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General Surgery

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General Surgery

About general surgery:                                      

General surgery department perform surgical procedures that involve diagnosis, preoperative, operative and post-operative management. The departments multidisciplinary approach, sophisticated monitoring system and state-of-art facilities and technologies allow our surgeons in Dubai to provide patients with quality care and improved recovery.

General surgery department provide the following services:

Circumcision:

 

Why it’s done?

Circumcision might have various health benefits, including:

  • Easier hygiene. Circumcision makes it simpler to wash the penis. However, boys with uncircumcised penises can be taught to wash regularly beneath the foreskin.
  • Decreased risk of urinary tract infections. The risk of urinary tract infections in males is low, but these infections are more common in uncircumcised males. Severe infections early in life can lead to kidney problems later.
  • Decreased risk of sexually transmitted infections. Circumcised men might have a lower risk of certain sexually transmitted infections, including HIV. Still, safe sexual practices remain essential.
  • Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis can be difficult or impossible to retract (phimosis). This can lead to inflammation of the foreskin or head of the penis.
  • Decreased risk of penile cancer. Although cancer of the penis is rare, it’s less common in circumcised men. In addition, cervical cancer is less common in the female sexual partners of circumcised men.

The risks of not being circumcised, however, are not only rare, but avoidable with proper care of the penis.

 

About the procedure

It can be at any age starting from day 1(since birth ), the procedure is taking 2 minutes under local anesthesia.

-Painless procedures.

 

After the procedure:

From day two after circumcision the baby can take a shower with shampoo.

Sebaceous cyst

What is a sebaceous cyst?

A cyst usually is a slow-growing lump that can move easily under the skin. The term “sebaceous cyst” refers to either an epidermis cyst, which originates from the skin, or a pillar cyst, which comes from hair follicles.

These cysts are closed sacs that can be found under the skin of the entire body (except the palms of the hands and soles of the feet). A foul odor may be noticed from the overlying skin.

What causes sebaceous cysts?

Sebaceous cysts may be caused by blocked glands or swollen hair follicles in the skin. Trauma to skin has been reported, as well. Cysts sometimes are inherited.

What are the symptoms of sebaceous cysts?

The main symptom of a sebaceous cyst is a small lump under the skin. The lump is usually not painful. In some cases, however, cysts can get inflamed and become tender to the touch. The skin on the area of the cyst may be red and/or warm. Drainage from the cyst will appear grayish-white and cheese-like, and will have a foul smell.

 

Complications

Potential complications of epidermis cysts include:

  • Inflammation
  • Rupture.
  • Infectio.
  • Skin cancer:In very rare cases.

 

How are sebaceous cysts diagnosed?

Usually, a doctor can diagnose sebaceous cysts with a simple examination of the skin. In some cases, the doctor will perform a biopsy to rule out other skin growths.

How are sebaceous cysts treated?

In most cases, sebaceous cysts can be drained if inflamed or excised in most regular’s cases.

Epidermoid cysts

Epidermis (ep-ih-DUR-moid) cysts are noncancerous small bumps beneath the skin. They can appear anywhere on the skin, but are most common on the face, neck and trunk.

Epidermis cysts are slow growing and often painless, so they rarely cause problems or need treatment. You might choose to have a cyst removed by a doctor if its appearance bothers you or if it’s painful, ruptured or infected.

Symptoms:

Epidermis cyst signs and symptoms include:

  • A small, round bump under the skin, usually on the face, neck or trunk
  • A tiny blackhead plugging the central opening of the cyst
  • A thick, yellow, smelly material that sometimes drains from the cyst
  • Redness, swelling and tenderness in the area, if inflamed or infected

When to see a doctor?

