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Laparoscopic, G.I. & colorectal surgery, Navi Mumbai, India


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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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Effectiveness of Neurotoxin

Effectiveness of Neurotoxin-Botox Injection for Anal Fissure

Anal fissure is a common condition which occurs due to the increased pressure in the internal anal sphincter located in the anal canal. Being this condition could affect all age groups, especially young adults and the main presenting complaints include pain in the anal area on defecation and bleeding per anus.

Acute anal fissures are usually treated conservatively either with life-style modifications like increased dietary fiber and water intake or using over the counter medications like stool-softening agents (Laxatives). Some Patients are also advised to use Sitz baths, local anesthetic ointments and Glyceryl trinitrate which will ease the pain on defecation and eventually heal the fissure completely.

Chronic anal fissures, do not respond to this kind of treatments and may require surgical interventions.

Botox injection (a neurotoxin) is a latest yet, very safe and efficient method of treatment used in patients with anal fissures and commonest indication for the procedure includes chronic idiopathic anal fissure uncomplicated by other anal conditions. It is also known to be involved with a very simple technique which can be carried out in the outpatient department (OPD), without the requirement of sedation or local anesthesia.

How botox Injection works on anal fissure?

An elevated resting pressure in the anal sphincter muscles due to their hyper-tonicity (increased tone) is known to be the major cause for anal fissures to develop. This will result in a disruption of blood supply to the anal mucosa, since the blood vessels which are responsible in distributing blood to the distal anal canal are being pressurized by the increased tone of sphincter muscles, creating a chronic anal fissure.

Botox injection which contains a neurotoxin, will paralyze the internal anal sphincter on a temporarily basis and thereby decrease its tone and spasms which obstruct the blood supply to the distal anal canal. With proper perfusion and nourishment, the fissure will heal over time and symptoms will disappear. The effect of the toxin will last for about two to three months, which is usually enough for an uncomplicated fissure to resolve.

This method can be expensive yet, cost effective since it will lead to complete healing of the fissure without having to go through the risk of bowel incontinence, complications of anesthesia and wound infections which may occur as a result of lateral internal sphincterotomy surgery. More importantly, the technique used and the site of injection are independent of patient’s age, gender and the location of internal sphincter ring.

Although, there are no major side effects of Botox injections, some patients may complain of minor reversible bowel leakage (incontinence), inability to control passage of air (gas incontinence), pain caused by the injection, bleeding or hematoma formation and infections at the site of injection.

Regular follow-ups are encouraged to see the response to the treatment and improvement of symptoms and patients who do not show any positive results even about eight weeks following the Botox injection or experience complicated fissures creating severe symptoms, will have to consult colorectal surgeon or surgical gastroenterologist and undergo a surgery.

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Diet precautions for piles

Diet Precautions for Piles

Piles, or Haemorrhoids, is the condition where blood vessels around the rectum swell. This often results in pain, itching and bleeding, and also possibly resulting in prolapse (protrusion of the inner vessels) in more serious cases.

Early Piles often may heal on its own with adequate home care and self-help measures. Over-the- counter medicines can be used for the swelling and warm tub baths can help with the pain. However apart from these, one of the most important things to keep in mind is to avoid straining during bowel movements as it can aggravate the condition immeasurably. This is why patients having haemorrhoids need to adhere carefully to the dietary precautions in order to avoid constipation. Without it, piles might worsen to the extent of needing surgery. Read more about colorectal surgery: Gall Bladder Stone

Lifestyle changes such as a healthy diet and regular exercise can thus make an enormous difference to people suffering from piles. Key diet precautions that patients need to follow are:

Include High Fibre food

High fibre food helps in digestion and ensures regular bowel movements. The fibre from food adds bulk to your stools, make it softer thus enabling you to pass stools regularly without any strain. The ideal amount of fibre recommended per day for adults is 20 to 30 gms

To get this, your diet must include sufficient amounts of whole grain, lentils, fruits, vegetables and nuts. These provide you with not just the necessary dietary fibre but also essential nutrients. Doctors, in fact, recommend a minimum of 4.5 cups of fruits and vegetables every day.

Some of the recommended items are: Fruits such as Apples, pears, papaya, and vegetables like green leafy vegetables, cabbage, carrots, beetroots etc.

However, you must make sure to introduce food with the high fibre slowly into your diet so as to avoid cramps, stomach upsets and gas.

