soap and tap water are
entirely adequate. Salted water is not necessary. You can bathe or shower as often
as you wish. You will be able to drink within an hour or two of the operation as long
as you are not feeling sick. The next day you should be able to manage small
helpings of normal food. You should plan to leave hospital the day of your operation.
The District Nurse may call on you at home as required. You will be able to stay in
hospital longer, if you are not ready to go home the same day. Some hospitals
arrange a check up about one month after you leave hospital. Others leave check-
ups to the General Practitioner. The nurses will advise about sick notes, certificates
etc. You should be able to return to a light job after about one week, and any heavy
job within two weeks.
After - At Home
Go to bed and rest for a few hours. Wait until you have had a check-up before
having sex. Your partner may need treatment.
This operation is a minor one. Complications are very rare. There is sometimes some
small bleeding after two weeks or so. This will settle down. If the warts come back,
your partner needs to get advice.
338
General Advice
Warts in themselves are easily dealt with. You need to be cleared of other infections
and have advice if you get the warts again. These notes should help you through
Varicose Ulcer Treatment
What is it?
A skin ulcer simply means a loss of a patch of skin. There are many causes for this.
In your case, the cause comes from the veins just under the ulcer. Your veins are a
little bigger than normal. These are called varicose veins because they look a bit like
a wine bottle from ancient Greece (varix). A varicose vein is a superficial (close to
the surface) vein lying under the skin. It has swollen because of overspill of blood
from veins running deep in the muscles of the legs. This happens because certain
valves that allow the blood to flow from the superficial to the deep veins of the leg
and not the other way around are not working any more. The problems with your
varicose veins are not their size, but the high pressure and sluggish flow of blood
inside them. These cause aching, cramping, itching, staining of the skin, eczema and
finally ulcers. The ulcers are often very painful. They can bleed and get infected. In
the long term they can range from a minor handicap to possible serious illness. Most
varicose ulcers will heal. The key to the treatment is to put continuous pressure on
the underlying veins. One of the best ways of doing this is to squeeze the veins with
bandaging. The latest way of bandaging is to use four different types of bandage all
at the same time. This is what you may have. The pressure dressing is far more
important than any ointments, powders, granules, or dressings on the skin.
Sometimes the blood supply is not good to the leg. The skin is starved of blood as
well as being damaged by the pressure. The doctors may need to do special tests
and suggest other treatment for this.
You will not need to have any anesthetic. The aim is to get your ulcers healed. This
means you wear a bandage on your leg for as long as it takes. Most people heal up
inside 16 weeks. You need to have the bandages changed each week. Your ulcers are
measured to make sure they are healing up. Once the ulcers have healed, the aim is
to keep them that way. This might mean injection treatment, or an operation for
some people. For others, some type of support stocking may always be needed.
When you see the surgeon, he will check you have straightforward varicose ulcers
and nothing else. He will also look into any other surgical problems you may have.
339
The Operation
Prior to the operation you will need a period of bed rest and elevation of the legs to
reduce the swelling (oedema) of the legs. At the same time you will be given
antibiotics to reduce the inflammation (cellulitis) of the skin around the ulcers.
The first step of the operation is for the ulcers to be measured. A probe test may be
done to check the circulation. A specimen of the discharge is taken for the laboratory
to examine for the presence of any bugs in the ulcers. This will guide the antibiotic
treatment that you will need in the future. The ulcers are cleaned. A non-stick
dressing is put on the ulcer. Four layers of special bandages are wrapped round your
leg from the knee down to the base of your toes. The doctors arrange to see you
again each week. You may need to take antibiotics when they have a report from the
laboratory.
Any Alternatives
There are dozens of dressings, powders, sprays, etc. on the market, but none of
them do much good. You can get the ulcer to heal by getting rid of the excess
pressure in the veins simply by going to bed with your feet up. This takes about
three weeks. It may be best to do this in hospital. Skin grafting on its own is not
very effective.

