Dr. Khomane Gorakshanath

The surgical procedure to remove the oesophagus (the tube between your stomach and mouth), partially or completely, and reconstruct it by using a section of the large intestine or stomach is called esophagectomy.

Esophagectomy is commonly used to treat oesophageal cancer.

Uses:

Early-stage oesophageal cancer is frequently treated with an esophagectomy. Other than that, esophagectomy is also performed to treat oesophageal dysplasia (a condition in which cells in the oesophageal lining are precancerous or likely to develop cancer if not promptly treated).

Esophagectomy is commonly performed when cancer has spread to the stomach, lymph nodes or associated organs.

Some other conditions which require esophagectomy include:

1. Oesophageal trauma.

2. Swallowing of cell-damaging, or caustic agents such as lye.

3. Problematic stomach disorders that make the passage of food to the stomach difficult.

4. A previously performed esophagectomy was unsuccessful.

Procedures:

There are three ways a surgeon may perform an esophagectomy, which include:

• Transthoracic Esophagectomy (TTE)

In this type of procedure, the incision is made on the chest. A TTE is mostly used to treat the following conditions:

1. • Cancer present only in two-thirds of the oesophagus

   • Barrett’s oesophagus (Abnormal cell transformation in the lower oesophagus)

   • Damage to the oesophagus by swallowing a caustic agent

   • Reflux esophagitis (stomach acids return to the oesophagus) complications

• Transhiatal Esophagectomy (THE)

In THE, the incision is made from the end of the breastbone to the bellybutton. THE is performed for the following conditions:

1. • To remove the cancerous oesophagus

   • To tighten or narrow the oesophagus in order to make swallowing easier

   • To fix issues in the nervous system

   • To repair frequent gastroesophageal reflux

   • Correct a hole in the oesophagus caused by any caustic agent

• En Bloc Esophagectomy

In this procedure, the oesophagus, part of the stomach and all the lymph nodes in the abdomen and chest are removed. The incisions are made in the abdomen, chest and neck; the stomach will be reshaped and brought up to the chest to put back the oesophagus.

Potentially curable tumours are treated by en bloc esophagectomy.

Outlook:

Recovery time of esophagectomy is three weeks approximately. You are allowed to go back to your regular diet after a month. You might find that you are eating smaller portions as you stomach size is reduced.

There are many kinds of conditions and symptoms that require different kinds of surgery for treatment as well as diagnostic management. One such procedure is called a laparoscopy or the laparoscopic surgery. This is a surgical diagnostic management procedure that is known to be a low risk process with minimal invasion and suitable for various types of ailments. Read on to know everything about laparoscopic surgeries.

• Definition: A laparoscopic surgery is one where small incisions are made and an instrument called a laparoscope is used in order to take a look at the organs in the abdominal region. This tool is a long tube shaped one that comes with its own high intensity light and a high resolution camera that can easily move along the walls of the organs while the camera sends back imagery that will be displayed on a video screen in front of the doctor. This avoids the need for an open surgery and helps the doctors in getting samples for a biopsy on an outpatient basis.
• Need for Laparoscopy: This procedure is performed when the patient complains of persistent pain that is also sharp and shooting, in the abdomen region and surrounding areas like the pelvic cavity. This non-invasive method helps in diagnosis where other imaging methods like an ultrasound and CT or MRI scans would have failed to give a conclusive reason for the pain and suffering of the patient. When these tests do not supply enough reason for proper diagnosis, then the doctors usually resort to this kind of procedure.
• The Organs it can be used for: The laparoscopic surgery can be used for many organs including the appendix as well as the gall bladder, the pelvic region and the reproductive organs, the small and large intestines, the spleen, the stomach, the liver and the pancreas.
• What all can it Detect: The laparoscopic surgery can help in detecting a number of issues including any abnormal growth or mass that may be a tumour. It can also point at the presence of any disease in the liver, as well as the proper functioning of certain treatments. Also, it can show the amount of fluid that may or may not be present in the abdominal cavity and the extent of cancer's progression in the body.
• Risks: There are a few side effects or risks of this method including fever, chills, swelling, bleeding or redness of the site where the incision was made for the surgery, and shortness of breath. All these symptoms must be reported to the doctor immediately as they may point at the presence of an infection. Also, there is a risk of organ damage in this procedure.

