Bladder cancer refers to a  cancer, which arises from the epithelial lining or the urothelium of the urinary bladder. In the most common form of bladder cancer, the normal histology of the urothelium is recapitulated. It is called transitional cell carcinoma. Bladder cancer is a serious form of cancer that leads to many deaths too.

Treatment:
There are several modes of treatment for bladder cancer. They are:

1. Bladder cancer surgery: Surgeries are common for treating bladder cancer. 

2. Transurethral resection of bladder tumor or TURBT: This mode is used for determining the presence of bladder cancer and to find out if it has invaded the bladder wall muscle layer. This treatment mode is generally used in the early stages of bladder cancer.

3. Cystectomy: A cystectomy is undertaken when bladder cancer is very invasive and parts of the bladder or the whole of it has to be removed. There are two types of cystectomy.

Partial cystectomy is used when the cancer invades the bladder muscle layer in a small area. It can be removed without the whole bladder being taken out.
A Radical cystectomy is undertaken in case the cancer affects a large area and is present in multiple areas of the bladder. This surgery removes the bladder entirely and all its nearby lymph nodes.
4. Intravesical therapy: In intravesical therapy, a liquid drug is put directly into the bladder via a catheter instead of injecting it or consuming it orally. The cells lining the bladder are affected without causing any harm to other body parts. This therapy is usually used after TURBT in non-invasive cases of bladder cancer to prevent recurrence.

5. Chemotherapy: Chemotherapy is an effective treatment for bladder cancer. Chemotherapy may be used in two ways:

Intravesical chemotherapy, where the chemo drug is put directly into the bladder and is applicable only for early treatment stages.
Systematic chemotherapy, which involves the injection of chemo drugs into the vein or muscle and can also be administered in the form of pills. The drug reaches all parts of the body via the bloodstream and affects all cancer cells.
6. Radiation therapy: This treatment procedure for bladder cancer involves the use of high energy radiation for killing cancer cells. It is used in early phases of treatment and is the primary remedy for people who cannot have a surgery. It is combined with chemotherapy to make the radiation effective. The most common type of radiation therapy for treating bladder cancer is called external-beam radiation therapy where radiation occurs from an outside source.

Bladder cancer is a severe form of cancer. Proper and ideal treatment is required among the several treatment methods available.

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

Bladder Cancer and How It Can Be Treated

Laproscopic Bariatric Surgery allows Surgeons to perform minimally-invasive treatments to obese patients who have had repeated failure in losing weight through diet change and exercise. Bariatric Surgery is a procedure that does not require any incisions. Patients can return home within 2-3days without much discomfort. In this procedure, inserting operative instruments through multiple holes along with a camera which displays video images on monitor without making a single incision. The camera allows the Surgeons to witness the internal condition and perform the procedure safely. The three most well-known Laproscopic bariatric surgery procedures include gastric bypass, gastric sleeve, and mini-gastric bypass. 

Most common types of Laparoscopic bariatric surgery: 

Gastric sleeve: This is a more drastic mode of surgery and is a new addition to the bariatric endoscopic surgery procedures. Through this procedure, 90 percent of a patient s stomach is removed to facilitate the loss of hunger. This also helps in portion control of food. 
Gastric bypass: This is the most widely used bariatric procedure to cut down fats and control hunger across the globe. The digestive system is re-routed to suppress the hunger of the patient in this procedure. It also contains minimal risk to a healthy individual. 
Mini-Gastric bypass: Similar to Gastric bypass but shorter procedure with approximately equal results in comparison to gastric bypass. 
Other procedures for weight loss are: EndoBarrier therapy and Intra-gastric balloon The procedure is decided by the Surgeons and depending on which types of the procedure will suit you the most. 
Bariatric Surgery allows doctors to perform minimally-invasive treatments to obese patients who have had repeated failure in losing weight through diet change and exercise. Bariatric Surgery is a procedure that does not require any incisions. Patients can return home within the few day without much discomfort. A keyhole procedure involves inserting camera and instructions within abdominal cavity and operations performed by viewing over the monitor. The camera allows the doctor to witness the internal condition and perform the procedure safely. 

