The liver has a significant role to play in metabolism and digestion. The failure of a liver can lead to significant health issues. There are some causes for liver failure, which cannot be treated with medications. In these people, a transplant, which is replacing the diseased or injured liver with another liver, is the only definitive treatment option.

Some conditions which can require a liver transplant are:

Severe cirrhosis with a life expectancy of less than a year
Severe liver failure
Non-alcoholic steatohepatitis (NASH)
Liver cancer
Chronic hepatitis C
Biliary atresia in children
Types of transplant:

Living donor transplant: In some patients, partial liver can be removed from a close family member and transplanted into the affected individual. The liver is known for its regeneration ability, and over time, will grow in the recipient.
Cadaveric transplant: Immediately after death, a liver can be removed and transplanted.
While the concept of a transplant sounds quite convincing and appealing for those with a severe liver disease, it is also important to note that not all would qualify for a liver transplant. The conditions which would disqualify a recipient are discussed below:

Significant heart disease: Those with severe coronary artery disease, valvular disease, cardiomyopathy, aortic stenosis, and cardiomyopathy are not candidates for a liver transplant.
Severe lung disease: Those with poor lung perfusion do not qualify for a liver transplant.
Advanced age: Greater the age, lesser the survival rates. So, people aged more than 70 are usually not considered for a transplant.
Obesity: A person with a BMI of more than 35 is often not a good candidate for a transplant. The overall health should be managed in these people.
Malnutrition: On the other extreme, severely malnourished individuals are also not considered for a transplant.
HIV infection: A person who is HIV-infected does not qualify for a liver transplant.
Substance abuse: Anyone who is actively abusing alcohol and/or substances is definitely removed from the list for a transplant.
Metastasis: If a patient is looking for a liver transplant due to hepatic cancer, it is essential that the cancer is contained. If it has spread to various parts, then containing it would be difficult, and a transplant may not succeed.
Multisystem organ failure: Other than heart and lungs, even people with poor renal function are not ideal candidates for a liver transplant.
A detailed liver recipient evaluation assessing the severity of liver disease, chances of survival, and overall health are done before a person is listed for liver transplant. This evaluation ensures a better success rate with the transplant.

Common Surgical Complications That One Should Be Prepared For?

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!

Hectic lifestyle, unhealthy food habits, poor bowel movements, and stress can all add up to one condition called the GERD. Gastroesophageal reflux disease or GERD refers to a particular type of digestive disease, and mainly affects the LES or lower esophageal sphincter, which is a muscle ring between the stomach and the esophagus resulting in the symptoms such as burning sensation in the chest or difficulty in swallowing.

Treatment options
While the moderate or mild GERD can usually be treated with healthy lifestyle changes, diet, and medications, when the condition gets severe, surgery becomes the only option to prevent the issue from deteriorating further. Here are some of the common surgical options available for treating GERD:

Fundoplication: This surgical procedure is the most common and standard surgical option for treating GERD. It focuses on tightening and reinforcing the LES by wrapping the upper portion of the stomach around the outer side of the lower esophagus which strengthens the sphincter.
Transoral Incisionless Fundoplication: Transoral incisionless fundoplication or TIF is another surgical procedure available for treating GERD and can be performed when an open fundoplication cannot be performed. It is performed by creating a barrier between the esophagus and the stomach which prevents the stomach acid from reflux or going backwards.
Stretta: This surgical procedure is performed as an outpatient option using an endoscope. Here, a flexible tube is passed into the esophagus where the electrode present at the tip of the tube creates tiny cuts on the esophagus by heating the esophageal tissues. As a result, the scar tissues formed, block the nerves that are responsible for acid reflux.
Bard EndoCinch System: This surgical procedure also uses an endoscope to create stitches to make pleats in the lower esophageal sphincter, which strengthens the LES. However, this surgical treatment option is not as common as other GERD treating procedures.
Linx Surgery: In Linx surgery, a special device called Linx, a ring containing microbeads of magnetic titanium, is wrapped around the sphincter to make it strong. As the beads are magnetized, they help in keeping the opening between the esophagus and stomach closed, while letting the food pass normally.
Recovery
As long as the surgical option is laparoscopy, they are the least time-consuming as well as less painful with lesser downtime, but may not be ideal for everyone. When it comes to traditional surgical treatment options like fundoplication, it takes around minimum six weeks to resume the daily activities. However, for laparoscopic fundoplication, the downtime is one or two weeks. Linx surgery is a minimally invasive surgical option and therefore, the recovery time is shorter than other traditional surgeries for treating GERD. Depending on the patient's health conditions and response to surgery, the recovery time may vary for each surgical treatment options for GERD.

