Articles on colorectal surgery

Changing Face of Colorectal (Bowel) Cancer in India

Dr. Maruthesh Gowda, Bariatric Surgeon
Colorectal cancer is cancer affecting the large intestine, and rectum. There has been rapid increase in colorectal cancer in India and this can be attributed to                                                                                               1. Increasing life expectancy        2.  Changing life style to western                                                                       Most cases occur above the age of 50. It is true that if detected early then colorectal cancer can be cured.      How does Colorectal cancer develop?Contrary to belief it take years to develop colorectal cancer. It develops from the inner lining of bowel (mucosa). Initially it forms a polyp which over the time turns into cancer. Tumor then starts to invade through different layers of bowel wall then into to lymph nodes near by.  If undetected, it can eventually spread to different parts of the body. Most of these cancer are on the left side. (see pic)Is there treatment for polyp? Yes. Most polyps do not contain cancer cells. Removal of polyp will be sufficient to prevent the cancer from developing.After removing the polyp, if cancer cells are found then it alone is sufficient if cancer cells are confined to polyp, however, if the cancer cells have spread to colon then further surgery is advised if necessary. What are risk factors for Colorectal cancer?Increases with ageWestern life style Genetic factor (First degree relative having colorectal cancer)Long term inflammatory bowel disease (Crohns, Ulcerative colitis)What reduces the chances of having colorectal cancer?Hormonal replacement therapy for womanVegetarian dietWhat are symptoms of colorectal cancer?Initially there might be no symptoms or very little symptoms and become more when the cancer grows in sizeChange in bowel habit either to constipation or passing too many  timesSensation of incomplete emptying after passing motionBlood mixed with the stoolPassing mucus with stoolSensation fullness after eating littleAbdominal distensionAbdominal painWeight lossWhat tests are needed before surgery?Colonoscopy and biopsy to prove it is cancer is a must unless its an emergencyCT scan to asses the spread inside the abdomen and chest MRI of pelvis if cancer is in rectumWhat are the treatment options?If it affects colon:  Surgery is done first. After excision the cancer is looked under microscope, if it has spread to lymph nodes then chemotherapy might be needed post op.If it affects rectum: In first two stages then surgery first. If 3rd/4th stage then chemo radiotherapy first is absolutely must. Chemo-radiotherapy is given first then operating reduces risk of recurrence from 85% to 5% (See Pic)If in Anal canal:  Chemo radiotherapy is main stay of treatment.How is Surgery done?If the patient is fit cancer surgery can be done safely with keyhole (Laparoscopic) with 3 or 4 small incisions. Usually the cut ends are joined using special stapler. In certain cases, colostomy can be done if the joining is thought to be risky. The options will be discussed with risk/benefits before surgery. Can the colorectal cancer be cured?Yes, if found in early stages. Even if it has spread to lymph nodes, then also it is curable. People with liver metastasis can also be cured at times.                                                                                                                                                           

Anal Fissure - Painful Morning

Dr. Deepak Rathi, Ayurveda
Fissure-in-ano is one kind of ailment that is embarrassing to talk about, given the nature of the symptoms and manifestations. However, it is one of the most prevalent conditions in the world, with millions of people suffering the agony of bad painful fissures.Introduction:A fissure is a tear of the skin at the edge of the anus. It can cause pain, bleeding and/or itching.Causes :An anal fissure is usually caused by a hard and dry bowel movement, alongwith a tight anal musculature, which tears the anal lining. Other causes include diarrhoea and inflammation of the anorectal area.Trauma also can cause fissures. During childbirth, 11% of women develop anal fissures. Fissures can also be caused by digital insertion, foreign body insertion, or anal intercourse.A low-fibre diet may play a role in the development of fissures.Anal fissures affect people of all ages, particularly young and otherwise healthy people. They are equally common in men and women.Symptoms :1. An anal fissure causes a sharp, stinging, or burning pain during a bowel movement. The pain, which can be severe, may last for a few hours.2. Fissures may itch. 3. They often bleed lightly or occasionally cause a yellowish dischargeTypes:Fissures can be acute (new) or chronic (persistent). An acute fissure has an 80% chances of healing.When a fissure lasts over 6 weeks or is repetitive in nature, it is considered Chronic and has less than 50% chances of healing.Sometimes an anal fissure and a hemorrhoid develop at the same time.Diagnosis:Most health professionals can diagnose an anal fissure by listening to the symptoms and by looking at the anus. Usually, the health professional can see the fissure by gently separating the buttocks.A health professional may use a gloved finger (digital rectal examination) or a lighted instrument (anoscope) to examine the fissure. However, if the fissure is extremely painful, the health professional will usually wait until it has begun to heal before performing a rectal exam or using an anoscope (anoscopy) to rule out other problems. A topical anaesthetic may be used if an immediate examination is necessary.Treatment:Ayurvedic Medicines - If it’s a first or second episode of Fissure, at least 50 % of fissures heal by medicines without need for any kind of procedure or surgery. Application of special medicated cream, use of stool softeners, avoidance of constipation, and the use of sitz baths (soaking the anal area in plain warm water for 20 minutes, several times a day) help to relieve the symptoms and allow healing to occur.Kshar Sutra Therapy - For those Fissures that are giving problem again and again, Kshar Sutra Therapy is the best treatment option. It is safer than surgery and completely effective.Surgery