Most epidermis cysts don’t cause problems or need treatment. See your doctor if you have one or more that:

  • Grows rapidly
  • Ruptures or becomes painful or infected
  • Occurs in a spot that’s constantly irritated
  • Bothers you for cosmetic reasons
  • Pain low back area
  • Is in an unusual location, such as a finger and toe

Causes

The surface of your skin (epidermis) is made up of a thin, protective layer of cells that your body continuously sheds. Most epidermis cysts form when these cells move deeper into your skin and multiply rather than slough off. Sometimes the cysts form due to irritation or injury of the skin or the most superficial portion of a hair follicle.

The epidermal cells form the walls of the cyst and then secrete the protein keratin into the interior. The keratin is the thick, yellow substance that sometimes drains from the cyst. This abnormal growth of cells may be due to a damaged hair follicle or oil gland in your skin.

Many people refer to epidermis cysts as sebaceous cysts, but they’re different. True sebaceous cysts are less common. They arise from the glands that secrete oily matter that lubricates hair and skin (sebaceous glands).

Complications

Potential complications of epidermis cysts include:

  • Inflammation
  • Rupture.
  • Infectio.
  • Skin cancer: In very rare cases.

Diagnosis:

Doctors can usually make a diagnosis by a simple examination or biopsy.

Treatment:

You can usually leave a cyst alone if it doesn’t cause discomfort or cosmetic problems. If you seek treatment, talk with your doctor about these options:

  • Incision and drainage.
  • Minor surgery to be totally excised

Lipoma

A lipoma is a slow-growing, fatty lump that’s most often situated between your skin and the underlying muscle layer. A lipoma, which feels doughy and usually isn’t tender, moves readily with slight finger pressure. Lipomas are usually detected in middle age. Some people have more than one lipoma.

A lipoma isn’t cancer and usually is harmless. Treatment generally isn’t necessary, but if the lipoma bothers you, is painful or is growing, you may want to have it removed.

Symptoms:

  • Lipomas can occur anywhere in the body. They are typically:
  • Situated just under the skin. They commonly occur in the neck, shoulders, back, abdomen, arms and thighs.
  • Soft and doughy to the touch. They also move easily with slight finger pressure.
  • Generally small. Lipomas are typically less than 2 inches (5 centimeters) in diameter, but they can grow.
  • Sometimes painful. Lipomas can be painful if they grow and press on nearby nerves or if they contain many blood vessels.

When to see a doctor?

A lipoma is rarely a serious medical condition. But if you notice a lump or swelling anywhere on your body, have it checked by your doctor.

Causes

The cause of lipomas isn’t fully understood. They tend to run in families, so genetic factors likely play a role in their development.

Diagnosis

To diagnose a lipoma, your doctor  may perform:

A physical exam

An X-ray or other imaging test, such as an MRI or CT scan, if the lipoma is large, has unusual features or appears to be deeper than the fatty

There’s a very small chance that a lump resembling a lipoma may actually be a form of cancer called liposarcoma. Liposarcomas — cancerous tumors in fatty tissues — grow rapidly, don’t move under the skin and are usually painful. A biopsy or an MRI or CT scan is typically done if your doctor suspects liposarcoma.

Treatment:

No treatment is usually necessary for a lipoma. However, if the lipoma bothers you, is painful or is growing, your doctor might recommend that it be removed. Lipoma treatments include:

Surgical removal. Most lipomas are removed surgically by cutting them out. Recurrences after removal are uncommon.

Liposuction. This treatment uses a needle and a large syringe to remove the fatty lump.

 

Ingrown toenails

What are ingrown toenails?

An ingrown toenail occurs when the top corner or side of your toenail grows into the flesh next to it. It happens most commonly on your big toe.

Common causes of ingrown toenails include:

wearing shoes that are too tight around your toe

cutting your toenails too short or with too much of a curve

toe or toenail injury

Toenail naturally grows into a curve

if you have complications, such as a skin infection, or if you get a lot of ingrown toenails, surgery may help. People with diabetes or other conditions that affect the foot may be more likely to need surgery.

What is ingrown toenail surgery?

