Ganglionectomy

Ganglionectomy is a surgery that is done to remove a ganglion cyst from the body.

A ganglion cyst is a non-cancerous swelling (a sac filled with jelly-like substance) that originates from the tissue covering a tendon or joint. The cyst can be found in any body part but is usually found around the wrist, hand, nails or behind the foot. The size of the ganglion cysts varies, and they are either situated close to the skin surface or deep within. However, regardless of the location, they are usually attached to the underlying origin of tissue (tendon or joint).

The formation of a ganglion cyst is not attributed to any specific cause or physical activity. While some cysts go away by themselves, others require medical treatment such as aspiration, which involves draining of the fluid from the ganglion cyst by making tiny punctures.

However, if the cyst cannot be treated successfully with non-surgical methods, ganglionectomy may be required. In this surgery, the ganglion cyst is removed with the root that connects it to the tendon or joint, this significantly reduces the chance of recurrent of the cyst. The chances of recurrence of a ganglion cyst are more if the root is not removed completely, like in aspiration, where only a small part of the root is removed.

Your surgeon may recommend ganglionectomy if the ganglion cyst is causing discomfort and interferes with your regular activities.

Although most ganglion cysts do not have any symptoms, some cause pain and soreness. Additionally, some ganglion cysts can put pressure on a nearby nerve, which may cause loss of sensation in that area. A lump may also appear under the skin.

The surgeon may not recommend this surgery or advise caution in individuals with one limb (upper or lower) as any complications of the surgery will have a much larger impact in such individuals.

The following preparations may be required before the surgery:

• The doctor may ask you to get some imaging tests, such as X-rays, magnetic resonance imaging, or ultrasound to distinguish the ganglion cyst from other conditions such as a bone tumour.
• Avoid smoking two weeks before the scheduled date of surgery since smoking can cause breathing problems during the procedure. It also delays the recovery time after surgery. Ideally, smoking should be stopped six to eight weeks before surgery.
• The surgeon may ask you to not drink or eat anything after midnight the night before the surgery or the morning of the day of surgery. 
• Arrange for a friend or family member to drive you home from the hospital after the surgery.

This surgery is performed under general or local anaesthesia. General anaesthesia puts you into sleep while local anaesthesia numbs a part of the body, but keeps you awake during surgery.

The surgeon may perform ganglionectomy by any of the following methods:

• Open surgery: In this method, the surgeon makes an incision around the affected tendon or joint to remove the ganglion cyst.
• Arthroscopic or keyhole surgery: Here, the surgeon makes tiny incisions over the affected tendon or joint. A camera, called an arthroscope, is introduced through one of the cuts to look at the ganglion cyst. Using the visual feed from the camera as a guide, the surgeon inserts surgical tools through other cuts to remove the cyst from the tendon or joint.

After the surgery, the incision is stitched and covered with a large dressing. Ganglionectomy takes about 20 to 45 minutes to complete.

Your stay at the hospital after surgery depends on the type of anaesthesia used. If local anaesthesia has been used, you would be discharged to home on the same day. If general anaesthesia has been used, you might need to stay at the hospital for a night. This will depend on your body’s response to anaesthesia and the time of day at which the surgery was performed.

The wound from surgery may heal in two to six weeks. Wound care after surgery depends on the location of the ganglion cyst. You can expect the following after surgery:

• If the surgery is performed under general anaesthesia, you may feel tired and dizzy for 24 hours after the surgery. Hence, you should rest after reaching home from the hospital. However, instead of staying in bed, it is best to move around your house slowly as this will prevent blood clot formation.
• If the surgery is done on your arm, the surgeon will ask you to rest your arm in a sling for 24 to 48 hours. However, he/she may suggest you to move your fingers, elbow, and shoulder to reduce the swelling in your hand.
• If the procedure is performed on your leg, the doctor may advise you to sit with your leg raised and/or keep the leg on a pillow to improve swelling.
• The dressing should be removed only after 48 hours following surgery.
• If swelling occurs at the wound site, applying ice on the swelling can help reduce it.
• You may experience pain at the wound site. The surgeon will prescribe medicines for the same. Take them as directed.
• The surgeon may also prescribe some antibiotics to prevent infections.
• After the wound heals, apply lotion on it to heal the scars. It will also help stimulate the nerve on the wound site.
• You may resume work depending on the location of the surgery and the type of job. If your work requires heavy manual labour, you will need to rest for at least three weeks.
• Once your stitches have been removed, you can continue with swimming and other sports activities. However, you may not be able to play or perform any activity for a long period as your joints may ache after a certain period.

Ganglionectomy helps to remove the lump and any resulting discomfort from a ganglion cyst. Moreover, surgery is the best way to prevent the recurrence of a ganglion cyst.

When to see the doctor?

You should call the doctor immediately if you experience any of the following near the wound after surgery:

• Increasing pain that does not respond to medications
• Drainage
• Swelling
• Pus
• Increasing redness

The risks associated with this surgery include:

• Pain or discomfort near the surgery site, which can persist for several months
• Infections, although uncommon, may occur
• Damage to a nerve located near the ganglion cyst
• Bleeding from the wound area
• The recurrence of a ganglion cyst in a few cases.

You may have a follow-up appointment with your surgeon one to two weeks after surgery to get the stitches removed.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.