Symptoms, Causes, Prevention and Treatment of Hernia with Laparoscopic Surgery in Pune by Sanjay Kolte

What Is a Hernia?

A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. The most common types of hernia are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).

In an inguinal hernia, the intestine or the bladder protrudes through the abdominal wall or into the inguinal canal in the groin. About 80% of all hernias are inguinal, and most occur in men because of a natural weakness in this area.

In an incisional hernia, the intestine pushes through the abdominal wall at the site of previous abdominal surgery. This type is most common in elderly or overweight people who are inactive after abdominal surgery.

A femoral hernia occurs when the intestine enters the canal carrying the femoral artery into the upper thigh. Femoral hernias are most common in women, especially those who are pregnant or obese.

In an umbilical hernia, part of the small intestine passes through the abdominal wall near the navel. Common in newborns, it also commonly afflicts obese women or those who have had many children.

Hernia Causes

Although abdominal hernias can be present at birth, others develop later in life. Some involve pathways formed during fetal development, existing openings in the abdominal cavity, or areas of abdominal wall weakness.

Any condition that increases the pressure of the abdominal cavity may contribute to the formation or worsening of a hernia. Examples include:

·         obesity,

·         heavy lifting,

·         coughing,

·         straining during a bowel movement or urination,

·         chronic lung disease, and

·         fluid in the abdominal cavity.

A family history of hernias can make you more likely to develop a hernia. 

Hernia Symptoms and Signs

The signs and symptoms of a hernia can range from noticing a painless lump to the severely painful, tender, swollen protrusion of tissue that you are unable to push back into the abdomen (an incarcerated strangulated hernia).

Reducible hernia

·         It may appear as a new lump in the groin or other abdominal area.

·         It may ache but is not tender when touched.

·         Sometimes pain precedes the discovery of the lump.

·         The lump increases in size when standing or when abdominal pressure is increased (such as coughing).

·         It may be reduced (pushed back into the abdomen) unless very large. 

Irreducible hernia

·         It may be an occasionally painful enlargement of a previously reducible hernia that cannot be returned into the abdominal cavity on its own or when you push it.

·         Some may be chronic (occur over a long term) without pain.

·         An irreducible hernia is also known as an incarcerated hernia.

·         It can lead to strangulation (blood supply being cut off to tissue in the hernia).

·         Signs and symptoms of bowel obstruction may occur, such as nausea and vomiting.

Strangulated hernia

·         This is an irreducible hernia in which the entrapped intestine has its blood supply cut off.

·         Pain is always present, followed quickly by tenderness and sometimes symptoms of bowel obstruction (nausea and vomiting).

·         The affected person may appear ill with or without fever.

·         This condition is a surgical emergency.

Hernia Medical Treatment

Treatment of a hernia depends on whether it is reducible or irreducible and possibly strangulated.

Reducible hernia

In general, all hernias should be repaired to avoid the possibility of future intestinal strangulation.

If you have preexisting medical conditions that would make surgery unsafe, your doctor may not repair your hernia but will watch it closely.

Some hernias have or develop very large openings in the abdominal wall, and closing the opening is complicated because of their large size.

The treatment of every hernia is individualized, and a discussion of the risks and benefits of surgical versus nonsurgical management needs to take place between the doctor and patient.

Irreducible hernia

All acutely irreducible hernias need emergency treatment because of the risk of strangulation.

An attempt to reduce (push back) the hernia will generally be made, often after giving medicine for pain and muscle relaxation.

In cases in which the hernia has been strangulated for an extended time, surgery is performed to check whether the intestinal tissue has died and to repair the hernia.

In cases in which the length of time that the hernia was irreducible was short and gangrenous bowel is not suspected, you may be discharged from the hospital.

If a hernia that appears irreducible is finally reduced, it is important to consider a surgical correction. These hernias have a significantly higher risk of getting incarcerated again.

What is Endoscopic and it's Type

Short history of endoscopy

Reports indicate that the first endoscope was devised in 1805. It consisted of a large tube and a candle. Because it was cumbersome and large it had very limited uses. Fiber optics, which appeared in the 1960s, was a major factor in the endoscopy revolution. With fiber optics it really became possible for the doctor to see and record the inside of the patient's body with a small and relatively painless device.

What is Endoscopic Surgery?

Endoscopic surgery uses scopes going through small incisions or natural body openings in order to diagnose and treat disease.

Endoscopic surgery uses scopes going through small incisions or natural body openings in order to diagnose and treat disease. Another popular term is minimally invasive surgery (MIS), which emphasizes that diagnosis and treatments can be done with reduced body cavity invasion.

