Anti-reflux surgery (Fundoplication) is a procedure for treating gastroesophageal reflux disease (GERD) incorporated in hiatus hernia operation. GERD occurs when stomach contents reflux and enter the lower end of the esophagus (LES) due to a relaxed or weakened sphincter or a hiatus hernia. GERD is very much treatable and can cause serious complications if left untreated. 

GERD symptoms
The main symptom of GERD is heartburn or indigestion, along with other symptoms, such as 

Acidic sour taste in the mouth
Burning pain in the throat
Difficulty in eating
Bloating and belching
Stomach pains
Regurgitating food
Nausea
Vomiting blood
Dark tarry stools
Laparoscopic Anti-Reflux Surgery
Laparoscopic surgery reinforces the lower oesophageal sphincter s ability to prevent gastroesophageal reflux from occurring. The surgery involves wrapping the top part of the stomach around the lower end of the esophagus and suturing it in place. Since the esophagus passes through the hiatus, suturing is done to narrow the hiatus as it helps in the prevention and treatment of concurrent hiatal hernia.

Laparoscopic Surgery Procedure
A laparoscope, a long, narrow telescope with a light source and a video camera at the end, is inserted through a tiny incision into the abdomen. Images from the camera are projected onto a large high definition monitor for the surgeon to view enlarged images as it helps the surgeon perform surgery with precision.

The patient is placed under general anesthesia
The surgeon makes a small incision in the upper abdomen and inserts the laparoscope into the abdomen.
The surgeon introduces carbon dioxide into the abdominal cavity near the belly button to expand the viewing area of the abdomen giving the surgeon a clear view and room to work.
Additional small incisions are made for a variety of surgical instruments to be used during the procedure.
After the identification of critical structure, the hole in the diaphragm, through which the esophagus passes, is then tightened with sutures.
The surgeon wraps the upper part of the stomach around the lower esophagus guided by the images on the laparoscope, then creates a valve which is precisely sutured in its place.
The laparoscope and other instruments are removed and the gas is released.
The tiny incisions are closed and covered with waterproof dressings to avoid any kind of infections.
The patient is usually discharged within 1-2 days of the surgery.
Post-surgery, hospitalization is required just for one day - no bed rest is required after that. The patient can quickly return to all normal activities and immediate relief from symptoms also happen. 

Laparoscopic Surgery - How It Can Help With Anti-Reflux and Hernia?

Anal fistula, a challenge for modern surgery, but can be cured with grade ksharsutra in Ayurveda (Indian system of medicine).  Anal fistula is a disease for which different methods of treatment have been advocated time to time, even today when we are talking about robotic surgery, this disease has no satisfactory method of treatment in modern surgery. The latest method of video assisted anal fistula treatment (VAAFT) is not satisfactory due to high incidences of recurrence after the surgery. But at Sushruta Anorectal Institute New Delhi; with the help of Graded KsharsutraTM all these patients of complex Anal fistula are being successfully treated.

In Ayurveda about 2000 yrs ago Acharya Sushruta has indicated ksharsutra treatment to treat fistula-in-ano. Late professor P J Deshpandey at the faculty of Ayurveda Institute of Medical Sciences B H U; had done extensive research in this field and established a treatment module to cure this disease. In 1990 Indian council of medical research has clinically evaluated this Ayurvedic treatment module at four premiere institutes in our country including AIIMS Delhi & PGI Chandigarh. Subsequently, it was concluded by I.C.M.R. that in the patients of fistula in ano, ksharsutra treatment is more effective& convenient as compared to modern surgery.

Ksharsutra is a thread coated with certain Ayurvedic medicines known for their antiseptic, debridement & healing properties. After u v sterilization this medicated thread (ksharsutra) is used under complete aseptic precautions in the patients. The patient is routinely investigated with special reference to any other associated disorder like hypertension, diabetes mellitus, tuberculosis etc. The next step lies in the proper identification& evaluation of the fistulous tract. It is mandatory to define the fistula tract wrt its depth, direction & branching pattern. This may be achieved by careful probing under expert hands using malleable probes& if required help may be taken from other investigations like x-ray fistulogram or MRI fistulogram. 