Jaw Surgeries for a Proportional Face

Dr. N Srinivas, Dentist
It may take more than a new smile to help you look your very best.Having a great smile is undoubtedly an asset, regardless of other aspects of your appearance. However, your smile is only one part of the whole composition of your face. Once you have improved your smile, you may be inspired to make a few other changes to look your very best, and it may be necessary to look beyond your dentist to help.If you are unhappy with your facial profile,the condition of your skin, or specific facial features such as your lips, nose or chin. An oral and maxillofacial surgeon reveals how repositioning the jaws can improve not only your bite but also your entire facial appearance, especially in profile.What is orthognathic surgery?Orthognathic surgery involves dividing and repositioning the jawbones to bring them into better alignment. It is typically used to correct bite problems that cannot be fixed by orthodontics alone.Often bone or soft tissues may be removed or augmented to further enhance facial esthetics. Orthognathic surgery can bring about significant changes in your appearance.Is orthognathic surgery right for me?Orthognathic surgery is typically performed by an oral and maxillofacial surgeon and can achieve dramatic improvement in facial esthetics. Orthognathic surgery may be the best option if you:1. Have jaw problems that can be treated only by surgery.2. Can pay for the procedure, as its a bit expensive.3. Feel strongly that your condition is inhibiting your success and happiness.4. Are willing to experience some discomfort and inconvenience.5. Understand and accept all associated risks.Communication is critical to success!1.It's important that you tell your doctor exactly what you want to correct.He or she may zero in on a particular problem,and you need to be sure that problem is also your primary concern.2. Your surgeon will design a highly specialized treatment plan for you based on information gathered by obtaining casts of your teeth, photographs,video images,and special x-rays.3. It's highly important that you know what results to expect from treatment.Some surgeons will use digital imaging to give you a good idea of what you'll look like after surgery;others may show you tracings of your new profile based on your x-rays.4.It's also essential that you understand each step of the surgical procedure that you're to undergo.The main risks and possible outcomes should be explained thoroughly, and it's then up to decide which procedures you wish to have performed.What can orthognatic surgery do?Problems that can be addressed using orthognathic surgery include. Recessive or protruding lower jaw and/or chin.. Chin that is too short,too long,or otherwise unattractive.. Open bite(teeth do not meet). Lower and/or upper jaw positioned to one side or a narrow arch. Discrepancies in upper and lower facial height (gummy smile or lack of enough tooth or gums showing)What does an oral and maxillofacial surgeon do?Oral and maxillofacial surgeons do more than just tooth extractions and jaw surgeries.If  you're interested in cosmetic procedures to enhance the appearance of your face and neck,talk to your surgeon about including them your overall treatment plan.