Avoid Processed Food

Processed food such as chips, burgers, freezer meals, pizzas although convenient do not contain any fibre and are also poor in nutrients. A diet which is predominantly made of processed food usually leads to constipation, which aggravates haemorrhoids. Doctors, therefore, advise patients suffering from piles to reduce junk food.

Avoid Refined Grains

Refined grains such as white bread, pasta are very low in dietary fibre and nutrients. Include whole grain items such as oatmeal, whole wheat pasta, brown rice to boost the amount of fibre in your meals.

Avoid Processed Meat

Patients suffering from piles must ideally avoid a diet that is meat-heavy since animal meat does not contain fibre. Processed animal meat is worse since apart having no fibre, it usually contains very high levels of salt, fat and sugar.

Increase Intake of water

Increased water consumption is helpful in softening the stools and to add bulk as the fibre in your digestive system absorbs the water and enlarges in size. This helps in the easy passage of stools. It is recommended to drink at least 8-10 glasses of water per day. Other recommended liquids that can be consumed include fruit juices and green tea, but avoid too much of caffeine.

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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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Doctor nitesh return from germany

Dr. Nitish returns from Germany after training in VAAFT for fistula

Dr. Nitish Jhawar General, Laparoscopic and Colorectal Surgeon at Fortis Hiranandani Hospital, Navi Mumbai, India recently attended a surgical workshop at Berlin (Germany )to understand and perform VAAFT – Video Assisted Anal Fistula Technique- better. This endoscopic treatment of fistula doesn’t have a risk of incontinence.

In today’s era of minimally invasive surgeries, emphasis on painless treatment and faster recovery without much dissection of the tissue is higher. Anal fistulas have been treated from the era of Hippocrates from 1600 DC. Everything starting from horse’s hair to laser has been tried to treat these nagging problem. The two main factors / fear in fistula surgery is recurrence and incontinence due to incomplete removal or excessive cutting of sphincter.

There are various surgical ways to treat fistula including removal of the fistula track completely. This is surely painful, requires daily dressing and also takes a lot of time to heal. Along with which there are higher chances of recurrence; whereas, VAAFT requires no incision, which helps patients to resume their daily lives with ease.

This endoscopic treatment offers a complete diagnosis of the fistulous tract in the form of fistuloscopy and since no cutting of the sphincter is involved, there is no risk of incontinence. The latest case studies are showing encouraging results in this particular modality. Tackling recurrence of the fistula with VAAFT is much easier option and acceptable to the patient because of its painless patient-friendly treatment.

On his visit to Berlin, Dr. Nitish Jhawar met Dr. Monreio, who is the inventor of this technique and have more than 10 centres all over the world.

Dr. Monreio takes pride in the efficacy of this treatment which is helping him treat patients all across the Globe. As per Dr. Jhawar –“ It was a wonderful experience to learn the Nitti gritty of the surgical challenges and their management from the inventor himself. VAAFT has clearly achieved a reputed place in ARMAMENTARIUM of fistula treatment modalities and is here to stay. I am aiming to continue his legacy of helping people with VAAFT and make it easier for the patients suffering from Anal Fistula.”

Doctor Nitesh Germany training
doctor-nitesh-germany-training-session
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Colon Cancer Causes

Colorectal Cancer: Detection and Treatment

There are various measures that may tell you if you are suffering from colon cancer that includes alteration of bowel habits (diarrhea, constipation etc) lasting for several days, continuous feeling that you need to go for bowel movement which doesn’t occur, dark stools with blood, rectal bleeding, abdominal pain, sustaining weakness and fatigue etc. It is highly advised that if you are suffering from any such symptoms then consult Gastroenterologist or Colorectal surgeon immediately.

Diagnosis

Certain tests may be recommended for screening of colorectal cancer.

  • FOBT (Fecal Occult Blood Test) is done to examine for the hidden blood in stool.
  • Sigmoidoscopy- through Sigmoidoscope the lower and rectum colon is tested to detect cancerous or any precancerous growth. They are further tested or removed for more clarity.
  • Colonoscopy- through colonoscope the entire colon and rectum is tested to detect the presence of cancerous or any precancerous growth. They are further tested or removed for more clarity.
  • Virtual or computerized tomography colonoscopy- through a special X-ray equipment 3-D pictures are taken out of colon and rectum and later through the arrangements of these pictures by computer shows detailed information about any abnormalities and polyps.

Treatment

Among the various methods of treating colorectal cancer, three standard treatments are:

1) Surgery – it could be called as the most effective measure as the cancer affected zone is removed through this treatment. It is highly recommended for treating local colorectal tumors.

