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    All Posts in Category: Laparoscopic

    Precautions after a laparoscopic gallbladder surgery

    Precautions After a Laparoscopic Gallbladder Surgery

    Laparoscopic gallbladder surgery (cholecystectomy) removes the gallbladder and gallstones through several small cuts (incisions) in the abdomen. The surgeon inflates patient’s abdomen with air or carbon dioxide in order to see clearly.

    Sometimes patients are nauseated after waking from the anesthesia. This sensation usually passes. If it does not, medication can be given to relieve it.
    Postoperative pain can usually be controlled with over-the-counter pain relievers. Some patients may need a stronger, prescription analgesic.

    The incisions are covered by small adhesive bandages that can be removed in about 5 days and the stitches dissolve over time. The area must be kept dry until the wound begins to heal and sponge baths are recommended for the first day or two.

    Recovery from the laparoscopic procedure is quicker than from the open procedure. As the anesthesia wears off, and once vital signs stabilize, the nurse offers the patient ice chips. If ice is tolerated, water and other clear liquids are offered. Once liquids are tolerated, patients can eat a light meal and the IV is removed.

    How is it different from an open surgery?

    Recovery from open surgery is not as rapid. Patients experience pain at the incision site and a narcotic pain reliever is usually required for the first day or two. The patient may not be able to eat until the morning after surgery. The intravenous is left in until food and fluids are taken and tolerated.
    Patients are usually able to get out of bed by the next morning. It is important to get up and walk as soon as possible to help blood circulation return to normal and to avoid complications such as blood clots. The hospital stay generally lasts 3 to 7 days and it usually takes about 3 weeks to fully recover. This procedure leaves a large abdominal scar, which may fade over time…

    Diet instructions you need to know after the surgery

    When you consider about your diet after the gallbladder surgery. No need to follow a special diet after having the surgery, as the gallbladder isn’t essential for digestion. You can usually start eating normally a few hours after your operation, although you’ll probably prefer to eat small meals to start with.

    You may have been advised to follow a low-fat diet for several weeks before surgery, but this doesn’t need to be continued afterward. Instead, you should aim to have a generally healthy, balanced diet (including some fats).

    Conclusion

    Even Though cholecystectomies are safe, but complications can develop. The main disadvantage of laparoscopic surgery has increased the risk of injury to the bile duct, which connects the gallbladder and the liver. This rarest complication can cause serious liver damage.
    If you experience side effects from the surgery – including indigestion, bloating, flatulence or diarrhea – it may help to make some small adjustments to your diet such as

    • Avoid drinks containing caffeine – such as coffee and tea,
    • Avoid foods that make the problems worse – such as spicy or fatty foods,
    • Gradually increase your intake of fibre – good sources of fibre include fresh fruits and vegetables, wholegrain rice, whole-wheat pasta and bread, seeds, nuts, and oats.
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    how are gallstones treated

    How are gallstones treated?

    Laparoscopic gallbladder surgery is the best choice of treatment for gallstones with severe signs and symptoms, disrupting one’s life style. It is time-saving and minimally invasive.

    What are gall stones?

    Gallstones are some stone like hard depositions in the gallbladder made out of Cholesterol, salt and Bilirubin (made out of destructed blood cells). Being a very common condition, gallstones vary a lot in size whereas some can be as small as a particle of sand where others can be as large as apples.

    Obesity, high consumption of cholesterol rich food, a rapid weight loss within a short period of time, Diabetes mellitus and long term intake of a high-fiber diet are the major risk factors for this condition to occur. Moreover, owing to a significant female predominance, Gallstones are most likely to affect people over 65 years of age, pregnant mothers and individuals with a positive family history.

    Treatment options

    Gallstones are usually treated depending on the severity and how they could disrupt the quality of life.