Cosmetic and Plastic Surgeries

Dr. Parthasarathi Dutta Roy, Dermatologist
Being beautiful and charming is very important in every stage of today’s life. Most of people become upset for not receiving attractive physical structure, nose alignment, slim physic and many more. But medical science creates revolution for establishing two significant surgeries named cosmetic surgery and plastic surgery. These are very helpful for treating any kinds of physical disorders.Effectiveness of Cosmetic and Plastic SurgeryThrough cosmetic surgery anybody can change their facial or body structure which is not desired. Plus from ageing lines to wrinkles can be reduced through method of cosmetic surgery.Plastic Surgery is basically used for reconstructing the facial or body features. Any kinds of birth defects, injury imperfection and disease feature can beautifully be repaired by plastic surgery.Features of Cosmetic SurgeryTwo types of cosmetic surgery are categorized in medical science- addition and deletion. Through cosmetic surgery with collagen injection something can be added for giving proper shape and size of the body parts if one is not satisfied with their parts, size and shape of the body. Breast augmentation and lips plumping are the best examples. Alternatively excess mass on some parts looks ugly; the cosmetic surgery helps to delete the volume to give the perfect shape.Procedures of Plastic Surgery:Many procedures can be performed through plastic surgery. But here are some most popular procedures which is remarkable possible to treat are described below.Breast Augmentation: The women having small breast can get beautiful and attractive big breast through breast augmentation procedure of plastic surgery.Rhinoplasty: Defect of nose can be treated through rhinoplasty.Blepharoplasty: To give redesign and shape of the eye lids, blepharoplasty is just incomparable plastic surgery.Liposuction: Excess fat is cut down through this liposuction procedure for giving attractive body structure.

Do I Have Appendicitis? Do I Need Surgery?

Dr. Maruthesh Gowda, Bariatric Surgeon
First thing we need to understand is that appendicitis is an surgical emergency. When treated appropriately complications are very few.What are the symptoms of appendicitis?It has dull aching pain around the umbilicus and slowly localises to right lower side. It is associated with vomiting and anorexia (patient does not feel hungry). If ignored then might lead to temperature, high heart rate (tachycardia).How is appendicitis diagnosed? It's based on history and clinical examination. Blood tests will reveal infection (Increased WBC, CRP). Ultrasound of abdomen might help to confirm the diagnosis but negative ultrasound scan does not rule out possibility of appendicitis. Ultrasound is more important in females as problems in ovaries, fallopian tube and uterus might present in the similar way and ultrasound helps to rule out those possibilities. What is the treatment of appendicitis?  In short treatment of appendicitis is immediate surgery. It is not I am busy for next few days and will have surgery later and this might lead to serious complications.Now a days surgery is done laparoscopically (Key hole) and involves three small cuts which will be barely visible with time. Most patients go home 24 hours later being able to do regular activities. There will be no food restrictions. Only restriction being not to lift weights for 1 month. Can appendicitis be treated with medicines? if so what are the complications?There are times when patients want antibiotics and not surgery. While this is proven treatment it is logistically difficult to apply in Indian settings unless patients and affordable and ready to take risks.Medical proof so far tells us to treat appendicitis with antibiotics we need to do CT scan and prove that there is no collection of pus inside abdomen. Once this is done admit patient for Intravenous antibiotics (IV) for 48 hours. Regularly review patient to make sure infection is not spreading. If infection does not settle down or patient suffers complication then do complicated surgery with more risks involved.What we have to be very careful is young females with appendicitis as untreated or poorly treated appendicitis might lead to infertility in the future by affecting the movements of fallopian tubes.In all patients treated with antibiotics there is small risk of long term abdominal pain and very rarely appendicitis might recur needing surgery.

How Do I Behave When I Am Undergoing Cataract Surgery?

