The Top 5 Most Common Major Surgeries Explained

Often overlooked in discussions about “major” surgeries due to its outpatient nature and high success rate, cataract surgery is, in fact, the most common surgical procedure globally. According to the American Academy of Ophthalmology, millions of cataract surgeries are performed annually in the United States alone.

What is a Cataract?

A cataract is the clouding of the eye’s natural lens, which lies behind the iris and pupil. This lens works much like a camera lens, focusing light onto the retina at the back of the eye. As we age, proteins in the lens can clump together, forming a cloudy area that makes vision blurry, hazy, or less colorful. Untreated, cataracts can lead to significant vision impairment and even blindness. While age is the primary risk factor, other causes include diabetes, eye injury, certain medications, and prolonged exposure to ultraviolet light.

The Procedure

Cataract surgery is typically performed on an outpatient basis and takes less than an hour. The most common technique is phacoemulsification.

• Anesthesia: Local anesthesia is administered, often with a sedative to help the patient relax.
• Small Incision: A tiny incision (usually less than 3mm) is made in the cornea.
• Lens Emulsification: A small ultrasonic probe is inserted through this incision. The probe emits ultrasound waves that emulsify (break up) the cloudy lens into tiny fragments.
• Aspiration: These fragments are then suctioned out of the eye.
• Intraocular Lens (IOL) Implantation: Once the natural lens is removed, a clear, artificial intraocular lens (IOL) is inserted and unfolded into place. These IOLs are custom-selected for the patient to correct their vision, often eliminating or significantly reducing the need for glasses for distance vision.

Outcomes

Cataract surgery has an exceptionally high success rate, with over 95% of patients experiencing improved vision. Complications are rare but can include infection, bleeding, or retinal detachment, though modern techniques have minimized these risks.

The Cesarean section, or C-section, is a surgical procedure used to deliver a baby through incisions in the mother’s abdomen and uterus. It is one of the most frequently performed surgeries globally and in the United States, accounting for approximately 32% of all births. While often performed as an emergency procedure, many C-sections are planned in advance due to various medical reasons.

Why is a C-Section Performed?

C-sections are performed when vaginal delivery poses a risk to the mother or baby. Common indications include:

• Failure to Progress: Labor isn’t progressing despite strong contractions.
• Fetal Distress: Concerns about the baby’s heart rate.
• Breech Presentation: The baby is positioned feet-first or buttocks-first.
• Multiple Pregnancies: Delivering twins or more can sometimes necessitate a C-section.
• Placenta Previa: The placenta covers the cervix.
• Maternal Health Conditions: Such as severe heart disease or certain infections (e.g., active genital herpes) that could be transmitted to the baby during vaginal birth.
• Previous C-Section: In some cases, a previous C-section leads to a planned repeat C-section, although vaginal birth after C-section (VBAC) is often possible.

The Procedure

A C-section typically takes 45 minutes to an hour, though the baby is usually delivered within the first 5-10 minutes.

• Anesthesia: Regional anesthesia (spinal or epidural) is commonly used, numbing the lower half of the body while the mother remains awake. General anesthesia is used in emergency situations.
• Abdominal Incision: A horizontal incision is typically made across the lower abdomen, just above the pubic hairline (a “bikini cut”). In emergencies, a vertical incision may be necessary.
• Uterine Incision: A second incision, usually horizontal, is made in the lower part of the uterus.
• Baby Delivery: The baby is gently guided out of the uterus. The umbilical cord is then clamped and cut.
• Placenta Removal: The placenta is delivered, and the uterus is cleaned.
• Suturing: Both the uterine and abdominal incisions are carefully closed with sutures.

Outcomes

C-sections are generally safe, but they are major abdominal surgeries and carry greater risks than vaginal delivery, including infection, blood loss, blood clots, and complications with future pregnancies. Recovery typically involves a hospital stay of 2-4 days and several weeks of recuperation at home.