    Patients without symptoms yet diagnosed with gallstones, coincidentally in ultra-sound scans, the concept of ‘active monitoring’ is recommended. This method doesn’t involve any immediate treatment, but prompt medical advice should be sought as soon as you notice unusual presentations like yellowish discoloration of the skin or mucosal membranes (obstruction by gallstones)

    As a rule of thumb, the more you go without getting any sign or symptom, related to gallstones, the less likely it is to get the condition worsened. But there are occasions where you may need to get medical treatment even if you don’t get any presentation mentioned above, which include underlying Diabetes, portal hypertension or scarring of the liver-Cirrhosis

    Treatment is also indicated if a scan reveals a high level of calcium inside the gallbladder which can lead to gallbladder cancer in future or if there are frequent episodes of abdominal pain. If they are mild and infrequent, conservative management is alright with painkillers to relieve discomfort and healthy diet which might help in reducing further episodes.

    Some doctors prescribe medications to dissolve gallstones which are small in size and do not contain cholesterol e.g. Ursodeoxycholic acid

    Surgical interventions are considered if the signs and symptoms of the gallstones become severe such and disrupt a person’s quality of life to avoid complications due to stones.

    The main surgical treatments available for Gallbladder removal

    • Gall bladder laparoscopic surgery – A keyhole surgery performed under general anesthesia, which will only take 60-90 minutes.
    • Patients will be fully recovered after about 10 days.
    • Single-incision keyhole surgery – Latest type of keyhole surgery where the gallbladder will be removed by making only one hole on the abdomen.
    • Open surgery – A cut-open type surgery indicated in pregnant mothers in their third trimester, extremely overweight and unusual anatomical structure of gallbladder or surrounding structures which might make the surgery difficult.
    • Endoscopic retrograde cholangio-pancreatography (ERCP) – Removes only the stones from the gallbladder without removing the entire organ.

    Because of all these latest and advanced laparoscopic surgical options available nowadays, you won’t have to suffer from gallstones anymore.

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    Nissen Fundoplication Surgery

    Precautions after a Nissen (laparoscopic) Fundoplication Surgery for GERD

    Laparoscopic Nissen fundoplication is a surgical approach to treating gastroesophageal reflux disease (GERD). This surgery aims to strengthen the weakened area of the esophagus that causes stomach acid to flow up instead of down. Nissen fundoplication surgery is designed to fix the weak area of the esophagus. The surgery is performed laparoscopically.

    Few complications after a fundoplication surgery are difficulty in swallowing, esophagus sliding out of the wrapped portion of the stomach, Bloating and discomfort from gas buildup, excess gas, risks of anesthesia, risks of major surgery (infection or bleeding).

    If an open surgery is done, you have to spend several days in the hospital and you may need 4 to 6 weeks to get back to your normal routine. If the laparoscopic surgery method is used, you have to stay in the hospital for only 2 to 3 days and most people can go back to their normal routine in about 2 to 3 weeks.

    After your surgery, you have to follow a special diet to help prevent diarrhea, gas, and problems swallowing. You can drink clear liquids for your first few meals. Then follow a full liquid diet and then a Nissen soft diet. Eat small, frequent meals (six to eight per day). This will help you consume the majority of the nutrients you need without causing your stomach to feel full or distended. Drinking large amounts of fluids with meals can stretch your stomach.

    Eat very slowly. Take small bites and chew your food well which will help in swallowing and digestion. Avoid crusty breads and sticky, gummy foods, such as bananas, fresh doughy breads, rolls and doughnuts. Sit upright while eating and stay upright for 30 minutes after each meal. Do not lie down after eating. Sit upright for 2 hours after your last meal or snack of the day.

    The first bowel movement may occur anywhere from one to five days after surgery. As long as you are not nauseated or having abdominal pain, this variation is acceptable. Remember that it is very common to pass a lot more gas from your rectum; this is because you will not be able to really belch.

    There are no significant restrictions on activity after surgery. You can walk, climb stairs, mow the lawn or exercise, as long as it does not put a strain on you. Returning to normal activity as soon as possible will most likely enhance your recovery. Try to avoid heavy lifting for several weeks.