Your doctor may recommend ingrown toenail surgery if:

At-home remedies don’t resolve your ingrown toenail

You have recurring ingrown toenails

You have another condition such as diabetes that makes complications more likely

Part of your toenail or the full toenail may need to be removed, depending on your situation.

To prepare you for surgery, your doctor will first clean and numb your toe with an anesthetic injection. A snug elastic band may be applied to the area near where your toe joins your foot.

Symptoms of ingrown toenails:

  • Common symptoms of ingrown toenails include:
  • Pain around your toenail edges
  • Buildup of fluid and thickening in the skin around your toenail
  • Redness and swelling around your toenail
  • Infection with draining pus around the toenail

 

 

Treatment of Anal Fissure

An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter).

Anal fissures are very common in young infants but can affect people of any age. An anal fissure usually heals on its own within four to six weeks.

Symptoms:

  • Signs and symptoms of an anal fissure include:
  • Pain, sometimes severe, during bowel movements
  • Pain after bowel movements that can last up to several hours
  • Bright red blood on the stool or toilet paper after a bowel movement
  • Itching or irritation around the anus
  • A visible crack in the skin around the anus
  • A small lump or skin tag on the skin near the anal fissure

When to see a doctor?
See your doctor if you have pain during bowel movements or notice blood on stools or toilet paper after a bowel movement.

Causes

  • Common causes of anal fissure include:
  • Passing large or hard stools
  • Constipation and straining during bowel movements
  • Chronic diarrhea
  • Inflammation of the anorectic area, caused by Crohn’s disease or another inflammatory bowel disease
  • Childbirth

Less common causes of anal fissures include:

  • Anal cancer
  • HIV
  • Tuberculosis
  • Syphilis
  • Herpes

Risk factors

Factors that may increase your risk of developing an anal fissure include:

Infancy – Many infants experience an anal fissure during their first year of life; experts aren’t sure why.

Aging – Older adults may develop an anal fissure partly due to slowed circulation, resulting in decreased blood flow to the rectal area.

Constipation – Straining during bowel movements and passing hard stools increase the risk of tearing.

Childbirth –Anal fissures are more common in women after they give birth.

Crohn’s disease –This inflammatory bowel disease causes chronic inflammation of the intestinal tract, which may make the lining of the anal canal more vulnerable to

Tests and diagnosis

Your doctor will likely ask about your medical history and perform a physical exam, including inspection of the anal region. Often the tear is visible. Usually this exam is all that’s needed to diagnose an anal fissure.

The fissure’s location offers clues about its cause. A fissure that occurs on the side of the anal opening, rather than the back or front, is more likely to be a sign of another disorder, such as Crohn’s disease. If an underlying condition is suspected, your doctor may recommend further testing:

Prevention

You may be able to prevent an anal fissure by taking measures to prevent constipation. Eat high-fiber foods, drink fluids and exercise regularly to keep from having to strain during bowel movements.

 

hemorrhoids

For some people, a healthy diet and lifestyle and over-the-counter medicines aren’t enough to treat

Hemorrhoid surgery is safe and effective most of the time. But you’ll still need to eat a high-fiber diet, avoid constipation, and take care of your bottom to help prevent new hemorrhoid flare-ups.

Talk to your doctor to figure out what’s right for you.

After Hemorrhoid Surgery:

Pain is the most common complaint, especially when you’re pooping. You can take over-the-counter pain relievers, if your doctor says it’s OK. Soaking in a warm bath may help, too.

Risks :

It’s very common and is considered safe. However, any surgery has some risks including:

  • Bleeding
  • Infection
  • Reaction to anesthesia

You might have some trouble peeing afterward because of swelling or muscle spasms.

If your anal sphincter gets damaged during surgery, you could have accidental bowel or gas leaks, a condition called fecal incontinence.

Call your doctor right away if you:

  • Are bleeding a lot
  • Can’t pee or poop
  • Have a fever

Benign prostatic hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement — is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract or kidney problems.

