Laparoscopic Gastro-Surgery Clinic

Hello,

My name is Dr. Nitin Jha and I am a senior laparoscopic surgeon. Today we will be talking about something called is SILS that is single incision laparoscopic surgery, as the name suggests, single incision laparoscopic surgery is a way of doing laparoscopic surgery by only one cut at the navel instead of the routine three or four cuts that normally we take for any laparoscopic surgery like for example for laparoscopic gallbladder surgery for gallbladder stones, previously we had to put around 3 or 4 small incisions, one in the navel, one in this area and one or two in this area. So this is the standard way of doing laparoscopic surgery and now we can do it by a very small cut inside the navel, very easily hidden and from outside you will not come to know from where the surgery has been done so this is what we call as a single incision. In the same way we do the surgery for a hernia. If you have incisional hernia anywhere in this area or umbilical hernia, we do it by a small cut here in the left lateral side or the side of the abdomen and that is almost like 1-1.5 cm long and that is only cut which is required for doing the laparoscopic hernia surgery also and similarly for appendix instead of the routine 3 cuts that is usually taken by all surgeons, normally we do it by single incision in which we just put a small cut again in the navel and that is sufficient to do the surgery, so this is what is called as single incision laparoscopic surgery.

The advantages compared to the single incision and the standard way of doing laparoscopic surgery is that in standard way you have around 3 to 4 cuts, so ultimately you have small wound scars but in single incision there is only one scar inside the navel so practically from outside you don't come to know about it that from where the surgery has been done. The 2nd advantages because the number of cuts are less, so the number of scar are less so the amount of pain is also supposed to be less in single incision surgery and obviously cosmetically it is better because the operative scar is almost like hidden, so don't come to know from where the surgery has been done. Another advantage is that the time of recovery is very less come in single incision as compared to the standard three-port, four-port surgery. Single-incision has its own drawbacks also in the form that we cannot in all patients we cannot provide this way or technique of doing surgery because suppose the gallbladder is very badly stuck or the appendix is very badly stuck then obviously we are not able to do it by single incision we have to convert it to normal four-port technique, so that is why before entering our scope inside it is very difficult to know whether in that typical case we will be able to do by the single incision or by the standard four-port, only once we put our scope inside, we have a look at the appendix or the gallbladder or the hernia and how good or bad of a condition it is that we will be able to do it by single incision or we will have to go with the conventional three or four-port technique.

This is one of the more reason why we should not allow any disease to become that bad, suppose you start having pain of appendix you should be done as soon as possible, suppose you start having pain of gallbladder surgery, gallbladder stones, you should do it as early as possible because the earlier we diagnose, the earlier we treat the disease, it is more simple, the more time that we waste in diagnosing or more time we will waste in deciding, becomes more and more complex and in that case we have to basically resort to the four-port technique or sometimes even open surgery if there are a lot of other complications of the disease. So that is why the sooner we tackle the disease, the easier it is to operate and the more chances of single incision surgery as compared to any other standard way of doing surgery.

Thank you

Hi,

I am Dr. Nitin Jha. Main Senior Consultant Surgeon hoon laproscopic. Aaj hum log baat karenge gallbladder stone disease ke bare mein bahut common disease hai normally logo ko initially simple acidic gas ke sath present karta hai so sabse jyada jo ilaaj log yahi karte hain ki pahle rantac ya zantac type of kuch antiacid treatment lete hain kuch din unse kaam chal jata hai par aur uske baad ek situation aisi aati hai jab pain jyada hota hai, discomfort jyada hota hai. Finally ultrasound karte hain to usme pata lagta hai ki gallbladder mein stone hai. So in short yeh hai ki kabhi bhi agar aapko acidity ya gas ki jyada takleef lage to definitely pet ka ek baar ultrasound jarur karen usse hamein pata lagega ki kahin gallbladder ko koi stone to cause nahi hai ye sabh problems ka.

