Losing weight is a daunting task. This becomes all the more difficult for obese people. In many cases, the patient may be advised to undergo bariatric surgery. There are many types of bariatric surgery. Some surgeries address both the stomach and the small intestines while others address only the stomach. A gastric band surgery is one such procedure.

For this procedure, an adjustable band is placed around the upper half of the stomach. This creates a small pouch that can hold a limited amount of food. The band is connected through a plastic tube to a small device placed under the abdominal skin. Sterile fluid may be injected or removed from the band through this device. By injecting saline, the band is made tighter and by removing the liquid the band is loosened. This allows the band to be customized to improve weight loss.

The result of a gastric band surgery may vary from person to person. Band adjustment starts after the third week of surgery. Because the size of the stomach is reduced, the person will feel full faster and hence eat less. In most cases, a person can expect to lose 60 to 75 % of their excess body weight. This should not be confused with a person s total weight. The procedure can be reversed at a later date if need be.



Some people may develop side effects like nausea and vomiting after the procedure. But why this procedure has not gained acceptance compared to other bariatric procedures like gastric bypass and sleeve gastrectomy is because, the compliance with the band is not very good and complications like band erosion, band slippage, band migration are very high. Another dreaded complication following the band surgery in non-compliant patients who eat large quantities and overstretch the small gastric pouch above the band is severe GERD.

In severe cases, rarely, grains of undigested food is seen in the mouth on waking up in the morning. This could be life-threatening. Vitamin deficiencies are rare provided supplements are taken regularly during the weight loss period.  

Gradual band adjustment is required and regular follow up with the bariatric surgeon will yield good results. Over adjustment is not good at all and could lead to higher chances of complications like band erosion. However, proper dietary compliance can make the results of a band better. Ideally, a patient should get follow up checks every month after such a surgery.

All said and done, the percentage of excess weight loss in the gastric bypass and sleeve gastrectomy are far superior to the adjustable gastric banding. Even the compliance, and maintenance of weight loss over years is better in the other bariatric procedures compared to the band.

Gastric Band Surgery - Know How Competent Is It?

Gastroesophageal reflux disease (GERD) is also called as acid reflux. It is a long-term digestive disorder that affects the lower esophageal sphincter, the ring of muscle between the esophagus and stomach which causes the stomach contents to come back up into the esophagus resulting in either symptoms or complications. Gastroesophageal reflux disease is mild acid reflux that occurs at least twice a week or moderate-to-severe acid reflux which occurs at least once a week.

Epidemiology

In western populations, GERD affects approximately 10% to 20% of the population and 0.4% newly develop the condition. In developed nations, the prevalence rate of GERD is associated with age; with adults aged 60 to 70 being the most commonly affected.

Signs and Symptoms

Esophageal symptoms include:

Heartburn
Regurgitation of food or sour liquid
Dysphagia
Sensation of a lump in the throat
Extraesophageal symptoms include:

Coughing and/or wheezing
Hoarseness, sore throat, or laryngitis
Otitis media
Noncardiac chest pain
Enamel erosion or other dental manifestations
New or worsening asthma
Disrupted sleep
Risk Factors

Obesity
Pregnancy
Hiatus hernia 
Scleroderma and systemic sclerosis
The use of medicines such as prednisolone
Delayed stomach emptying Zollinger-Ellison syndrome which can show an increase in gastric acidity because of gastrin production
A high blood calcium level which can increase gastrin production, leading to increased acidity
Visceroptosis or Gl nard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach.
Factors that can increase acid reflux involve:

Smoking habit
Eating heavy meals or eating late at night
Eating fatty or fried foods
Drinking certain beverages, such as alcohol or coffee
Medications, such as aspirin
Tight clothes
Increased intra-abdominal pressure
Differential Diagnosis

Heart disease causing chest pain
Laryngopharyngeal reflux OR extraesophageal reflux disease
Infection
Peptic ulcer
Esophageal spasm
Complications

Narrowing of the esophagus (esophageal stricture): Stomach acid causes the formation of a scar tissue which narrows the food pathway.
An open sore in the esophagus (esophageal ulcer): Acid causes an open sore which bleeds, causes pain, and makes swallowing difficult.
Precancerous changes in the esophagus (Barrett's esophagus): Damage from acid can cause changes in the tissue lining the lower esophagus
Anemia
How to arrive at the diagnosis?