There are several effective treatments for prostate gland enlargement, including medications, minimally invasive therapies and surgery. To choose the best option, you and your doctor will consider your symptoms, the size of your prostate, other health conditions you might have and your preferences.

Symptoms:

The severity of symptoms in people who have prostate gland enlargement varies, but symptoms tend to gradually worsen over time. Common signs and symptoms of BPH include:

  • Frequent or urgent need to urinate
  • Increased frequency of urination at night (nocturnal)
  • Difficulty starting urination
  • Weak urine stream or a stream that stops and starts
  • Dribbling at the end of urination
  • Inability to completely empty the bladder

Less common signs and symptoms include:

  • Urinary tract infection
  • Inability to urinate
  • Blood in the urine

The size of your prostate doesn’t necessarily determine the severity of your symptoms. Some men with only slightly enlarged prostates can have significant symptoms, while other men with very enlarged prostates can have only minor urinary symptoms.

In some men, symptoms eventually stabilize and might even improve over time.

Other possible causes of urinary symptoms

Conditions that can lead to symptoms similar to those caused by enlarged prostate include:

  • Urinary tract infection
  • Inflammation of the prostate (prostatitis)
  • Narrowing of the urethra (urethral stricture)
  • Scarring in the bladder neck as a result of previous surgery
  • Bladder or kidney stones
  • Problems with nerves that control the bladder
  • Cancer of the prostate or bladder

When to see a doctor

If you’re unable to pass any urine, seek immediate medical attention.

Causes:

Comparing normal and enlarged prostate glands

The prostate gland is located beneath your bladder. The tube that transports urine from the bladder out of your penis (urethra) passes through the center of the prostate. When the prostate enlarges, it begins to block urine flow.

Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow.

It isn’t entirely clear what causes the prostate to enlarge. However, it might be due to changes in the balance of sex hormones as men grow older.

Risk factors:

Risk factors for prostate gland enlargement include:

  • Family history.
  • Diabetes and heart disease.

Complications of an enlarged prostate can include:

  • Sudden inability to urinate (urinary retention).
  • Urinary tract infections (UTIs).
  • Bladder stones.
  • Bladder damage.
  • Kidney damage.

Most men with an enlarged prostate don’t develop these complications. However, acute urinary retention and kidney damage can be serious health threats.

Having an enlarged prostate is not believed to increase your risk of developing prostate cancer

Treatment

A wide variety of treatments are available for enlarged prostate.The best treatment choice for you depends on several factors, including:

  • The size of your prostate
  • Your age
  • Your overall health

Varicocele

A varicocele (VAR-ih-koe-seel) is an enlargement of the veins within the loose bag of skin that holds your testicles (scrotum). A varicocele is similar to a varicose vein you might see in your leg.

Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, not all varicoceles affect sperm production. Varicoceles can also cause testicles to fail to develop normally or shrink.

If a varicocele causes symptoms, it often can be repaired surgically.

Symptoms:

A varicocele often produces no signs or symptoms. Rarely, it might cause pain. The pain may:

  • Vary from sharp to dull discomfort
  • Increase with standing or physical exertion, especially over long periods
  • Worsen over the course of a day
  • Be relieved when you lie on your back
  • Impaired fertility

With time, varicoceles might enlarge and become more noticeable. A varicocele has been described as looking like a “bag of worms.” The condition might cause a swollen testicle, almost always on the left side.

When to see a doctor?

Because a varicocele usually causes no symptoms, it often requires no treatment. Varicoceles might be discovered during a fertility evaluation or a routine physical exam.

However, if you experience pain or swelling in your scrotum, discover a mass on your scrotum, notice that your testicles are different sizes, or develop a varicocele in your youth, or you’re having problems with fertility, contact your doctor. A number of conditions can cause a scrotal mass or testicular pain, some of which require immediate treatment.