Benefits of Laparoscopic Bariatric Surgery: 

Being a minimally-invasive procedure, laparoscopic bariatric surgery has its own advantages. Since minimal incisions are made, the risk of operative complications is easily mitigated. Bariatric surgery is also a long-term solution.

Most Common Types Of Laparoscopic Bariatric Surgery!

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?

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?

Bariatric surgery is advised in cases of morbid obesity (BMI >37.5). This degree of obesity is usually associated with comorbidities like diabetes, hypertension, dyslipidemia, obstructive sleep apnea, infertility, knee joint pains, etc. In the present scenario, when all efforts of weight loss seem ineffective, bariatric surgery seems to be the only way to lose excess weight in the morbidly obese patients. Undergoing bariatric or weight loss surgery requires some preparation prior to surgery, and also after surgery to ensure its success.

Most of them will have an enlarged fatty liver, hence a low-calorie diet is advised so that the fatty liver does not pose problems during surgery. Due to obesity, there will be a compromise on the lung function, decreasing the lung capacity. Hence improving the lung function is of importance from the anaesthetic point of view and also concerning the quick postoperative recovery.

For the first few months following surgery, there will be a significant reduction in the intake of food, as the size of the gastric pouch has been decreased. In addition, there will be some restrictions on the caloric density of food for the first few months after surgery. However, for a person who understands these requirements and is willing to so, the long-term benefits are multiple. 

Read on to know how bariatric surgery can turn your life around.

Weight loss: One of the first benefits they would see is weight loss which starts right from the first week following surgery. The patients are so very happy to see this weight loss which they had not seen in spite of all their attempts at losing weight over the last few years. This boosts their morale and helps them to follow the instructions given to them more diligently, as they are seeing results. The weight loss is maximum in the first 6 months following surgery and in fact, this is called the honeymoon period for weight loss. A monthly follow up with the doctor is essential and up to 60 to 70% of the excess weight is lost in the first 6 months. It takes another 3 to 4 months to lose the remaining excess weight.

Emotional gains: For a person who is used to seeing an obese image in the mirror, it is a great morale booster to see that image changing to a slender version. This is a big boost to continue the effort towards diet and exercise, which will only improve the confidence and esteem levels.

Overall health: Morbid obesity is not an isolated condition. It brings with it a host of medical issues including sleep apnoea, diabetes, hypercholesterolemia, etc. With obesity under control, these conditions also begin to improve and the person s overall quality of life begins to improve. This, in turn, provides a big boost for the person to continue working at weight loss.

Reduced healthcare expenses: Obese people often need to eat various medications to manage overall health. There could also be emotional health management issues. With this controlled, the patient spends less on overall health and feels good again.

Social connect: Morbid obesity is both a physical and an emotional blockage for a person to engage socially. Once it is controlled, the person is more confident in meeting people and participating in social activities. This further leads to increased overall happiness.

Active life: With reduced weight, the person s level of activity improves. What seemed difficult earlier is suddenly doable. A person who could not walk some steps is able to, and this is a big booster.

People who undergo bariatric surgery require quite a bit of effort to change their overall lifestyle. However, the benefits are for them to see for themselves, and that is the biggest motivator to continue working towards their goal. Family support is definitely required to boost up the morale. The benefits are there for all to reap.

Bariatric Surgery - Stunning Gains You Must Know!

