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


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All Posts Tagged: Laparoscopic Surgery

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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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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Testimonial

What patient says about Dr. Nitish Jhawar

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    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