Dr. Manoj Rai Mehta, Ophthalmologist
Cataract Surgery nowadays is usually performed under 'topical anaesthesia' that involves instillation of drops of the anaesthetic agent on the eye surface.  The patient retains the power to close the lids and move the eyeball during surgery, feel no pain but touch and pressure sensations are unaffected.  A peribulbar block anaesthesia may be used at times on surgeon's discretion that involves an injection of anaesthetic agent around the eyeball with a short needle.  This takes away lid and eye movements to a large extent but some control may remain with the patient.     Operating Surgeon expects the patient to follow the instructions for a smooth surgery.  It is important to have a surgical counselling session with the doctor to understand the procedure and expected sounds/conversation during the operative procedure.  The sequence of events should be understood and played in your mind while you move through the surgical suite.You should be wearing loose, comfortable hospital pyjama suit.  Do not hesitate to change it if it is tight around your neck.  Some hospitals have the policy to allow you to wear your own loose clothes and give you a hospital gown over them.  Please ensure you are not wearing tight fitting clothes and your neck is free.  Ladies to tie their hair in a ponytail with a band or a soft bun with no clips or claspsSit quietly in the pre-operative area and use the washrooms before going to the OR.  You may take sips of water if your mouth feels dry but do not hydrate yourself too much.You may be given a cap and eye marked for surgery.  The antiseptic solution will be painted around the eye.  Let the solution dry and do not touch your eye. OR assistant will help you lie down on the OT table with a rubber ring under the head to prevent rolling from side to side. You should be comfortable and be able to breathe rhythmically while lying down.  Ask for a head raise if neck extension is hurting you and get the ring adjusted to your comfort and if it is hard for you to ask for a softer ring.When you are comfortable allow the staff to put monitoring devices which could be a pulse oxygen meter alone or additional cardiac electrodes.  Breath rhythmically and try to relax.Sterile Drapes will be placed around your head and an adhesive eye drape on the eye to be operated upon.  Please maintain your head in a position as required and adjusted by the surgeon.  Do not move your head or lower your chin.  The surgeon works under a microscope and any movement shifts the focus and obstructs in smooth surgery.There will be several sounds in the OR that you should ignore-beep of monitors, hum of air circulation unit, trolley wheels, the doctor would be giving instructions to staff and asking for instruments etc.  Try to keep your attention focused towards surgery only.Coughing and snorting during surgery can create complications, always ask the surgeon to stop the surgery if you feel like doing so.  Do not try to suppress a cough or sneeze by holding breath.  Do not bear down or move.Follow instructions of a surgeon and do not start a conversation. Answer only when a question is directed towards you.  The surgeon may ask you to look in a particular direction.  You have to follow the command by moving your eyes and not head unless the specific instruction is made. The first touch of the instrument will increase your confidence.  Do not wince, squeeze your lids or make a jerky movement if you feel some pain.  Inform the doctor, who will reinforce anaesthesia.Cataract Surgery machines also produce different types of sounds during different phases of surgery and also have synthesised verbal outputs.  Do not get distracted by the same.You will see movements in front of the eye during surgery and also perceive vibrations.  Light intensity will increase towards the end of surgery.  A calm patient who is having a regular rhythmic breathing and a regular normal pulse rate makes a surgeon's job easy.(In case of specific problems additional monitoring and specialised anaesthetic cover may be required which the operating surgeon will discuss before hand).               

What is orthognathic surgery?

Dr. N Srinivas, Dentist
Having a great smile is undoubtedly an asset, regardless of other aspects of your appearance. However,your smile is only one part of the whole composition of your face. Once you have improved your smile,you may be inspired to make a few other changes to look your very best,and it may be necessary to look beyond your dentist for help.If you are unhappy with your facial profile, the condition of your skin,or specific facial features such as your lips, nose or chin, surgeon reveals how repositioning the jaws can improve not only your bite but also your entire facial appearance, especially in profile.What is orthognathic surgery?Orthognathic surgery involves dividing and repositioning the jaw bones to bring them into better alignment. It is typically used to correct bite problems that cannot be fixed by orthodontics alone. Often bone or soft tissue may be removed or augmented to further enhance facial esthetics. Orthognathic surgery can bring about significant changes in your appearance,particularly as you are seen in profile.What can orthognathic surgery do?Problems that can be addressed include:Recessive or protruding lower jaw and or china chin that is too short, too long, or otherwise unattractiveOpen bite (teeth do not meet)Lower or upper jaw positioned to one side or a narrow archDiscrepancies in upper and lower facial height Communication is critical to success!It's important that you tell your doctor exactly what you want to correct. The doctor may zero in on a particular problem and you need to be sure that problem is also your primary concern.The surgeon will design a treatment plan based on information gathered by obtaining casts of your teeth, photographs, video images, and special x rays.It's highly important to know what results to expect from treatment, either by digital imaging or tracings of your new profile based on x-ray.It's essential to understand each step of surgical procedure that you undergo.

