Amniotic Membrane Transplantation (AMT)

What is the amniotic membrane?

The amniotic membrane is the innermost layer of the placenta and can be used as a graft or dressing in a range of different surgical procedures, typically involving the eye. It is used for its anti-inflammatory and anti-scarring effects.

What is amniotic membrane transplantation (AMT)?

This describes the surgery performed in which the amniotic membrane is used as a graft or as a dressing.

In ophthalmology, AMT has been used in the revision of scars in the eye and also correcting defects following the removal of conjunctival tumours. However, such transplantations come with risks, including the transmission of infectious diseases.

Generally, the amniotic membrane is obtained through donors, who have been screened for diseases such as HIV, undergoing a caesarean section.

Surgeons clean the placenta with a mixture of salt solution, penicillin and other ingredients. The amnion is separated through sterile dissection and stored in a glycerol solution.

Bile Duct Injury

What is bile?

Bile is a fluid in the digestive system that is stored in the gall bladder, which helps to break down food and get rid of toxins from the body.

Bile ducts and the biliary system

The biliary system is made up of a series of tubes and organs, beginning with the liver and ending with the small intestine. There is also a number of bile ducts, such as the common bile duct and the hepatic duct.

Causes of bile duct injuries

Injuries to the bile duct are most common during laparoscopic gall bladder surgery, where it may be cut, pinched or burned. If the bile duct is injured then it will not function correctly, which could result in bile leaking into the abdomen or a blockage of the normal flow of bile. This can be very painful, and even deadly, if not treated.

Symptoms

Bile duct injuries could cause the following symptoms:

• Fever
• Nausea
• Abdominal pain
• Vomiting
• Swelling
• Jaundice
• Chills

Treatment and surgery

Once the injury to the bile duct has been noted, the main goal is to manage the infection and leakage caused by the injury. The surgeon may have to reconstruct the bile duct using a piece of intestine to bypass the blockage.

Most bile duct injuries are successfully repaired but in severe cases the patient may require months of recovery time.

Small bowel resection

This surgery removes part or all of your small bowel (small intestine) when it is blocked or diseased.

Most digestion (breaking down and absorbing nutrients) of the food you eat takes place in the small intestine. The surgery can be performed laparoscopically or with open surgery.

Small bowel resection is used to treat:

• A blockage in the intestine caused by scar tissue or congenital (from birth) deformities
• Bleeding, infection, or ulcers caused by inflammation of the small intestine. Conditions that may cause inflammation include regional ileitis, regional enteritis, and Crohn's disease

• Cancer
• Carcinoid tumor
• Meckel's diverticulum
• Noncancerous (benign) tumors
• Precancerous polyps

Most people who have a small bowel resection recover fully. Even with an ileostomy, most people are able to do the activities they were doing before their surgery. This includes most sports, travel, gardening, hiking, and other outdoor activities, and most types of work. If a large part of your small intestine was removed, you may have problems with loose stools and getting enough nutrients from the food you eat.

Corneal Graft/Transplant

This is an operation to remove the damaged cornea in the eye and replace with healthy tissue to improve sight or treat a severe infection.

The cornea is the clear outer layer of the eyeball which acts as the lens of the eye which is made up on six delicate layers. When the cornea becomes damaged it can prevent light from reaching the retina which can make images appear unclear.

A corneal graft/transplant can be performed in a number of ways. These include: penetrating keratoplasty which is a full-thickness transplant, a deep anterior lamellar keratoplasty which involves replacing or reshaping the outer and middle cornea and a endothelial keratoplasty where the deeper parts of the cornea are replaced.

After about one in five corneal transplants, the patient may reject the foreign body as the immune system attacks the transplanted cornea. This rejection can often be treated with a dose of steroid eye drops.

Other complications after a corneal transplant include astigmatism where the cornea is not a perfectly curved shape as it should be. The pressure could build up in the eye resulting in trapped fluid, which is known as glaucoma.

Also, uveitis may occur whereby the middle layer of the eye becomes inflamed. Retinal detachment can also occur which is where the thin lining at the back of the eye (retina) begins to pull away from the blood vessels which supply it with oxygen and nutritions.

Laminectomy

This is one of the most common back surgeries where a surgeon removes the rear portion of one or more spinal bones (vertebrae).

Ligaments and bones that are pressing on the nerves may be removed at the same time during surgery.

People with arthritis in their spine can sometimes develop bony overgrowths within the spinal canal which can cause the pressure.

As with any form of surgery, there can be complications during a laminectomy including:

• Bleeding,
• Infection blood clots,
• Nerve injury

Orthopaedic injuries can also occur during surgery in which case a clinical negligence claim may be brought against the hospital.