Once the tract has been clearly defined the Ksharsutra is placed in it with the help of certain instruments, under local anesthesia. This entire procedure is usually completed in ten to fifteen mins. As there is no cutting of tissues hence no bleeding, no pain & patients can go home after half an hr rest in the daycare room. The medicine-coated on the thread is gradually released in the tract. The cumulative effect of the coated drugs exerts a powerful debridement effect on the fistula tract & induces healing by the fresh & healthy granulation tissues. Thus Ksharsutra is the mechanism of drug delivery precisely at the tissues involved. 

Every seventh or tenth day the old sutra is replaced with a new Ksharsutra till there is a final cut through. It has been observed that the tract heals @ 0.5-1 cm per week. The post-operative complications like recurrence of the disease, fecal incontinence, bleeding is not seen with Ksharsutra treatment. Further, this therapy is performed as an OPD procedure. No general anesthesia & no hospitalization is required. Patient maintains his normal routine activities as usual during the treatment period. 

 At Sushruta Anorectal Institute; Rohini - New Delhi, we have been working on this disease including piles fissures & pilonidal sinus for the last 30 yrs. Here we have developed the concept of Graded KsharsutraTM which has given us a more effective & convenient way to treat anal fistula. At Sushruta Anorectai Institute we have treated on record thousands of patients of anal fistula from different states including overseas patients. We have records to prove that the patients of high anal complex fistula, those have been operated two or three times but failed to heal were successfully treated at this institute.

How to Treat Anal Fistula Naturally without Surgery

Hemorrhoids, also known as piles, are swollen veins or blood vessels, which can be internal (located inside rectum) or external (located outside rectum). They might be managed by increasing fluid intake and a high-fiber diet. Sometimes, Hemorrhoids might get infected and irritated to an extent that they require surgical removal.

Causes of Hemorrhoids:

Hemorrhoids are caused by increased pressure in blood vessels around the anus, causing them to swell and inflame which might be caused by a number of reasons.

Prolonged constipation

Chronic diarrhoea

Obesity

Aging

Pregnancy as it increases pressure on pelvic blood vessels

Weight lifting

Family history of Hemorrhoids

Persistent cough

Vomiting repeatedly

Sitting continuously for a very long period of time.

Symptoms of Hemorrhoids:

Some of the common symptoms of Hemorrhoids are:

Internal Hemorrhoids might bleed painlessly after bowel movement, but are problematic if they bleed too heavily.

External Hemorrhoids might also bleed after bowel movement, but often become irritating and painful.

External Hemorrhoids can lead to blood clots inside the vessel, which can cause severe pain. Proper treatment for such Hemorrhoids involves  incision and drainage  procedure.

Itchy and sore bottom.

A lump hanging off the anus.

Types of Hemorrhoids:

The type of Hemorrhoids decides the course of action for treatment.

First degree Hemorrhoids are small swellings which develop on inner lining of anus, being invisible from outside.

Second degree Hemorrhoids are larger swellings which might come out of the anus during bowel movement before disappearing inside again.

Third degree Hemorrhoids are lumps hanging off the anus which can be pushed back inside.

Fourth degree Hemorrhoids are larger lumps hanging down from the anus but cannot be pushed back inside.

Surgeries without Anesthesia:

Banding or rubber band ligation involves using a tight band around the base of Hemorrhoid to cut off its blood supply. It takes two or more procedures to be performed about two months apart.

Having the best success rate for small and internal Hemorrhoids, sclerotherapy involves injecting a chemical into Hemorrhoids, causing them to shrink and stop bleeding.

Coagulation therapy or infrared photocoagulation uses infrared light (heat or extreme cold) to retract and shrink the Hemorrhoid and is usually performed along with an anoscopy.

Hemorrhoidal artery ligation (HAL) or transanal hemorrhoidal dearterialization (THD) locates blood vessels causing Hemorrhoids to close them off.

