General Surgery FAQs: Expert Answers

Patients visiting our general surgery outpatient clinics often have many questions about the decision to have surgery, the operation process, and the recovery period. Offering a wide range of diagnosis and treatment options—from thyroid and breast diseases to the digestive system and bariatric surgery—this department frequently encounters similar concerns. To correct common misconceptions and help you step into your treatment process with confidence, we have compiled the most frequently asked general surgery questions and their detailed answers from our specialist physicians.

In short:

• The decision to operate on thyroid nodules depends on the needle biopsy result and the nodule's size.
• Not every palpable breast lump is a sign of cancer; most are benign structures like cysts or fibroadenomas.
• Endoscopy procedures are performed under sedation (sleep) by an anaesthesiologist to maximise patient comfort.
• After a sleeve gastrectomy, patients can usually return to their daily lives and work within 7 to 10 days.
• Ninety per cent of rectal bleeding is caused by benign reasons such as haemorrhoids or anal fissures (tears).

Thyroid Diseases

Does every patient with a thyroid nodule need surgery?

Not every nodule detected in the thyroid gland requires surgery. This is one of the most common concerns our patients have in the clinic. Thyroid nodules are first evaluated radiologically using ultrasonography. The nodule's structure, borders, and whether it contains calcification are examined. A fine-needle aspiration biopsy (FNAB) is performed on nodules that carry a potential for malignancy (being cancerous) or are above a certain size. If the biopsy reveals cancer or a suspicion of cancer, surgical intervention is recommended. If the nodule is smaller than 2 centimetres and the biopsy result is benign (non-cancerous), the patient is placed under regular ultrasound follow-up without surgery.

Will there be a scar after thyroid surgery?

One of the most common aesthetic concerns for patients is whether a scar will remain after thyroid surgery. This depends on the size of the thyroid gland, the amount of tissue to be removed, and the purpose of the operation. If a comprehensive thyroid surgery is to be performed due to a cancer diagnosis, a horizontal incision scar will remain at the lower part of the neck; however, this scar gradually blends in with the natural skin lines and becomes less noticeable. If surgery is planned solely for a benign thyroid nodule, closed methods performed through the inside of the lip (transoral) or under the armpit, which leave no visible scar on the neck, may be preferred for suitable patients.

Will I need to take medication continuously after surgery?

The answer to this question depends on the extent of the surgery. If both sides of the patient's thyroid gland are removed (total thyroidectomy), the body will no longer be able to produce thyroid hormone, making it mandatory to take external thyroid hormone medication for life. However, if only one side of the thyroid tissue is removed (lobectomy), the remaining healthy thyroid tissue usually continues to meet the body's hormone needs. In this case, the patient's blood values are monitored regularly; if the remaining tissue produces enough hormone, medication is not required.

Breast Diseases

Is a breast lump cancer?

Not every lump felt during a breast self-exam or discovered by chance means breast cancer. Although the question "is a breast lump cancer?" causes great panic among our patients, the vast majority of detected lumps are benign formations like fibroadenomas or simple cysts. The rate of malignancy varies depending on the patient's age, genetic risk factors, and the structure of the lump, but it is generally between 10 and 20 per cent. However, this is not a rate to be underestimated. Since breast cancer is the most common type of cancer in women, every palpable lump should be evaluated without delay by a general surgeon using ultrasonography or mammography.

Does a breast lump cause pain, or is pain a sign of a bad disease?

Breast pain (mastalgia) is frequently seen, especially in young women of reproductive age, due to the physiological effects of the hormones that regulate the menstrual cycle on breast tissue. Patients often present in fear, mistaking the pain for a sign of cancer. In reality, breast cancer usually manifests itself as a painless, hard, and immobile lump. The likelihood of breast pain being the first symptom of advanced-stage breast cancer is quite rare. Nevertheless, if there is unilateral, continuous pain that increases in severity, a detailed examination is a must.

Endoscopy

Do you perform the endoscopy while the patient is asleep?

Patients with stomach and bowel complaints often shy away from endoscopy due to a fear of the gag reflex or pain. At our hospital, endoscopy and colonoscopy procedures are performed under a method called sedation, accompanied by an anaesthesiologist, meaning the patient is asleep. Thanks to the medications administered intravenously, the patient feels no pain, nausea, or discomfort during the procedure; they fall into a deep sleep and wake up remembering nothing once it is over. Furthermore, advanced endoscopic examinations such as early diagnosis of stomach and bowel cancer with the staining method are also successfully performed in this comfortable state of sleep.

How many hours after the endoscopy procedure can I return to work?

Because the procedure takes place under sedation (sleep), the patient is not allowed to leave the hospital immediately. After the procedure is finished, the patient is taken to a private observation room. They rest for about 1 hour until the effects of the medication wear off and they fully regain consciousness. After waking up, they are asked to start consuming light, liquid foods orally. If there is no nausea or dizziness, the patient is discharged approximately 2 hours after the procedure. Although it is possible to return to desk jobs that do not require heavy physical exertion on the afternoon of the same day, we generally recommend spending that day resting.

Can I drive after the procedure?

Even though the patient's consciousness may appear fully clear, the sedation medications used during the procedure can cause slowed reflexes, distraction, and mild drowsiness. For this reason, we strongly advise our patients not to drive, operate dangerous machinery that requires attention, or make important legal decisions during the first 24 hours after the procedure. It is highly important to come to the hospital with a companion.

Bariatric Surgery

How much of the stomach is removed in a sleeve gastrectomy?

