Indications and Contraindications for Surgery

Types of surgical indications

The urgency of performing a surgical intervention directly depends on the established indications. They are conventionally divided into three groups:

1. Vital (life-saving). Delay is unacceptable, care is provided on an emergency basis. Examples: massive ongoing bleeding (rupture of the spleen, liver, ectopic pregnancy, vascular injury), acute inflammations with a risk of peritonitis or gangrene (appendicitis, incarcerated hernia, intestinal obstruction), as well as purulent pathologies (phlegmon, mastitis, abscess) threatening the development of sepsis.
2. Absolute. The surgery is urgent and performed within 1–2 weeks. Further delay will lead to a life-threatening condition (hepatic failure, metastasis, cachexia). They arise in oncology, pyloric stenosis, mechanical jaundice.
3. Relative. There is no direct threat to life. Interventions are performed on an elective basis (non-incarcerated hernias, benign tumors, varicose veins).

Main contraindications

The presence of contraindications is assessed individually, comparing the severity of the patient's condition and the invasiveness of the upcoming procedure. The decision is made by a medical board (surgeon, general practitioner, neurologist, endocrinologist).

Key pathologies limiting surgeries:

• Cardiovascular system: shock states, myocardial infarction, thromboembolic disease.
• Respiratory system: pronounced respiratory failure.
• Central nervous system: stroke.
• Metabolism and organ functions: hepatorenal failure, decompensated diabetes mellitus (precoma and coma), severe forms of anemia, extreme exhaustion (cachexia).

When a high risk is identified and there are only relative indications, the surgical procedure is postponed until the treatment of comorbid conditions is completed.

Specifics of surgeries for vital indications

If a surgical intervention is the only chance to save the patient, all existing contraindications automatically change status to relative.

In such critical situations, preoperative preparation is reduced to a few hours. The joint task of the surgeon and the anesthesiologist-resuscitologist is to provide rapid transfusion support and choose the optimal method of anesthesia.

The main principle of emergency surgery is the minimal scope of intervention. Physicians perform only those actions that are necessary to preserve life. For example, in acute intestinal obstruction due to a tumor, the surgeon will simply perform a colostomy (artificial fistula) rather than a lengthy bowel resection. Similarly, in a severe patient with acute cholecystitis, instead of gallbladder removal, they will limit themselves to drainage (cholecystostomy).

Tasks of the preoperative period

The main goal of preparation is to minimize the risk of the surgery itself and the likelihood of postoperative complications. To achieve this, after diagnosis, the following algorithm is implemented:

• Determining indications, urgency, and potential limitations.
• Performing additional tests to assess vital systems.
• Calculating anesthetic and surgical risk.
• Psychological and somatic support of the patient (correction of homeostasis).
• Prevention of endogenous infection development.
• Choosing anesthesia and performing premedication.
• Preparing the operational field and transporting to the operating table.

Class and exam questions

What else to study on this topic

• Assessment of the degree of anesthetic and surgical risk
• Methods of somatic preparation and correction of homeostasis systems
• Prevention of endogenous infection before surgery
• Choice of anesthesia method and premedication rules

Other topics in "CHAPTER 8. SURGICAL OPERATION"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.