Total hip replacement is a highly effective surgical procedure that alleviates pain and improves mobility in patients with severe hip joint damage. With an aging global population and increasing rates of osteoarthritis, hip replacement surgeries have become incredibly common, with hundreds of thousands performed annually in the U.S. alone.

Why is a Hip Replacement Performed?

The primary reason for hip replacement surgery is severe arthritis, most commonly osteoarthritis, which causes the cartilage cushioning the hip joint to wear away, leading to bone-on-bone friction, pain, stiffness, and loss of motion. Other conditions include:

• Rheumatoid Arthritis: An autoimmune disease that causes inflammation of the joints.
• Post-traumatic Arthritis: Arthritis resulting from a severe hip injury or fracture.
• Osteonecrosis (Avascular Necrosis): When blood supply to the femoral head is interrupted, causing bone tissue to die.
• Childhood Hip Disease: Conditions like developmental dysplasia of the hip.

The Procedure

Total hip replacement involves removing the damaged bone and cartilage and replacing them with prosthetic components. The surgery typically takes 1-2 hours.

• Anesthesia: General anesthesia or a spinal/epidural anesthetic with sedation is used.
• Incision: An incision is made over the hip area, allowing the surgeon access to the hip joint. There are various approaches (anterior, posterior, lateral) depending on the surgeon’s preference and patient factors.
• Femoral Head Removal: The damaged femoral head (the ball part of the joint) is removed.
• Acetabular Preparation: The damaged cartilage and bone from the hip socket (acetabulum) are removed, and the surface is prepared to receive the new socket component.
• Socket Implantation: A metal shell is implanted into the prepared acetabulum, often secured with screws or a press-fit technique. A liner (plastic, ceramic, or metal) is then inserted into the metal shell.
• Femoral Component Implantation: The hollowed-out center of the femur (thigh bone) is prepared, and a metal stem with a ball on top is inserted into it. This stem can be cemented into place or designed for “press-fit” where bone grows onto the implant.
• Joint Assembly: The new ball on the femoral stem is placed into the new socket, recreating the hip joint.
• Closure: The muscles and tissues are meticulously repaired and the incision is closed.

Outcomes

Hip replacement surgery is highly successful in relieving pain and restoring function. The vast majority of patients experience significant improvement in their quality of life. Modern hip replacements are designed to last 15-20 years or more. Rehabilitation, including physical therapy, is crucial for optimal long-term results.

Similar to hip replacement, total knee replacement is an extremely common and effective procedure for individuals suffering from severe knee pain and disability due to arthritis or injury. The number of knee replacements performed annually rivals that of hip replacements, reflecting the widespread impact of degenerative joint disease.

Why is a Knee Replacement Performed?

Like hip replacement, the primary indication for knee replacement surgery is severe damage to the knee joint, most commonly due to:

• Osteoarthritis: The “wear-and-tear” arthritis, leading to cartilage breakdown and bone-on-bone friction.
• Rheumatoid Arthritis: An inflammatory autoimmune disease affecting the joint lining.
• Post-traumatic Arthritis: Resulting from a serious knee injury (e.g., fracture, ligament tear) that damages the joint over time.
• Other conditions: Such as bone deformities or avascular necrosis of the knee.

The Procedure

Total knee replacement involves resurfacing the damaged parts of the knee joint with artificial components. The surgery typically takes 1-2 hours.

• Anesthesia: General anesthesia or regional anesthesia (spinal or epidural) is used.
• Incision: An incision is made over the front of the knee.
• Bone Preparation: The damaged ends of the thigh bone (femur) and shin bone (tibia) are precisely cut and shaped using specialized instruments to fit the prosthetic components. The underside of the kneecap (patella) may also be reshaped.
• Component Implantation:
  • A metal component is secured to the end of the femur.
  • A flat metal component is secured to the top of the tibia.
  • A high-density polyethylene (plastic) spacer is inserted between the femoral and tibial components to create a smooth gliding surface.
  • If the kneecap was resurfaced, a plastic component is attached to its underside.
• Joint Alignment and Stability: The surgeon carefully checks the knee’s movement, stability, and alignment to ensure proper function.
• Closure: The joint capsule and overlying tissues are repaired, and the incision is closed with sutures or staples.