During a sleeve gastrectomy, which is the most frequently applied method in bariatric surgery, approximately 70 to 80 per cent of the stomach is surgically cut and removed from the body. In this procedure, the connections between the stomach, spleen, and large intestine are freed. Because the removed portion includes the fundus region, where the appetite hormone ghrelin is secreted the most, the patient's appetite decreases significantly after surgery. What remains is a new stomach in the shape of a long, thin tube, resembling a banana.

What is the recovery process like for a sleeve gastrectomy, and when can I return to work?

The recovery process for a sleeve gastrectomy is quite fast and comfortable, thanks to the operation being performed using a closed (laparoscopic) method. Because it is done by entering through a few small holes in the abdominal area, large incision pains are not experienced. Patients may have mild gas pains and aches on the first day after surgery, but usually, no significant complaints remain by the third day. The average hospital stay is 2-3 days. For patients working in desk jobs or light-paced roles, we generally recommend returning to work after 7 to 10 days.

When can I exercise after the surgery?

Moving after bariatric surgery is of critical importance, both to prevent blood clotting and to support the weight loss process. Patients are encouraged to start walking in the hospital corridor just a few hours after the surgery. Within the first 10 days after discharge, light exercises such as brisk walking can be started. However, because it will take time for the internal abdominal stitches to heal completely, it is necessary to wait at least 3 months before starting heavy sports like weightlifting, sit-ups, or strenuous fitness routines.

Do I need to use vitamin supplements after the operation?

Unlike malabsorptive surgeries where the intestines are also bypassed, such as a gastric bypass, a sleeve gastrectomy does not alter the absorption pathways of food; it only reduces the stomach volume. Therefore, severe vitamin and mineral deficiencies are not expected. However, because portion sizes become very small in the first few months, it can be difficult to get the daily nutrients the body needs entirely from food. During this period, you may need to use multivitamin supplements recommended by your doctor and dietitian. Based on blood test results in the following periods, these supplements are usually discontinued.

Anal and Rectal Diseases

What are the causes of rectal bleeding, do I have a bad disease?

Seeing blood in the toilet rightly frightens patients; however, not every instance of rectal bleeding is a sign of cancer. When the causes of rectal bleeding are examined, it is seen that approximately 90 per cent of cases stem from completely benign diseases such as haemorrhoids (piles) or anal fissures (tears). However, the remaining 10 per cent may involve serious conditions like intestinal polyps or colon cancer. Therefore, every patient with a bleeding complaint should definitely get examined instead of wasting time with unverified home remedies, and if the physician deems it necessary, they should agree to undergo a recto-sigmoidoscopy or colonoscopy procedure, where the last part of the large intestine is examined.

Should a recto-sigmoidoscopy be done immediately, or can it wait to pass with medication?

This decision is made based on the result of the rectal examination performed by the general surgeon. If no obvious haemorrhoidal lump or anal fissure that would explain the bleeding is detected during the physical examination, the endoscopic procedure should be performed as soon as possible to understand whether the source of the bleeding is further inside (in the intestine). However, if the patient has an acute anal fissure accompanied by severe, sharp pain that feels like a glass cut, or a thrombosed (clotted) haemorrhoid, instrumental examination can cause the patient a lot of pain. In such cases, the pain is first relieved with creams, warm sitz baths, and medications, and the procedure can be postponed to a few weeks later.

The Process and Emergencies at BHT CLINIC

While some general surgery diseases require planned surgeries, conditions such as acute appendicitis, gallbladder inflammation, intestinal obstruction, or severe gastrointestinal bleeding require emergency intervention. Our Emergency Medicine department at BHT CLINIC İstanbul Tema Hastanesi is equipped to intervene rapidly in such sudden-onset conditions with its expert staff 24 hours a day, 7 days a week. If you are experiencing symptoms such as severe and persistent abdominal pain, a large amount of bleeding from the rectum or mouth, or abdominal rigidity along with a high fever, it is of vital importance that you visit the emergency room or call 112 without delay. For your planned examinations, you can start your detailed evaluation process by booking an appointment at our outpatient clinics.

Frequently Asked Questions

What diseases does general surgery treat?

General surgery is a comprehensive medical department that deals with the diagnosis and surgical treatment of diseases of the thyroid, breast, oesophagus, stomach, small and large intestines, liver, gallbladder, pancreas, hernias, and the anal region (anorectal). Additionally, bariatric surgery and trauma surgery also fall under the expertise of this department.

What should I pay attention to before surgery?

Before surgery, you will be asked to undergo a detailed evaluation by an anaesthesiologist. It is mandatory to inform your doctor about your chronic illnesses and all the medications you use (especially blood thinners). You must completely stop eating and drinking at least 8 hours before the operation.

Is closed surgery (laparoscopy) applied to every patient?

Laparoscopic surgery has become the gold standard in gallbladder, hernia, appendicitis, and bariatric surgeries, and it can be applied to the vast majority of patients. However, open surgery may be preferred for patients who have had multiple previous open abdominal surgeries, have advanced intra-abdominal adhesions, or have very large masses.

What is an incisional hernia?

An incisional hernia is the weakening of the suture line of a previously performed open abdominal surgery over time, causing internal organs to bulge towards the subcutaneous tissue from this weak point. It usually occurs in situations that increase intra-abdominal pressure, such as heavy lifting, chronic cough, or excessive weight gain, and it needs to be repaired surgically.

To clear up any doubts about your health and to plan the right treatment, you can reach our specialist physicians through our BHT CLINIC appointment page.

This article is for informational purposes only; please be sure to consult your doctor for diagnosis and treatment.