Upper gastrointestinal endoscopy/esophagogastroduodenoscopy
Esophageal manometry
Ambulatory 24-hour pH monitoring
Treatment

The goals of treatment are controlling symptoms, healing esophagitis, and prevention of recurrent esophagitis or other complications.

Lifestyle modifications include the following:

Losing weight (if overweight)
Eating small and frequent meals instead of large meals
Waiting 3 hours after a meal to lie down
Elevating the head end of the bed by 8 inches
Avoiding bending or stooping positions
Medications

H2 receptor antagonists (ranitidine, cimetidine)
Proton pump inhibitors (omeprazole, pantoprazole)
Prokinetic agents (aluminum hydroxide)
Antacids (magnesium hydroxide)
Surgery

Transthoracic and transabdominal fundoplication
Placement of a device to augment the lower esophageal sphincter

Gastroesophageal Reflux Disease - What Should You Know

A hysterectomy is an operation to remove the uterus and, usually, the cervix. The ovaries and tubes may or may not be removed during this procedure, depending on the reasons for the surgery being performed. If the ovaries are removed, you will commence menopause. A hysterectomy is a major surgical procedure with physical and psychological consequences.

Why is a hysterectomy performed?

Common reasons include painful or heavy periods, pelvic pain, fibroids or as a part of therapy for cancer. You should have a clear understanding of your reason for this surgery.

How is this done?

The procedure is normally performed under a general anesthetic and takes approximately one hour. To commence your anesthetic a drip is inserted into your arm. Once you are asleep, you will have a urinary catheter inserted. The importance of the catheter is to reduce the size of your bladder, keeping it away from the operation site and reducing the risk of complications.

There are three ways to remove the uterus:

Vaginal hysterectomy - The removal of the uterus and the closing of the wound is performed through the vagina. There is no cut in the abdomen. 
Laparoscopic hysterectomy - About four small keyhole cuts are made in the abdomen to divide the attachments of uterus, ovaries, and tubes in the pelvis. The uterus is usually then removed through the vagina.
Abdominal hysterectomy - The uterus is removed through a cut in the lower abdomen. The cut is about 15 20 cm in length and runs across your abdomen, usually below the bikini line. Less commonly, it may be necessary to have a cut that runs from the belly button down to the pubic area.
What are the risks of undergoing this procedure?

Although the risks associated with hysterectomy are low, you should be aware that every surgical procedure has some risk. This may also depend upon the type of surgery you have. 
Severe bleeding from large blood vessels around the uterus or top of the vagina. This is not common. A blood transfusion may be required to replace blood loss. A vaginal pack may also be used to control the bleeding.
Infection in the operation site, pelvis or urinary tract.
Nearby organs such as the ureter (tube leading from kidney to bladder), bladder or bowel may be injured expected to happen to approximately one in every 140 women. Further surgery will be needed to repair the injuries.
The bowel may not work well after the operation; this is usually temporary. Treatment may include a drip to give fluids into the vein and no food or fluids by mouth.
Things to do before you come to the hospital

It is important for you to have all the tests ordered at your outpatient clinic appointment completed prior to coming to the hospital these include blood tests and an ECG and chest X-ray, if you are more than 50 years old

You may be required to have a bowel preparation, which will empty your bowel prior to the surgery.

You should stop eating and drinking at the following times on the day of your surgery unless otherwise notified

At midnight if your procedure is in the morning

At 6 am if your procedure is in the afternoon.

You will need to shower and dress in clean clothes prior to coming into hospital. It is important that you do not shave your operation site as this increases the risk of wound infection.

Please remove all body jewelry.

After your surgery

When you wake from the anesthetic, you will be ready to be transferred, in your bed, for recovery.

Having an anesthetic can make you feel sick and may cause vomiting. You will have a drip in your arm which is necessary to maintain fluid intake and provide pain relief. This will remain in until you can tolerate food and fluids and your pain control is changed to oral medication.