Anyway jab ye ek bar detect ho jata hai uske baad hame kya karna chahie, jabhi bhi gallbladder me stone hoga uska ilaj hamesha ek hi hai uska surgery hai. Aapko bahut saare information milenge koi stone ko galane ki dawai batayen ge koi aur aisi koi dawai duniya mein exist nahin hoti hai ise sirf hamara time waste hota hai, aapka money waste hota hai aur obviously jo sada simple disease tha starting mein simple ek uncomplicated gallbladder disease jo bolte hain bina koi khaas complications ke wahi cheez baad mein bigadh ke aur badi ho jati hai usme phir hamein aur 2-3 cheez karna padta hai kyunki simple agar initially hum karte to ek hi simple cheez se kam chal jata. Isko samajhne ki koshish karte haiin iske liye main ek chhota sa diagram banaya hai ye apna liver hai, yeh bile duct bolte hain isko yeh jo bile yahan se banta hai wo is duct ke dwara neeche aata hai aur ye ek theli type ki cheez jisko hum pit ki theli bolte hain, ye pit ki theli mein pit thodi der jama hota hain aur uske baad fir wahan se wo neeche release hoke small intestine mein aa jata hai.

Ab kisi karan se ye pit ki theli ki jo peeckne wali property hoti hai wo khatam ho jaati hai jiske karan pith iske ander phas jata hai aur kyunki wo nikal nahi pa raha hai to pit ke ander kuch aisi cheez hoti hai jisko hum bile salt, cholesterol, bile pigment bolte hain ye sabhi initially liquid form mein thi but kyunki yahan per pit fass gaya to ye bahar nahi nikal pati to isliye wo solidify hoke stone ban jaate hain aur wo chahe stone ek ho, do ho, hazaar ho koi fark nahi padta chahe wo stone to 2mm ka ho ya 20mm ka ho koi fark nahi padta, chhota stone alag pareshaan karta hai, bada stone alag pareshaan karta hai par Itni surety hain ki dono hi stone aapko pareshan karenge. Ab initially kya hota hai yeh sirf pit initially to infact kahi baar asymptomatic rehta hai agar aap koi dusre karan se janch karna chahte ho to aapko pata chalta hai ki gallbladder mein stone bhi pada hua hai ya kahi baar aap health checkup mein jate ho ultrasound ke liye tab tab aapko dikhta hai ki stone pada hai tab tak wo aapko koi pareshan nahin kiya hota usne lekin koi bhi initially choti hoti hai dheere-dheere apna wo kharab roop dharan karna shuru karti hai waise hi ismain jab second asymptomatic phase raha uske baad jo next phase aata hai usko hum bolte hain dyspepsia matlab thoda sa gas jyada ban na, khatte dkaar aana, kadwa pani ka muh mein aana ye sabhi initial symptoms hote hain jisko log confused karte hain ki simple acid hai ya gas hoga jiske karan hum log digene or rantac type tablet se kaam chalane ki koshish karte hain kuch salon ke baad fir wahi pain jo hai wo pain shuru hota hai ye usually pain is area mein jo pet ke upar ka hissa hota hai aur kabhi-kabhi isike piche jo back hota hai usme jata hai.

Initially pain chota aur kam hota hai dheere-dheere obviously or badhna shuru ho jata hai isko hum bolte hain cholecystitis matlab pit ki theli ka infection karna shuru karta hai wo ab kuch saal ke baal kabhi-kabhi aapne suna hoga appendix main pus ban jata hai, appendix fat jata hai waise hi iske ander bhi pus ban jata hai that is called as empyema gallbladder usi mein kabhi-kabhi stone jo hai iske neck par, mouth par fassh jata hai to aapka pain or dugna ho jata hai us situation main aapko aur takleef jehlani padhti hai par anyway yahan tak bhi agar hum usko timely correct kar lete hain to is problem se hum hamesha ke liye chutkara paa lete hain lekin suppose kisi karan se ye stone jo hai slip karke yahan bile duct mein ya pit ki nali jo bolte hain usme fass jata hai tab aapki pareshani or double ho jati hai us situation mein aapko aur simple pit ki theli ke operation se kaam nahi chalega aapko fir hamein endoscopy karke ERCP ek process bolte hain wo pehle muh se ek durbeen jayegi, durbeen pet mein aake yahan small intestine mein aake pahle is nali ko saaf Karega aur uske baad phir hamein surgery karni padegi matlab jahan pahle simple kaam tha wo aapka 2 kam ho jayega.

