General Surgery

A laparoscopic Fundoplication is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to perform the procedure through four tiny incisions, most of which are less than a half-centimetre in size. One advantage of this method is a brief hospitalization. Most of the time it will require an overnight stay. Other advantages include less pain (less of a need for pain medication), fewer and smaller scars, and a shorter recovery time.

Laparoscopic Fundoplication is a safe and effective treatment of GORD. However, in rare cases the laparoscopic approach is not possible because it becomes difficult to visualize or handle organs effectively. In such instances, the traditional incision may need to be made to safely complete the operation.

Hiatal Hernia

A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Although hiatal hernias are present in approximately 15% of the population, they are associated with symptoms in only a minority of those afflicted.

Normally, the esophagus or food tube passes down through the chest, crosses the diaphragm, and enters the abdomen through a hole in the diaphragm called the esophageal hiatus. Just below the diaphragm, the esophagus joins the stomach. In individuals with hiatal hernias, the opening of the esophageal hiatus (hiatal opening) is larger than normal, and a portion of the upper stomach slips up or passes (herniates) through the hiatus and into the chest. Although hiatal hernias are occasionally seen in infants where they probably have been present from birth, most hiatal hernias in adults are believed to have developed over many years.

Types of Hiatal Hernia

• Sliding Hiatal Hernia: The most common (95%) is the sliding hiatus hernia, where the gastro-esophageal junction moves above the diaphragm together with some of the stomach.
• Rolling Hiatal Hernia: The second kind is rolling (or paraesophageal) hiatus hernia, when a part of the stomach herniates through the esophageal hiatus and lies beside the esophagus, without movement of the gastro-esophageal junction. It accounts for the remaining 5% of hiatus hernias.

Laparoscopic (Key Hole) Hiatal Hernia Surgery Disease in India

The procedure is often done ‘laparoscopically’ through five small (1.5 cm) cuts (incisions) in your abdomen. The video camera and special instruments are then inserted through the incisions to do the repair. You may undergo a “Nissen” Hiatal Hernia procedure where the stomach is wrapped around the lower end of the esophagus to tighten up the sphincter.

Occasionally, the surgeon is unable to do the procedure laparoscopically and must convert to open surgery in order to make it safer for you. In this case, you will have an incision in the middle of your abdomen and your recovery will be longer. To help prevent blood clots from forming in your legs during and after surgery, sequential compression stockings may be applied.

A hernia is an opening or weakness in the muscular structure of the wall of the abdomen. This defect causes a bulging of the abdominal wall. This bulging is usually more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. Any activities that increase intra-abdominal pressure can worsen a hernia; examples of such activities are lifting, coughing, or even straining to have a bowel movement. Imagine a barrel with a hole in its side and a balloon that is blown up inside the barrel. Part of the inflated balloon would bulge out through the hole. The balloon going through the hole is like the tissues of the abdomen bulging through a hernia.

A hernia is sometimes described as a rupture and is found commonly as a lump in the groin area. This type of hernia is referred to by doctors as a primary inguinal hernia. A hernia develops when a loop of the gut bulges out through a weakened part of the abdominal wall. Hernias can occur at any age and affect both men and women.

Types of Hernia

• INGUINAL HERNIA (or Groin Hernia) – Commonly occurs in males. – commonly occurs in males.
• Congenital – Present since birth.
• Acquired – Acquired during the lifetime. The common conditions leading to this type of hernia are-
• Lifting of heavy weights.
• Doing strenuous exercises.
• Later in life when the abdominal musculature becomes weak.
• FEMORAL HERNIA – Occurs below the inguinal ligament and through the Femoral Canal. This commonly occurs in females.