Surgeries with Anesthesia:

Hemorrhoidectomy is used for large and external Hemorrhoids which do not respond to non- surgical intervention. So, they are cut out. Anesthesia can be general, regional, or local in this procedure. It takes longer time to recover completely.

Hemorrhoidopexy or stapling requires general, regional, or local anesthesia, and is used to treat prolapsed Hemorrhoids. A surgical staple cuts off the blood supply to Hemorrhoids to make the tissue shrink and reabsorb. It takes relatively less time for a full recovery.

Post- Surgical Care:

Some of the post care instructions are as follows

Painkillers might be prescribed for rectal and anal pain.

Consumption of a high-fiber diet prevents constipation and recurrence of Hemorrhoids.

Staying hydrated helps a lot.

Avoid heavy weight lifting and pulling.

Sitz bath helps to deal with post- surgical discomfort.

Seek medical help if having painful urination, fever, or dizziness.

Non-surgical Management of Hemorrhoids:

Hemorrhoids can be managed non-surgically by reducing strain in and around the anus.

Consuming a high fiber diet including cereals, fruits, vegetables, pulses, nuts, seeds, etc.

Consuming healthy fluids like water but avoiding alcohol and caffeinated drinks.

No delaying the emptying of the bowels.

Preventing constipation.

Weight management to lose excess body weight.

Regular exercise.

Take Away:

Hemorrhoids, if not severe, can be managed non- surgically. But if they get very painful and severe, surgical intervention through a number of techniques might be required; each one of them being safe, depending upon the severity of the situation.

Surgery For Hemorrhoids - What Should You Know?

Hernia is the name given to the condition where an internal part of your body pushes itself into another area of the body where it does not belong. A hiatal is the opening in the muscular wall which is called the diaphragm. This usually separates the abdomen from the chest cavity. In the human body, the food pipe, which is called the esophagus passes through this hiatal and joins the stomach area. Hiatal hernia is a condition when the stomach bulges up through this opening, into the chest.

Causes of Hiatal Hernia:
The main cause of hiatal hernia is not known at present, but there are certain factors that can cause it. It could occur when there is an increased pressure on the abdomen area such as during a pregnancy, coughing, obesity, too much straining at the time of bowel movement. Some people are also born with a wide hiatal opening.

Who needs surgical treatment for Hiatal Hernia?
In most of the cases, hiatal hernia does not show any kind of serious signs and hence you need not have to worry about it, When you experience symptoms such as acid reflux, gastroesophageal reflux disorder or heartburn, then you can treat them with mild medication and with the help of your doctor. But when the symptoms are severe and interferes with the quality of your life, or if the symptoms are not responding to medication, when the blood flow to the herniated tissue is blocked, causes ulcers, or heavy bleeding, you will need a surgery.

There are three types of surgeries for hiatal hernia.

Nissen Fundoplication: This is the most common surgery done for hiatal hernia. This is also called keyhole surgery or laparoscopic surgery. Small incisions are made in the abdomen area and the hernia is repaired. The surgeon also tightens the stomach in order to avoid the reoccurrence of this condition. It is a less painful and minimal scar process. Recovery time is also less compared to other surgical techniques and you also need not have to stay for a long period in the hospital.
Open repairs: For the repair of the hernia, a large incision is made in the abdomen area. The stomach is pulled back to its original place from the chest area. A small tube is also inserted in certain cases in order to keep the stomach in its original place and prevent it from moving towards the chest area. This kind of surgery has a lot of risks.
Endoluminal Fundoplication: This is the latest surgery technique and rarely used. No incisions are made in this procedure. Only a tube and camera are passed through the throat. The stomach is tightened and acid reflux is prevented.

Hiatal Hernia - 3 Types Of Surgeries That Are Often Recommended!

Haemorrhoids or piles is a condition where the veins in and around your anus become swollen. This swollen vein sticks out from the anus and can make sitting and moving difficult. Laser haemorrhoidoplasty is one of the best ways to treat advanced forms of the condition. However, before knowing more about the procedure, you should learn more about piles in general.