    Important

    Contact your surgeon immediately, if a fever arises up to 100.4 or greater, shaking chills, pain that increases over time, redness, warmth, or pus draining from incision sites, persistent nausea or inability to take in liquids.

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    Most Common Laparoscopic Procedures

    Most common Laparoscopy Procedures

    What is meant by a laparoscopy?

    Also known as Key-hole surgery, laparoscopy is a mode of surgical intervention on patients who have been diagnosed with different conditions in the abdomen or pelvis. This procedure allows the surgeon to visualize the inner aspect of the abdomen and pelvis using laparoscope without creating a large incision on the skin for its diagnostic access.

    More importantly, laparoscopy is used to carry out various additional surgeries and procedures other than simple visualization, where the surgeon could connect numerous instruments to the laparoscope and excise or trim tissues, take out tissue samples known as biopsies, grasp organs whenever necessary. Being a minimally invasive surgery, laparoscopy has been accepted world-wide as a very effective surgical intervention preferred by health professionals as well as patients over extensive open surgeries.

    Laparoscopy is vastly used in the aspects of gynecology and obstetrics, gastroenterology and urology which mainly deals with pathological conditions related to organs lying inside the body.

    Most common surgeries carried out using this latest technology include, gall bladder removal (laparoscopic cholecystectomy), Removal of the appendix (appendicectomy), Hernia Repair, Fundoplication, removal of the ectopic endometrial tissues (in Endometriosis), removal of various part of the bowel, female sterilization, surgical intervention for ectopic pregnancy, biopsy samples in suspected cases of malignancy etc.

    Most of the Laparoscopic surgeries are carried out under general anesthesia so that the patient will be unconsciousness and pain free throughout the surgery. The surgeon will then make one (single-incision or single port laparoscopy) or few tiny incisions on the abdomen using a special needle.

    Through a small flexible tube Co2 gas is pumped inside. This gas is very much useful to push bowel away from the operative site, in order to make a clear visualization. Laparoscope is inserted inside abdomen through tiny hole.

    Once the procedure is over, the gas is pumped out, the incision is sutured and a dressing is put on.Some patients will be discharged on the same day after wearing off of anesthesia while others will be kept for monitoring for 24 hours depending on the post-operative condition of the patient and type of surgery.

    Complications of laparoscopic surgeries are quite rare but there can be mild bleeding or bruising at the site of excision, accidental trauma to the organs inside the abdomen resulting in perforation (generalized sepsis) which might need emergency laparotomy or open abdomen surgery, general complications of anesthesia and wound infections which might need antibiotics. The incidence of these complications will vary according to the type of surgery carried out and comorbidities of the patient.

    However, despite of all the complications reported, Laparoscopy is still preferred over open surgeries due to its minimal invasive nature, negligible pain post operatively, shorter duration of hospital stay, quick recovery and comparatively small scar.

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    Laparoscopic Fundoplication or Anti Reflux Surgery is the Best Surgical Option for Failed Treatment of GERD

    Laparoscopic Fundoplication or Anti Reflux Surgery is the Best Surgical Option for Failed Treatment of GERD

    GERD patients who are not getting benefitted by life style modifications and medications will require reference to surgical gastroenterologist to assess for anti reflux surgery (Nissen fundoplication).

    Gastro esophageal reflux disease (GERD) is a condition which occurs due to the reflux of acids from the stomach back into the esophagus (food pipe) due to improper functioning of lower esophageal sphincter (LES) located between stomach and esophagus. This resultant, harsh acid causes a burning sensation (Heart Burn) in the area between the ribs or just below the neck which may sometimes radiate along the chest into the jaws and throat.

    Commonly experienced complaints may include nausea, vomiting, regurgitation, difficulty in swallowing, chronic cough with or without wheezing.

    Patients with mild GERD could be treated with lifestyle modifications such as avoiding alcohol, avoiding spicy & salty food, losing weight, quit smoking, using 2-3 pillows while sleeping and practicing proper sleeping patterns whereas some may require medications like antacids, H2 blockers or proton pump inhibitors (PPIs).