Outcomes

Knee replacement surgery is highly effective in relieving pain and improving mobility, allowing most patients to return to daily activities with far less discomfort. The longevity of knee replacements is comparable to hip replacements, often lasting 15-20 years or more. Extensive physical therapy is essential for a successful recovery and to regain strength and range of motion.

Coronary Artery Bypass Graft (CABG) surgery, commonly known as bypass surgery, is a major heart operation designed to improve blood flow to the heart muscle. It is one of the most frequently performed open-heart surgeries, vital for treating severe coronary artery disease.

Why is CABG Performed?

CABG is performed to treat coronary artery disease (CAD), a condition where the arteries supplying blood to the heart muscle (coronary arteries) become narrowed and hardened due to the buildup of plaque (atherosclerosis). This narrowing reduces blood flow, leading to symptoms like:

• Angina: Chest pain or discomfort.
• Shortness of Breath: Especially during exertion.
• Fatigue:
• Heart Attack: In severe cases, complete blockage can lead to a heart attack.

CABG is typically recommended when CAD is severe, affecting multiple coronary arteries, and symptoms are not adequately controlled by medication or less invasive procedures like angioplasty and stenting. It provides a long-term solution by rerouting blood flow around the blockages.

The Procedure

CABG is a complex operation, usually taking 3-6 hours, and involves creating new pathways for blood flow to the heart.

• Anesthesia: General anesthesia is administered.
• Incision: A long incision is made down the center of the chest, and the breastbone (sternum) is divided to expose the heart.
• Heart-Lung Machine: In conventional CABG (“on-pump” bypass), the patient is connected to a heart-lung machine. This machine temporarily takes over the functions of the heart and lungs, allowing the heart to be stopped for the duration of the grafting.
• Graft Harvesting: Healthy blood vessels (grafts) are harvested from other parts of the patient’s body, most commonly:
  • Internal Mammary Artery (IMA): From inside the chest wall. This is often the preferred graft due to its excellent long-term patency.
  • Saphenous Vein: From the leg.
  • Radial Artery: From the arm.
• Grafting: One end of the harvested healthy artery or vein is attached to the aorta (the main artery leaving the heart), and the other end is attached to a coronary artery beyond the point of blockage. This creates a new channel for blood to bypass the narrowed segment, restoring blood flow to the heart muscle. Multiple bypasses (e.g., double, triple, quadruple bypass) may be performed depending on the extent of the blockages.
• Weaning from Bypass Machine: Once the grafts are complete, the heart is restarted, and the patient is gradually weaned off the heart-lung machine.
• Closure: The breastbone is rejoined with wires, and the incision is closed. “Off-pump” or “beating heart” bypass surgery, performed without stopping the heart, is also an option for some patients.

Outcomes

CABG is a highly effective procedure for improving symptoms, increasing exercise capacity, and extending the lives of patients with severe CAD. While it is a major surgery with a significant recovery period (weeks to months), it significantly improves the quality of life and reduces the risk of future cardiac events for appropriate candidates.

These top five most common major surgeries—Cataract Surgery, Cesarean Section, Hip Replacement, Knee Replacement, and Coronary Artery Bypass Graft—represent a broad spectrum of medical interventions that collectively improve the lives of millions worldwide each year. From restoring sight and facilitating safe childbirth to mitigating debilitating pain and extending cardiac function, these procedures underscore the incredible advancements in surgical science and technology.

While each surgery carries inherent risks, continuous innovations in techniques, anesthesia, and post-operative care have dramatically improved patient safety and outcomes. Understanding these common major surgeries not only demystifies them but also highlights the profound impact that modern medicine has on alleviating suffering and enhancing human well-being. They serve as a testament to the dedication of healthcare professionals and the ongoing evolution of surgical excellence.