So, seek the advice of your gastroenterologist for the best possible treatment option to get completely cured of the condition.

Treating GERD: 5 Surgery Options That Can Help!

Gall bladder is a very important digestive gland, which is located on the right side of your abdomen, just beneath your liver. Its main function is to collect, store and release bile, a digestive fluid produced in your liver, essential for metabolizing fats, into your small intestine.

Sometimes, small hard stones comprising of cholesterol, bile pigments and calcium salts in the shape of a pebble, can form in your gall bladder. Gallstones may cause no symptoms but when the gallstone lodges in ducts and blocks the flow of bile, it can cause persistent high-intensity pain which requires gallstone surgery.

Surgery is then prescribed to remove the gall bladder. This surgery is called cholecystectomy. It s done when there are

Gallstones in the gallbladder
Gallstones in the bile duct
Gallbladder inflammation
Inflammation in pancreas
Gallstone surgery or cholecystectomy is a common surgery, and it comes with only a small risk of complications and you can walk out of the hospital on the day of the surgery itself.

Procedure

Minimally invasive or laparoscopic cholecystectomy
During this procedure, the surgeon makes 4 tiny incisions in your abdomen and inserts a tube with a tiny video camera inside it.
Through a video monitor, the surgeon watches while he inserts surgical tools through the other 3 incisions to remove your gallbladder.
After the surgery, the surgeon confirms that there are no gallstones left. Once this is done, he sutures your incisions and you are taken to the recovery area. A laparoscopic cholecystectomy takes just 2 hours or so.
But the problem with this procedure is that it  not appropriate for everyone. Sometimes, what happens is that, the surgeon may start with a laparoscopic surgery and then may decide to go for an open gallstone surgery because of scar tissue or complications.
Traditional or open cholecystectomy
This procedure requires a bigger incision of about 6-inches in your abdomen, below your ribs on the right side. The liver and gallbladder are exposed and the surgeon removes the gallbladder.
An open cholecystectomy takes one or two hours.
Single-incision Laparoscopy Surgery

Traditional laparoscopic surgeries use a telescopic rod attached to a video camera called a laparoscope, which is inserted through a small incision. Apart from this, 3 to 5 additional small cuts are made to insert the other surgical instruments to perform the surgery.

However, single-incision laparoscopy surgery (SILS) is a revolutionary minimally invasive surgical procedure conducted through a single incision. It provides a better cosmetic outcome, as a small incision is made through the patient s navel or belly button, resulting in an almost scarless outcome.

Indications

Most patients who are good candidates for laparoscopic surgery are eligible for single-port procedures. Some of the surgeries that single incision laparoscopy is indicated for include cholecystectomy (removal of gall bladder), appendectomy (removal of appendix), splenectomy (removal of spleen), hepatectomy (removal of liver) and adrenalectomy (removal of adrenal glands). SILS can also be used for diagnostic purposes.

However, patients who have previously undergone multiple major surgeries to the abdominal region and those who are morbidly obese are not considered for SILS.

Procedure

Single Incision Laparoscopy is usually performed as day surgery either in the hospital or outpatient surgery center under general, regional, or occasionally local anesthesia depending on the type of procedure performed and the surgeon s preference.

The patient is made to lie down in a tilted position so that the feet are placed higher than the head. The surgeon makes a single incision of about 3/4th of an inch at the belly button and injects a harmless gas to expand the area and obtain a clear view of the operative site. A tube called a trocar or port is placed through the incision, through which the laparoscope (a narrow telescope having a light source and camera) and tiny surgical instruments are inserted. The laparoscope guides your surgeon with images of the abdominal contents that can be viewed on a large screen. Once the diseased organ is excised, your surgeon removes the instruments, releases the gas, and closes the incision with a small bandage.

Recovery

Common post-operative guidelines following Single Incision laparoscopy include the following:

You will need someone to drive you home after you are released as the anesthesia may make you feel groggy and tired
Do not remove the dressing over the incision for the first two days and keep the area clean and dry.  No showering or bathing during this time.  The incision usually heals in about 5 days
Your surgeon may give you activity restrictions such as no heavy lifting. It is very important that you follow your surgeon s instructions for a successful recovery
You may feel soreness around the incision area. Your surgeon may give you a prescription pain medicine or recommend NSAID s (non-steroidal anti-inflammatory drugs) for the first few days to keep you comfortable
If the abdomen was distended with gas, you may experience discomfort in the abdomen, chest, or shoulder area for a couple days while the excess gas is being absorbed
Diet

You must be very careful with your diet after gallstone removal as your body will not be able to digest fats well. You will of course be sticking to a liquid diet for a week or two and then introduce solids back into your diet. When you do so, you have to stick to a low fat diet. Stay off fried foods and gas-forming foods. Also make sure that you consume no more than 60 gm of fats per meal to avoid discomfort. Stay off spicy foods to avoid bloats and abdominal pains.