All your old dressings are taken off. You are given a general check over.
After - In Hospital
There may be some discomfort. Painkillers such as paracetamol should be all you
need to control the pain. If the painkillers are not strong enough, contact the
dressing clinic or your own doctor.
340
After - At Home
The bandages need to stay on day and night until the ulcers have healed. That is
until the skin has grown over again. Three out of four ulcers will have healed within
12 weeks or so. Most of the others will have healed within a further six weeks. It is
very rare for an ulcer not to heal. Sometimes other treatment, such as a stay in
hospital is needed. Do not get the bandages wet or they will become rather smelly
and unpleasant. Wash the rest of yourself with ordinary water and soap. You can
cover the bandages with polythene bags to keep them dry. Just eat your normal diet.
Eat less if you are overweight. Take your usual medications. If you can sleep with
the foot of your bed raised 6 inches (15cm.), this will be helpful. The bandages will
make ankle movements a little stiff. Check that you can use the foot pedals easily
before you drive. You can restart sexual relations within a day or so, when the
bandage is comfortable enough. You should be able to do a light job straight away. It
is sensible so avoid a dirty or a wet occupation. Walk as much as you can. Three
miles a day is an ideal distance. Do not stand without moving for more than 10
minutes at a time. It is better for you to sit down with your foot up on a stool if you
are not walking.
Minor problems include:
• the bandage is too tight
• the bandage is too loose
• discharge coming through the bandage.
This can be easily solved by removing the bandage, cleaning the ulcer and putting on
new bandages and applying “just the right” pressure.
More severe problems include:
• severe pain
• fever (signs of infection)
• bleeding.
If the infection is very localized, it can usually be settled by taking antibiotics for a
couple of weeks. Spreading of the infection into the tissues lying deep under the
ulcer or into your bloodstream is a serious condition. It will require you to stay in the
hospital and take antibiotics given into one of your veins and possibly an operation to
clean the infected tissues.
Bleeding is very rarely a serious problem. Most of the time it consists of some oozing
under the bandages and can usually stopped by applying some extra pressure. Very
rarely it will require another operation to stop it.
In order to prevent the recurrence of a healed ulcer you will need to wear supportive
stockings in the long run. If you are compliant with this treatment the chance of the
ulcer coming back is about 16%. If you are not, it can be much higher.
General Advice
You will need to be patient, but the ulcers will nearly always heal in time. These
notes will help you through your procedure. They are a general guide. They do not
341
Varicose Vein Removal
What is it?
A varicose vein is a superficial (close to the surface) vein lying under the skin.. It has
swollen because of overspill of blood from veins running deep in the muscles of the
legs. This happens because certain valves that allow the blood to flow from the
superficial to the deep veins of the leg and not the other way around are not working
any more. Varicose veins may cause no symptoms. However, most patients
experience problems such as itching, aching and a feeling of heaviness in the legs.
Less frequently, varicose veins can cause bruising and swelling and can get clotted.
Rarely they can also be the cause of leg ulcers.
342
The Operation
Usually, the main feeder vein to the varicose veins is tied off through two small cuts
- one at the groin and one below the knee - and is then removed. There are many
ways of doing the operation and you can ask your surgeon for details of his method.
The most frequently used method is the passing of a special wire through the cut in
the groin into the vein followed by stripping of the vein. Sometimes another feeder
vein behind the knee has to be tied off as well using a similar procedure as for the
main feeder vein. Following that, smaller varicose veins are removed through tiny
cuts dotted down the leg. Your operation will either be a day case, where you come
into hospital on the day of the operation and go home the same day, or a non-day
case, where you are in hospital for one or two nights. A general anesthetic is given
so that you will be asleep during the operation. Local anesthetic may be injected into
the groin as well as into the other smaller cuts on your skin to make them pain free
when you wake up.
Any Alternatives
If you leave things as they are, there is no harm done in the short term. Over 5 or
10 years or more, you will probably notice the veins getting worse. This is usually
associated with worsening of the symptoms and you will experience more pain,
bruising and swelling. Injection treatment works on its own, if the veins are only
seen below the knee and they are relatively small Injections are also useful to
control small veins that are still there after an operation. Elastic stockings are helpful
if you are not keen on an operation. They can help determine if your pains are due to
varicose veins. Laser treatment, ointments, and drug treatment are not helpful for
your type of veins. Camouflage make-up is helpful to cover up small flare veins.

