Bariatric surgery is unlike other surgeries, as its effects are not instant but gradual and are seen over the months. Like any other surgery, it is not without complication. But again unlike all other surgeries, the complication rate can be negligible if a strict protocol is followed. Moreover, the factors like technology advancements, development in the field of advanced laparoscopy, enhanced skillset of the bariatric surgeon, dedicated management of bariatric and metabolic surgeries by bariatric surgeons, play a vital role in the reduction of complication rate which eventually results in safe surgery.

As the procedure is done laparoscopically, the pain is just for a day and is minimally managed by analgesics.

The fear of increasing incidence of incisional hernias while operating an obese patient is so negligible or nil, as the procedure is performed through tiny key holes and all precautions are taken to suture the sheath through which the ports are put to perform the surgery.

Reduced hospital stay and early resuming to work is one of the biggest benefits of this laparoscopic bariatric procedure.

Sometimes, problems that may be faced are:- 

Post-operative bleeding: Normally, this a nearly bloodless surgery involving 5 to 10ml loss of blood. However bleeding from the staple edges is known, but this can be managed well by the surgeon, by choosing the right size of the cartridge as well the right technique of application of the cartridge.

Dehydration: We are normally accustomed to drinking water at long intervals (a few hours) as we can consume nearly 200 to 400ml at one go. Following bariatric surgery, gulping or drinking water in one go is not possible in the first 2 to 4 weeks, due to reduced capacity of the gastric pouch. Hence, care needs to be taken to drink small quantities of water at frequent intervals to avoid dehydration. This is possible only if the patient is counselled about this prior to surgery and is fully aware of this. Also, the patient needs to be given good and clear post operative instructions regarding the quantity and frequency of liquid consumption, not forgetting the type of liquids. Coffee taken frequently could be another cause for dehydration. Family members and colleagues and friends at work play a major role in reminding tthe patient about consuming water frequently. Special care needs to be taken in people who are not accustomed to consuming adequate quantities of water prior to surgery as a general habit.

Vomiting/Fullness/ Discomfort/Indigestion: Following bariatric surgery, soft food is introduced in the diet in the third week, after the first 2 weeks of taking liquids. Due to the reduced capacity of the gastric pouch, the morsel size is significantly reduced and one has to chew the morsel well and eat slowly, giving a gap of 40 to 50 seconds between the morsels. This prevents distension or overdistension of the gastric pouch and thus avoids vomiting. This again requires good counselling prior to the surgery and on the follow up visit too before stating soft food. There is a subjective difference when we say small morsels and we cannot reach a standardization as the morsels size of each individual varies prior to the surgery itself. The best way to avoid this confusion is to make the person have the first soft food meal before you where in you can physically show the way food is expected to be eaten. However, by mistake, there is a chance that one can have a regular sized morsel as over years one is used to eating in that manner. If this happens, the person will vomit , and this will be a reminder to gauge the morsel size the next time the person eats. Following the vomiting, there could be a burning sensation in the stomach which will subside afer taking an antacid. If one follows the instructions of small morsel size, chewing properly and eating slowly, there is no chance that there will be vomiting. Another reason for vomiting could be keeping the stomach empty for a longer duration or having sicy food on an empty stomach. Avoid nuts, seeds, fried foods and processed foods. Very rarely vomiting could be due to reduced size of the joint between the gastric pouch and the small intestine. This could require an Endoscopy and necessary treatment.

Vitamin and mineral deficiency: It is seen that many of the obese patients are seen to have vitamin B12, vitamin D, iron and protein deficiencies in their blood tests that are done prior to surgery. With the significant reduction in the amount of food consumed after bariatric surgery, the existing deficiencies are bound to increase. Hence, it is necessary to do these tests, before surgery and rectify the deficit prior to the surgery.  

Gall bladder stones: Significant weight loss which is consistant over a short duration could lead to the formation of gall bladder stones, be it with or with out surgery in a small percentage of patients. To avoid this there are two schools of thought, one is have a prophylactic removal of the gall bladder along with the bariatric surgery and another is to put the patient on ursodeoxycholic acid (a tablet) for the first few months after surgery during which there is significant weight loss.