Minimally Invasive Hernia Surgery Options at World’s Best Hospitals in India

• Laparoscopic Inguinal Hernia Repair
• Laparoscopic Paraesophageal Hernia Repair
• Laparoscopic Ventral and Incisional Hernia Repair
• Laparoscopic Nissen Fundoplication for Hiatal Hernia/Gastroesophageal Reflux Disease
• Laparoscopic Paraesophageal Hernia Repair
• Laparoscopic Paraesophageal Hernia Repair
• Herniorrhaphy and Hernioplasty

Advantages of Laparoscopic Hernia Repair

• Latest & better mode of treatment for hernia is laparoscopic repair.
• Done by imported state of art miniature karl storz instrumentation.
• Done through small hole in the abdominal wall.
• Short hospital stay.
• No scar at the hernial site
• Cosmetically superior.
• Best for recurrent or bilateral inguinal hernias.
• Almost no pain or infection.
• Bigger hernia can be treated laparoscopically.
• Less need of medications.
• Minimal blood loss.

Fibroids are growths enclosed in capsules in the wall of your womb. They don’t spread to other parts of your body, except in very rare circumstances.

Fibroids are very common – around one in two women will be affected at some point in their lives. However, most don’t ever get any symptoms. You may have only one fibroid or you may have many fibroids of different sizes. Fibroids can range from being very small to around the size of a basketball.

Fibroids are named according to where they are found in your womb

• Intramural fibroids grow within the muscular wall of your womb.
• Subserous fibroids grow from the outside wall of your womb into your pelvic cavity. They can become very large.
• Submucosal fibroids grow from the inner wall of your womb into the space inside your womb.
• Pedunculated fibroids grow from the outside of your womb. These fibroids are almost free of the wall of your womb and are only attached by a narrow stalk.

Fibroid growth is very slow and can be stimulated by hormones – especially oestrogen. Fibroids tend to become smaller and reduce in number when your oestrogen levels fall, such as after the menopause.

Symptoms of fibroids

Fibroids don’t usually cause symptoms. However, you may get one or more of the symptoms listed below, often depending on where the fibroid is within your womb. You may:

• have heavy periods, sometimes leading to anaemia
• feel pain in your tummy (abdomen)
• have swelling in your pelvic area
• pass urine more often than normal, or feel an urgent need to pass urine – this happens if a fibroid is pressing on your bladder
• have constipation – this happens if a fibroid is pressing on your bowel

Diagnosis of fibroids

Most women with fibroids have no symptoms, so they often go undetected. Sometimes they are found during a routine gynaecological (vaginal) examination. If you have symptoms, such as pain or heavy periods, your doctor may do the following tests.

• An internal examination to check the size of your womb. This is because having an enlarged womb indicates that you may have fibroids.
• An ultrasound scan. This uses sound waves to produce an image of part of your womb and can confirm if you have fibroids.
• An MRI scan. This uses magnets and radiowaves to produce images of the inside of your womb.Hysteroscopy. This is a test that involves your doctor putting a small camera into your vagina to look inside your womb.
• Blood tests to check for anaemia.

Minimally Invasive Surgery for Fibroids at World’s Best Hospitals in India

Fibroid Embolization

It is a minimally invasive procedure, which means it requires only a tiny nick in the skin. It is performed while the patient is conscious but sedated – drowsy and feeling no pain. Fibroid embolization is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally invasive procedures. The interventional radiologist makes a small nick in the skin (less then ¼ of an inch) in the groin and inserts a catheter into an artery. The catheter is guided through the artery to the uterus while the interventional radiologist guide the progress of the procedure using a moving X-ray (fluoroscopy). The interventional radiologist injects tiny plastic particles the size of grains of sand into the artery that is supplying blood to the fibroid tumor.

This cuts off the blood flow and causes the tumor (or tumors) to shrink. The artery on the other side of the uterus is then treated. Embolization preparation: A tiny angiographic catheter is inserted through a nick in the skin in to an artery and advanced into uterus.

Advantages of Nonsurgical Fibroid Embolization

On average, 85-90 percent of women who have had the procedure experience significant or total relief of heavy bleeding, pain and/or bulk-related symptoms.

Requires only a tiny nick in the skin (No surgical incision of abdomen).

Recovery is shorter than from hysterectomy or open myomectomy.

All fibroids are treated at once, which is not the case with myomectomy. There has been no observed recurrent growth of treated fibroids in the past 9 years.