Q1. What exactly is Laparoscopy?
Laparoscopy is an alternative to 'Open' surgery wherein the abdomen is opened by tiny 'key hole' incisions and surgery is done. 'Scopy' means the use of an endoscope or telescope to see inside the abdomen. This is attached to a camera and a light source and the inside of the abdomen is projected on to a monitor. The surgeon performs surgery looking at this screen. The surgeon makes a total of 2-4 small cuts on the abdomen ranging from half to 1 cm through which the telescope and other thin surgical instruments are passed into the abdomen. When the uterus is removed , known as hysterectomy, there is also a cut at the top of the vagina where the uterus is attached.
Q2. What kind of gynaecological surgeries can be performed by Laparoscopy?
Most surgeries done in gynaecology can now be performed by Laparoscopy and do not require the large incision as for open surgery. Laparoscopy can be done sometimes only for diagnosis and is called Diagnostic Laparoscopy, as in checking whether the tubes are open or not and to look for any causes of infertility or pain outside the uterus. In women who are unable to conceive, Diagnostic Laparoscopy is often combined with Hysteroscopy (endoscope inside the uterus, inserted from below, via the vagina). When laparoscopy is done to perform some surgical procedure inside the abdomen it is called Operative Laparoscopy. This may be for simple procedures like sterilization, minor adhesions, drilling ovaries; or for intermediate or major reasons like fibroids, endometriosis, removal of ovaries or tubes or both or removal of uterus, for staging of cancers or radical surgeries for cancer. However, about 5% of all surgeries including those for cancer or very large tumours may benefit from open surgery.
Q3. Why does an expert surgeon recommend Laparoscopy over Open Surgery?
Laparoscopic surgery has many advantages above open surgery: the incisions are much smaller (open surgery incisions are 8-10 cms long), therefore pain is much less; requirement for pain killers (which can have side-effects like sleepiness, impaired judgement) is lesser; hospital stay is shorter; complications fewer; requirement for blood transfusions infrequent; recovery in terms of physical, emotional and mental state is much better and quicker; return to work is faster with consequent lesser loss of working and earning days. Surgery with laparoscope is more precise because it is magnified view. Further vision is much better because it's like having your eye behind the structure because you can see with the telescope at places where the surgeon's eye cannot reach.
Q4. If the cuts on the abdomen are so small in Laparoscopic surgery, how do you remove the uterus or a large tumour from inside the abdomen?
Quite often if the tumour is not malignant and contains fluid, it is punctured to collapse it into a smaller size. If it is solid, it can be cut into smaller pieces inside the abdomen using a special instrument. The collapsed or cut structures can be removed gently through the 1 cm cut on the abdomen which may be increased a bit if required. After hysterectomy, the uterus can be removed easily from below, through the vagina.
Q5. Will there be much pain or discomfort after Laparoscopic Surgery?
There may be some pain and discomfort in lower abdomen for one day to few days after Laparoscopic surgery but this is much less as compared to open surgery because the incisions on the abdomen are much smaller and there is much less tissue handling inside the abdomen by fine instruments instead of rough, big, gloved hands which can cause tissue injury in open surgery. There may be some pain in the shoulder following laparoscopy. This is not serious and is due to the gas used in the surgery to make space for instruments.
Q6. When can I be discharged from hospital?
Following Diagnostic Laparoscopy or with simple Operative Laparoscopy you can expect to be discharged from hospital latest by the morning after surgery. In most other cases of intermediate or even major surgery, discharge is generally 1-2 days following the surgery unless there is some health issues prior to the surgery or any complication during the surgery. The complication rates for Laparoscopic surgery are not more than for open surgery and depend upon patient factors like anaemia, diabetes, obesity and skill of the surgeon.
Q7. When can I perform routine household activities or return to work after Laparoscopic Surgery?
Recovery after surgery depends upon many factors: presence of health problems before surgery; why the surgery is required; what surgery is being done; problems or complications of surgery, anaesthesia or blood transfusions. If all is well, one can perform routine household activities by 1 week, provided one doesn't feel tired. Although there may not be any harm, it may be unwise to be normally active within 48 hours of procedure. Following Diagnostic Laparoscopy or Operative Laparoscopy for simple procedures, one can return to work in 1 week. For other procedures, a 2-3 week off from work is reasonable. It depends on the type of work you are returning to. Avoid too rapid return to work if it is manually hard or requires standing for long durations of time. Sometimes a surgical procedure brings on a well needed rest and break from a lifetime of work. Mostly, when you return to work depends upon your own body and its signals of tiredness. You need to listen to those signals.


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