During colonoscopy a small tumor may be removed but removing the entire area with the surrounding fats and lymph nodes is undoubtedly the best way to treat. This surgery may be performed by open surgery method or by laparoscopy as suggested by your doctor.

In a process called colostomy the waste product is collected in a bag placed over stoma which is an opening made by surgeons. After the healing of bowel colon and rectum is reconnecting through another operation. In rectal cancer permanent colostomy is essential.

Painkillers along with medicines are often provided to the patients after operation to get relief from the pain.

Nutritious foods which are rich in protein and calories are advised to the patient to heal faster.

2)Chemotherapy – this treatment for cancer utilizes drugs to arrest the growth of cancerous cells by killing them or restricting them from further division. The drugs consumed through injection or mouth directly hits the bloodstream and reach cancer cells and when it is taken through spinal column it affect the area having cancer cells.

Combination of Xeloda (Capecitabine), Oxaliplatin, 5-fluouracil and Camptosar (Irinotecan) are used to treat the diverse stages of this cancer. Directly the chemotherapy may be provided to the liver if the cancer is metastasized there. The five drugs Cetuximab (Erbitux). Bevacizumab, ziv-aflibercept, panitumumab and regorafenib is approved by FDA for treating this cancer. These drugs together arrest the protein or blood which is helping in the growth of cancer.

3)Radiation therapy – this therapy utilizes the highly advanced X-Ray or radiation to restrict or kill the cancer cells. Two methods of radiation therapies are there.

The first one is external radiation where the machine is used to send radiation from outside part of the body to the cancer affected area.

The second method called internal radiation therapy utilizes substances of radioactive which are sealed in wires, seeds, catheters, needles and are injected directly on the infected area. It is done after the surgery with the Chemotherapy to kill all the possible existing cancer cells. If the tumor of the patient had stick to another part of the abdomen or if it is present on the point of cancer which was removed then radiation therapy is highly recommended.

You can live a normal life after the treatment as per the advice of the surgeon but remember to keep a regular follow-up as suggested by your healthcare provider.

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Person Image with anal fissure

Question and Answers related to Anal Fissure by Dr. Nitish Jhawar

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

Q1. I am 26 yrs old sales executive I had severe constipation after my travel last week ,now feeling severe pain while passing stool and noticed some bleeding also on the tissue while cleaning is it piles ?

A. Most commonly piles cause painless bleeding so if it’s a classical cutting glass pain following defecation with smudging on the tissue or a streak of blood on a stool then it may be Fissure – in – Ano. A simple visit to your surgeon will solve your problem.

Q2. Do fissures always require surgery?

A. The mainstay of treatment is medical which is aimed at reducing the pain, relaxing the anal muscles & curing the constipation surgery can be avoided in many cases.

Q3. If medical treatment fails then is there any other remedy other than conventional surgery?

A. Fissures refuse to heal due to spasm of the sphincter muscle if medical treatment fails then we can actually temporarily paralyze the internal sphincter muscle by injecting BOTOX. It is safe, fast and convenient but fissures may relapse once the muscle gains their normal tone again.

Q4. What is the conventional surgery all about will I lose control over my feces after getting it done?

A. Standard treatment for a fissure is called LIS (Lateral Internal Sphincterotomy) with or without fissure ectomy (excision of the fissure) it comprises of loosening the internal muscle by cutting a part of it. It is the very controlled way of releasing the spasm and there is no long-term effect on the continence.

Q5. Can LASER be done to cure fissures?

A. Yes LASER can be used to treat the fissures it’s a little expensive option but the equally good option as an LIS.

Q6. I recently delivered a baby and now having a painful bleeding from rectum since last 2 weeks do I need surgery as it is difficult to take care of by newborn with this painful condition?

A. It is very common to have fissure problem during or after delivery, medical treatment mostly helps and surgery is required only in nonresponsive cases.

Q7. I am a 40-year-old man I noticed some painful bleeding recently. I looked up on the internet I am scared that it could be Cancer please help?

A. The bleeding from the rectum can very well be a sign of cancer if associated with any of the RED flag signs like weight loss, change in bowel habits, black or tarry stools, anemia, family history of colorectal cancer etc. A short duration fresh bleed is usually not so ominous but visits to a specialist are required to rule out any lurking danger avoid self-medication at all cost.

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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 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.

  • 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.

  • 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