Anyway kabhi-kabhi yahi stone jo hai ye yahan par pancreatic duct bolte hain usme fass jata hai us situation mein wo pancreatitis karne ka bhi power rakhta hai. So in short ye hai ki bimari Ko itna badhne kyon dena jo sada simple bimari hai usko sada simple hi rehna chahiye aur pahle isi ko hamein operation itna bada cheera marke karna padta tha jise hum open surgery bolte the to abh jo ye hai laparoscopy se hota hai isme 3-4 chhote-chhote ched hote hain usi mein pura operation ho jata hai, usi ko agar ander bahut bad condition nahi hai to usko hum ek cut se hi kar lete hain usko bolte hain single incision laparoscopic surgery us situation mein aap bina, matlab koi aur cheera faadi karte hue nabhi ke ek chhota sa ched hota hai usi mein jo pura operation hai wo ho jata hai so that is called single incision.

So jo kaam aaj shayad ek cut se hojaye ya ho sakta hai ya do ya teen cut Lage uske liye pura pet kyon kholne ki jarurat padni chahiye. So that is why it's all depend on us ki hum koi bimari ko kitna bura karke fir hum wohi ilaaj karate hain ye jab starting mein jab sada simple hota hai usi samay ilaaj karate hain. Starting mein hamein takleef bhi kam hoti hai, jhanjat kam hota hai, pain kaam hota hai, operation bhi simple rehta hai, Jaise-Jaise kahani aur bigadti hai to utna hi pain ya takleef jo hai patient ko jyada jhelna padta hai aur obviously surgeon ke liye bhi pareshani badhti hai because wo operation utna hi difficult hota jata hai. Isliye mera simple sujhav rahega ki kabhi bhi agar aapko gallbladder mein stone rahe to isko turant dikhayen surgeon ko jaake iske bare mein aur jankari le aur iske bare mein jo uchit ilaaj hota hai wahi karen unnecessary bina koi logic ke treatment ke chakkar mein na fasse aur kuch janna chahte hain to aap mujhe mere clinic mein aakar mil sakte hai.

Thank you!

Hi, I am Dr. Deepak. Rathi, Ayurveda Specialist. Aaj mein aap ko piles ke bare mein bataunga. Is problem mein patient ko bohot pain hota hai. Ismein patient ko bleeding, pain or kabhi-kabhi masse bhi bahar aane lagte hain. Ismein swelling aa jati hai. Ismein wound ho jata hai and bleeding bhi hoti hai. Ye external and internal problem hoti hai. Ismein aap medicines le sakte hain ya fir surgery kra sakte hain ya fir ayurvedic sharsutra therapy le sakte hain. Is therapy se is disease ko manage and control kia ja skta hai. Ismein bleeding and pain ki problem 7-10 days mein hi control ho jati hai. Ismein internal masse shrink bhi ho jate hain. Surgery major hoti hai jismein aap ko anesthesia diya jata hai.

Logon ke liya ye ayurvedic therapy boon hai. 3-4 days mein ye thread shed off ho jata hai. Ayurvedic medicines se roots bhi khatam ho jati hain is disease ki. Is disease ko control karne ke liya aap constipation ko control rakhen. Iske alwa pani jayada piyein. Fibre rich diet len. Fruits and vegetables jayada len. Fast food and maida kam khayein. Fried chizen na khayein. Agar aap ko koi information chaiye to aap mujhse Lybrate ke through contact kar sakte hain. Thank You.