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

HI,

I am Dr. Khomane Gorakshanath, Laparoscopic consultant and surgeon in Suchak and Sanchaiti Hospital in Kandivali. Today we are talking about laparoscopic gallbladder removal. What is laparoscopic gallbladder removal? It is a minimally invasive surgery in which small incision with specialized tools used to remove the gallbladder when it is diseased or infected. The gallbladder is a small organ which is located near the liver. The bile is released from the gallbladder in the small intestine for digestion or breaks down of the fact. Normal digestion is possible without a gallbladder. So, removal of the gallbladder is a treatment option if it becomes diseased or infected.

Laparoscopic gallbladder removal is a common type of surgery. It is formally known as laparoscopic cholecystectomy. Why is laparoscopic gallbladder removal performed? The main reason for gallbladder removal is the presence of gallstones and the complications they cause. The presence of gallstones is called as colelitiasis. Gallstones form inside the gallbladder. They can be as small as a grain of sand. or as big as a golf ball. This type of surgery, if you have following problem like biliary dyskinesia, the gallbladder is incorrectly filling or it is not emptying properly. Then there is coledocolitiasis wherein the bile duct has got stones which are removed from the gallbladder and they have a potential blockage causing the complications. It prevents the gallbladder from draining from the bile. Colelitiasis one another inflammation in the gallbladder which requires removal of the gallbladder.

Then pancreatitis can be caused by gallstones our gallbladder problems. Laparoscopic surgery is preferred open surgery because a smaller incision that is made reduced your risk of infection, bleeding and the recovery time. Reduced drainage of the gallbladder. The risk of laparoscopic gallbladder removal. Mainly it is considered very safe. The complication rate is less than 2%. Every surgical procedure carries some risk. But they are rare. Your doctor will perform the complete physical examination. He will review your medical history before any procedure. This will help to minimize the risk. The risk of laparoscopic gallbladder removal include allergy to anesthesia or any other drug then bleeding, blood clots, damage to the blood vessels. Some heart problems wherein rapid heart rate is there, infection is there or injury to the bile duct or small intestine or pancreatitis.

How to prepare for a laparoscopic gallbladder removal? You have to go for several tests beforehand to ensure that you are healthy enough for the procedure. This will include blood test, imaging test for gallbladder like ultrasonography or MRCP then complete physical examination by your doctor. Review of your medical history. You have to tell to your doctor about any medications, you are taking or nutritional supplements. Sometimes you may have to stop medicines. Also, you have to tell your doctor about your status of your pregnancy. If you are pregnant or if you think you could be pregnant then you have to tell your doctor about it. Your doctor will give you complete instructions about preparing for a surgery.

And you should not eat or drink before 4-6 hours of surgery. Planning for a hospital if there are some complications. Now, how gallbladder laparoscopic surgery performed? Before beginning the procedure, you will be changed into a hospital gown, you will be given to IV, so your doctor can give medications and fluids through a vein when you will be under general anesthesia means you will be in painless sleep. Your surgeon will make 4 small incisions in your abdomen. Through these incisions, he will guide a tool, which will be with the lighted camera so that inside the abdomen can be seen. You will be inflammated with some gas into the abdominal cavity so that it can be operated.

After your gallbladder is removed, your surgeon will use some special x-rays to check the problem in your bile duct. This technique is called as cholangiography. Any abnormality in the bile duct will be removed. Once your surgeon is satisfied with the results, he will stitch all the incisions taken and he will be bandaging. After the procedure, you will be taken to a room, where you will allow to recover through anesthesia. Most people can go home on the same day. Sometimes you have to go on the next day. After laparoscopic gallbladder surgery, removal of the gallbladder is done, there are very rare complications or symptoms. You may sometimes feel loose motions or diarrhea. We encourage you for early walking once you start feeling better.

