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?

A fistula is an abnormal, tube-like connection, a passage or hole that forms between two organs or an organ in your body and your skin. There are various types of fistulas that can develop in different parts of your body but the most common types are-

1. Obstetric Fistulas: This is the name given to a hole between the vagina and rectum or bladder. A vaginal fistula that opens into the urinary tract is called a vesicovaginal fistula and one that opens into the rectum is called a rectovaginal fistula. 

A woman with obstructed labour or labour that is not attended by a doctor or a midwife, can suffer labour pain for up to six or seven days. And as the labour produces contractions that push the baby s head against the mother s pelvic, the soft tissues between the baby s head and the pelvic bone are compressed and do not receive adequate blood flow between the mother s bladder and vagina and/or between the rectum and vagina.
This means that a hole forms on the vaginal wall between the urinary tract and her rectum. The urine and faeces thus start to leak from the vaginal opening causing soiling and foul smell.

Apart from labour, hysterectomies that damage the vaginal wall can also cause such types of fistulas.

Enterovaginal   A woman may have gas and foul smelling fluids leaking out of her vagina due to an enterovaginal fistula which is a hole between the vagina and the digestive tract. It s usually caused due to inflammatory bowel disease or IBD and ulcerative colitis.

2. Anal fistula

These are fistulas that form between the end of the bowel and skin near the anus.

An anal fistula usually develops due to a previous or current anal abscess. An anal abscess is an infected cavity filled with pus found near the anus due to an acute infection in the internal glands of the anus.

Common symptoms are:

Pain in the anorectal area
Swelling
Redness
Fever
Rectal bleeding
Urinary symptoms, such as trouble initiating urination or painful urination
Causes:

Inflammatory bowel disease   a chronic condition of the GI track which causes inflammation
Diverticulitis   An infection in the large intestine
Tuberculosis, HIV
Surgery near the anus
Anal abscess and likewise anal fistula are treated by surgical drainage in which an incision is made in the skin near the anus to drain the infection causing an anal abscess. Hospitalization may be required for patients who have impaired immunity like diabetics.

Anal fistula though has no medical treatment and surgery is almost always necessary to cure it.

If the fistula is straightforward which means one that involves minimal sphincter muscle, a fistulotomy may be performed. This involves cutting open the whole length of the fistula so it heals.
Seton is another procedure in which a surgical thread called a seton is placed in the fistula and left there to help it heal.

Different Types of Fistula and Treatments!

Many women experience a temporary encounter with hemorrhoids when they are pregnant. Quite surprisingly, most people tend to experience this in their daily lives. By the age 50, majority of people have encountered one or more symptoms of this ailment, including rectal pain, bleeding, itching and may be prolapse where the hemorrhoids protrude out of the anal canal. Though this ailment can be rarely detrimental, it can be a painful intrusion. But thankfully, there are a lot of things we can do about them.

How may this be diagnosed?
Hemorrhoids are usually diagnosed from a plain medical history and health exam. External hemorrhoids, more commonly known as piles, are normally apparent, particularly if a blood clot is formed. Your physician shall perform a digital rectal test to detect blood in the stool. Then the physician may also inspect the anal tube with the aid of an anoscope, which is a short plastic channel interjected into the rectum with illumination. If he finds any evidence of microscopic blood or rectal bleeding in the stool, then there may be a need to perform colonoscopy or flexible sigmoidoscopy to determine the probable causes of bleeding like cancer or colorectal polyps, specifically in women aged over 50.