Skin sagging: In the morbidly obese, when the skin is overstretched beyond a certain point, it tends to sag once significant weight is lost. This sagging is influenced by a number of factors like age of the patient, the BMI, pre existing sagging, pre-existing muscle tone and protein supplements taken during weight loss and exercises done during the weight loss period. Skin sagging is less if the age is less than 45, BMI less than 45, good protein intake during weight loss and good toning exercises done during the weight loss period.

Hairfall: Significant weight loss either by diet and exercise, aerobics, bariatric surgery, will entail hair loss. But this can be minimised to a greater extent by ensuring good protein intake during the weight loss period and adequate supplements in terms of vitamins and minerals.

Dumping syndrome: With a reduced size of the stomach, the food moves from the stomach into the smaller intestine much faster. This causes the pancreas to release excessive amount of insulin, leading to very low blood sugar levels , producing various symptoms like abdominal cramps, bloating, diarrhoea, sweating, dizziness, nausea, weakness, and anxiety. This is managed by eating less amount of sugars and fats and spacing out the meals through the day, having four to five small meals compared to  2 to 3 large meals. Having a high protein diet and avoiding liquids during meals is also an option.

Bariatric Surgery - Know Problems Of It!

When an organ or fatty tissue is squeezed through a hole (weak spot) in the connective tissue or a surrounding muscle then it causes a hernia. Usually, hernia happens at the abdominal wall and sometimes it can be seen as an external bulge.

There are various types of hernia which include:

  Inguinal Hernia (happens in the inner groin).
  Incisional Hernia (develops through a scar or an incision in the abdomen).
  Umbilical Hernia (develops at the belly button).
  Femoral Hernia (develops in the outer groin or upper thigh area).
  Ventral Hernia (develops in the general ventral or abdominal wall).
  Hiatal Hernia (develops inside the abdomen, beside the upper diaphragm or stomach).

The most common cause of hernia is the combination of pressure and opening of connective tissue or weakness of the muscle. Anything that escalates the abdominal pressure can lead to a hernia, including lifting heavy weights, constipation, persistent sneezing or coughing, obesity, and diarrhea. Overexertion, poor nutrition, and smoking can also weaken the muscles and can increase the possibility of a hernia.

Mesh Surgery 
Surgical mesh is used to supply extra support to the damaged or weakened tissue. It is a medical device, usually made out of either animal tissue (from skin or intestine) or synthetic material. Surgical mesh of synthetic material can be made in non-knitted sheet forms or in the knitted mesh. The synthetic material used for making a surgical mesh can be absorbable, non-absorbable material, or a combination of both.

Surgical mesh made out of animal tissue is disinfected and processed in a way that makes it suitable for implantation. These are absorbable and mostly made from the tissues of pig or cow.
Absorbable mesh degrades and loses its strength over time. It is not made to supply
long-term support to the restored site.

On the other hand, non absorbable mesh remains in the body for a long duration and is accounted for as a permanent implant. It provides permanent strength for restoring hernia.

In Hernioplasty or the mesh surgery for a hernia, the muscle opening is not stitched shut, instead it is covered with a sterile, flat mesh which is mostly made of synthetic or animal tissue. Small cuts are made around the hole in the shape of the mesh and the patch is stitched into the healthy surrounding tissues. The weak or damaged tissues around the hernia use the mesh, as support to regrow.

Recovery
Usually it takes up to 4 to 6 weeks to recover completely from mesh surgery. However, one can get back to his/her normal routine within 2 weeks post the surgery. There are certain precautions that one should undertake to avoid any complications. One should avoid heavy weight lifting, heavy exercises, stretching, and running. These precautions include diet modifications too. One should avoid consuming heavy fatty food and meat.

Takeaway
A hernia can be caused by a number of reasons and mesh surgery is a medical procedure helps to treat this problem. One should not avoid the treatment of hernia as the early treatment reduces the complications.

Mesh Surgery For Hernia - All You Must Know!

