Excision of ganglion

Summary

This operation is performed for symptoms caused by a ganglion, a benign, harmless swelling occurring from a joint or tendon.  The ganglion occurs when synovial fluid from the affected joint or tendon escapes and collects into a cyst.  Ganglions may or may not be painful.  Removal or aspiration can be performed if it is painful but there is a reasonable chance that the ganglion can recur.

Factors to Consider

You have been diagnosed with a ganglion.  It is likely that you have already tried non-surgical treatments for this such as pain killers, footwear modification, weight loss and injections.  

If these measures have not improved your symptoms then the next logical step is to consider surgery.  

Description of Surgery

The procedure can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation is performed through a small incision over the ganglion itself.  The ganglion cyst can then be removed in its entirety.  The operation takes about 30 minutes.

Anaesthetic

The operation may be performed under a local or general anaesthetic depending on the size or location of the ganglion.  If it is under a general anaethetic you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The main risk is recurrence of the ganglion and this is seen in about 20% of patients.   The risk of infection is small and is thought to be less than 1%.  Most infections will settle simply with antibiotics.  Damage to nerves and blood vessels around the foot can occur but this is rare.  

Surgery to the foot may increase the risk of developing a clot in your leg (DVT).  Your surgeon will assess your risk of this prior to surgery and may offer you blood thinning medication if your risk is considered high.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the foot may be sore after it wears off.  You will be given a combination of pain killers to go home with.  

Dressings

You will wake up with your foot in a bandage.  You will be able to walk on your foot but it may take a number of weeks before you can wear your normal footwear again.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able perform an emergency stop.  This will vary between patients but normally takes a few weeks.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 6 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable but the expectation is that you will make a full recovery in the first 6 weeks.