CHOLECYSTECTOMY
Cholecystectomy is a surgical procedure to remove your gall bladder. This is a pear-shaped organ that sits just below your liver in the upper right side of your abdomen.
What Is The Gallbladder?
It is an organ that stores bile, a digestive enzyme produced by the liver.
What Are The Indications?
Indications of gall bladder removal include:
1. Cholecystitis or inflammation of the gall bladder usually associated with stones.
2. Pancreatitis- inflammation of the pancreatic gland caused frequently by the passage of stones or sludge down the common bile duct (CBD).
3. Obstructive Jaundice – increase in bilirubin due to obstruction of the flow of bile down the CBD.
4. Biliary colic – pain caused frequently by stone traversing the CBD. Surgery is done principally after the CBD has been cleared of stones.
5. Gallbladder polyps.
What Are The Benefits Of A Laparoscopic Procedure For Gallbladder Removal?
1. Better Cosmesis
2. Early return to work
3. Less pain postoperatively
4. Shorter hospital stay
5. Prevention of complications related to a pathological gallbladder
What Is The Recovery Period?
Typically a patient commences on oral fluids within 6 – 7 hrs after surgery followed by a light diet. Hospital stay is usually for about one day after day of surgery or less.
Patient can resume work within 48 hrs of returning home. Typically travel can commence safely within 5 days after surgery.
HERNIA REPAIR
A Hernia is an abnormal protrusion of intestine or part of it through an abnormal opening in the wall that normally contains it.It usually presents as a swelling noticed by the patient.
Hernia repair refers to a surgical operation for the correction of a hernia. Hernias can occur in many places, including the abdomen, groin, diaphragm and at the site of a previous operation.
The two main types of hernia repair surgeries are:
Laparoscopic Hernia Repair Surgery
Open Hernia Repair Surgery
How Long Does It Take To Perform A Laparoscopic Hernia Surgery?
Laparoscopic hernia surgical repair take typically between 1 -2 hrs depending on the type of hernia repair the patient is undergoing.
How Long Does It Take To Recover From A Hernia Surgery?
Recovery from hernia begins with the commencement of fluids and diet 5 hrs after surgery. Patient is mobilized on the same day of the surgery. The following day patient typically goes home. In the case of more complex hernia repairs, the patient has a hospital stay for a further 2 -3 days, Resumption of work begins 2 -3 days after surgery.
Travel can be resumed 5 days after surgery.
What could cause a Hernia?
1. Lifting of heavy objects
2. Chronic coughing
3. Constipation
4. Straining recurrently during micturition
What Follow Up Care Is Necessary After Hernia Surgery?
Regular follow ups at the clinic
Avoidance of lifting of weights in excess of the 14 pounds during the first 3 – 4 weeks.
HAEMORRHOIDS
Haemorrhoids are swollen veins in the anal canal. This is a common problem that is usually not serious.
Veins can swell inside the anal canal to form haemorrhoids.
How Are Haemorrhoids Diagnosed?
Haemorrhoids are diagnosed by a detailed history followed by a rectal digital examination and proctoscopy. This is all done at the clinic itself. The history will classically entail the passage of hard motions, bright red painless bleeding associated with motions and a history of constipation.
What Is The Treatment For Haemorrhoids?
Treatments of haemorrhoids depend on the stage of this disease process. Early stage haemorrhoids are successfully treated with a combination of high fibre diet, plenty of oral fluids, avoidance of straining during defaecation and local application of topical ointment. Surgery is almost never warranted.
More advance stage haemorrhoids (stage III and IV) may require surgical intervation if all efforts at conservative treatment are unsuccessful. Surgery can be done usually via an open technique or a stapler procedure. Various other techniques can also be used in the surgical treatment of haemorrhoids, including rubber band ligation, sclerotherapy, photocoagulation etc.
Recovery From Surgery
Patients are commenced on fluids and a diet 4 hrs after the surgery which itself may take upto one hour. Patients are mobilised, including made to sit on the same day of the surgery itself. Patients can be discharged typically the next day after surgery, or after the patient has had a bowel movement.
Follow Up
Follow – up include warm sitz bath, plenty of fluids and increased fibre in the diet, Stool softens are helpful at this stage. Patient may notice some bleeding associated with motions after surgery, but this typically recedes and then stops by the end of the first week after surgery.
Patient can resume work about 3 – 4 days after surgery.
Discomfort that the patient experiences after surgery during a bowel movements gradually recedes to a minimum by about 2 weeks after surgery.
Complete healing takes about 3 – 4 weeks.
Patient can resume work within 48 hrs of returning home.
Typically travel can commence safely within 5 days after surgery.
ANAL FISSURES
It is a painful tear at the lower end of the anal canal.