look after you for the first week after the operation. Bring all your tablets and
medicines with you to hospital. On the ward, you will be checked for past illnesses
and will have special tests to prepare you so that you can have the operation as
safely as possible. Many hospitals now run special preadmission clinics, where you
visit for an hour or two, a few weeks or so before the operation for these checks.
After - In Hospital
There will be some slight discomfort on moving. Painkilling tablets should easily
control this discomfort. If not, you can have painkilling injections. By the end of one
week the wound should be just about pain-free. A general anesthetic will make you
slow, clumsy and forgetful for about 24 hours. Do not make important decisions
during this time. The nurses will help you with everything you need until you can do
things for yourself. There will be a dressing on the groin wound which may be
changed after 24 hours for a day case or 48 hours for a non-day case. An elastic
sleeve bandage is always used. You will need to wear it for about 10 days. Under the
elastic sleeve, the wounds may be covered with tiny paper strip dressings. Take off
all dressings and bandages 10 days after the operation. If the elastic sleeve becomes
slack or too tight let the nurses know. Sometimes there are stitches under the skin
which melt away, so that the wound does not need any more attention. You can
wash, bathe, or shower as soon as the stitches, clips or paper strips are taken off.
Soap and tap water are quite alright to use. Salted water is not needed. Some
343
hospitals arrange a check-up about one month after you leave hospital. Others leave
check-ups to the general practitioner. The nurses will advise about sick notes,
certificates etc.
After - At Home
At first discomfort in the wound will prevent you from harming yourself. You can
i.e. after about 10 days. You may restart sexual relations within a week or two, when
the wound is comfortable enough. You should be able to return to a light job after
about two weeks, and any heavy job within four weeks. The wounds take a month or
more to heal and soften up. Sometimes injections are given for minor veins that are
still present.
Minor complications after an operation for varicose veins occur in about 17% of
cases. They include:
• minor bleeding from one of the wounds which almost always stops by applying
some extra pressure on the wound or more frequently bruising and swelling. Bruising
and swelling may be troublesome, particularly if the veins were large. They may take
four to six weeks to settle down completely.
• minor infection of one or more of the wounds or of a bruised area of the skin that
settles down with antibiotics in a week or two.
• occasionally there are numb patches in the skin around the wounds which get
better after two to three months. This is due to the cut of very small nerves of the
skin around the wounds.
The chances of serious complications are very small (less than 1%). This includes the
formation of a blood clot in one of the deep veins of the leg that can potentially push
a life-threatening embolus (part of a clot) to your lungs or cause damage to one of
the big arteries, veins or nerves of the leg. All necessary precautions will be taken to
avoid such complications (i.e. helping you to be as mobile as possible after the
operation and giving you blood thinners to avoid the formation of clots in your leg)
and it is important to know that they very rarely happen in centres with good
experience in performing this operation.
Finally, you have to keep in mind that approximately 1 in 10 patients may need more
treatment to the veins in the 10 years after the operation.
General Advice
back to their normal duties within one month. If you have both legs operated on, the
recovery is a little slower. These notes should help you through your operation. They
344
Vasectomy
What is it?
The vas is the name of the tube that carries the sperm from each testicle, up into the
groin and then deep inside the body to the base of the penis. A vasectomy means
that a piece of the vas on each side is taken out just above each testicle and the
ends are tied off. The sperm cannot pass into the penis, so you will no longer be
fertile. However, you will still make fluid at intercourse.
The Operation
The skin of the scrotum will be numbed with an injection of local anesthetic just as a
dentist numbs a tooth. A 1cm (1/2 inch) cut is made in the front of the scrotum.
There may be stitches to close the wound. You can expect to feel some pushing and
pulling, but it is less uncomfortable than having a tooth filled. The operation takes
about 20 minutes. You do not need to shave or starve beforehand and you can drive
home straight away afterwards. You should wear Y-front or slip underpants, but not
boxer shorts. Alternatively, you can have a general anesthetic in which case you
would be asleep during the operation. You would need to starve beforehand, but you
would be able to go home the same day. You would not be fit to drive, use
machinery or make big decisions for 24 hours. Sometimes a cut is made on each
side of the scrotum. Once the vas tubing has cleared itself of sperm (which may take
several weeks), the operation is very reliable.
However, in spite of all surgical efforts, pregnancies do occur in about 1 in 2000

