Monday, 10 December 2018

Why the type and quality of hernia surgery is crucial!

    Hernia is a very common problem and its surgery is available at every nook and corner. Most of the times, neither hernia nor its surgery is life threatening. This makes the case for ignoring the need for perfection in surgery by a specialist.

    Most of the people including many doctors fail to understand, that the abdominal wall (the wall of your tummy with its different muscles) is an organ in itself, with its special functions. The muscles of the wall of your tummy along with the muscles of your back are needed to function optimally, for the core functions of your body. These core functions are breathing, coughing, sneezing, passing motion and urine. And many other activities like sports, running, swimming and other strenuous work are dependent on the efficiency of your breathing.

    Thus, hernia which is a defect in the muscles of your tummy, impacts many of your activities and your core body functions. Hence, surgery for hernia is not done just to stop the intestines from coming out of your tummy and create an emergency, but also to normalise your activity level to best possible. Anything less than the best possible in your case, depending on your hernia type, other medical problems and age, will not serve the purpose of restoring the function of the wall of your tummy. Type of surgery, type of anaesthesia, type of mesh and sutures and precision of surgery, each play a crucial role in the outcome and none can be ignored.

      In a nutshell, all the hernia surgeries are not the same, but each type is suited to a particular kind of hernia and patient. And overall, the aim is not just to cure hernia but to optimise your tummy wall function, so that you can live your life as actively as possible.


Tuesday, 27 November 2018

GERD / Acid Reflux / Heartburn: Does surgery really solve the problem?

       Acid reflux is a problem that troubles a large number of people. Many of them are very young, and find themselves in a state of inefficiency at work due to this problem. Is surgery an ideal solution to there problem or it is just a gimmick? Lets discuss.

       I encounter a large number of these patients, taking medications for years for heartburn and acid reflux. Still not feeling completely normal. On and off have a bad day due to heartburn and either have to skip work or continue suffering at work place. Missing medication for a day brings very harsh punishment for these people. Thus starts their search for an effective solution to their problems.

      The problem of acid reflux, if it has been very convincingly confirmed with endoscopy and pH study, certainly gets cured by a laparoscopic surgery. The problem is many a times people have additional digestive issues like constiaption and IBS (Irritable bowel syndorme) along with acid reflux. The person may require medications for these conditions even after surgery. If these conditions are not recognised before surgery and explained to the patient, they are likely remain dissatisfied with the surgery.

     Even larger is the problem of misdiagnosis. If someone having IBS or constipation or functional problems are wrongly diagnosed as acid reflux (which is quite possible even with experienced doctor if complete evaluation is not done) and a surgery is considered, then they are not likely to benefit from the surgery. And hence we always recommend to get a complete work up including an endoscopy, esophageal manometry and 24 hr pH study before surgery. So that we can pick the patient who is unlikely to get benefited from surgery and avoid the surgery. 

    All in all, those finding themselves stuck in this situation, should not feel hopeless. Should get themselves thoroughly evaluated. If these tests confirm the diagnosis of acid reflux, then should consider laparoscopic surgery with the confidence of leading a normal life after that.

   Watch some of our videos to understand these problem and solution in a way that you would understand better. Directly form the ones who have faced it.         

Review of patient one year after surgery

Review of the patient after a laparoscopic acid reflux surgery

How thorough evaluation can change treatment and avoid surgery


Wednesday, 14 March 2018

Having chronic cough and breathing problems! Is it due to Obesity or Acid Reflux?

     Hello friends, am writing this because it is a very common practice to ignore Obesity and acid reflux as the primary cause of cough and breathing problems. I am not saying your doctor is not aware of this possibility. But it is commonly seen that patients and their primary physicians both many a times don't give Obesity and Acid reflux its due importance. And the treatment and evaluation is focused on lung problems. The reason for such a casual approach to these conditions is our human nature. Obesity and Acid reflux do not pose any immediate threat to one’s life, so it is taken casually by all of us.

               But the problem is, if not addressed in a proper way these conditions, Obesity and Acid reflux affects your quality of life in a major way. Without treating obesity and acid reflux, complete relief form cough and breathing problems is not achieved even with aggressive lung treatments. I see a lot of patients who have a very compromised quality of life, they have to take frequent leave form work, don’t get a good sleep, can’t concentrate on work, the personal life is affected, are forced to stop physical activity and exercise. I have also seen patients who have eventually developed psychological problems due to years of poor health.

And it feels terrible when you see life being lost because of a preventable and treatable condition. And it is never a single life that is affected; just think the life of a spouse or children or parents of these patients. They all suffer along with the one who is having this disease.

So my appeal is “If you are suffering from a long term cough and breathing problem, do ask your chest physician if Obesity or GERD could be a reason for this. If you are obese, then reducing weight by any means will be the primary treatment that you need. Recall if you had in past or are now having heartburn and feeling of food coming back after eating. If yes, than you should see a Gastro-surgeon and get evaluated by an endoscopy and pH study." 

Studies show that when a pH study is done on all the patients with chronic cough and breathing problems,  32-50  % had acid reflux even if they had no acid reflux symptoms. This percentage goes up to  50-82 % for those who had acid reflux problems. 

So apart from obesity if you have even a mild problem of acid reflux, you should get yourself evaluated by a 24 hr pH study. This may change your line of treatment and improve you cough and breathing problems like never before.

Saturday, 27 January 2018

Pain relief in the immediate post surgery time: Importance of not just to treat the disease but also to decrease suffering

            World is progressing very fast. Centuries back the treatment was primarily aimed at relieving pain and other symptoms. At the time there was lack of the understanding of what is going on inside, so the treatment was not aimed to cure the diseases but relieve the pain. Then gradually medical science developed and developed. The understanding for the underlying disease improved, various ways of detecting the disease in detail improved along with the various ways of treatment aimed at cure of the underlying disease. The negative thing about these developments brought along was a tendency to partially ignore the symptoms due to a deep focus of the disease itself.   
             There was no lack of good intent for the patient. But the thinking was "We are doing the right treatment for the cure of the disease. Even if the patient is bit in pain now, he will be cured in coming time". This thinking led to the scenarios where you can see patients in agony and pain after an excellent surgery by a doctor. There was apathy towards the pain of patients by doctors and the healthcare workers. And patients would eventually be doing great in the coming weeks being cured of the disease."  Partly this was because of the belief that this is what we can do with all our effort.  Cure him of the disease by a surgery and in doing so he will have to bear some pain. I am sure any surgeon who undergoes a surgery would surely think of developing ways of decreasing this pain. 

              And due to thoughts of such doctors medical science have further improved to level where not just curing the disease, we are able to significantly reduce the pain and discomfort of a surgery. Thanks to development of minimal invasive surgical techniques like laparoscopy and thoracoscopy, and also the development of many pain relieving therapies like nerve blocks. Apart from the pain killers that are given after surgery, a lot of surgeons now make the maximum use of a local anaesthetic agent to block the pain sensitive nerves at the site of operation. Hence the patient wakes up after surgery with very minimal pain and is ready to get up in few hours. The improved understanding of the futility of many procedures like putting a tube through the nose and a urinary catheter in many surgeries have decreased the patient discomfort. Years back we used to do that in many more surgeries than we do now, just because that was thought necessary.    

               Now our patients wake up after surgery without any tube coming out of their nose or private parts. There are in very minimal pain, walk around in few hours, go to washroom. Most of the cases they drink and eat on the same day and go home on the same day or next.    

              I would like to share a few videos of our patients taken on the same day or next day of surgery. Some had a bit complex surgeries done laparoscopically but you can yourself make out their comfort level.

To watch click the links below