Uterine fibroid embolization involves virtually no blood loss or risk of blood transfusion.

Many women resume light activities in a few days and the majority of women are able to return to normal activities (including exercise) within a week. If the presenting complaint was excess vaginal bleeding, 87-90% of cases experience resolution within 24hours.

Thyroid is a butterfly-shaped gland in your neck, just above your collarbone. It is one of your endocrine glands, which make hormones. Thyroid hormones control the rate of many activities in your body. These include how fast you burn calories and how fast your heart beats. All of these activities are your body’s metabolism. If your thyroid gland is not active enough, it is called hypothyroidism. It can make you gain weight, feel fatigued, and have difficulty dealing with cold temperatures.

If your thyroid is too active, it makes more thyroid hormones than your body needs. That condition is called hyperthyroidism. Too much thyroid hormone can make you lose weight, speed up your heart rate, and make you very sensitive to heat.There are many causes for both conditions. Treatment involves trying to reset your body’s metabolism to a normal rate. The thyroid gland can also develop cancer.

Disorders of Thyroid

• Hypothyroidism: This disorder attacks women more than men. Hypothyroidism results from under-active thyroid gland which results in less production of thyroid hormones that leads to lots of weight gain, hypertension and other problems. This is a very common disease which occurs in many children and aged people.
• Hyperthyroidism: Hyperthyroidism results from over active the thyroid glands which result in increased production of thyroid hormones which leads to over stimulation (weight loss, tension, anxiety and others).
• Postpartum Thyroiditis : After giving birth to a baby, a female’s thyroid glands may swell and turn larger in size. This type growth of glands to a very large extent is due to Postpartum Thyroiditis.
• Thyroid Cancer : Thyroid cancer is also of many types. This is due to the lump. Once you are affected by thyroid cancer, surgery is the only option.

Thyroidectomy

A thyroidectomy is an operation to remove all, or part, of your thyroid gland. If all of your thyroid gland is removed, it’s called a total thyroidectomy. If only part of it is removed, it’s called a partial thyroidectomy, a sub-total thyroidectomy or a lobectomy. A thyroidectomy is used to treat several conditions, including

• an overactive thyroid gland (hyperthyroidism) – a condition where your thyroid gland produces and releases excess hormones
• an enlarged thyroid gland (goitre)
• cancer of your thyroid gland
• a cyst or benign (non-cancerous) lump on your thyroid gland
• Total Thyroidectomy: It is the most common of type of thyroid surgeries. With this surgery the entire gland is removed. Surgery of this type is most often used on the aggressive types of thyroid cancers such as medullary and anaplastic. It is also used in the treatment of uncontrollable hyperthyroidism/Graves’ and for goitres. When papillary and follicular thyroid cancer cells are found in both lobes a total thyroidectomy will be performed.
• Partial/Subtotal Thyroidectomy: It is the operation where only a portion of the gland is removed. Occasionally the isthmus and a piece of the second lobe may also be removed. This operation is used in small and non-aggressive thyroid cancers such as papillary and follicular. The thyroid cancer is contained to one lobe only.

Minimally Invasive Thyroid Surgery in India

Minimally invasive thyroid surgery is performed through a small 2-3cm keyhole incision placed directly over the enlarged thyroid nodule. It is generally suitable for patients with small thyroid nodules, less then 3cm in maximum diameter. Through the small incision the surgeon removes the thyroid nodules as well as the surrounding thyroid gland, taking great care not to injure the nearby nerves. The skin incision is closed and many patients can go home after an overnight stay in hospital.

This technique allows the surgeon to see inside the patient’s body and operate through a much smaller incision than would otherwise be required for traditional open surgery.

Compared Open Surgery with Minimally Invasive Thyroid Surgery can have the following potential benefits

• Faster recovery time and return to normal activities.
• Small incision and local anesthesia
• Decreased chances for complications
• Less bleeding and postoperative pain
• Fewer and/or smaller scars
• Minimal blood loss.