Your nurse will take frequent observations of your vital signs e.g. temperature, pulse, blood pressure.

You may have small amounts of water or ice to suck, then progress from fluids to a normal diet as tolerated.

If you have pain or nausea, please tell your nurse. Effective pain management is important.

You will have a urinary catheter in place. The catheter will normally be removed the day following your surgery.

Recovering at home

What to expect

You may have a blood-stained vaginal discharge which is similar to a light period. This will gradually reduce to nil over 4-6 weeks as your internal wounds heal

You may need to take some simple analgesia for pain/discomfort, especially on waking and settling at night

You may feel fatigued

You may require up to four to six weeks off work. You should have returned to normal activity by two to three months, depending on the type of surgery, although full recovery may take longer

After the operation, you will no longer have a period

For the majority of women, hysterectomy surgery does not have a negative effect on sexual function

What to avoid

For the first two to three weeks lift nothing greater than two kilograms. Increase gently as tolerated over six weeks.

It will take about three weeks before you should drive a car. Only when you know you can act confidently with emergency breaking should you attempt driving the car.

Avoid sexual intercourse for six weeks to allow healing to take place.

Avoid inserting anything into the vagina for six weeks to allow time for healing to take place (e.g. use sanitary pads and not tampons).

It is important to avoid constipation and straining immediately after your surgery as this will assist healing and improve your comfort.

Contact your doctor if you develop any of the following complications:

Your wound becomes red or inflamed, painful.

You have heavy vaginal bleeding heavier than a normal period.

You have offensive vaginal discharge.

You develop a fever i.e. temperature of about 38  C, or you are feeling unwell.

You have pain that is not relieved by simple analgesia.

You are having difficulty passing urine or opening your bowels.

 In case you have a concern or query you can always consult an expert & get answers to your questions!

Surgery For Womb Removal - What You Need To Be Aware Of?

The heart may sometimes face excessive fluttering or a throbbing sensation, which may make you feel uncomfortable. Such sudden throbbing sensations resulting in discomfort are called 'palpitations'. Homeopathy has some great remedies depending on the cause of these problems.

Let s have a look at these:

Palpitations caused by anxiety: This is one of the top causes for palpitations which occur before sitting for an exam, interview or before important events of your life. However, they may tend to stay longer and it is advisable that you control them with the use of Aconite or Arsenic Album.
Palpitations caused by Physical exertion: If you have a weakened heart or if you smoke and thus tend to feel a lot of exertion even with the slightest of physical efforts, then Spigelia, Iberis and Digitalis are good medications. Digitalis is especially good for palpitations caused by the slightest of movements, while spigelia is very good with palpitations that cause arm pain as well.
Anemia: Anemia or the lack of red blood cells can be very dangerous for your health as it can damage your vital organs. It can also cause palpitations along with other symptoms such as paleness, lack of strength and drowsiness. Natrum Mur and Ferrum Met are two of the most effective remedies in such cases.
Use of tobacco products: Another reason for palpitations developing is the use of tobacco products, such as cigarettes or chewing tobacco. In such cases, palpitations may occur even with the slightest of exertions or at rest. Medications effective in such situations are Kalmia, Tabacum and Convallaria. These variations may be required depending on the types of symptoms you may show such as a quick heart rate or a slow heart rate.
A palpitation caused by hyperthyroidism: Excessive secretion of thyroid is called hyperthyroidism and can cause a host of problems within the body including palpitation. Iodum and Spongia are two excellent medications in treating variations of palpitations caused by an over active thyroid gland.
Palpitations caused by acidity or gastric problems: This is possibly the most common cause for palpitations and Lycopodium as well as Abies Can are two very effective homeopathic medications, which can easily remedy the situation, depending on the type of problems you are having.

Palpitations - How Homeopathic Remedies Can Help You Manage Them?

High blood pressure can lead to hypertension, which is known to cause a variety of debilitating side effects or symptoms in the life of the patient. It can also lead to a number of related ailments which can affect the various organs of the body. The eyes are one of the organs that are most susceptible to this kind of spike in the body s blood pressure. Let us learn more about the connection between the two.