Hi!

I am Dr. Nitin Jha, Fortis Hospital, Noida me a senior consultant, laparoscopic surgeon hun. Stomach ke major problems ko hum laparoscopic surgery se treatment krte hain. Aaj me sabse common symptoms acidity and gas ke bare me discuss krenge. Kuch logon ko khana khane ke baad peat fulna or gas formation, khatte dakar aana or kbhi kbhi adha pacha hua khana vapsa muh me aana. Ye sab upper GI ke symptoms hote hain. Iska sabse common cause hai gallbladder stones. Iske or bhi symptoms hai jaise muh me kadva pani aana, khatte dakkar aana, indigestion hona. Isko noral condition maanke hum normal tablets lete rehte hain.

Or fir kuch time baad jab pain jhela nhi jata to hum hospital jate hain. Uske baad diagnosis hota hai jisme kbhi gallbladder stone paya jata hai or hiatal hernia milta hai. GERD me khana upar se niche jane ke baad niche se upar bhi aa skta hai. Is bimari me itna major ho jata hai ki stomach bhi chest tak aane lgta hai. Hiatal hernia ko medicines se control krne ki koshish krte hain. Ise prevent krne ke ek baar me heavy khana nhi khana, thoda khana khana or bar bar khana, khana khane ke baad turant nhi letna and thoda walk krna, in sabse isko control kia ja skta hai. Bina surgery ke hi ise thik kia ja skta hai. Lekin in sab ke bad bhi agar ye overcome na ho to surgery di jati hai.

Iska operation laparoscopy se kia jata hai. Laparoscopic nissen fundoplication surgery ka name hai. Isme hum stomach ko niche late hain. Chest and stomach k bich ke gap ko thik kia jata hai. Is se stomach abdominal cavity me rhega and chest me nhi jayega. Isme khana niche ko hi puch krega. Islia simple advice hai ki acidity and gastric problem ko avoid na kren. Iska proper diagnosis bhut important hai taki surgery tak jane ki requirement na pade. Medicines lene se bhi apko problem ho skta hai. Islia kbhi bhi aisa problem ho to consult your surgeon. Agar aap mujhse koi information lena chahen to Lybrate ke through contact kar skate hain.

Thank You!

Hernia: Types, symptoms and treatment

Yeah! Hi, I’m Dr. Nitin Jha, I’m a senior consultant laparoscopic surgeon at Fortis hospital, Noida and I also have a clinic in sector 61 Noida which goes by the name of Agarwal Clinic and today we’ll be discussing about Hernia.

By Hernia we mean that there is a small gap in the muscle of the abdomen wall and through this gap there is a protrusion of the contents which are inside of the abdomen like small intestine or the, even large intestine or the omentum fat and which tries to come out of this hole and as long as they go out and then they come back it’s okay. But the day it gets stuck, you know if you have a swelling in which the swelling refuses to go in, that means it is like an emergency then you have to immediately go to the hospital and get it operated upon.

Now, what is the cause, the basic cause of any hernia is, the weakness in the muscle wall and it can be even sometimes without any cause. That is called as Idiopathic. Now, there are basically there are three types of common hernia that we all encounter. The one is the Inguinal Hernia which are present in the lower part of the abdomen on the left as well as on the right side. Then you have our Umbilical hernia which is a hernia in the umbilicus itself, so that in the umbilicus instead of being a pit it becomes a elevated out pouching and then you have something called Incisional hernia in which after any surgery in the abdomen you can have a small bulge occurring from that incision side which is called basically insicional hernia. So be it any type of hernia the treatment is always surgical only. In contents, the usually, the intestine, the small ball, the large ball or the omentum fat can be the content of the hernia.