Types of endoscopies

Here is a list of some types of endoscopies and their meanings:

• Amnioscopy - examination of the amniotic cavity and fetus.
• Arthroscopy - examination of the joints.
• Bronchoscopy - examination of the air passages and the lungs.
• Colonoscopy - examination of the colon.
• Colposcopy - examination of the cervix and the tissues of the vagina and vulva.
• Cystoscopy - examination of the urinary bladder.
• EGD (Esophageal Gastroduodenoscopy), also known as panendoscopy - examination of the esophagus, stomach and duodenum.
• ERCP (endoscopic retrograde cholangio-pancreatography) - examination of the liver, gallbladder, bile ducts, and pancreas.
• Fetoscopy - examination of the fetus.
• Laparoscopy - a small incision to examine the abdominal cavity.
• Laryngoscopy - examination of the back of the throat, including the voice box (larynx) and vocal cords.
• Proctoscopy - examination of the rectum and the end of the colon.
• Rhinoscopy - examination of the inside of the nose.
• Thoracoscopy - examination of the lungs or other structures in the chest cavity.

Treating Diabetes Wounds - Dr. Sanjay Kolte, General Surgeon in Pune

Diabetes is a chronic disease where the blood sugar level increases. This can be due to the inability of pancreas to produce enough insulin or due to failure of the cells to respond to the insulin produced. Increased thirst, increased hunger and increased urination are common symptoms of diabetes.

When you have diabetes, then you are strictly not allowed to ignore a minor wound on your body. A minor cut, if neglected, can cause major problems to a diabetic person. 

These include:

• Weakened Immune System: A minor wound can also cause infection if the body’s immune system is down.

• Neuropathy:You don’t feel the pain of a blister or cut until it gets worse.

• Narrow Arteries: People with narrow arteries are more likely to get wound infections and their wound healing process also is slow.

Symptoms of Foot Ulcers:

Any person who has diabetes can develop foot ulcer. Pain is not a very common symptom for this, because most of the people lose the feeling of pain. You can see redness or swelling, and not notice some bad odour.

Treating the diabetic wound:

• No matter how small the wound is, if you have diabetes, then it must be healed as early as possible to avoid any type of infection.

• Don’t Waste Time: Take care of the wound immediately so as to avoid any further infection or major problem.

• Clean-up the Wound: Remove the dirt by rinsing the wound under running water. Apply antibiotic ointment and cover the wound with sterile bandage. Change the bandage daily.

• See your Doctor: Don’t ignore even minor symptoms of wound and see your doctor immediately. Have the wound healed before it causes infection.

Proper Care: If your wound is healing, take proper care of the affected area. For example, if you have wound at the foot, make sure you wear proper footwear and socks. And keep the affected area clean.

Laparoscopic Surgery Treatment for Paraesophgeal Hernia

Minimally invasive surgical techniques have revolutionized the treatment par esophageal hernia—but there's continued controversy over some key technical aspects of the procedure. Five nationally recognized leaders in fore gut surgery "systematically and point-by-point" outline their approach to this effective but technically challenging procedure. The special feature section provides "a fascinating picture in which all authors agree that the basic principles of the operation should be respected," according to an introductory article by Dr. Sanjay Kolte. " 

Paraesophgeal hernia is a common condition in which part of the stomach becomes herniated through the diaphragm and into the chest—higher than the junction between the esophagus and stomach. In addition to stomachache and difficulty swallowing, patients may experience chest pain, especially after meals, and shortness of breath. When other treatments can't relieve symptoms, surgery is recommended.

In the past, surgery was performed through an open incision in the abdomen or chest. But over the past decade, minimally invasive laparoscopic approaches have revolutionized the treatment of Paraesophgeal hernia.

Laparoscopic surgery provides excellent results with a low rate of recurrent hernia, less pain, and faster recovery.

But the laparoscopic procedure is technically challenging, with a "long learning curve" for surgeons, and is best performed by experienced specialists at referral medical centers. And even among the experts, there is ongoing debate regarding key areas of surgical technique.

Cancer Treatment - Cancer Surgeon in Pune, Maharashtra

Cancer, broadly called as malignancy, is caused due to abnormal growth of the cells. There are about 100 types of cancer and the symptoms and treatment of each varies from the other. Cancer types include skin cancer, lung cancer, lymphoma, breast cancer, prostate cancer, colon cancer, etc.

Normal cells follow a fix and orderly pattern of growth, division and death. But when this pattern breaks down, cancer starts to grow in the body. The cancer cells grow and divide. Due to this, there is uncontrollable growth of cells all over the body which hampers its proper functioning.

Treatment to cure cancer depends on the type of cancer and its stage. This may include traditional treatments like surgery, chemotherapy, radiation therapy and new forms of treatments and complementary and alternative therapies.