vasectomy cases. This is a very low chance and is lower than the chance of
345
pregnancy when the contraceptive pill is used, lower than the 1 in 500 chance of
pregnancy after female sterilization, and much lower than when the sheath, coil or
diaphragm are used. The operation can be reversed by re-joining the cut ends but
the rate of success in producing further pregnancies is only about 1 in 3. It is best to
have a vasectomy on the understanding that it is not reversible.
YOU NEED TO DECIDE THAT COME WHAT MAY YOU DO NOT WANT MORE CHILDREN.
Bear in mind that 1 in 3 marriages break up nowadays. Do not make a hasty
decision about vasectomy, it is basically permanent.
Any Alternatives
Most of the other methods of contraception are not permanent, form example the
condom, coil, the Pill and the long-term female injection treatment. Less proven
ways include the morning after contraceptive pill and the contraceptive pill for men.
Clipping the tubes in the female is worth thinking about. It is not as reliable as a
vasectomy and needs a general anesthetic. Removal of the womb in the female is
clearly a permanent solution. You should only think about this if your partner has, for
instance, fibroids and heavy/painful periods.
After - At Home
After a local anesthetic you will not have any discomfort for an hour or two, so that is
a good time to get home. Take painkillers such as aspirins or paracetamol, if you feel
discomfort coming on. It is not severe. Take things quietly for the rest of the day.
After a general anesthetic you will feel sleepy for two to four hours. The nurses will
help you with everything you need until you are able to do things for yourself.
Painkillers will control discomfort from the wound. On the next day you may feel
sore. You can take off the dressings and wash, bathe or shower but try to keep the
wound(s) dry for five to seven days. You will have spare dressings to cover the
wound. Use underpants to hold them on. On the third day you may notice black
bruising in the skin. This fades away in a day or two. After a week the wound settles
almost completely and the stitches will have dissolved out. The operation does not
interfere with the passing of urine. The urine will not sting or get bloody.
You need to have a sperm count done about 10 weeks after your operation to test
that the tubing is clear of sperm. Straight after your vasectomy you will probably be
given dated specimen pots and forms. On each appointed day you should produce a
specimen by masturbation, and take it to the hospital to be tested. If the tests are
not clear then the hospital will write to you with further pots and forms. When the
tests are finally clear the hospital will inform you. Only then should you stop using a
contraceptive. (These tests are sometimes arranged by your general practitioner).
You can work the next day, but you may find it more comfortable to take a day off
after the operation. It is sensible to avoid mild sports for three or four days and
contact sports for a week or so. You can start sex again as soon as the wound is
comfortable, usually after about a week. Remember, you are still fertile until the
sperm tests are clear. Continue to use a contraceptive until you get the go ahead
from the hospital or your general practitioner.
If you have this operation under general anesthetic there is a very small risk of
After a vasectomy, the testicles will still make sperm, but these sperm are melted
346
away by the body as quickly as they are made. The testicles do not swell or feel
heavier or tense afterwards.
The testicles still make sex hormones, so that you