Your doctor will instruct that when you will be ready for normal activities. Full recovery is typically taking a week. Then you will be in charge of looking after your own and taking care of washing it till the period it is there. In the next follow-up, your doctor will remove stitches. So, these are the information. If you want more than these, you can contact me through lybrate.com.

Thank You.

I’m Dr. Gorakshanath Khomane. I’m Laparoscopic consultant surgeon in Kandivali Manat working in Sanchaiti and Suchak hospital.

Today we are talking about hernias. What is hernia? Hernia is a it occurs when organs or fatty tissues which squeezes out through some part into the surrounding tissue, connected tissue and surrounding fascia, is called hernia. Hernia usually is of different types. There are inguinal hernias; which are lower abdomen hernias, then femoral hernias, incisional hernias, umbilical hernias also called as belly button hernia. Inguinal hernias are most common hernias, these are around 96% hernias are inguinal hernias. These are above the groin areas and then usually they are present in man commonly in man. Femoral hernia are common in females which is below the groin, it is usually protrude out through the femoral canal which is the femoral vessels and it comes into the upper thigh. Then umbilical hernia is at the umbilicus around the umbilicus which usually protrude through the umbilical area. It is weak part due to obesity or sometimes in childhood newborn, sometimes due to poor nutrition, and in elderly it is quite common. Where is another hernia called as incisional hernia, these hernia are due to some surgeries on the abdominal cavity which causes incisions and then there is weakness in the inner part which they through which the intestine or the contents of the abdominal cavity protrudes out into the surrounding tissues and causes the obsessions and triangulation. These are common in elderly people and or in women. The another hernia is hiatal hernia which is totally different. In this hernia the stomach protrudes through the abdominal cavity into the chest through hiatus of diaphragm. So what are the causes of these hernias? Mainly there is a pressure increased pressure in the abdominal cavity and weakening of the abdominal muscle wall. Main things are like lifting heavy weight without stabilizing the abdominal wall muscles, then obesity then nutritional poor nutritional diet so that there is a weakness of abdominal wall, continuous loose motions or diarrhea or constipation. Sometimes also there is persistent coughing, sneezing, which can cause these types of hernias. In elderly patient where benign enlargement of prostate can cause resistance of frequency of urine straining of urine which also can cause hernias.

How to diagnose hernia? For diagnosing hernia one thing is that physical examination by a healthcare provider is very important by which you can actually diagnose hernia. Second ultrasound of the abdominal wall abdominal cavity by which you can know the different types of hernia. Third is taking x-ray abdomen in which you can see whether there is option of the intestine or not. Sometimes you can do CT scan of the abdomen, the triangulation of the hernia is present or if the obstruction of the abdominal wall or the abdominal cavity because of the intestinal obstruction it can be diagnosed. How to treat hernia? In babies umbilical hernias can get resolved of its own in the beginning periods of the years. Sometimes it may remain and it can increase in size then it has to be treated. In elderly age or in later age groups if the hernia occurs then simply you can monitor it you can be with the hernia but then it is risky. Sometimes intestines can get strangulated there it can obstruct the complete bowl and there will be swelling of the abdomen there will be risk of life because of perforation of the intestine or shock or sometimes death. So it has to be treated it should be treated in conventional manner in recent advances there are other moralities of the surgeries. Conventionally they is to treat the hernia with mentoplasty where the mesh is kept on the part where the gap is there where the defect is there the defect is closed and then the mentoplasty is done. That is done usually in the conventional surgery which is called as herniorrhaphy. In all these hernias the mesh is used nowadays. There are other recent moralities via a laparoscopically where putting the telescope inside you put the hernia mesh on the defect and you close it properly, Trans abdominally or proportionally you can do it. Umbilical hernia can also be done by laparoscopy by which you can put double layer mesh and repair the umbilical hernia. Whereby you can actually move on very fast you can life start early, the movement or conversant period is very less and risk is less. So nowadays the laparoscopic hernia repair is given a choice and should be done. Hernia may reoccur after surgeries so preventive measures has to be taken care. Preventive measures has to be done so that the hernia should not occur.