Most people who undergo a laminectomy see an improvement in their symptoms but, as the spine ages over time, the benefit may lessen.

Laparoscopic Cholecystectomy

This is a surgical procedure to remove the gall bladder through a 'key hole' method whereby the surgeon inserts a thin tube with a camera to view the gall bladder on a screen.

The use of a laparoscope is a less invasive method, using several small incisions rather than one large one. Other benefits of a laparoscopic procedure usually include a shorter hospital stay, shorter recovery time and therefore less time off work.

There is usually also less pain with this procedure than with a normal cholecystectomy due to the fact that the abdominal muscles have not been cut open.

The removal of the gall bladder is one of the most common operations performed in the UK.

Bile, the digestive fluid which helps break down fatty food, is stored in the gall bladder.

Sometimes the cholesterol, salts and waste products become out of balance causing gallstones to develop.

When the gallstones become an issue, this is when a laparoscopic cholecystectomy is usually recommended.

Gallstones can often have no symptoms and can remain undetected. However, they can become trapped in the bile duct, irritate and inflame the gallbladder or travel to other parts of the body.

Your body will still function without the gallbladder - the liver will still produce bile to digest food.

However, some people have reported bloating and diarrhoea when eating certain foods.

Microdiscectomy

This is a form of spinal surgery to decompress the spine using a microscope to view the spine and the lumbar disc.

A small portion of the bone over the nerve root is removed to relieve neural impingement and to provide the nerve with more room to heal.

Compression of the spine can cause substantial leg pain and a microdiscectomy is usually performed for a herniated lumbar disc which is said to be more effective for treating leg pain than lower back pain.

The success rate of a microdiscectomy is approximately 90-95% with 5-10% of patients developing a recurrent disc herniation at some point in the future.

In any spinal surgery, there is the risk of a cerebrospinal fluid leak which occurs in 1-2% of these procedures. This means the patient will have to lay horizontally for one or two days to allow the leak to seal. Other complications can include; nerve root damage, bleeding or infection.

Salpingo-Oophorectomy

This is a surgical procedure which can be either unilateral or bilateral.

Unilateral is where the fallopian tube and an ovary are both removed and a bilateral procedure involves the removal of both sets of fallopian tubes and both ovaries are removed.

The reasons for this surgery to be performed is usually to treat forms of gynaecological cancer or pelvic inflammatory disease.

This procedure may also be done to treat endometriosis as well as if a woman has been diagnosed with an ectopic pregnancy.

Salpingo-oophorectomy is considered major surgery if performed through an abdominal incision and would require three to six weeks to fully recover.

However, if the procedure if performed laparoscopically, the recovery time can be much shorter.

Immediately following the operation, sharply flexing the thighs or the knees should be avoided.

And if the patient suffers with persistent back pain or blood in the urine then it may indicate that a ureterhas been injured during surgery.

Other complications, as with most major surgeries, can include infection, haemorrhage and scars at the incision.

Complications after a salpingo-oophorectomy, however, can include changes in sex drive, hot flashes and other menopausal symptoms if both ovaries are removed.

In general, studies have shown that the complication rate following salpingo-oophorectomy is essentially the same as that following hysterectomy.

Sarocolpopexy

This is a surgical technique used to repair a pelvic organ prolapse to restore the vagina to its normal position and function.

Reconstruction can be made using an open abdominal technique or through minimally invasive surgery such as a laparoscopy, depending on the severity of the pelvic prolapse.

A permanent synthetic mesh is used as a graft to cover the front and back surfaces of the vagina. The mesh is then attached to the tail bone and covered by a layer of tissue which lines the abdominal cavity called the peritoneum which prevents the bowel getting stuck to the mesh.

Although the majority of women fully recover from this surgery, there is a small risk that a prolapse can develop in another part of the vagina which could require further surgery.

Other complications can include; pain during intercourse, exposure of the mesh in the vagina and damage to the bladder, bowel or ureters. There are also more general risks associated with this surgery such as wound infection or a urinary tract infection.

Ureteric Implant

Some children are born with their ureters not joining the bladder in the correct place which can cause a condition called vesio-ureteric relux (VUR).

This can cause the valves to fail, allowing urine to flow backwards from the bladder to the kidneys, which can cause kidney failure.

The ureteric implant operation involves disconnecting the ureters and re-attaching them to the bladder in the correct place.

The end of the urecters joining the bladder are surrounded by muscle to strengthen the valves to reduce the chance of backwards flow again.

A catheter is often inserted into the bladder after the procedure to help drain the urine during the healing process.

Common problems after surgery can include blood in the urine, bladder spasms and cramping.

Sometimes children can suffer from a high temperature or intolerance to liquids after surgery. Children can still be prone to urinary tract infections after a ureteric implant.