• will still grow a beard
• have the same abilities at sex
• remain just as aggressive
• do not put on weight
• will not change your voice.
You will still make fluid at intercourse after a vasectomy because this fluid is made
further down the tubing than the tied off part of the vas. The operation appears free
from long-term side effects. There is always a swelling about the size of a marble on
each side, due to the internal stitches, and minor bleeding. This settles down in a
week or two. About 1 in 100 men notice bleeding which causes swelling bigger than
marble size or which comes through the dressings. This usually happens to patients
who do not follow the instructions for rest after the operation. If this happens (it will
be in the first 12 hours or so), get surgical help immediately. Sometimes the stitches
do not drop out in a week. If this happens they can be nipped out easily. Very rarely
there is some pain and discharge due to infection four or five days after the
operation. This responds to antibiotics. Even more rarely swellings appear four to six
weeks after the operation on each side where the internal stitches have been. These
can be removed if necessary. Minor twinges may be felt for several weeks. There is a
5% chance that you will develop sperm grannulomata (hard rounded tissue the size
of a small marble) on one or both sides. This happens on the side of the vas that is
still connected to the testis. It is basically sperm that can’t move forward, doesn’t
melt as quickly and gets accumulated and eventually gets converted into scarred
tissue. These are usually harmless and most of the time get softer and smaller.
There is small chance however, that they may become painful or infected and then
you will need another operation to remove them.
Very rarely, the vessels that provide the blood supply to the testis can be damaged
during the operation and this can result in necrosis (dying) of the testis which
requires another operation to remove it.
Also, very rarely, patients feel some chronic pain (mild to moderate and sometimes
severe) in or around the area of the operation. This is probably due to damage to the
small nerves in the area of the operation or chronic irritation of the nerves from the
scarred tissue in the area.
Finally, some patients experience sexual problems after the operation. It is almost
certain that the operation is not the cause of such problems. The cause is either
psychological (feeling of “disability” after the operation) or more frequently they are
problems that existed before the operation and for psychological reasons become
more prominent after the experience or “trauma” of the operation.
General Advice
Your main decision is that you do not want to have any more children. After that, the
operation is basically straightforward. We hope these notes will help you through
347
Vasectomy Reversal
What is it?
When you had your vasectomy operation, a piece of the tube (vas) running up from
each testicle was taken out. Ever since that time, your testicles have been making
sperms, but your body has been melting the sperm away because they cannot pass
along the vases. If the cut ends of the vas on each side can be joined up again, the
sperm will pass along the vas once more and you may become fertile again. The
chance of fathering more children is about 1 in 3. This depends on the size of the
gap between the cut ends, the method of stitching the ends, and earlier infection or
scarring. Even though the sperm tests after operation may be alright, this does not
always mean that a pregnancy is a certainty. This is because the sperms may not be
as strong as they used to be before the vasectomy.
The Operation
You will usually have a general anesthetic, and will be asleep for the whole
operation. A cut is made into each side of the scrotum. The vas on each side is
found. The cut ends are trimmed and freshened and stitched together using plastic
stitches that are finer than hair. The cuts in the skin are then closed up. After two to
three hours on the ward, you should feel fit enough to go home.
Any Alternatives
There are no real alternatives. Drawing sperm from inside the testicle and using it to
fertilize the female egg is worth thinking about if the vasectomy reversal fails.

