Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. The World Bank in 2002 reported that an estimated 164 million disability-adjusted life years, representing 11% of the entire disease burden, were attributable to surgically treatable conditions

If the surgery is categorized according to the medical specialty/ system involved, among the 426 surgical procedures reported it was seen maximum number of surgeries were Obstetrics and Gynaecology related (32.4%). Next most common system was abdominal surgery (29.3%), cardiovascular (14.3%), ophthalmic (11%), orthopedic (5.4%), head & neck (3.5%) and surgeries involving other systems (4%).

In this study 61.7% surgery were elective in nature and rest 38.3% were emergency type. These included 3.75% surgeries that had been carried out on an emergency basis following an accident. Majority of the surgeries (81.9%) were carried out in the private hospitals, only 17.8% surgeries were done in a Government hospital and rest were in other hospitals like ESI hospital

Common surgical procedures:

Some of the most common surgical operations performed in the India include the following:

Gall bladder stones: It is the presence of stones in the gall bladder that explains almost all of the ills inflicted by this organ. The processof stone formation is thought to be the result of a triple defect:

Patients with gall stones have even more unstable bile than the rest of us

They have more sluggish activity of the gall bladder, which allows crystals to grow into large stones

They are also more prone to nucleate crystals in the first place, thereby initiating theprocess.

Cases: At Apollo Hospital, New Delhi, the author did a study on urban affluent people ( see adjoining graph) coming to the hospital for a routine health check and found that 18 percent of females and 9 percent of males suffered from gall stones ( Over all incidence of 12% ). This is higher than the average incidence in US and Western Europe of 8%. In New Delhi hospitals, a total of approximately 100 operations are done every day for this ailment.

Appendectomy/Appendicitis/Appendix An appendectomy is the surgical removal of the appendix, a small tube that branches off the large intestine, to treat acute appendicitis. Appendicitis is the acute inflammation of this tube due to infection.

Cases:

Appendicitis is most common between the ages of 5 and 40;[58] the median age is 28. It tends to affect males, those in lower income groups, and, for unknown reasons, people living in rural areas.[59] In 2013 it resulted in 72,000 deaths globally down from 88,000 in 1990

Cases:

India has now the world's third largest number of obese individuals following USA and China. We have 20% of our population classified as obese, 40% as malnourished and 40% normal weight.

Our diabetic population is world's highest and there is correlation between diabetes, metabolic syndrome and obesity. India has already been labelled as the Diabetes capital of the world with nearly 80 million diabetics.

Cardiovascular disease

Ischemic heart disease (IHD) is the leading cause of death in economically developed countries and is rapidly assuming serious dimensions in developing countries. It is expected to be the single most important cause of death in India by the year 2015

Cases: Cardiovascular disease According to recent estimates, cases of CVD may increase

from about 2.9 crore in 2000 to as many as 6.60 crore in 2015, and the number of deaths from CVD will also more

than double.

Cancer

Cases: Cancers account for 14% of the overall NCD mortality and 7% of the NCD related DALYs in India6 . The pooled estimates for data of all six population based registries (Delhi, Mumbai, Chennai, Barshi, Bangalore and Bhopal) were 25.19 per lakh for men and 23.52 per lakh for women in 2004. The prevalence of cancer in India is estimated to be around 2.5 million, with over 800,000 new cases and 550,000 deaths occurring each year due to this disease in the country17. In India, cancers account for about of 3.3% of the disease burden and about 9% of all deaths.

There are about 2.8 million cases of cancer at any point of time1 An estimated increase of 19.2 % cases in last 10 years1 Approx. 0.8 million new cases occur every year out of which 5 lakh deaths occurs

Oral and dental diseases

Available data on the current prevalence and future projections for oral health conditions suggest an increase by 25% over the next decade.

Kidney stones are hard mass deposits that form in the kidney or ureter. They are made up of tiny crystalline minerals and acid salts that settle out of the urine and stick together.Cases:

Mental health disorders

Mental health was a much neglected field until recently.There is, however, increasing realization that conditions

such as schizophrenia, mood disorders (bipolar, manic, depressive and persistent mood disorders) and mental

retardation can impose a marked disease burden on Indians. This was confirmed by a study conducted for the NCMH

which stated that at least 6.5% of the Indian population had some form of serious mental disorder, with no discernibleruralurban differences; women had slightly higherrates of mental disorder than men.

COPD:

Chronic obstructive pulmonary disease(COPD), also known aschronic obstructive lung disease(COLD)Chronic Obstructive Pulmonary Disease (COPD) kills more than 3 million people every year, making it the 4th largest cause of death in the world. It has been estimated that by the year 2030, COPD will become the third biggest cause of death. According to the World Health Organisation, COPD kills more people than HIV-AIDS, Malaria and Tuberculosis all put together in the South East Asian region

Cataract: A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. By age 80, more than half of all Indians either have a cataract or have had cataractsurgery.

A cataract can occur in either or both eyes. It cannot spread from one eye to theother.

Cases:

Using age-specific data for those aged 50+ years it was observed that prevalence of blindness at different age cohorts (above 50 years) reduced over three decades with a peak in 1989. Projections show that among those aged 50+ years, the quantum of cataractsurgerywould double (3.38 million in 2001 to 7.63 million in 2020) and cataractsurgicalrate would increase from 24025/million 50+ in 2001 to 27817/million 50+ in 2020. Though the prevalence of cataract blindness would decrease, the absolute number of cataract blind would increase from 7.75 million in 2001 to 8.25 million in 2020 due to a substantial increase in the population above 50 years inIndiaover this period

Projections show that among those aged 50+ years, the quantum of cataract surgery would double (3.38 million in 2001 to 7.63 million in 2020) and cataract surgical rate would increase from 24025/million 50+ in 2001 to 27817/million 50+ in 2020.

Diabetes

Cases:Diabetes is also associated with an increased risk for CVD,and is emerging as a serious health challenge in India.Even though it accounted for only about 0.7% of Indias disease burden in 1998, data suggest a significant load of diabetes cases in Indiarising from 2.6 crore in 2000 to approximately 4.6 crore by 2015, and particularly concentrated in the urban population.

Hernia : The lump of the hernia is due to the weakness in the wall of the muscles of the abdomen or groin. The content of the sac is usually a part of the intestine.About 25% of males and 2% of females develop inguinal hernias; this is the most common hernia in males and females. Approximately 75% of all hernias occur in the groin; two thirds of these hernias are indirect and one third direct.