    However, patients who are not responding to both these ways of treatment will require surgical interventions. The latest and the most preferred surgical therapy for GERD includes Fundoplication Surgery, which can be done either as an open procedure or laparoscopically. The primary objective of fundoplication is to reinforce the LES to redevelop the barrier which will prevent the occurrence of reflux back from the stomach.

    The procedure is carried out by wrapping a portion of the stomach around the bottom part of the esophagus in order to strengthen the affected LES valve. Being the commonest and most preferred type of surgery, Nissen fundoplication uses a method where the stomach itself is wrapped 360 degrees around the lower esophagus so that acid reflux will completely get halted. Also, there are other types of surgeries which do not involve a complete wrap up around the stomach. However, Nissen fundoplication is known to be the treatment of choice for GERD.

    Similar to most surgeries done these days, fundoplication can also be performed using a minimally invasive method of laparoscopy in which a narrow tube-like camera is inserted into the abdomen through small incisions on the abdominal wall.

    The major benefits of this minimally invasive technique involves,

    • Minimal pain
    • Short duration of hospital stay
    • Quick recovery
    • Tiny scars which are rarely visible
    • A very low risk of wound infections and hernias

    According to research studies, following the laparoscopic anti-reflux surgery, both short-term (1–5 years) and long-term follow-ups (5–10 years) have proved that majority of patients have shown an effective improvement, a high satisfaction with an enhanced quality of life. More importantly, all most all the patients have taken off the anta-acid drugs, they have been using for a long period of time, after the surgery. Interestingly, most patients have consistently answered that they would not think twice to go through the anti-reflux surgery if necessary due to its extremely comfortable nature.

    However, even if complications like adverse effects of general anesthesia, bleeding, infection or injury to nearby organs are possible, the surgery when performed by an experienced Laparoscopic GI surgeon is exceptionally safe where life threatening outcomes are highly unusual.

    Laparoscopic fundoplication or anti reflux surgery is known to be the best surgical option available for failed treatment of GERD and large hiatal hernias due to its comparatively effective consequences.

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    Open and Laparoscopic Surgery

    Comparison between Open and Laparoscopic Surgery, what’s the best?

    You may be wondering why your surgeon suggested two options to choose from, in order to perform the surgery which is due on next month. Open or laparoscopic? It is not a hard question at all, if there are no other special indications to go for an open surgery.

    But, we shall let you decide by your own by providing a complete comparison between these two methods available, with all the pros and cons associated with.

    What is an open-surgery?

    This is a surgical procedure, performed by making a large (8cm-10cm) incision into the abdomen in order to expose the area inside, on which the intervention is to be done. Resulting in a comparatively more post-operative pain due to the large incision and this kind of surgeries often need a longer hospital stay (5-7 days) until a satisfactory wound healing and recovery takes place. In some cases, you will have to rest for up to six weeks before returning to routine activities and occupation due to several possible negative outcomes like infections and breaking of sutures.

    Open surgery also has a higher risk of adhesion formation, wound infections and incisional hernias due to its wide exposure of tissues to external environment. However, this types of surgeries are still carried out in some cancer operations and huge pelvic masses.

    What is a Laparoscopic surgery?

    Also known as ‘keyhole surgery’, Laparoscopic surgery is usually performed by making a ½-1 cm incision where a flexible tube attached to a camera and light source is inserted into the abdomen. The surgeon will see the whole inside-scenario on a monitor, where handling of instruments inside will be done by a visual guided procedure which requires a highly specialized training.

    These type of surgeries do not require large incisions which is safe and effective compared to that of open surgery.

    What is the need of having two options as open approach and laparoscopic approach?

    The laparoscopic technique, introduced in early 1990s based on the successful outcomes of a laparoscopic gallbladder removal, many research studies were carried out to find out, further benefits of this un-opened approach.