your family doctor to check that these are under control. Check you have a relative
or friend who can come with you to hospital, take you home, and look after you for
are using. Keep them in their original boxes and packets. Bring them to hospital with
you.
checks.
After - In Hospital
Although you will be conscious soon after the operation ends, you are unlikely to
remember anything until you are back in your bed on the ward. Some patients feel a
bit sick for a few hours after the operation, but this passes off. You will be given
some treatment for sickness if necessary. You may be given oxygen from a face
mask for a few hours if you have had chest problems in the past. You will have a
dressing on the scrotum held on with elastic net pants. A general anesthetic will
time. There is some discomfort on moving rather than severe pain. You will be given
348
painkilling tablets to control this as required. Ask for more if the pain is not well
controlled or if it gets worse.
After - At Home
Make sure you are going home by car with your relative or friend. Once home, go to
bed. Take painkiller tablets every six hours to control any pain. The next morning
you should be able to get out of bed quite easily despite some discomfort. You will
not do the wound any harm. The exercise is good for you. The second day after the
operation, you should be able to spend most of your time out of bed in reasonable
comfort. You should be able to walk 50 yards slowly. By the end of a week the
wound should be nearly pain-free. It is important that you pass urine and empty
your bladder within 6 to 12 hours of the operation. If you are experiencing difficulty
in doing that, phone the hospital or your GP. Replace the dressing 24 hours after the
operation. Hold it in place with Y-front or jockey underpants. Keep the wound
dressed like this for a week. You can wash and bathe as often as you like but try to
keep the wounds dry for five to seven days. Use ordinary water and soap. Salt water
is not needed.
After you leave hospital you may feel tired for a day or two after the operation but
you will quickly get back to normal activities and exercise within a week. You can
i.e. after about seven days. You should be able to return to a light job after about
one week, and any heavy job within four weeks. You can restart sexual relations
within two or three weeks when the wound is comfortable enough, and remember
you may be fertile straight away. The hospital will arrange sperm tests two months
or so after your operation when you will be seen again. It is best to take
contraceptive precautions from the time of the operation. At first, discomfort in the
wound will prevent you from harming yourself by lifting things that are too heavy.
After two weeks you should be able to lift as much as you used to lift before the
operation.. There is no value in trying to speed the recovery of the wound by special
exercises before the month is out.
phone the hospital or your GP. Bruising and swelling may be troublesome. Swelling
may take four to six weeks to settle down. Infection is a rare problem and settles
down with antibiotics in a week or two. Sometimes the stitches do not drop out in a
week. Contact the hospital or your GP to have them removed. Aches and twinges
may be felt in the wound for up to six months. In the first 24 hours, bleeding from
the wound is the most important thing to look out for. A little blood staining on the
dressing is normal. If bleeding comes through onto your underpants, phone the
hospital. The same applies to any swelling under the skin bigger than 1 inch
(2.5cm.). The bleeding is extremely rarely life-threatening, but if left untreated it can
result in a big painful hematoma (blood clot) which can also get infected and might
require another operation to fix the problem. Bleeding becomes a real problem
mainly for patients who don’t follow the instructions for rest after the operation. . In
the first week, if the wounds get painful, reddened, and swollen, there may be some
infection, contact your GP.
349
Very rarely, the vessels that provide the blood supply to the testis can be damaged
during the operation and this can result in necrosis (dying) of the testis which
requires another operation to remove it.
Also very rarely patients feel some chronic pain (mild to moderate and sometimes
severe) in the area of the operation. This is probably due to damage of the small
nerves at the area of the operation or chronic irritation of the nerves from the
scarred tissue in the area.
Finally, some patients experience sexual problems after the operation. It is almost
certain that the operation is not the cause of such problems. The cause is either
psychological (feeling that after the operation things have to go well and result in a
pregnancy soon) or more frequently they are problems that existed before the
operation and for psychological reasons become more prominent after the
experience/“trauma” of the operation.
General Advice
The operation is relatively a small one. The sperm test will give a guide to the
outcome, but the true test will be whether you father a child. These notes will help
Vulval Lesion Excision
What is it?
The skin on part of the opening of your vagina - the vulva is causing a problem.
There is a swelling or a raw patch which may be bleeding or itching. To find out what
the cause is, you need to have some or all of the problem area taken away. The
piece of tissue will be looked at under the microscope to give an answer. Often that
is all that needs to be done. Sometimes more treatment is needed.
350
The Operation
You will have a general anesthetic, and be completely asleep during the operation.
Alternatively, the operation can be done under local anesthetic (by numbing the area
with a local anesthetic injection like when you go to the dentist). Although a few
centres do this operation successfully under local anesthetic, many carry out the
procedure under general anesthetic because this is a very sensitive area and you can
sometimes feel rather uncomfortable during the procedure. A small cut is made
around the area or around a part of it. The piece is taken away for examination. The
cut is closed up with a few stitches. The stitches melt away after a few days and do
not need to be taken out. The operation takes about 20 minutes. You should be able
to come into hospital on the day of the operation and go home the same day.
Any Alternatives
If you leave things as they are, the problem is unlikely to go away. It may get larger
and be more difficult to treat. Lasers and X-rays will not be helpful before the tissue
has been looked at under the microscope. Your best way forward is to have this little
operation.

and may have special tests, to make sure that you are well prepared and you can
have the operation as safely as possible. . Many hospitals now run special
After - In Hospital
You will have a sanitary pad in place. The vulva will feel tender for a week or more
afterwards. Take painkillers to ease the pain. Take baths three times a day to keep
the vulva clean and to help healing. There may be slight bleeding from the vulva or
vagina for the first three or four days. Only use external pads for this. You need to
pass urine before you leave the ward. If you have any difficulty, tell the nurses. You
can wash the wound area as soon as you wish. Soap and tap water are entirely
adequate. Salted water is not necessary. You can bathe or shower as often as you
wish. You will be able to drink within an hour or two of the operation as long as you
are not feeling sick. The next day you should be able to manage small helpings of
normal food. You should plan to leave hospital the day of your operation. A District
Nurse may call on you at home as required. You will be able to stay in hospital
longer, if you are not ready to go home the same day. You will be given an
appointment to come to the clinic for a check up and for the results of the test about
six weeks after the operation. The nurses will advise about sick notes, certificates
etc. You should be able to return to a light job after about one week, and any heavy
job within two weeks.
After - At Home
Go to bed and rest for a few hours. Wait until you have had a check-up at the clinic
before having sex.
351
This operation is a minor one. Complications are very rare. There is sometimes some
bleeding after two weeks or so. This will settle down. There is also a very small
chance of a minor infection of your wound which can be settled by taking antibiotics
for a few days.
General Advice
This is a minor operation and may well be all you need. Some people go on to have
further treatment. Others may need to have further check ups from time to time.
Wisdom Teeth Removal
What is it?
Wisdom teeth are the last molar teeth to develop which usually grow at the very
back of the upper and lower jaw bones, one at each back 'corner' of the mouth. They
usually appear when people are aged 18 to 21 years old, and they are called wisdom
teeth because by that age people become 'more mature and wise'. Wisdom teeth can
be as good and useful as any other teeth provided that, as they develop, they can
penetrate the gums and emerge or erupt into the mouth completely and properly.
Unfortunately, this is not always the case. Frequently wisdom teeth erupt only partly
or they don’t erupt at all. They are then called impacted wisdom teeth and they are
usually a cause of many problems that makes it necessary for them to be removed.
The wisdom teeth usually need to be
removed because of one or more of the following:

• severe pain and swelling caused by the wisdom teeth themselves
• recurrent infection of the gum around the tooth
• serious decay of the wisdom teeth which cannot be repaired
• helping to reduce crowding of other teeth before straightening with a 'brace'
(orthodontic appliance).
Very rarely, the tissues around the wisdom teeth can develop cysts or tumors and
this can be one more reason for removing them.
352
The Operation
In some cases a wisdom tooth can be removed under local anesthetic. In this
situation, the area around the tooth is made numb with an injection of local
anesthetic. Sometimes the local anesthetic is combined with sedation to help you
relax and allow you to go through the operation. Having sedation means that you will
be conscious during the operation, but will not be aware of what is going on.
Finally, the operation can also be done under general anesthetic. Having a general
anesthetic means that you will be completely asleep during the operation and you
will not feel any pain. The choice of anesthetic depends partly on which you prefer,
and partly on what your surgeon thinks is best. It is generally better to have local
anesthetic and sedation or a general anesthetic if it is anticipated that the operation
will be difficult; for example when a wisdom tooth hasn’t erupted at all and lies deep
in your gum.
Your wisdom teeth will be removed from inside the mouth. The gum may need to be
cut slightly at the back of the mouth and a small amount of bone removed to loosen
the wisdom tooth. The tooth may need to be cut into one or more pieces to help its
removal. The gum will be stitched after the tooth is removed, often with a type of
stitch that is designed to dissolve. Most patients are allowed to go home in the early
evening after the operation. If you have had local anesthesia with or without
sedation you will normally go home about three to four hours after your operation.

