Surgical procedures in which internal body structures are accessed by large incisions made in the skins
Most operations are carried out using open surgery. In this type of surgery, an incision is made in the skin large enough to allow the surgeon to see clearly the internal body parts that require treatment and the surrounding tissues. A large incision provides easy access, but it may leave an obvious scar.
Open surgery is used for all internal organ transplant operations and for caesarean sections. Open surgery may also be necessary for the removal of certain types of tumour or in cases in which the extent of the problem is not known. Sometimes, open surgery may need to be performed urgently in order to deal promptly with an emergency such as internal bleeding.
What happens during the operation?
There are a number of open surgery procedures, such as a caesarean section, that may be performed under regional anaesthesia (see Having a regional anaesthetic). However, most open surgery is carried out under general anaesthesia (see Having a general anaesthetic). Once you are fully anaesthetized, the surgeon makes an incision through the skin and the layers of fat and muscle below it. The skin and muscles may be held back by clamps, and organs and tissues that are not being operated on are pulled out of the way by retractors. When the area to be treated is clearly visible, the surgeon is able to carry out the procedure.
Blood vessels that have to be severed during surgery are sealed in order to prevent serious loss of blood. This is done using electrocautery, a process in which blood vessels are sealed by an electric current applied through a pen-like instrument, or by tying off the severed ends of the vessels with synthetic thread. Lasers are also sometimes used during open surgery to seal blood vessels (see Laser treatment).
The operation site is kept free of blood and other fluids to ensure that the surgeon can see clearly what he or she is doing. Sponges and suction tubes are positioned around the area to remove fluids. The number of sponges used is counted carefully and is checked after the operation to make sure that they have all been removed. The surgeon checks that there is no internal bleeding before he or she sews up the wound (see Rejoining tissue). The wound may be covered with a sterile dressing.
What are the risks?
All surgical procedures, whether major or minor, involve some risk. For example, there may be an adverse reaction to the anaesthetic, excessive bleeding, formation of blood clots, or infection.
A general anaesthetic can provoke changes in heart rhythm during or after surgery. The risk of this is higher if you are elderly, have a heart problem, or are overweight. In rare cases, an allergic reaction to the anaesthetic may occur.
Rarely, if blood vessels are not fully sealed, excessive bleeding may occur during the operation, or there may be persistent bleeding afterwards. In either case, a blood transfusion may be required. A supply of cross-matched (compatible) blood is made available for each person having major surgery.
After surgery, blood has an increased tendency to clot, which may lead to the formation of blood clots in the deep veins of the legs (see Deep vein thrombosis). These blood clots may cause pain and swelling in the leg, and they can sometimes travel to the lungs. If a blood clot becomes lodged in an artery that supplies a lung, it can cause chest pain and shortness of breath and may be life-threatening (see Pulmonary embolism). To reduce the risk of blood clots developing, you will be encouraged to move around as soon as you can after the operation. Treatment with drugs such as heparin (see Drugs that prevent blood clotting) may be given during and after surgery to thin the blood. Painkillers may also help to prevent the formation of blood clots by allowing you to move around more easily without pain.
Infection may occur if bacteria or other microorganisms enter a wound during or after surgery, preventing or delaying the healing process and causing tissue damage and fever. The risk of infection is minimized by performing the operation in a highly sterile environment with instruments that have been carefully sterilized. Antibiotics may be given before, during, or after surgery to help to prevent infection.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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