    As a result of that, beneficial factors like-

    • Minimal pain
    • Early return to normal day today activities and work
    • Minimally visible scarring
    • Lesser risk of wound infections, adhesion formation and incisional hernias

    over open-approach were identified, which eventually made laparoscopic surgeries to become highly popular among health care professionals as well as the general population all over the world.

    However, it is important to know that, there can be instances where planned Laparoscopic surgeries will have to be performed as open ones, being quickly decided on the operating table due to various unexpected findings, complications and difficulties.

    Also, some surgeons prefer to perform open surgeries over laparoscopic interventions due to various reasons including inexperience, assessing the risk of possible bowel obstruction and traditional like preference for proper visibility and handling rather than doing procedures over a monitor.

    Considering all these factors, it is highly convincing that laparoscopic surgeries have several beneficiaries over the open-surgery which is why it is widely used.

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    Life style modifications for GERD

    Laparoscopic Fundoplication is Reliable Surgical Procedure for GERD

    Are you also suffering from mild or severe heartburn and regurgitation which interferes with your day to day activities?

    Then, you may be a victim of the commonly prevailing condition known as Gastro-esophageal reflux disease, or GERD. This occurs due to reflux of stomach acids from the stomach back into the esophagus due to lax lower esophageal sphincter (LES) located between stomach and esophagus.

    Commonly experienced presenting complaints may include burning sensation in throat /Chest (Heart burn), nausea, vomiting, regurgitation, difficulty in swallowing, chronic cough with or without wheezing.

    Some patients with mild GERD could be treated with life style modifications such as change of dietary pattern, usage of over the counter anta-acids when necessary, losing weight, quit smoking and alcohol, and practicing proper sleeping patterns whereas some may require medications like anta-acids which will neutralize acids, flowing back to the esophagus.

    However, patients who are not responding to both these ways of treatment will require surgical interventions. The latest and the most preferred surgical therapy for GERD includes Fundoplication Surgery, which can be done either as an open procedure or laparoscopically.

    As far as the technique of fundoplication is concerned, the patient will be made unconscious and pain free by administering general anesthesia. The upper curvature of the stomach also known as fundus is sutured as a wrapping around the esophagus, allowing the lower portion of the esophagus exit through a tiny canal formed by the stomach muscle.

    This method will help to tighten the lower esophageal sphincter, and there by stop the back flow of stomach acids. The already damaged, or inflamed esophageal lining will heal eventually and the symptoms will improve over time.

    If the patient undergoes an open surgery which generally needs a larger incision, he will be advised to stay in the hospital for a few days and can return back to routine work within 4-6 weeks whereas in the case of laparoscopic fundoplication surgery, he will be discharged within 2-3 days and can get back to day to day work within 2-3 weeks.

    Most of the patients who undergo fundoplication surgery will recover completely over time while some may rarely develop a recurrence with new symptoms like bloated feeling in the stomach, flatulence and renewed heart burn which may require further medication or even another surgery. Other possible complications are a difficulty in swallowing if the stomach is wrapped too high or too tightly on the esophagus during the procedure or develop general complications of anesthesia.

    However, GERD is a condition which can reduce the quality of one’s life in a long term basis due to its irritating and painful nature and therefore it is worth trying to undergo a fundoplication surgery, in case where life style modifications and medical interventions fail.

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    Why is it advised to remove gall bladder when patients suffer from gall bladder stones

    Why is it Advised to Remove Gall Bladder When Patients suffer from stones?

    Gallstones are formed when bile, which is normally fluid, solidifies and hardens into small deposits in the gall bladder. The gallbladder is a part of the digestive system and is responsible for storing and releasing bile, which the liver produces, into the small intestine. Bile is essential for digestion since it helps in breaking down fat contents in the food.

    Understanding gall stones

    Gallstones are quite common in both men and women. Although the number and size of the stones can vary person to person, gallstones typically range in the size from a few millimetres to several centimetres in diameter.