After - In Hospital
Your mouth will feel bruised and swollen, the jaw will be slightly stiff and usually
there is some mild to moderate discomfort. Your cheeks will usually swell a little with
slight bruising of the skin. You will be given painkillers to help with any discomfort.
The swelling, bruising and stiffness of the jaw will disappear over a week to 10 days.
The same can happen with sedation but to a lesser degree. The nurses will help you
time. You will be able to drink two to three hours after the operation but eating may
not be possible for a few hours. It may be hard to chew normally for a while so you
should eat a softer diet and initially avoid very 'spicy' or 'vinegary' foods. A little
extra daily fibre in the form of porridge or 'Ready Brek' often helps to prevent
constipation whilst your diet is temporarily altered. The stitches which may have
been put in usually dissolve, but you are normally asked to attend for a short
353
outpatient visit to check healing about two weeks after your operation. The stitches
may be removed if required. An after surgery –X-ray may be taken at that visit.
Occasionally further visits may be arranged to monitor your progress. Some
hospitals arrange a check-up about one month after you leave hospital. Others leave
check-ups to the general practitioner. You will be given a 'summary discharge letter'
for your doctor or dentist to let him or her know what has been done for you in
hospital. The nurses will advise about sick notes, certificates etc.
After - At Home
You will be given a small 'take home drug pack' containing an antiseptic mouthwash,
some painkillers and some antibiotics. It is important to keep your mouth cleaner
than normal to prevent infection of your wounds. A warm salt water mouth bath,
three times a day (a pinch of salt to half a pint of warm water), used for one minute
each side of the mouth after tooth-brushing often helps soothe the mouth. The
antiseptic mouthwash given to you should also be used after the salt water for one
minute. You should finish the full course of antibiotics but only take painkillers as
directed. Antibiotics can affect function of the contraceptive pill and alternative
precautions are advisable whilst taking the antibiotics and for about a week after
finishing the antibiotics.
It is generally recommended that you have the operation for wisdom teeth removal
sooner rather than later because as you get older the chance of complications after
this operation increases.
Bleeding after the operation occurs rarely and usually stops when the surgeon
applies some pressure with a sponge on the area of the operation. Extremely rarely
you will need another operation to stop the bleeding.
If you experience increasing pain at the area of the operation, you feel that it is
getting more swollen and you have a temperature, it most probably means that the
antibiotics that you were given to prevent an infection were not adequate and that
the area of the operation has become infected. This happens relatively rarely and
taking antibiotics (most likely different to the ones you were given to prevent the
infection) for another week or two usually solves the problem. In a very small
number of patients the infection can be very and lead to a collection of infected fluid
or pus (abscess) at the area of the operation. In this situation you will need another
operation to drain the infected fluid or pus.
The lower wisdom teeth are usually very close to a nerve which supplies the tongue
and lip for touch sensation. There is a separate nerve like this on each side. The
nerve(s) may be affected by bruising and swelling around the wound(s). This may
cause some numbness of the lower lip and tongue on one or both sides. It happens
in 1 to 3% of patients who are up to 21 years old but in about 10% of patients who
are over 35 years old. Normal feeling usually returns but in some very rare instances
permanent numbness may persist.
In 5 to 10% of cases you can have experience a problem called a “dry socket”. This
happens because following the removal of the wisdom tooth a clot was not formed in
354
the area or socket where the tooth used to be or it did form but was then dislodged.
This can be painful, and often causes foul bad breath and it is something you usually
experience four to five days after the operation. The socket needs to be packed with
some medicated gauze for a few days to relief the symptoms until the healing
process progresses and starts to fill the socket. The gauze needs to be changed
every other day and most patients don’t need more than two to three changes until
they feel much better and packing of the socket is no longer required. It is believed
that patients who smoke or women who use contraceptive pills experience this
problem more frequently. Although a “dry socket” can be very annoying, with proper
care it settles completely, relatively quickly.
If you have any problems relating to your surgery whilst at home and are not sure
what to do, ring your hospital and ask to speak to the senior nurse responsible for
oral surgery. You may feel quite tired for one to two weeks after your operation.
General Advice
You will be aware of the 'hole(s)' left after removal of your teeth for several weeks,
but the bone and gum will reshape and after six months it will be hard to tell you
have had surgery there. These notes should help you through your operation. They
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Abdomino-Perineal Resection of Rectum

Diagram © Copyright EMIS and PIP 2005

Before the operation

If the problem is related to simple accumulation of fat in limited areas, liposuction

After the Operation

Abscess - Intra Abdominal

Before the operation

Before the operation

Before the operation

Before the operation

Before the operation

Amputation - Above Knee

Another possible complication after this operation is the development of pressure

Amputation - Below Knee

Before the operation

Another possible complication after this operation is the development of pressure

Before the operation

Before the operation

Before the operation

Ankle Fusion Operation - Arthodesis

Before the operation

Before the operation

Most vaginal repairs are without complications. Minor complications occur in 3 to 4%

Before the operation

Before the operation

Apicetomy - Tooth Root Operation

Before the operation

Diagram © Copyright EMIS and PIP 2005

Before the operation

Before the operation

Diagram © Copyright EMIS and PIP 2005

Before the operation

Bladder Outlet Incision

Diagram © Copyright EMIS and PIP 2005

Before the operation

Breast - Wide Excision and Axillary Sample

© Copyright EMIS and PIP 2005

Before the operation

Before the Operation

© Copyright EMIS and PIP 2005

Before the Operation

Broken Ankle - Open Reduction and Fixation

Before the operation

Before the operation

Before the operation

Before the operation

Carpal Tunnel Decompression

© Copyright EMIS and PIP 2005

Before the operation

Cataract Lens Replacement

Before the operation

Cholecystectomy - Gall Bladder Removal

Before the operation

Before the operation

Colectomy - Total - and Ileostomy

Diagram © Copyright EMIS and PIP 2005

Before the operation

Diagram © Copyright EMIS and PIP 2005

Before the operation

Diagram © Copyright EMIS and PIP 2005

Before the operation

Before the operation

Colostomy Closure - Colorectal Anastomosis

Before the operation