An anorectal abscess is a painful swelling near the anus or in the buttock. The swelling contains pus. 60% anorectal abscesses are superficial and resulting from infection in small anal glands present in between internal and external anal sphincters (intersphincteric space). They are known as a perianal abscess. 30% of anorectal abscesses are deep-seated and results in systemic infection. They are call Ischiorectal abscess. Submucous abscess, pelvirectal abscess and pilonidal abscess developed from versatile cause are comparatively less common. Inadequate and improper management of anorectal abscess may potentially cause complication like fistula formation.


Fast facts on Anorectal abscess-

* Anorectal abscess should be drained at the earliest.
* Conservative medical management almost invariably invites complication like fistula formation.
* Surgical drainage of pus reduces the chance of fistula formation by 50%.


What causes Anorectal abscess?

* Blocked and infected anal glands (cryptoglandular infection).
* Untreated anal fissure that becomes infected.
* Sexually transmitted infections.
* Penetrating injury of the perianal or buttock region.
* Crohn s disease.
* Colon cancer.
* Tuberculosis.



What are the symptoms of Anorectal abscess?

Superficial abscess-

* Constant and throbbing pain that worsens on sitting down.
* Swelling, redness and tenderness of the skin around the anus.
* Discharge of pus.
* Pain is often associated with bowel movement.

Deep abscess-

* All or some of the symptoms of a superficial abscess.
* Fever with chill and rigor.
* General weakness.
* Sometimes fever is the only symptom of the deep abscess.

The anorectal abscess should preferably be explored under general or spinal anesthesia. Medical management often fails and subsequently fistula is formed.

Anorectal Abscess - Know In Detail About It!

Ovaries are a part of a woman s reproductive system. The primary function of ovaries include producing  ova  or eggs and secreting hormones such as progesterone and estrogen. Cysts are fluid filled sacs that form the ovaries; they usually do not cause any symptom and are not painful.

There are primarily two types of ovarian cysts:

1. Follicle cysts: During a woman s menstrual cycle, the egg develops in a sac known as the follicle. Under normal circumstances, the sac breaks open and releases the egg. When this doesn t happen, fluids start accumulating in the follicle to form a cyst.

2. Corpus luteum cysts: Follicle sacs dissolve after releasing the egg, but in some cases, these sacs remain and the opening of the sacs gets sealed. It again results in fluid accumulation, leading to the formation of corpus luteum cysts.

Symptoms

Usually, cysts do not cause any symptom. If the size of the cysts increases, they may cause symptoms such as stomach pain, pain during bowel movements and sex as well as pelvic floor pain. The breasts may become tender and one may experience rapid breathing. Other symptoms of ovarian cysts are fever, nausea and dizziness. Usually, rupturing of a cyst leads to these symptoms surfacing; hence you would know when exactly to call the doctor.

Treatment

The treatment options for ovarian cysts are:

Laparoscopy: Laparoscopy is carried out if the cysts are small in size. An incision is made close to the navel, through which an instrument is inserted to get rid of the cyst.
Birth control pills: For chronic ovarian cysts, oral contraceptives are prescribed to stop the ovulation process in order to arrest the formation of cysts.
Laparotomy: In case of large cysts, this procedure is recommended. A relatively bigger incision is made in the abdomen, through which the cyst is removed.
Ovarian cysts, if left untreated, can certainly cause infertility. Pre-menopausal women and who suffer from frequent hormonal imbalances in the body are the most vulnerable to this condition.

Ovarian Cysts - 3 Ways it Can Treated

What is a hysterectomy? This is a surgery that is used to remove the ovaries or even the uterus. This surgery is usually conducted in order to deal with the extreme conditions that may be caused by the severe onset of various conditions related to the reproductive system of women. Read on to find out why this surgery carried out and what are the after effects?