    Doctors usually advise a wait-and-watch policy for gallbladder stones when there is no report of pain. However, when the patient starts experiencing symptoms, doctors explore other treatment options including surgery.

    Gallstones produce a variety of symptoms such as nausea, bloating, vomiting and abdominal pain. The most common symptom experienced is the however, abdominal pain.

    Why should gall bladder be removed (and not only gallstone removal)?

    Removal of the gallbladder is often recommended as a treatment option for gall bladder patients for a number of reasons, especially since it is a non-essential organ. Doctors mandatorily advise the removal of gallbladder when it is inflamed and infected, as the infection can turn life-threatening. In other cases, doctors advise removing the gall bladder when the pain and discomfort become very severe during an attack. It is also advised when the patient suffers repeatedly from gallstone attacks.

    The removal of the gallbladder is usually advised for the following reasons:

    1. Prevents future gallstone attacks completely: The removal of the gallbladder eliminates gall stones entirely. This means that patients will not need to suffer pain arising from gallstones ever again.
    2. Prevents complications: Having gallstones as a condition predisposes patients to additional complications such as inflammation of the gallbladder also known as Cholecystitis. An infection arising as a result of the inflammation can turn life-threatening if the infection spreads to other parts of the body
    3. Prevents gall bladder cancer: In certain cases, patients with gallstones become more susceptible to gallbladder cancer. Doctors suggest removal of the gallbladder in order to avoid this.
    4. Prevents development of related medical conditions: An infected gallbladder can cause other complications such as inflammation of the Pancreas (Pancreatitis )and infection in the Common Bile Duct. The removal of the gall bladder removes the danger of this occurring.

    Gall Stone Removal Process: Laparoscopic Cholecystectomy

    Today laparoscopy is the most preferred form of surgery for removing the gallbladder. It is a far less invasive procedure than the traditional open cholecystectomy which requires a large incision in the abdomen.

    As a part of the laparoscopic surgery, a small incision, less than an inch, is made in the navel and the surgeon inserts thin tubes that have a light, a camera and special surgical instruments using which the procedure is carried out. The patient recovers faster as a result of experiencing lesser trauma, lesser pain and lesser blood loss. It also results in lesser complications thus making it safer than open surgery.

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    Recovery after a laparoscopic inguinal hernia surgery

    Recovery After a Laparoscopic Inguinal Hernia Surgery

    An inguinal hernia occurs when tissue or portions from the intestine pushes through weak muscle walls in the groin area, causing a visible bulge. Surgery is usually required to treat it, during which the loop of intestine that has moved out is pushed back into the abdominal cavity and the weak muscle is repaired and sealed to avoid re-occurrence.

    Laparoscopic inguinal hernia surgery is a minimally invasive surgical procedure requiring only a few incisions, usually less than an inch long. This type of surgery is today highly preferred as patients recover faster and experience lesser trauma and pain.

    Guidelines for Post-Operative Care

    Laparoscopic inguinal hernia surgery usually does not require long hospitalization, allowing patients to go back home early. However patients need to take precautions so as to aid the recovery process. Patients normally need 1 or 2 weeks to recover fully and the following are important things to keep in mind:

    Diet:

    There are no specific diet restrictions to be followed but since nausea or vomiting is often reported by patients in the first few days, small and light meals are recommended. High fibre diet helps avoid constipation.

    Activity

    After the inguinal surgery, light activity such as walking can be started immediately as it aids recovery however it is recommended to increase activity levels slowly. Strenuous activity such as heavy lifting must be done only 3-4 weeks post the surgery.

    Feeling of fatigue is common in the first few days, it is hence advised that patients must keep their activity levels to the extent that is comfortable.

    Pain management

    Feeling of soreness and some pain is normal although the level of pain varies from person to person. Painkillers are prescribed to the patient for managing this pain in the immediate postoperative period. Application of ice packs can also help with pain around the site of the surgery

    There might also be some discomfort in bowel movements arising from the medication. Diet supplements such as milk of magnesia or yogurt can be used to alleviate this.