For further and more information on hernia or treatment of hernia you can contact at me by through lybrate.com or booking an appointment. Thank you!

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:

1. 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.
2. 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.

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

Esophagectomy is a procedure of removing a part of the esophagus and reconstructing the same using another organ of the body. The oesophagus is the tube that connects the stomach and the mouth. This procedure is often performed in an advanced stage of esophageal cancer and Barrett’s esophagus. This procedure removes the cancer cells from the esophagus and gives relief from the symptoms. The organs from where the reconstructing tissues are taken are generally large intestine and stomach.

Many esophagectomy surgeries are performed with minimally invasive techniques. The latter is commonly known as laparoscopic surgery. This is a procedure where numerous small incisions are made in order to perform the surgery. This procedure results in faster recovery and reduced pain as compared to the conventional surgery.

Newer methods such as Robotic surgery are being adopted by many doctors these days. Procedures like these can access the oesophagus through places such as the throat, collarbone and abdomen. They make a minute incision to get to the exact location of the cancer and treat them with an improved precision, unlike the conventional surgical methods.

An important aspect of treating this condition is to determine the procedure that is going to be implemented. To determine this, doctors uses imaging techniques such as PET scan, CT scan and an MRI scan. A doctor might also prescribe other tests such as FNAC and endoscopic ultrasound. Heart evaluations are also conducted before the surgery to ensure that there are no complications involved while performing the surgery.

Before Esophagectomy

Unless the cancer is detected at a very early stage, most doctors recommend radiation or chemotherapy or both. These treatments help to shrink the size of the cancer and make for an effective oesophagectomy. Both chemotherapy and radiation have their set of side effects, which include loss of appetite, fatigue, hair loss, vomiting and skin discolouration.

After Esophagectomy

Post the procedure, a patient cannot directly consume food. He is required to consume food through a pipe for a duration of four-six weeks. Adequate nutrition is required during this phase to recover quickly. Once the patient is able to resume a normal diet, it should be ensured that he takes food in reduced quantities to make up for the reduced stomach size.

Follow-up

Almost 90% of patients who have gone through this procedure report an improved life quality. While lifestyle related adjustments have to be made, there could be regular follow-ups to ensure the below mentioned complications do not arise:

1. Breathing-related problems

2. Swallowing problem

3. Effectively managing heartburn and ensuring the pain is under control

4. A thorough review of the nutritional diet to be consumed by the patient to counter sudden weight loss.

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

Laparoscopy, also known as minimally invasive surgery or keyhole surgery, is a modern surgical procedure in which small incisions of about 0.5-1.5 cm are made far from the location of the operation.

Mechanism of laparoscopy:

One or more such holes on the abdominal wall serve as passageways for a specialised instrument called a laparoscope. A long, thin tube headed by a high-resolution camera and a high-intensity guiding light is inserted through the incision. As the instrument moves along, the camera transmits images to a video monitor enabling your surgeon to see inside without opening up your body for surgery.This process is used to diagnose unidentified abdominal or pelvic pain.

What conditions laparoscopy deals with

Conditions like ectopic pregnancy, endometriosis and pelvic inflammatory disorders are generally treated using laparoscopic surgery. Moreover, laparoscopy is also used to remove the gallbladder, appendix, patches of endometriosis or detect adhesions, fibroids and cysts. Also a biopsy of the organs inside the abdomen can be done through laparoscopy.

Restrictions you need to follow during the first couple of weeks:

For the first couple of weeks after the surgery, your doctor might ask you to abstain from driving, tub bathing, swimming and having sexual intercourse. Make sure that you follow these rules and get adequate amount of sleep to ensure speedy recovery.