Is it possible to treat hemorrhoids at home?
Most of the common symptoms of piles can improve drastically with simple in-home measures. If you are suffering from occasional flare-ups, you may try the following:

    Eat a lot of fibre: It is recommended to add fibre in the diet; may be a fibre supplement like Citrucel, Fibre con, etc. When you drink a lot of water along with loads of fibre, stools get softened making them effortless to pass, which will reduce the pressure on the swollen veins. Eating broccoli, wheat, oats, beans, fresh fruits every day will help in decreasing bleeding caused due to piles. It also reduces swelling and inflammation. If you feel digestive issues with a sudden splurge of fibre in your diet, you may start slowly and gradually increase the amounts.
    Take a sitz bath: A sitz bath is a lukewarm water bath for the lower back portion of the body, which can help in relieving irritation, itching as well as spasms occurring in the sphincter muscle. You can either get small plastic tubs for a sitz bath or sit in a normal bath tub. Most physicians suggest a half an hour sitz bath after every bowel movement. Then tenderly dry the area and avoid wiping it hard.

There are several invasive treatments that can be opted if these conservative treatments are not able to help your condition. In such an instance, it is always wise to seek advice of a medical practitioner. 

How to Deal with Hemorrhoids?

What you eat plays an important role while you are udergoing thyroid disorders. Certain nutrients can influence the functionalities of the thyroid gland, while some foods can prevent the body s ability to absorb the hormones to a substantial extent. As with a lot of health conditions, some factors are not in our hands which include family history and the environmental factors around you. However, the factor that you can control, is diet.

You can empower yourself to choose a healthier lifestyle through the right diet. It is advisable that you choose your foods wisely. Some of the following foods are known to be beneficial in managing thyroid:

1. Yoghurt
You will be happy to know that dairy products can contribute to fulfilling the much-needed iodine requirement of your body. Since livestock are generally given copious amounts of iodine supplements and the process of milking incorporates iodine-based cleaners, you can get plenty of iodine from dairy products, particularly, yoghurt. Greek yoghurt is one of the prime sources of iodine and can make up to about 50 percent of the daily intake of the nutrient.

2. Seaweed
When suffering from thyroid, you need iodine to function properly. Producing adequate levels of the thyroid hormone is important to fulfil the needs of the body. Though taking iodized salt can help a lot in your daily iodine intake, you can take additional aid from seaweed. It is important to understand that taking too much iodine can trigger the symptoms of hypothyroidism and the trick here is to balance out how much your body needs.

3. Milk
Much of the iodine in one s diet comes from dairy products. When you drink about 1 cupful of low-fat milk, you can effortlessly consume around 1/3rd of the daily iodine requirement. It would be better if you take milk rich in Vitamin D. If you are neither a fan of milk nor yoghurt, you may also resort to cheddar cheese, as a single slice can give you around 12 micrograms of the much-needed iodine.

4. Chicken
While all the hype is about iodine, zinc also plays an important role in controlling thyroid symptoms. When you take too little amount of zinc, you can get hypothyroidism and in case you already have this condition, your body will need it more since the thyroid hormones help in the absorption of the minerals. Meat, particularly chicken is an amazing source of zinc when you have it roasted.

5. Fish
Fish is yet another source of iodine since it is found in sea water as well as in soil. Taking 3 ounces per serving of baked cod fish can give you around 99 micrograms of iodine. Moreover, shellfish, lobster, and shrimp are good sources of iodine as well.

By adding these foods, you can definitely control your thyroid symptoms to a considerable extent. Controlling your diet is the key to managing your thyroid condition, and therefore you must pay special attention to it.

Diet Tips For Managing Thyroid!

Gallstones are solid deposits/stones of digestive fluids that form in the gall bladder. The size of these stones varies from person to person. While some people may develop only one stone in the bladder, others may develop multiple gallstones simultaneously.

Signs you must watch out for-

Abdominal pain
Pain in the back or between the shoulder blades
Vomiting and nausea
Heartburn
Bloating and indigestion
Change in bowel movement
Dark urine
Fever and chills
Rapid heartbeat
Yellowish skin and pale eyes (Jaundice)
These are the most common symptoms that a person with gallstones encounters. One should consult the doctor right away upon experiencing these symptoms. If ignored for long, these signs can aggravate and lead to further complications.

