Dr. Shrikant Kurhade

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.

Proctology refers to the study of the structure and diseases of the anus, rectum, and sigmoid colon. Laser surgery in proctology field enables excellent cutting, limiting thermal damage to the surrounding tissues reducing the post-operative pains. Piles are also called hemorrhoids. They are swellings in blood vessels found in or around the rectum and anus. Piles manifest symptoms like bleeding after passing stool, itchy bottom, hemorrhoid mass hangs out of the anus that pushes back in after passing of stool (prolapse), a mucus discharge, soreness, redness and swelling around the anus. Proctology conditions like piles might not be life-threatening, but they’re associated with poor quality of life and embarrassment.

Laser Treatment for Piles
Piles are classified into grades based on their severity.

• Grade one is the initial stage where a person has bleeding or itching but no prolapse. At this stage conservative measures are recommended.
• In grade two, the mass of hemorrhoids begins prolapse during defecation but goes back in, on completion of the act. 
• In Grade three, the prolapsed haemorrhoidal mass does not go back on its own, and manually pushed back. LHP is recommended for early stages of Grade 3; however, stapler surgery is recommended for advanced stages.

The LHP process
A laser fiber is passed through the anal opening and laser energy is applied to the haemorrhoidal mass. The controlled emission of laser energy reaches the submucosa zone, causing the haemorrhoidal mass to shrink. Fibrosis reconstruction generates new connective tissue, ensuring the mucosa adheres to the underlying tissue preventing the recurrence of prolapse.

Benefits

• Reduced pain, faster healing, higher outcome, and shorter procedures.
• Optimal treatment and outcomes.
• Presets enabling ease of use improved surgical control and accurate dosage.
• Requires no incisions and suturing.
• The procedure leaves no foreign material in the body.

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.

A tumor may be defined as an abnormal unwanted growth of tissue in any part of the body. This word need not immediately cause panic because the tumor may or may not cause a health threat. There are three types of tumors:

1. Benign tumor: This is a noncancerous type of tumor. In our body, new cells are formed while the old ones called dead ones are disposed by our immune system. When this disposal of cells does not occur, the remaining dead cells form a lump, which is called a benign tumor. They are not dangerous since, they do not contain harmful fluids and do not spread. A person suffering from a benign tumor in the brain may have frequent headaches.
2. Pre-malignant tumor: It is an initial disorder, or an earlier symptom of cancer manifestation. The inclination of this medical condition is that it will progressively become precarious. This is so because it is capable of conquering neighboring tissues and spreading as well. Leukoplakia is a form of premalignant cancer. They evolve as thick white patches inside the cheeks or on gums below the tongue. These patches are very difficult to be scraped off from the mouth. They are caused mainly due to chewing tobacco and smoking, and ff left untreated can expand.
3. Malignant tumor: These are the cancerous tumors, in which cells multiply abnormally and rapidly. They are unstable and travel along bloodstream, circulatory system and lymphatic system to other parts of the body. Sarcomas and carcinomas are the most common types of malignant tumors. While the former is related to connective tissues the latter is related to organs and glands.

The most common procedure to name the type of cancer is to refer to their site of origin. Adenocarcinoma, refers to cancer in the adenoid glands. Similarly, a benign tumor of fatty tissue is called lipoma, where as a malignant tumor in the same area is referred to as liposarcoma.

What is a biopsy? How does it relate to a tumor?
A Biopsy is a medical procedure practised by qualified medical practitioners. This procedure helps in identifying the type of tumor within a patient. It aids the doctor to conclude the type of treatment to be given to any patient. This procedure is a definite diagnosis to the identification of cancer. A Biopsy is the removal of a sample of the abnormal, unwanted tissue for laboratory examination. Biopsies are of different types, and they may be performed using ultrasound, CT scan or MRI depending on where the tumor is.

1. Excisional biopsy: In this method the entire lump of excess tissue is removed.
2. Incisional biopsy: Here a sample of the abnormal tissue is removed surgically.
3. Needle aspiration biopsy: Here the sample is extracted with the help of a needle.

After extraction, the tissue layers are sent to pathological departments to check their composition, and cause of disease.

For people recovering from a back surgery, constipation is quite common and causes discomfort or pain. There are several aspects of a back surgery which may lead to constipation. They include anaesthesia, changes in diet, stress and the use of some pain relieving medicines.

Symptoms:

1. The symptoms of constipation are:
2. Pain and bloating in the abdomen.
3. Nausea and vomiting.
4. Hard stools and the inability of bowel movement.

Ways to prevent constipation:
Here are several simple ways by which you can prevent or minimize pain or discomfort due to constipation after a back surgery.

1. You should increase your daily activities as early as possible after a back surgery. You should walk regularly.
2. You must reduce the use of narcotic medicines and use only what is needed for controlling pain. Narcotic medicines slow bowel movement and cause constipation. Use non-narcotic pain relieving medicines to prevent constipation.
3. You can use fiber laxatives, stool softeners or combination products after a back surgery to prevent constipation.
4. Drinking a lot of water and non caffeinated fluids is very important. You should also have apple cider juice and prune juice, which are effective natural laxatives.
5. You should eat natural fiber-rich food for intestinal stimulation. These include whole grains, cereals, fresh fruits and vegetables. It is best to avoid cheese, meat and processed food. Instead of large meals, you must have frequent, small meals throughout the day.

Medicines for constipation:
Non prescription medicines can be taken for preventing or treating constipation after a back surgery.
Here is a list of some effective medicines that relieve constipation:

1. Bulk fiber laxatives, which add bulk to stool and encourage water to stay in the colon. These medicines need up to three days to show effect.
2. Stool softeners or emollient laxatives help in softening stool by making fluids mix with them.
3. Stimulant laxatives take action by stimulation of bowel contractions for moving stool out. They are effective and start working very quickly.
4. Combination laxatives perform the functions of laxatives and stool softeners together.
5. Suppositories also perform the dual function of stool softening and acting as laxatives. The colon gets contracted, and stool is pushed out and as the stool gets softer, it can pass easily.
6. Enemas perform the function of bowel movement stimulation. Liquids are injected into the rectum, up into the colon. This stimulates the colon, and stool is passed.

Constipation occurs commonly in patients after undergoing a back surgery. This may cause utter discomfort and pain. You should take proper precautions and remedies in case of constipation after a back surgery.