Retina: When high blood pressure goes untreated for a prolonged period, it can easily start to affect the blood vessels that can be found in the retina. The retina is the third or the inner most layer of the eye which is sensitive towards light and usually helps in refraction. This is where the light reaches so that one can focus clearly on an image. When the blood pressure of the patient stays high for a prolonged basis, there is significant pressure on the blood vessels in this part of the eye which can lead to an eye disease known as hypertensive retinopathy.

Symptoms: Symptoms of this eye disease include lack of clarity and focus when the eye comes to rest on an object, as well as headaches and other vision problems that typically spring from eye strain that one will go through while trying to focus even harder. It may be seen that the symptoms do not appear in the very early stages of this disease.

Diagnosis: The diagnosis of the condition is usually done by an ophthalmologist who will use an ophthalmoscope in order to project light towards the specific part of the eye so that the back of the eyeballs can be examined. The signs that the doctor will look for during the examination include narrowing of the blood vessels in this part of the eye, inflammation of the macula which is the central portion of the retina, and bleeding in the back of the eye. Also, the doctor will check for spots in the retina with the help of cotton swabs and exudates.

Treatment: The best and only way of treating this condition is by keeping one s blood pressure in control with the help of medication prescribed by the doctor.

Prevention: There are many ways of preventing the onset of this disease, including losing weight so that there is less pressure on the body. Also, one must stick to a healthy diet and exercise regularly after taking recommendations on the appropriate exercises from the doctor. Additionally, it is also important to see a doctor on a regular basis so that there is constant monitoring and regulation of the medicines and the blood pressure.

Blood Pressure - How it Affects Your Eye Sight?

A hernia is a condition where fatty tissue or an organ in your body might bulge through a muscle or an abnormal opening in the body. It is caused mainly due to pressure in the muscle area or weakening in the spot. This may occur due to heavy lifting or weakness that was present since birth.

The different types of hernia are inguinal, incisional, hiatal, umbilical and femoral. For inguinal hernias, surgical methods are used. The most common method is laparoscopic repair.

What is laparoscopic hernia surgery?

In this process, you will be given general anaesthesia before the surgeon performs the surgery. Before undergoing the operation, you will have an evaluation of your complete health that will include an analysis of your past medical history and a physical examination. An electrocardiogram or ECG will also be conducted. 

Then a small cut or incision is made in the lower part of your abdomen below the navel. The laparoscope that is a small telescope-like instrument is inserted to view your internal organs. A video camera is attached to the device that projects the internal view of your body on to a screen. This is viewed by the surgeon in the operating room.

During the process, your abdomen is inflated with carbon dioxide, to create some space for the doctor to look inside easily. The inner abdomen lining called peritoneum is cut open to observe the weakness of the abdominal wall or the location of the hernia sac. After locating it, the surgeon will remove the hernia sac from the wall and use a prosthetic mesh to cover the defect. Then the small incisions are closed with surgical tapes or stitches.

Furthermore, if hernias are found on both sides, they can be operated without making a second incision. The mesh can be placed on all the abdominal areas that are weak. This prevents the hernia to occur in the same spot again or spreading to other areas.

However, laparoscopic surgery is not performed for children. It is also not suitable for some cases such as if you are pregnant, or cannot tolerate general anaesthesia or are obese. 

Aftercare

You will be able to go back home on the same day of the surgery after laparoscopic hernia repair. The recovery time lasts for about 1 to 2 weeks. After that period you can return to light activity like walking. However, you must not engage in any kind of strenuous activity like working out or lifting heavy objects.

You might observe soreness after the first 2 days of the surgery. In some cases, bruising is found in your groin area. But if you observe significant swelling in the groin region, contact the doctor immediately.

It is recommended that you maintain a diet that is rich in fibre. This is because if you suffer from constipation, the straining during your bowel movements might put pressure on the area that is repaired.

People prefer laparoscopic hernia repair as they suffer lesser pain and can get back to their normal lives faster than open repair surgeries. It is advised that you take the medications and follow the instruction of your surgeon properly after the procedure. 

 



 Laparoscopic Hernia Repair - What Should You Know?

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