OVERVIEW
Doctors at the Department of Gastroenterology at Sri Ramakrishna Hospital have immense experience dealing with the diagnosis and treatment of conditions of the digestive tract and liver. The diseases of this part of the body are extensive and complex and we have an excellent team of gastroenterologists and hepatologists working together to treat patients around the clock. We make use of the very latest technology and techniques to offer minimally invasive,laparoscopic surgical treatment to a number of patients. From gall bladder removal to hernia surgery,keyhole surgery has enabled thousands of our patients to recover quickly and continue living happy,healthy lives.
MEDICAL CONDITIONS
There is a sheath of muscle and fascia which runs the length of the torso from the ribs to the groin. This is called the abdominal wall and it holds in the intestines and the abdominal contents. Sometimes there are weak spots in this abdominal wall for a multitude of reasons. When this happens the abdominal contents which push outwards from the body, break through it and push through to the surface. This causes a bulge beneath the skin which is very often visible. The word hernia basically means ‘something coming through’ and thus aptly describes the condition. There are a number of types of hernia but the most common are inguinal (inner groin), femoral (outer groin), incisional (which results from an incision), hiatal (the upper stomach) and umbilical (at the belly button). As for the cause, the essential cause is pressure. Anything which causes excess pressure within the abdominal cavity combined with weakness of muscle in the abdominal sheath can result in a hernia. This can include heavy lifting of objects, constipation, consistent coughing, sneezing, bad nutrition, obesity and so on. There are a number of surgical interventions for hernias.
This is an inflammatory disease of the pancreas. The pancreas is a gland which is part of the digestive system. It produces hormones and enzymes which help to break down food. It also produces insulin which regulates the the glucose levels in the body. Chronic pancreatitis is long-term and progressive and results in the permanent damage of the pancreas in both function and structure. The most common cause for it is alcohol abuse and with the rising trends in income and consequent lifestyle changes, it is becoming more widespread. Some of the symptoms include pain in the region of the upper abdomen, nausea, vomiting, bloating, abdominal cramps, flatulence and so on. When it progresses it will render the pancreas unable to produce insulin which will result in type 2 diabetes.
Bile is a fluid for aiding digestion. It is made in the liver and stored in the gallbladder - a tiny organ. Sometimes some of the components in the bile may crystallise and harden. This leads to gallstones. Gallstones are comprised of cholesterol, salt and bilirubin. Most of them (around 80%) are made up of cholesterol while the rest are salt and bilirubin, called pigment stones. Some of the symptoms of gallstones are pain in the upper belly and upper back (lasting for up to several hours), nausea, vomiting, digestive problems and so on. Diagnosis is through blood tests, ultrasound, CT scans, MRCP (magnetic resonance cholangiopancreatography), endoscopic ultrasound and ERCP (endoscopic retrograde cholangiopancreatography). Surgical treatment for gallstones usually involves surgery to remove the gallbladder laparoscopically or through the traditional open method.
Haemorrhoids, also commonly known as piles, are swollen veins in and around the anus or located in the lower rectum. They can be internal or external i.e. within the anus or outside the anus and rectum. The latter is the most common. There are a number of things which contribute to haemorrhoids including straining during bowel movements, chronic constipation, extended seating on toilets, family history and so on. During pregnancy the chances of contracting haemorrhoids are higher. Haemorrhoids are very common and affect as many as half the population by the age of 50. They are also very treatable.
Within the entrance to the anus exist a number of small glands. Sometimes they can be blocked resulting in an abcess or an infected cavity. A fistula is a condition in which a tiny tunnel is formed from the infected gland within the anus to the area around the anus. Around half of all anal abcesses develop into fistulas. There are some other causes as well such as Crohn’s disease, sexually transmitted diseases, tuberculosis, trauma, diverticulitis and cancer. A fistula is diagnosed through rectal examination, an ultrasound and MRI. There are surgical procedures to treat the condition which have excellent results.