    Care of Surgical incisions

    The incisions made during the surgery need to be treated till they heal. Band aids placed on the incisions can remain for 24 -48 hours and some amount of blood on them is normal in the first day. Mostly the sutures taken are dissolvable and wounds are covered with water proof dressings. patients can take bath immediately after the discharge from the hospital . Band aids on the wounds must be removed during the shower and replaced only after the wound has dried thoroughly. Tub baths, pools etc are to be avoided for one week.

    Returning to Work

    This typically depends on the pace of recovery of the patient. At the minimum doctors recommend spending less than a week in rest to aid the recovery process.

    When to reach out for help

    Patients must contact their health care provider in case of following symptoms as they might indicate complications:

    • Severe pain or persistent nausea
    • Chills and high fever
    • Significant amount of bleeding
    • Redness or swelling at the site of the surgery
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    Laparoscopic Appendectomy

    Question and Answers related to Appendicitis by Dr. Nitish Jhawar

    Dr. Nitish Jhawar is answering questions related to Appendicitis in Times of India

    1Q. My 15 yrs. old had sudden severe pain in his abdomen last night I gave him some medicine he felt better but now complaining pain in right side abdomen my GP feels its may be appendicitis is it correct?

    A. The classical pain in appendicitis starts in the whole abdomen and then it shifts to right side if the pain is persisting the blood test and sonography will help clinch the diagnosis.

    2Q. In a diagnosed case of appendicitis is surgery mandatory?

    A. If the signs, symptoms and investigations are suggestive of acute appendicitis then surgery is the only treatment and it should be done as early as possible .

    3Q. my daughter is 22 admitted with right sided pain in a hospital the Sonography is not showing appendicitis but pain and fever are there can we do something to be sure about the diagnosis?

    A. Sonography is a first line investigation specially in females as it rules out ovarian problems which may cause similar pain, CT scan of the abdomen in almost conclusive in such cases & is highly recommended.

    4Q. is Laparoscopy safe for appendectomy or should I go for open surgery?

    A. Laparoscopy has a definite advantage over open surgery as we can examine the whole abdomen by moving camera inside the abdomen, moreover the tip of appendix is not fixed in its location so almost all types of appendix may be tackled in this way. open surgery may be required if anatomy inside is not clear or if there is a lump formation due to a neglected appendicular infection.

    5Q. my colleague underwent appendectomy but was in hospital for 15 day post surgery with a tube coming out of his abdomen ,is it normal to have such a long recovery time?

    A. Acute appendicitis is a surgical emergency if the appendix is blocked due to hardened fecal matter called fecalith it may rupture leading to infection called peritonitis if neglected for long then it may take longer to heal and patient may suffer more like your colleague .

    6Q. I have been advised laparoscopy appendectomy by my surgeon how soon I can resume my daily routine following that?

    A. Laparoscopy appendectomy is a safe simple and quick surgery, but a lot depends on the condition of the appendix, in a standard case it is just one day stay in the hospital and one can resume within 3 to 5 days.

    7Q. I am little scared to lose a part of my body will I have long term digestion problem?

    A. Appendix is a vestigial organ so it doesn’t have any function in human body its removal will not have any long term effect on digestion per se.