Complications that may arise from gallstones-
There are quite a few complications of gallstones, including the following-

Cholecystitis- when gallstones become stuck at the neck of the gallbladder, it causes inflammation.
Obstruction in the pancreatic duct- a gallstone blocking the pancreatic duct can cause pancreatitis followed by intense abdominal pain.
Blockage in the bile duct- if the gallstones create a blockage in your bile duct, the outcome may be an infection or jaundice.
Gallbladder cancer- people, who have a history of gallstones, are more likely to develop gallbladder cancer.
Treatment of Gallstones-
Gallstones can certainly be treated, if diagnosed early in time. To confirm the diagnosis, your doctor may perform a CT scan, X-ray, Ultrasound or an ERCP. Once the condition is diagnosed, your doctor will recommend a surgery to remove the stones in the gallbladder (known as Cholecystectomy). The preferred choice of surgery includes the following-

Laparoscopic removal- In most of the cases, the doctor adopts this minimally invasive approach to remove gallstones. First, he makes a small incision in the abdomen. He will then insert a tube-like instrument with an attached camera into the gallbladder to have a clear sight of the gallstones, and surgically remove them from the gallbladder.
Open surgery- This is performed under general anesthesia. During this procedure, a single, long incision of roughly 3-6 inches is made on the upper side of your right abdomen. The tissues and muscles are pulled back to divulge the gallbladder. The gallstones are then removed, and the incision stitched up. Open surgery is performed when laparoscopic surgery is not suitable for the patient.
Gallstones cannot be managed with just diet and medications. A surgery is usually needed to remove the stones and cure the patient. For Laparoscopic surgery, the rate of success is nearly over 95%. Identify the symptoms before it aggravates, and consult a doctor for treatment.

Gall Stones - Is Surgery The Only Treatment?

Anal Fistula - What Causes It? 
An anal fistula refers to a small infected tunnel connecting the anus to the outer skin. Your body eliminates solid waste products or feces through the anus. When any of the glands inside the anus becomes infected or blocked, an abscess may form, which in turn results in formation of anal fistula. In about 50% of the cases, abscesses develop into fistulae. What are the causes for anal fistula? Anal fistulae occur primarily due to the formation of an abscess or infection in the anus. If the abscess does not heal completely after the pus has been drained away, a fistula can develop. 

Other factors responsible for the occurrence of anal fistulae are- 

Crohn s disease- a chronic condition where the digestive system becomes inflamed. 
Diverticulitis- an inflammation of the small pouches that develop along the intestinal walls. 
Hidradenitis suppurativa- a chronic painful skin condition which causes scarring and abscesses on the skin. Apart from these, people with HIV or infected with Tuberculosis disease also develop anal fistulae. If you ve had a surgery around the anus, then post-surgery complications may lead to infection or abscess on the skin. 
What are the symptoms to watch out for? 
The commonly observed signs and symptoms of anal fistulae include- 

Irritation or discomfort on the skin around the anus 
Occasional throbbing pain, especially while seated, moving around or having a bowel movement 
Nodular swelling around anal region 
Intermittent Discharge of blood or pus from an opening near anal orifice. 
How does Ayurveda treat anal fistulae? 
Ayurveda recommends Ksharsutra treatment for complete healing of Anal Fistula. 

In this procedure; Ksharsutra   a medicated thread is placed in Fistula tract. Medicine released from Ksharsutra debrides the fistula tract and induces healing. This medicine remains active for about 5-7 days so this thread needs to be changed with a new thread at weekly interval. No. of Ksharsutra changes required for complete healing of Fistula depends on length depth and branching pattern of fistula. It has been observed that Fistula heals at the rate of 0.5 to 1 cm per Ksharsutra changes so for a fistula tract of 3 cm length about 4-5 weekly thread changes are necessary for complete healing. Clinical trials conducted by Indian Council of Medical Research at AIIMS New Delhi have proved that Ksharsutra treatment is more convenient and more effective than Surgery in case of Anal Fistula. In this way Ksharsutra is the best way to treat Anal Fistula without Surgery.

Anal Fistula - What Causes It?

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