TREATMENTS & PROCEDURES
The traditional method of surgical treatment for hernia is called 'open hernia repair' and it may be done using local anaesthetic or general. The surgeon pushes the tissue which is protruding back into position. Then the weakened area of the abdominal wall is closed using sutures and the area is reinforced using a synthetic mesh. The opening is then closed using staples or even using surgical glue.
Here at Sri Ramakrishna Hospital we are also adept at using the laparoscopic or minimally invasive procedure (also called keyhole surgery). This is done under general anaesthesia. Multiple little incisions are made. Gas is used to inflate the cavity and then a laparoscope is passed into it. The surgeon views the region and then uses other instruments (inserted through other incisions) to repair the weakened section using mesh. This procedure has considerably less scarring and quicker recovery times with less pain for patients.
There are a number of surgical procedures which provide relief to people suffering from chronic pancreatitis.
Peustow’s Operation:
The pancreatic duct is opened up from head to tail. Then the small intestine is attached directly to the pancreatic duct using sutures. This results in the pancreatic juice directly draining into the small intestine. It is done either through open surgery or laparoscopically. Whipple Procedure: Also called a pacreaticduodenectomy or a pancreatoduodenectomy, the Whipple procedure involves removing the head of the pancreas, the duodenum, the proximal jejunum, gallbladder and distal stomach.
Whipple Procedure:
Also called a pacreaticduodenectomy or a pancreatoduodenectomy, the Whipple procedure involves removing the head of the pancreas, the duodenum, the proximal jejunum, gallbladder and distal stomach.
Haemorrhoidectomy:
This is a surgery to remove haemorrhoids. It is done under conventional anaesthetic for the most part although general may also be used. The procedure involves making incisions around the anus. This allows the surgeon to cut out the haemorrhoids. It gives patients relief from pain, swelling, bleeding and itching caused by the haemorrhoids. However, the incisions are in the sensitive place and require stitches, causing pain in itself. It is usually done as an outpatient procedure and patients go home the same day.
Stapler Haemorrhoids:
This is a minimally invasive procedure to treat a condition wherein the haemorrhoids slips out of the anal canal and down. To correct it, a staple repositions the haemorrhoids. It also cuts off blood supply causing them to die. It causes less pain and recovery is quicker
Laser:
As the name indicates, a laser is used in this minimally invasive procedure. It is precisely used to target haemorrhoid tissue which it burns away.
Rubber band ligation:
In this, a rubber band is installed around the base of the haemorrhoid. This cuts off blood supply and results in the death of the tissue.
Sclerotherapy:
In this, the principle is the same - reducing blood flow to the area. But, in this case, a chemical solution is used to to shrink the haemorrhoid and kill it.
There are several surgical approaches to treating an anal fistula. It is usually carried out under general anaesthetic although overnight stay may not be necessary. The main challenge is to not to damage the sphincter muscles (the muscles which control the opening and closing of the anus) as it can cause bowel incontinence.
Fistulotomy:
In this procedure, the surgeon cuts along the length of the fistula, thereby opening it up. This will allow it to heal as a flat scar. This is the most effective method but when it runs the risk of injuring the sphincter muscles, other techniques (as listed below) are preferred.
Seton Techniques:
A seton is a strip of surgical thread which is allowed to stay in the fistula for weeks, keeping it open. It allows it to drain and helps in healing while avoiding damage to the sphincter. Advancement Flap Procedure: In this procedure, the fistula is cut and scraped out first following which it is covered using a flap of tissue taken from inside the rectum.
Fibrin Glue or Collagen Plug:
Fibrin glue is made from plasma protein. It might be used for sealing up a fistula and healing it (instead of cutting it open). The tract is first cleaned and then the internal opening is closed using stitches. Then the glue is inserted through the external opening to seal the fistula. Alternatively, a plug made up of collagen protein may be used.
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