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    Testimonial

    What patient says about Dr. Nitish Jhawar

    • Person Image

      I was diagnosed with gall stones a year ago in Delhi, I showed it to a doctor at Max hospital, he just asked me to get a surgery done and get my gall removed on any date of my choice, I was sacred and too young to get it done I got a vibe from doctor that for him it’s just a small things, however according to for a patient it’s important first be convinced on the urgency to get it done and feel safe . A year later I shifted to Mumbai and started having a frequent pain in shoulder blades and gall area. It went sharp this time. We went to Dr Nitish , as oppose to Delhi doc, Dr Nitish was very polite, first asked us to get the scan done and understand the current scenario, the scan showed one big 17 mm stone which was earlier also there but this time also there were multiple various sized stones as well along with the big one. Dr Nitish examined the scan, explained me and my husband about the condition and need of surgery or else the stone Would have slipped in the panacea or bile calling for a bigger operation. He explained diagramatically . He was patient in explaining, gave us time to think and be convinced. We were ready and then he performed it . It was flawless, quick and went well. He is a very experienced and fine surgeon , he is caring and doesn’t create panic at all rather he takes it slowly and makes patient comfortable. It was lapro, it’s been 2 months I m writing this . I faced no issues till now. Apollo staff was also very caring and good. I would mention Apollo Hospital, Navi Mumbai in specific. Good follow up diet makes it normal. I would strongly recommend Dr Nitish. He knows his job perfectly. He is not money minded at all. He would recommend surgery only if it’s required.

    • Person Image

      I was diagnosed with gall stones a year ago in Delhi, I showed it to a doctor at M.... hospital, he .... asked me to get a surgery done and get my gall removed on any date of my choice, I was sacred and too young to get it done I got a vibe from doctor that for him it’s just a small things, however according to for a patient it’s important first be convinced on the urgency to get it done and feel safe . A year later I shifted to Mumbai and started having a frequent pain in shoulder blades and gall area. It went sharp this time. We went to Dr Nitish , as oppose to Delhi doc, Dr Nitish was very polite, first asked us to get the scan done and understand the current scenario, the scan showed one big 17 mm stone which was earlier also there but this time also there were multiple various sized stones as well along with the big one. Dr Nitish examined the scan, explained me and my husband about the condition and need of surgery or else the stone Would have slipped in the panacea or bile calling for a bigger operation. He explained diagramatically . He was patient in explaining, gave us time to think and be convinced. We were ready and then he performed it . It was flawless, quick and went well. He is a very experienced and fine surgeon , he is caring and doesn’t create panic at all rather he takes it slowly and makes patient comfortable. It was lapro, it’s been 2 months I m writing this . I faced no issues till now. Fortis staff was also very caring and good. I would mention fortis Vashi in specific. Good follow up diet makes it normal. I would strongly recommend Dr Nitish. He knows his job perfectly. He is not money minded at all. He would recommend surgery only if it’s required.

    • Kishore-Kumar-Das

      I had surgery of my left hydrocele on 27th May 2017 by Dr Nitish Jhawar. An excellent experience of service I got particularly from Dr Jhawar. He is not only a qualified experienced doctor but also a splendid human being. Thanks a lot.

    • Siddappa-Hasbi

      It was a Laparoscopic operation for the removal of Gall Bladder (stones). I had developed on and off pain in abdomen before the operation, after the operation feeling good, totally pain free. Thanks and respect for handling my case very well.

    • Person Image

      I met doctor Nitish for piles problem and wanted to undergo LASER procedure only, my operation is successful and I thank doctor for being a good human being and great surgeon.

    • Person Image

      I was suffering from piles since long time. For bleeding heavily I met Dr Nitish Jhawar and after meeting him decided to go for Stapler surgery for piles. I found him a doctor who listens to our problem and explains properly.

    • Person Image

      I got diagnosed about a year back but was avoiding operation for Hernia repair, Dr Nitish Jhawar explained me why surgery should be done and I chose surgery by laparoscopy method. I am happy with the doctor and the hospital.

    • Person Image

      I visited for Gall Bladder removal by Laparoscopy after searching for best laparoscopic surgeon. After meeting dr my fear for surgery was vanished and my surgery went well and recovery was smooth.

    • Person Image

      Honest doctor, expert in his field....can trust his words

    • Person Image

      Very good he describe everything in very pleasant manner about the problem which was very helpful to me to understand my disease.

    • Person Image

      Very nice. Doctor is very patient and gives you correct advice.

    • Person Image

      He is very erudite and smart at getting to the bottleneck of the problem. And before realized he had pinched away d growth bothering me near my anal area.

    • Person Image

      Dr. Jhawar is few of the best doctors in town. Extremely pleasant and comfortable experience