Causes:

Male reproductive system

Your spermatic cord carries blood to and from your testicles. It’s not certain what causes varicoceles.

However, many experts believe a varicocele forms when the valves inside the veins in the cord prevent your blood from flowing properly. The resulting backup causes the veins to widen (dilate). This might cause damage to the testicle and result in worsened fertility.

Varicoceles often form during puberty. Varicoceles usually occur on the left side, most likely because of the position of the left testicular vein.

Complications:

A varicocele might cause:

  • Shrinkage of the affected testicle (atrophy).

 

Treatment:

The purpose of surgery is to seal off the affected vein to redirect the blood flow into normal veins. In cases of male infertility, treatment of a varicocele might improve or cure the infertility or improve the quality of sperm if techniques such as in vitro fertilization (IVF) are to be used.

Clear indications to repair a varicocele in adolescence include progressive testicular atrophy, pain or abnormal semen analysis results. Although treatment of a varicocele generally improves sperm characteristics, it’s not clear if an untreated varicocele leads to progressive worsening of sperm quality over time.

 

What is the Injection therapy for acute and chronic low-back pain ?

Injection therapy is one of many treatments available for patients with sub acute (longer than six weeks) and chronic (longer than 12 weeks) low-back pain. Where the injection is given, what drug is used and why the injection is given can all vary.

The injection can be given into different parts of the spine (the space between the vertebrae, around the nerve roots, or into the disc), ligaments, muscles or trigger points (spots in the muscles that when pressed firmly will produce pain). Drugs that reduce swelling (corticosteroids, non-steroidal anti-inflammatory (NSAIDs) and pain (morphine, anesthetics) are used. Injection therapy can be used for individuals with low-back pain with or without pain and other symptoms in the leg.

Is the injection painful?

Any procedure using needles will have some associated discomfort; however your clinician has had intensive training in the techniques used to maximize comfort throughout.

How fast does the injection work?

If local anesthetic is also used, the pain from your tissue damage should reduce within a few minutes, though it may return after about an hour. Some injections are undertaken with steroid alone. The steroid usually starts to work within 24 – 48 hours but the steroid can continue to be absorbed for 3 – 4 weeks.

What should I do after the injection?

It is advisable to avoid any strenuous or repetitive activity which involves the part of your body where you received the injection for 1 – 2 weeks. You can continue the majority of your daily activities during this period. If you have any doubts then do not worry as this will be discussed in detail with you prior to the injection being given.

 

Burns / management of burn wounds

Background

The principles of managing burns in children are similar to those for adults, but burn depth assessment is often more difficult due to their thinner skin. Children also require burns resuscitation fluid at a lesser total body surface area (TBSA) percentage than adults (10% in children as opposed to 20% in adults). Beware hypothermia during initial cooling, especially in young children.

Initial management

 

First aid

Commence cooling as soon as possible (within 3 hours from time of burn), with cool, running water for 20 minutes total duration. Cooling should be targeted to the affected area only.

Do NOT apply ice or ice slush as this may cause additional tissue damage.

Do NOT apply hydrogel burn products (e.g. Burnaid®) as a first aid measure UNLESS there is no access to a water source.

Cold water compresses are less effective than running water to cool a burn wound, and must be changed frequently.

Applying plastic (cling) wrap to burn wound after cooling aids analgesia and limits heat loss and evaporation.

Irrigate any chemical burns with copious volumes of water.

Burns to the eyes require early irrigation with copious volumes of normal saline or water.

Pain relief

Immediate, effective analgesia should be provided, with the route and choice of analgesia determined by the condition of child and potency of analgesia required.

Rapid options include intranasal fentanyl (1.5 mcg/kg) or IV morphine (0.1mg/kg given in titrated boluses).

Dressing changes should be accompanied by appropriate analgesia and sedation.

Dr. Hossameldin Sultan

Specialist General Surgeon

Dr. Mohamed Ibrahim

Specialist General Surgery

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