Causes of piles-
You are likely to develop piles in the following events  
  If you strain excessively during bowel movements
  If you sit for prolonged periods on the toilet
  If you suffer from constipation or chronic cases of diarrhoea
  If you are overweight or obese
  If you are pregnant
  If you engage in anal sexual intercourse
  If your diet lacks proper quantities of fibre
The likelihood of having piles increase with your age. This is because the tissues supporting your veins tend to lose their strength, as you grow old.

Symptoms of piles-
If you suffer from piles, you can easily notice certain symptoms from the condition. Here are the most common signs of haemorrhoids  
  You will notice bleeding during bowel movements. However, you will not feel any pain from the said bleeding.
  Your anal and rectum area will itch throughout the day. You will experience irritation in the region as well.
  You will notice a lump formation near the anus, which will lead to extreme pain and discomfort. Sitting and walking may also become painful due to the presence of the lump
  You may also notice a general swelling in your anus region.
However, the exact symptoms may vary from one affected person to the next, based on the location and type of haemorrhoids.

How does laser haemorroidoplasty help in the treatment of piles?
While most haemorrhoids are treated with medication and lifestyle changes alone, advanced cases require additional procedures. Laser haemorrhoidoplasty is one such procedure used to treat severe piles cases.
This treatment results in the reduction of the size of the haemorrhoid. The laser energy passes through the haemorrhoidal node, destroying it in the process.

Here are some advantages of laser haemorrhoidoplasty  
  Closes the arteries carrying blood inside the haemorrhoid
  Reduction of the haemorrhoidal node tissues
  Preservation of most of the mucosa, anal lining and muscle
  Rectifies the issues with the anatomical structure and restores it to normal
  A minimally invasive procedure, which limits post-operative pain and scarring

If you suffer from an advanced stage of piles, speak to your doctor and see whether laser haemorrhoidoplasty is an option for you.

Laser Haemorrhoidoplasty - What All Should You Know About It?

Hernia or what in Ayurveda is known as Antra Vriddhi, is a condition that takes place when an internal organ in your abdomen gets displaced and protrudes outward, giving rise to swelling in the abdominal region. 
Even though you can develop a hernia anywhere in your body, it mostly occurs in the abdominal region and can affect both men and women at any age.

The causes of hernia are: 
Even though hernia can be a hereditary condition, certain factors can contribute in causing it. These are:
1.   Persistent coughing
2.   Putting excess pressure while passing faeces
3.   Straining your abdominal muscles by exercising or lifting objects that are heavy
4.   Obesity
5.   Buildup of fluid in your abdominal cavity

Symptoms
Some of the symptoms that indicate you have hernia include a visible, hard protrusion, development of soft lumps and pain. However, some people may not experience any symptoms at all. Hernia can be of many types, depending on the part of the body affected and even varying on the basis of your gender. In worst cases, you may require surgery but Ayurveda can cure your hernia completely without the need of you going through a surgical process.

How does Ayurveda help?
Ayurveda helps in curing your hernia by focussing on your diet. If you follow these rules, you can cure yourself of hernia completely.

1.   Reduce the amount of food you eat in a day and take small meals frequently instead of the standard three meals.
2.   While eating, make sure you eat your food slowly.
3.   Drink lots of water and other fluids, but do not consume aerated drinks
4.   It is advised not to take water with your meals, but only to drink a glass of water an hour after and half an hour before each meal. By doing this, you reduce your chances of getting heartburn and aid in the proper functioning of the digestive system.
5.   Eating any form of raw food, such as uncooked meat and vegetables is strictly forbidden along with processed foods such as bread, cakes, cookies etc. However, when eating cooked food, make sure it's lightly cooked and not overcooked.
6.   Having a glass of juice freshly squeezed from vegetables or fruits is recommended, especially carrot juice as it is enriched with calcium and vitamin A that help in the healing process.
7.   Make sure that whole grains, nuts, seeds, vegetables and fruits are a part of your diet.
8.   Lastly, go for a walk after each meal and do not sleep after eating, especially if you've had a heavy meal.

Hernia : Ayurveda Treatment for Hernia Problem

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