Why Does An Anal Fissure Occur?
Anal fissure typically occur after the passage of a hard constipated motion. It sometimes is associated with other pathological processes in the colon.
What Is The Treatment Of Anal Fissures?
Like other small tears in the body an anal fissure may heal by itself within 14 – 21 days.
During this period a patient should:
Increase the fibre in their diet
Increase the oral fluid intake
Not delay a bowel movement when urge to defecates occurs
Apply topical ointments including a local anesthetic ointment and / or glycerol trinitrate preparation
Sit in a warm sitz bath 2 – 3 times/day
Oral analgesia may be required
If inspite of the above no improvement has been achieved, then other interventions may have to be considered.
This includes amongst others:
Internal Sphincterotomy
Botulinum toxin injection
Both the above can be done as a day procedure operation with excellent long term results.
Recovery From Surgery
Recovery following surgery largely consists of an extended period of the conservative treatment described above. However relief from symptoms dissipate largely instantaneously. Patient can go home on the same day of surgery or the following day. Resumption of work is typically achieved within 48 hours of surgery.
ANAL FISTULA / FISTULA IN ANO
An anal fistula is a passage (tract) from the anal canal to an opening in the skin near the anus.
Why Does An Anal Fistula?
This a channel extending from the anal canal (usually) to the skin in the area surrounding the anal verge. It is frequently a result of the formation of an anal gland infection which may manifest as an abscess.
What Is The Treatment Of An Anal Fistula?
Surgery is almost always needed as only very few fistulas heal by themselves.
The procedure of choice depends on:
Type of Fistula
Presence/ absence of infection/large abscess.
In majority of cases a fistulotomy procedure alone suffice. In this the tract is layed open along its entire length, and the wound so created is allowed to heal by scar tissue formation.
Occasionally in the case of a complex fistula a two stage procedure is warranted to achieve full healing without complications.
Recovery From Surgery
Can be done as a day procedure operation. Occasionally depending on the type of fistula and therefore selection of surgery, a few days (2 -3) hospital stay may be necessary. Patient commences on a diet within 4 hours after surgery. Resumption of work can occur, typically in 2 -3 days after surgery.
COLECTOMY
Colectomy is a surgical procedure to remove all or part of your colon.
Total Colectomy involves removing the entire colon
Partial Colectomy involves removing part of the colon
Proctocolectomy involves removing both the colon and rectum
Why Does Colectomy?
Colectomy is performed via open surgical or a Laparoscopic method.
What Are The Benefits Of The Laparoscopic Or Minimally Invasive Approach?
Benefits of Laparoscopic method includes:
Better Cosmesis
Earlier return of bowel function
Less postoperative pain
Shorter hospital stay
Indications For Surgery
Some of the frequent indications for Colectomy include:
Diverticular disease of the colon
Colon cancer
Inflammatory bowel disease i.e. Crohn’s Disease or ulcerative colitis
Bowel infarction (loss of blood supply)
Recovery From Surgery
Typically the patient is started on oral sips of fluids by the 1st post operative day itself, from where the quantity of oral intake gradually increases until the patient is on a semi solid diet by the 3rd – 4th post operative day.
Patient is made to sit up, stand and start walking as early as possible without any undue straining on the wound area .
Usually by the 5th – 6th post operative day, the patient can get discharged, and is advised to follow – up as per requirement, at the clinic.
PILONIDAL SINUS / COMPLEX DISEASE
A Pilonidal sinus is a tract,small cyst or abscess that occurs in the cleft of the buttocks. It can cause severe pain asinusnd often becomes infected.
Why Does Pilonidal Sinus Disease?
Causes of Pilonidal sinus is believed to be chiefly bifactional
Seen in hirsute (hairy individuals) individuals with potential for free hair to lie within the natal cleft
Presence of pits/dimples within the natal cleft area that promote the entrance of loose hair/debris into the subcutaneous tissue
How Are Pilonidal Sinus Treated?
Once a pilonidal sinus has been definitely identified, surgery is the treatment of choice. Sometimes if this condition manifests with an abscess formation, then a procedure to drain the abscess will be required as a pre – requisite. Occasionally abscess drainage alone may suffice.
Surgery is done under General Anathesia where the entire diseased complex is excised. Primary closure of this wound is almost always done (no regular dressings required as there is no open wound). This is usually achieved by using a Cleft lift / modified Cleft lift procedure.
Recovery From Surgery
4 – 5 hours after surgery, the patient consumes fluids and a full diet. The patient is mobilised within 8-12 hrs following surgery.A drain usually stays in place for approximately 48 hrs.The patient can thereafter get discharged from hospital and follow – up at the clinic at regular intervals.
