- Decision Making in SurgeryDhiraj Choudhury
- Preparations for OperationDhiraj Choudhury
- An Operation: Step-by-stepDhiraj Choudhury
- Methods of Hemostasis in SurgeryDhiraj Choudhury
- Sutures, Ligatures and Knots in SurgeryDhiraj Choudhury
- Role of Surgical DrainsDhiraj Choudhury
- Techniques of Achieving Skin CoverDhiraj Choudhury
- Principles of Minimal Access Surgery/Minimally Invasive SurgeryDhiraj Choudhury
- Principles of Day Case SurgeryDhiraj Choudhury
A successful operative strategy begins with decision making: how to operate; when to operate; when not to operate. The decision should be evidence-based supported by clinical diagnosis, investigations and previous experience. Patients are often referred to surgeon with a provisional diagnosis and results of investigations for operation. Sometimes a decision for further investigations or consideration of an alternative therapeutic option may lead to postponement of operation. It is important on the part of the surgeon to explain the nature of illness, decision to proceed with operation or postpone operation, the benefits of surgery and risk involved, to the patient.
Once surgery is decided, a number of considerations must be addressed.
TIMING
If surgery is the treatment of choice, the question is when to proceed? Elective operations are planned routine operations decided from outpatient department. For daycare surgery patients are prepared from clinics, e.g. operations for groin hernias, varicose veins, biopsy, excision of superficial lumps. For operations involving body cavities or patients having medical problems, they have to be admitted 2–3 days prior to surgery.
Emergency operations mean immediate surgery where resuscitation and operation are carried simultaneously. Very few patients seen in emergency require operation within minutes of admission. Penetrating wounds of heart and neck require emergency operation.
Urgent operations are undertaken as soon as possible after resuscitation, e.g. operation for perforated peptic ulcer and acute intestinal obstruction.
PROCEDURE
Procedures standardized to give best results in majority of circumstances, should be followed.
APPROACH
Once the procedure has been decided, the next important decision is selection of type of approach. In the present time, the choice lies between conventional open method or minimally invasive method. The decision should be based on training and experience of the surgeon, availability of facilities and choice of the patient.