Causes: This surgery can be carried out for a variety of reasons. One of the main reason is the manifestation of uterine fibroids that can cause severe pain and bleeding. These fibroids will have to be removed surgically and in case they have spread, the uterus will have to be removed entirely. Also, if the condition has spread to the ovaries, it may be imperative to remove the ovaries as well. Furthermore, if the patient is suffering from endometriosis, where the tissue has spread too much and cannot be contained merely by medication or other forms of treatment, then the doctor will have to conduct a hysterectomy surgery in order to remove the affected areas of the reproductive area. Also, other conditions for which this surgery may be required include adenomyosis, chronic pain in the pelvic area, cancer of the uterus, cervical cancer and uterine prolapse.

Procedure: A hysterectomy is performed under anesthesia, and the doctor makes a five to seven inch incision in the abdomen for an open surgery. The doctor will then continue to remove the uterus through this incision. Also, usually, the patient will have to spend about three to four days in the hospital following this surgery. A vaginal hysterectomy may also be conducted for certain cases, depending on the type and severity of the condition that has led to this form of treatment. For this kind of surgery, the incisions will be made in the vaginal area.

After effects: Starting from hormonal imbalances to early menopause, this surgery can leave significant after effects in its trail. The patients who have been through this surgery will be asked to abstain from heavy physical work that involves lifting heavy objects and bending. Also, the doctor will recommend abstinence from sex. One will have to avoid these things for a period of at least six weeks after the surgery. In many cases, the patient may also go through heavy menstrual bleeding.

Doctor visits: In case the bleeding and hot flashes are excessive, then the patient will have to see a doctor and take further appointments so that the condition may not reoccur. Also, the doctor will usually prescribe supplements like vitamins, which must be taken on a regular basis after the surgery to avoid any complications at a later date.

Hysterectomy Surgery - Know the After Affects!

Rectal bleeding is the collective name associated with all the conditions that cause blood to pass into the stool. Blood may appear in the form of small flecks in the stool, or clots, or a lot of liquid mass. It can also appear on the toilet paper, instead of in the pot. The blood may be coming from the anus, colon, or rectum itself.

Causes of Rectal Bleeding

The causes are multiple, and they include-

  Swelling and irritation of the anal veins, a condition known as haemorrhoids. Piles are the more common name for this phenomenon.
  Constipation (inadequate and painful passing of stools)
  Tears or scratches in the anus (fissures), sometimes as a side effect of constipation.
  Anal cancer
  Colon cancer
  Rectal cancer
  Diarrhoea
  As a side effect of radiation therapy, used in the treatment of diseases like cancer

Ayurveda believes that such a condition occurs due to the imbalance of the three doshas - fire (Pitta), water (Kapha) and air (Vata). Therefore, the aim of Ayurveda is to restore the dosha balance in your body and improve the condition. The help of a medical professional must be sought immediately after you notice this phenomenon occurring with you.

Treatment of rectal bleeding: Why Ayurveda is your best resort?

Ayurvedic treatment is the best possible alternative at your disposal. Besides being tailor-made to cater to your medical history, it is the only form of treatment that has negligible side effects. Hence, you might want to talk to an Ayurveda medicine specialist in the first place.

Rectal bleeding has a whole host of possible solutions within the fold of Ayurveda treatment. They are-

  Use laxatives, but natural ones. Laxatives are compounds that make stool less hard and easier to pass. The substances that can act as natural laxatives are coconut water, chia seeds, spinach, flaxseeds and prune juice.

  Foods that are rich in fibre should comprise a major chunk of your dietary intake during treatment. These foods include the peels of fruits and vegetables, and figs, beans and prunes.

  There are certain items you should not consume as well according to Ayurveda, like alcohol or fried foods. Also, to not further irritate haemorrhoids and exacerbate your condition, avoid hot and spicy foods like those flavoured with green chillies.

  Reduce time spent on sitting on the toilet seat, as this puts a strain on the muscles around that region.

Rectal bleeding is a common medical phenomenon that may require critical attention. While some of the reasons behind it may be easily treatable, there are some conditions with deep complications underlying it, like rectal cancer. You should get yourself checked immediately if you are experiencing rectal bleeding. After getting a primary diagnosis, you should try Ayurvedic remedies for the best results.

Rectal Bleeding - Causes & Treatments Of The Problem!

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