Bursectomy and Its Indications

Introduction

Bursectomy is a minimal-invasive operative procedure. The procedure has emerged as a medical intervention in managing musculoskeletal and inflammatory disorders. During this surgical procedure, the bursae are surgically extracted from the joints. A bursa is a sac filled with liquid and is made up of connective tissue. These are present in between the bones and tendons. The function of a bursa is to provide adequate movement of the joints and reduce friction. Due to any injury or trauma, the bursa between the joints gets inflamed, called bursitis. This will lead to a decrease in joint mobility, pain, and joint swelling. Bursitis can be acute or chronic.

• Acute bursitis can be due to any infection or trauma.

• Chronic bursitis can be due to chronic inflammation.

It is essential to consult a healthcare professional to get a bursectomy done. The article discusses bursectomy, its procedure, indications, contraindications, uses, and side effects.

What Are the Types of Bursectomy?

The two types of bursectomy are described below:

• Open Bursectomy: This is a surgical procedure in which the healthcare provider directly sees the bursae and removes them.

• Endoscopic Bursectomy: The other name of endoscopic bursectomy is arthroscopic bursectomy. During this procedure, the healthcare provider may make multiple incisions, and through those incisions camera is inserted, which may help guide the procedure.

How Is Bursectomy Performed?

The procedure of bursectomy is described below:

1. Before the Procedure: The steps before the procedure are as follows:

• The healthcare provider may require evaluations such as X-rays or ultrasounds of the bursa.

• The pre-operative tests are performed, such as Electrocardiogram (ECG) and blood tests to check for heart activity and infections. In addition, the blood pressure of the patient is checked.

• The person should inform the doctor, in case if they are taking any medication before the procedure. The healthcare provider may advise the patient to discontinue such medications a week before the surgery. The antihaemorrhagic drugs should be discontinued a few weeks before the surgery. These are discontinued to prevent bleeding during the surgical procedure.

• The patient may be advised not to consume beverages or food one night before the surgery.

2. Bursectomy Procedure: The healthcare provider may give general or local anesthesia. The choice of anesthesia is based on the location of the bursa. The two types of bursectomy procedures are as follows:

• Endoscopic Bursectomy: This type of bursectomy is generally advised in case of shoulder injury. The steps of the procedure of endoscopic bursectomy are as follows:

  • The patient is asked to lie down on their back. The compression bandage is placed near the surgical site. This applies pressure on the affected limb.

  • The affected skin is cleaned with an antiseptic solution.

  • The doctor may make two incisions, one in the center and the other toward the edge of the affected area.

  • The endoscope or camera is inserted into the one incision, which may guide the surgical instruments.

  • The shaver tool is used to remove or trim the liquid present in the bursa.

  • After the fluid extraction from the bursa, the incisions are closed with the help of the suture. The procedure causes less discomfort and faster recovery than the open bursectomy. The patient can go home on the same day of the surgery.

• Open Bursectomy: This type of bursectomy is recommended in case of knee or elbow joint injury. The steps of the open bursectomy procedure are as follows:

  • The healthcare provider may ask the patient to lie on their back and administer regional anesthesia.

  • The doctor may make an incision over the affected joint. After making an incision, once the doctor visualizes the bursa, will remove it.

  • The incision is closed with absorbable sutures. Dressings are placed over the surgical area for ten days.

  • The total time of the procedure is a maximum of two hours.

3. Post-Surgical Care:

• After surgery, the healthcare provider may check heart rate and blood pressure.

• The ice pack is applied over the surgical area to reduce swelling.

• The compression bandage is kept for at least three days.

• A course of antibiotics is prescribed to reduce infection and inflammation.

• Some physiotherapy exercises are recommended to improve joint mobility.

• The person can begin sports-related activities after three to four months of surgery.

What Are the Indications of Bursectomy?

The indications for bursectomy are as follows:

• An individual experiencing chronic bursitis can seek a bursectomy procedure, which may reduce chronic pain and inflammation.

• The bursitis may recur again and again. During this case, the person can go for a bursectomy procedure, in which other treatment fails to resolve the condition.

• In the case of septic bursitis, bursectomy is indicated to remove the infected tissue and reduce the spread of an infection.

• To manage Rheumatoid Arthritis (joint inflammation) symptoms.

• Removal of calcium bursa can be done through bursectomy. Calcium bursa can lead to inflammation and pain.

• In case of irritation to adjacent tendons due to bursal inflammation. Bursectomy procedures can reduce pain and improve function.

• In case of traumatic injury to the bursa.

• Bursitis can cause a restricted range of motion. The bursectomy procedure is recommended to ease physical impairments.

• Bursectomy is the best option in which other conservative treatments fail to resolve the symptoms.

What Are the Contraindications of Bursectomy?

The contraindications of bursectomy are as follows:

• Medically unstable people are not suitable for bursectomy.

• Active local or systemic infection may raise the risk of post-operative infections.

• People with bleeding disorders.

• People have severe heart conditions, such as myocardial infarction (heart muscle death).

• People with severe respiratory diseases, such as asthma.

• Poor health status.

• Anatomical concerns, such as the involvement of multiple bursae during the surgical procedure.

What Are the Benefits of Bursectomy?

Several benefits of bursectomy are as follows:

• Bursectomy helps in relieving pain and discomfort.

• It improves the patient's quality of life.

• The person after this procedure can resume their daily activities.

• With this procedure, joint function and mobility are improved.

• It helps in the resolution of chronic inflammation.

• For people with recurrent bursitis, the bursectomy procedure prevents future recurrent episodes and removes the inflamed bursa.

• The situation in which other conservative treatments are ineffective, such as anti-inflammatory medications and physical therapy. The bursectomy procedure is an effective treatment intervention.

• In the case of septic bursitis, the further spread of infection is prevented by removing infected tissue.

• It reduces pressure on adjacent structures.

What Are the Side Effects of Bursectomy?

The bursectomy procedure is generally safe and effective. In addition, there are several side effects and complications, which are described below:

• Pain and discomfort in the surgical area. These can be managed by taking pain medications.

• There can be a risk of infection at the surgical site. The infection can be prevented by taking proper antibiotic medications. If the person fails to take proper antibiotic therapy, there can be skin death or necrosis.

• There can be scar formation at the surgical site.

• In some cases, there can be a risk of nerve damage.

• The procedure can cause joint stiffness and reduced joint mobility. The doctor may recommend physical therapy to prevent joint stiffness.

• There can be allergic reactions to anesthesia, medications, and surgical materials.

• There is the possibility of recurrence of inflamed bursa.

• Formation of blood clots. To prevent blood clot formation, the doctor recommends medications and physical therapy.

Conclusion

In conclusion, bursectomy is a minimally invasive operative procedure to treat inflamed bursa. The procedure is safe. However, there are certain complications. Before going for the procedure, the patient should discuss with the healthcare provider about the benefits and risks. The benefits include improved joint mobility and reduced pain, swelling, and inflammation. Rarely, there can be blood clot formation, infection, and nerve damage. People may resume their normal daily activities after this procedure.