Recovery time:

Recovery time for a laparoscopic surgery is only a few days, and to get through this period easily seek the help of a friend or family member to manage your medications and lift your spirits. In case you have a concern or query you can always consult an expert & get answers to your questions!

Terms like ileostomy and colostomy really sound a bit too scientific, don’t they? Well, it is true that may seem to be pretty scary to almost anybody who is not professionally familiar with them! That being said, it is quite important to know what these things are, as it is always good to be informed of things like these. After all, one never knows when he or she may need to consider the possibility of having one.

The similarity which exists between these two procedures is due to the fact that both of them require the surgeon to cut an opening into the intestine from the skin of the abdominal wall. To be more specific about each of the procedures, the ileostomy involves the removal of the entire colon as well as the rectum of the person who is undergoing it. When this operation is performed, the small intestine’s end is adapted so as to expel the faeces which are produced as a result of the digestive process.

Now, this does seem like quite a daunting prospect, does it not? Well, it does and with good reason as it is really not a small matter, at all. That is why the surgery is performed on people who suffer from diseases such as Crohn's disease, who have a condition in which entire sections of their gut cannot be linked in a proper manner!

On the other hand, a colostomy refers to a follow-up surgery to a colectomy, in which the surgeon creates an opening which is known as a stoma. A colectomy is when there is a removal of a part of the large intestine. In many cases of colostomies being performed, they are intended to be temporary in nature.

Now, taking into account just how serious these operations are, a person may wonder just what unfortunate thing needs to happen to warrant a surgery of this sort to be performed! Well, essentially, if there is an occurrence of bowel cancer which is significantly bad, then there may be a need which arises as a result of the same.

Advanced medicines do have some interesting facts; contrary to what most people think, a stoma does not hurt. This is because there are no nerves in the area! While a person may hopefully never need either surgery performed on oneself, that surely does not mean that awareness about them should not be widespread. In case you have a concern or query you can always consult an expert & get answers to your questions!

Adverse respiratory events (AREs) are leading causes of post-operative morbidity and mortality. Anesthesia is the use of medicine to prevent or reduce the feeling of pain or sensation during surgery or other painful procedures (such as getting stitches). Giving as an injection or through inhaled gases or vapours, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.

Anesthesia can help control your breathing, blood pressure, blood flow, and heart rate. It may be used to:

1. Relax you,
2. Block pain,
3. Make you sleepy or forgetful,
4. Make you unconscious for your surgery.

Adverse Respiratory Events (ARE)
Adverse outcomes of such events are fatal and lead to Death & Brain Damage. Three mechanisms of injury are reported to account for highest adverse respiratory events:
Inadequate Ventilation: Insufficient Gas Exchange can produce the adverse outcome. Esophageal Intubation: Incubation between the two sides of the esophagus inadvertently.
Difficult tracheal intubation: Tracheal Intubation is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway. It is performed facilitate ventilation of lungs in severely ill, anesthetized patients.

Other’s are as listed below:

• Airway Obstruction
• Inadequate inspired oxygen delivery
• Aspiration
• Endobronchial Intubation
• Premature Extubation

Residual neuromuscular blockade is an important postoperative complication associated to the use of neuromuscular blocking drugs and is commonly observed in the post-anesthesia care unit (PACU) after non-depolarizing neuromuscular blocking agents (NMBAs) are administered intra-operatively. Incomplete neuromuscular recovery can be minimized with acceleromyography monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intra-operative acceleromyography use.

Reintubation is a serious adverse respiratory event and the consequences include increased cardiac and respiratory complications, prolonged length of stay at the PACU, intensive care unit (ICU) and hospital, prolonged mechanical ventilator support, higher costs, and increased mortality. Overweight and obesity have also been identified as risk factors for postoperative respiratory complications. Most adverse respiratory events are considered preventable with improved monitoring such as:

• Pulse Oximetry
• Capnometry
• Combination of Both

Closed observation of the clinical factors and appropriate monitoring by well trained people are factors necessary to prevent adverse outcome.

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