TOPIC 6. SURGICAL OPERATIONS
1. Definition
A surgical operation is a planned or emergency invasive procedure performed to diagnose, treat, palliate or prevent disease, injury or deformity. It may involve incision, excision, reconstruction, drainage, repair, transplantation or endoscopic intervention.
2. Classification
3. Preoperative assessment
- Confirm diagnosis, indication, urgency, expected benefit, alternatives and whether non-operative management is appropriate.
- Take history: comorbidities, previous operations/anaesthetic problems, medications (including anticoagulants/antiplatelets), allergies, smoking, alcohol, functional capacity and bleeding history.
- Examine the patient and assess airway, cardiopulmonary status, hydration, nutritional state and relevant surgical site.
- Order investigations according to clinical need and operation: blood count, renal function, coagulation tests, ECG, imaging, pregnancy test or group-and-screen/crossmatch when indicated.
- Optimise comorbidities, correct fluid/electrolyte disturbances, plan anticoagulation and thromboprophylaxis, and assess infection risk.
- Explain procedure, risks, benefits, alternatives, expected recovery and possible complications; obtain valid informed consent.
- Confirm fasting and medication instructions according to anaesthesia guidance; avoid unnecessary prolonged fasting.
4. Intraoperative stages
Preparation and positioning: identity/site/procedure check, safe positioning, pressure-point protection, skin preparation, draping and equipment check.
Anaesthesia: appropriate technique, airway and physiological monitoring.
Access and exposure: incision or minimally invasive access, careful dissection and protection of adjacent structures.
Definitive procedure: repair, removal, reconstruction, drainage or other intended intervention.
Haemostasis: control bleeding with pressure, ligation, clips, energy devices or other appropriate methods.
Closure: close tissues in appropriate layers, manage dead space and decide whether a drain is needed.
Documentation and handover: record findings, procedure, specimens, implants, blood loss, complications and postoperative instructions.
5. Postoperative care and complications
- Monitor airway, breathing, circulation, consciousness, pain, temperature, wound, drains, urine output and fluid balance.
- Provide multimodal analgesia, antiemetic therapy when needed, nutrition, early mobilisation and respiratory physiotherapy.
- Prevent venous thromboembolism using risk-based mechanical and/or pharmacological prophylaxis.
- Watch for haemorrhage, infection, wound dehiscence, anastomotic leak, ileus, urinary retention, respiratory complications, delirium and organ dysfunction.
- Escalate promptly for hypotension, tachycardia, hypoxia, oliguria, increasing pain, fever, altered mental state or suspected bleeding/sepsis.
Exam framework: Preoperative assessment → consent and preparation → anaesthesia and operation → recovery and monitoring → complication prevention and follow-up.