Name of the Procedure:

Excision of the Ischial Bursa

Summary

Excision of the ischial bursa is a surgical procedure that involves the removal of the ischial bursa, a small fluid-filled sac located near the ischial tuberosity (part of the pelvis). This procedure is performed when the bursa becomes inflamed, causing pain and discomfort, a condition known as ischial bursitis.

Purpose

The procedure addresses chronic ischial bursitis, which can cause significant pain and impair mobility. The goal is to provide relief from pain and inflammation, improve mobility, and enhance the patient's quality of life by removing the problematic bursa.

Indications

• Persistent pain in the buttock area, especially when sitting
• Swelling and tenderness over the ischial tuberosity
• Failure to respond to conservative treatments like medication, physical therapy, or steroid injections
• Recurrent bursitis despite previous treatment efforts

Preparation

• Patients may need to fast for several hours before the procedure
• Adjustments to medication schedules, especially blood thinners
• Pre-operative imaging tests such as MRI or ultrasound to locate the inflamed bursa
• Completion of a pre-surgical assessment including physical examination and medical history review

Procedure Description

1. The patient is positioned appropriately, usually lying down on their front.
2. Anesthesia is administered; this may include local anesthesia with sedation or general anesthesia depending on the case.
3. The surgical area is sterilized and an incision is made over the ischial bursa.
4. The surgeon carefully dissects the tissue to expose and then excise the inflamed bursa.
5. Hemostasis is achieved, and the incision is closed with sutures.
6. A sterile dressing is applied to the site.

Duration

The procedure typically takes between 30 minutes to 1 hour.

Setting

The surgery is usually performed in a hospital operating room or an outpatient surgical center.

Personnel

• Orthopedic surgeon or general surgeon
• Surgical nurses
• Anesthesiologist or nurse anesthetist
• Surgical technician

Risks and Complications

• Infection
• Excessive bleeding or hematoma formation
• Nerve damage
• Scarring or poor wound healing
• Recurrence of bursitis
• Adverse reactions to anesthesia

Benefits

• Relief from chronic pain and inflammation
• Improved ability to sit and perform daily activities without discomfort
• Enhanced overall mobility and quality of life
• Typically, pain relief can be noticed within a few weeks post-surgery

Recovery

• Post-procedure care includes keeping the surgical site clean and dry
• Pain management with prescribed medications
• Limitation on certain activities, especially sitting for prolonged periods, until healing is achieved
• Physical therapy may be recommended to restore full function
• Full recovery usually occurs within several weeks to a few months
• Follow-up appointments for suture removal and to monitor progress

Alternatives

• Non-surgical treatments such as physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), or corticosteroid injections
• Alternative surgical procedures like bursectomy with less invasive techniques
• Each option comes with its own advantages and potential drawbacks, such as varying recovery times and success rates

Patient Experience

During the procedure, patients under general anesthesia will be asleep and not feel anything. With local anesthesia and sedation, patients will be relaxed and pain-free. Post-procedure discomfort can be managed with medications. Patients might experience temporary restrictions on mobility and will need to follow specific care instructions to ensure proper healing.