Liposuction: The Most Misunderstood Surgery in the World

Dr Deepali Agarwal
The procedure involves fat removal but is not an alternative to dieting and exercise. It is not a means of weight reduction but body contouring and sculpting. Although following a good healthy diet and a daily exercise is a better idea but localized fatty deposits such as on thighs, hips and abdomen etc may be inherited traits and may not be corrected by just a good lifestyle. In such cases liposuction rather we should say liposculpting is a good option.Some fast facts about the surgery are as follows:The length of the surgery varies from 30minutes to 5 hours depending on the extent of fat removal.It is done under local anesthesia, intravenous sedation, epidural block or general anesthesia.The length of the stay at the hospital is usually 1 day.Initially there is mild to moderate discomfort. You can go back to work after 10 days but sternous exercises should be avoided for atleast a month.Most of the swelling subsides within a week while mild residual swelling goes after 3 months.The scars are minute and inconspicuously placed.Complications are possible but unlikely if done by a well trained and experienced plastic surgeon.To conclude would like to emphasize on the point that the success of the procedure lies in the understanding of the patient that the procedure is not for weight reduction but spot reduction i.e. localized fatty deposits. It is the most frequently done aesthetic procedure in the USA and worldwide which seems to be a truly magical procedure than any other aesthetic procedure.

Anal Fistula Now Can Be Completely Cured Without Surgery

Dr. S K Singh, Ayurveda
Anal fistula a challenge for modern surgery but curable by grade kshar-sutra in Ayurveda (Indian system of medicine).Anal fistula is a disease for which different methods of treatment have been advocated time to time, Even today when we are talking about robotic surgery, this disease has no satisfactory method of treatment in modern surgery. The latest method of video assisted anal fistula treatment (VAFT) is not satisfactory due to high incidences of recurrence after the surgery. But we at Sushruta Anorectal Institute New Delhi are successfully treating all these complex anal fistulae without surgery  & with the help of graded ksharsutra (healing thread for fistula-in-ano) developed from Ayurveda.In Ayurveda about 2000 yrs ago Acharya Sushruta has indicated kshar sutra treatment to treat fistula-in-ano. Late professor P J Deshpandey at faculty of Ayurveda Institute of Medical Sciences B H U, had done extensive research in this field and established a treatment module to cure this disease.In 1990 Indian council of medical research has clinically evaluated this Ayurvedic treatment module at four premiere institutes in our country including AIIMS Delhi & P G I Chandigarh . Subsequently it was concluded by I.C.M.R.that in the patients of fistula in ano, ksharsutra treatment is more effective& convenient as compared to modern surgery.Ksharsutra is a thread coated with certain Ayurvedic medicines known for their antiseptic, debridement & healing properties. After u v sterilization this medicated thread (ksharsutra) is used under complete aseptic precautions in the patients. The patient is routinely investigated with special reference to any other associated disorder like hypertension, diabetes mellitus, tuberculosis etc. The next step lies In the proper identification& evaluation of the fistulous tract. It is mandatory to define the fistula tract wrt its depth, direction & branching pattern. This may be achieved by careful probing under expert hands using malleable probes& if required help may be taken from other investigations like x ray fistulogram or mri fistulogram. Once the tract has been clearly defined the Ksharsutra is placed in it with the help of certain instruments, under local anesthesia.This entire procedure is usually completed in ten to fifteen mins. As there is no cutting of tissues hence no bleeding, no pain & patients can go home after half an hr rest in the day care room. The medicine coated on the thread is gradually released in the tract.The cumulative effect of the coated drugs exerts a powerful debridement effect on the fistula tract & induces healing by the fresh & healthy granulation tissues. Thus Ksharsutra is the mechanism of drug delivery precisely at the tissues involved. Every seventh or tenth day the old sutra is replaced with a new Ksharsutra till there is a finale cut through. It has been observed that the tract heals @ 0.5-1 cm per week. The post-operative complications like recurrence of the disease, fecal incontinence, bleeding is not seen with Ksharsutra treatment. Further this therapy is performed as an OPD procedure. No general anesthesia & no hospitalization is required. Patient maintains his normal routine activities as usual during treatment period.   At Sushruta Anorectal Institute; Rohini - New Delhi, we have been working on this disease including piles fissures & pilonidal sinus for the last 15 yrs. Here we have developed the concept of graded kshar- sutra which has given us a more effective &convenient way to treat anal fistula. on record At Sushruta Anorecta Institute we have treated thousands of patients of anal fistula from different states including overseas patients. We have records to prove that the patients of high anal complex fistula, those have been operated two or three times but failed to heal were successfully cured at this institute.                   Dr  S K Singh (gold medalist)                           M S (ayurveda) B.H.U.