Cancer Surgery:

It is used to detect cancer, determine its stage and cure it. Biopsy, a surgery type, is used to diagnose cancer. In biopsy, a tissue sample from the affected area is taken and is examined to determine the presence of cancer.  Every cancer affected person will have some type of surgery. Surgery is most effective and cures the person completely if the cancer has not spread to other parts of the body.

Chemotherapy:

Chemotherapy involves use of drugs or medicine to treat cancer. It may consist of a single drug or combinations of drugs. It is given orally in the form of a pill, administered in the vein or injected in the body cavity.  Most of the cancer affected people are given chemotherapy. If one becomes aware of the side effects and outcomes of this method, then chemotherapy can prove pretty helpful.

Radiation Therapy:

Radiotherapy or radiation therapy uses high energy particles or waves to damage or destroy the cancer cells. This method is used to eradicate visible tumours. However this method is not useful if the cancer cells have spread all over the body. It is used to cure or eliminate cancer or to provide relief from some of the symptoms of cancer. Radiation therapy is used with other methods of treatment or sometimes alone.

Hormonal Therapy:

Hormonal therapy is used to breast cancer or prostate cancer. Hormones are the natural substances that stimulate the growth of hormone sensitive tissues like the prostate gland. When cancer occurs in breast or prostate tissue, then the hormones may cause the cancer cells to grow and spread in the body. This can be avoided by using a drug that controls the hormones from doing so.

Targeted Therapy:

This is the newer treatment method of cancer. In this method, only the cancer cells are targeted and killed. In conventional methods like chemotherapy, healthy cells are also killed along with cancer cells. Newer methods of treatment use drugs that can distinguish between healthy cells and cancer cells.

Apart from these, there are also other treatments of cancer like 

immunotherapy :

It uses body’s immunity to fight cancer, 

hyperthermia : 

It uses heat to treat cancer, stem cell transplant, photodynamic therapy, Laser treatment, etc.

Colorectal Cancer

Colon cancer is caused at the large intestine i.e. colon (lower part of the digestive system) and rectal cancer is the cancer caused at the end of the colon. Together they are denoted as colorectal cancers. It is also known as bowel cancer. It is caused due to uncontrolled cell growth in the colon or rectum or in appendix. This cancer can show prominent symptoms of anemia and rectal bleeding.

The cancer begins with a small, non-cancerous benign of cell called as polyps. With time, these polyps become colon cancer. Doctors recommend regular screening tests to avoid colon cancer by early identification of polyps before they cause colon cancer. Bowel cancer is diagnosed through colonoscopy or sigmoidoscopy.

The research shows that colorectal cancer is the third most commonly diagnosed cancer all over the world. But it is observed that mostly people of the developed countries are affected by colorectal cancer. This type of cancer is caused to lifestyle and increasing age. Minority cases show underlying genetic disorders as the cause of this cancer.

Colorectal cancer starts in the lining of the bowel and grows into the muscles layers underneath and then through the bowel wall, if not treated on time. At the age of 50 till 75 years of age, screening is recommended to decrease the chances of death due to colorectal cancer. If diagnosed and treated on time, colorectal cancer is curable. If not, then chemotherapy, surgery are advised to colorectal cancer patients.

Usually bowel cancer shows no early symptoms.

The warning signs may include the following:

• Pelvic Pain
• Abdominal discomfort
• Dark patches of blood in stool
• Unexplained fatigue
• Loss appetite and/or weight loss
• Changes in bowel movements, which includes diarrhea or consistent constipation, difficulty in constipation, rectal cramping or rectal bleeding

Obesity Surgery

Obesity was once counted as a problem in developed countries only, but nowadays we can see that almost everywhere in the world, obesity and overweight have become serious problems. We generally see people neglecting health and competing in the race of success. We do not have enough time for exercising and eating healthy food. Fast and junk food have become very common today and from young kids are seen consuming junk foods on regular basis.

Obesity can cause different diseases like type 2 Diabetes, heart diseases, some type of cancer, high blood pressure, etc. Obesity can be reduced today by different methods and obesity surgery is one of them. Weight loss surgery is very famous these days and many people go for it. It is trusted method to lose your extra kilograms.

• Who can do an obesity surgery?
• People with BMI(body mass index) greater than 40.
• People with BMI between 35 and 40 who are facing obesity related diseases like type 2 Diabetes, high blood pressure, heart disease, etc.
• Women who are 80 pounds overweight and men who are 100 pounds overweight.

Numbers of obesity surgery options are available like adjustable gastric band, intragastric balloon, sleeve gastrectome, biliopancreatic diversion, and gastric bypass surgery.

The after-surgery program helps to maintain a proper health and weight:

• Medical Follow-up
• Support Group
• Psychological Counseling
• Nutrition and Exercising Programs
• Cooking Classes