Gallbladder Surgery - Aftercare Tips To Help You Recover Better!

Cancer can affect even small glands like the adrenal glands. Adrenal glands are responsible for the production of hormones like cortisol and aldosterone. These glands are located above the kidneys and have two parts; the cortex and the medulla. Adrenal cancer generally affects the cortex of the adrenal glands. This type of cancerous tumour is rare and can be difficult to diagnose.

Most adrenal cancer symptoms are triggered by an excessive production of estrogen and androgen. Symptoms can also be caused by the pressure put on other organs by the tumour. Adrenal cancer symptoms are most easily noticeable in children as this is the stage where the body is changing and developing. Some of these symptoms are:

Facial hair growth
Excessive pubic and underarm hair
An enlarged penis or clitoris
Early onset of puberty in girls
Development of enlarged breasts in boys
Symptoms of adrenal cancer in adults includes:

Excessive weight gain in the abdomen and above the collar bone
High blood pressure
Irregular menstruation
Easy bruising
Depression
Frequent urge to urinate
Muscle cramps
Additionally, men with adrenal cancer that causes excessive estrogen production may notice an enlargement of breast tissue and tenderness in the area. Women suffering from excessive androgen production triggered by adrenal cancer may notice their voice deepening and facial hair growth. In most cases, adrenal cancer symptoms in women do not appear until the tumour presses on other organs. This includes symptoms like pain around the tumor, a feeling of fullness in the abdomen and difficulty eating because of this feeling.

The cause of adrenal cancer has not yet been determined, but conditions such as Beckwith-Wiedemann syndrome, Li-Fraumeni syndrome, familial adenomatous polyposis and multiple endocrine neoplasia can increase a person s risk of suffering from this disease. A thorough physical examination and a detailed medical history is required to diagnose this disease. The doctor will also need a blood test and urine test. Additional tests that may be required include:

Biopsy of the tumor
CT scan
MRI scan
PET scan
Adrenal angiography
Adrenal cancer can be cured if diagnosed in its early stages. There are three types of treatment for adrenal cancer; surgery to remove the adrenal gland, chemotherapy and radiation. However, adrenal cancer can recur and hence it is important to schedule and maintain regular check-ups with your doctor.

Adrenal Cancer - Know Its Symptoms!!

Looking good and feeling good are sometimes one and the same thing which can be achieved with good skin and a fit body. One can turn to many measures to achieve the same, including cosmetic procedures. Cosmetic surgery like liposuction is generally used to remove the excess fat in the body which cannot be treated with normal exercise or diet control measures. This surgery is conducted by a plastic surgeon. Here is everything you need to know about liposuction.

About: Liposuction is a cosmetic procedure. It removes the excess fat present in one s body with the help of a procedure known as body contouring. This kind of contouring may be carried out in various parts of the body including the calves, knees, buttocks, hips, abdomen, upper arms, breasts and even the neck and chin area. These are the areas that generally end up accumulating excessive fat which does not go away easily. For some people, persistent diet control and exercising may help. But for severe and chronic cases, one will have to make use of measures like liposuction.

Types of Liposuction: Depending on your case as well as the individual system of the patient, one can go in for one of the various types of liposuction. The fluid injection based liposuction is the most popular and common form where a large dose of medicated solution is injected with a local anaesthesia blended into it. This helps in contracting the blood vessels so that the fat can be suctioned out. The next type is the super wet liposuction where the amount of liquid solution injected is the same as the amount of fat that has to be removed. Ultrasound assisted liposuction uses ultrasonic waves in order to transform the fat cells into liquid which can be vacuumed out later. Further, laser assisted liposuction makes use of laser pulses and beams in order to make the fat cells liquid before they are vacuumed out of the system.

The procedure: The plastic surgeon will make use of a special liposuction machine and cannulas or special instruments, so that the surgery may be carried out in a proper manner. Also, depending on the type of procedure you are going in for, you will require local or general anaesthesia. A small incision is made so that the tube may be inserted for the liquefaction process to begin. After this, the fat that has been dislodged will be vacuumed away through the same suction tube. Small drainage tubes will be inserted to remove blood and fluid from the deflated areas and in some rare cases, blood transfusion or fluid replacement may also be required. High blood pressure and cardiovascular cases should not use this option.

Liposuction - How It Can Help You?

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