Now, What is the problem? Why to get it operated? As long as, as I told you, as long as it comes out and then goes back in, it is okay. But the day it refuses to go back in, that means it has become a bit complicated hernia. It starts with irreducibility, matlab, it doesn’t go back inside. Then there is something called as obstruction in which the intestine gets stuck in that pouch and it causes obstruction of the intestine. That is obstruction to the flow of the contents of the intestine. In that case the abdomen becomes bloated, the patient is not able to pass gas or motion from below and he or she can have a continuous vomiting from up. So, and obviously if the time goes on like this because of a decrease in blood supply of the intestine, the intestine can sometimes become strangulated. In that case it is an emergency and we have to immediately go to the surgeon and get it operated upon because if we give it more time the intestines can lose its blood supply and then we have to do a proper, major, big surgery. In which we have to cut the caught part of the intestine and rejoin the normal part. So, obviously we should definitely avoid this kind of circumstances which increases the cost also and plus it increases the morbidity, the trouble to the patient also.

Talking about surgery we initially had only open surgery, in which a small cut almost of this size used to be given whether it was inguinal or umbilical or incisional, but it had its own problems. The issue was, with open surgery, was you had to have a big incision on the belly. Then the bigger the incision the more the pain. The bigger the incision the more the chances of infection. But usually now we don’t do it by open surgery. We do it by something called laparoscopic surgery, in which there are almost two or three small, small holes of the size of around 5 millimeter or 1 centimeter and through, without cutting open the abdomen, through these small, small holes only the whole surgery is done. So the advantage is the patient becomes alright much faster. He needs to stay in the hospital for lesser number of time. He can be back to his work probably in three to four days. But as the thing is you know is any good thing is costly. Similarly the laparoscopic surgery is costly because the mess and the things which are required to fix the mess to the abdominal wall are costly. But if you compare between these two methods, laparoscopic surgery is far, far, far better than open surgery.

My specialty is doing the same surgery which is usually done by all other laparoscopic surgeons by three or four small, small cuts, I do it by only one single cut. So, especially with a uncomplicated simple hernia of the anteroapical wall, be it incisional or be it umbilical or super umbilical hernias which is commonly referred as ventral hernia. They are done by single incision only. That means I just put a small cut almost of this size around 1 to 1.5 centimeters size in the left part of the abdomen and through this same incision we conduct the whole surgery. So, the patient has not three small cuts but only one small cut. That’s the advantage of single incision laparoscopic surgery. So, you can consult me at my clinic in

So, you can consult me at my clinic in sector 61 Noida, Agarwal Clinic C122 and, otherwise you can also meet me in Fortis hospital Noida. Plus you can take an appointment via Lybrate and we’ll be glad to discuss your problems, thank you.

Hi, I’m Dr Nitin Shah. I’m a senior consultant at Fortis hospital, Noida. I’m a laparoscopic surgeon. I do all sorts of abdomen surgeries. Today we are going to be talking about the gallbladder disease, in which there are stones formed in the gallbladder. We need to understand that patients can initially be absolutely asymptomatic. The patient can have no pain or any discomfort. Many times it is detected by routine health examinations when the patient undergoes an ultra sound of the abdomen.

The initial stages after asymptomatic, the patient starts having little bloating in the abdomen which is commonly referred as gas and acidity. So people have a tendency of neglecting it and keep on taking some antacid or pantocid or Digene and this kind of stuff to suppress the symptoms. So after dyspepsia, the patient starts having pain in the abdomen. This pain can initially very simple pain. It can even progress into severe pain. It starts usually in the pre-gastric region, upper abdomen and goes to the back. This is very typical of a bilicuric and increases after any fatty meal like any extra oily friend. This kind of stuff when we eat, the patient has more pain and then depending on the severity of the inflammation, even patients are known to have pus in the gallbladder, thereby, increasing the mobility of the disease.

Some stones can slip from the gallbladder into the bile duct thereby obstructing the bile duct and producing something that is called obstructive jaundice. In which the patient has severe pain and has visible jaundice also. These stones not only block the bile duct but also can block the pancreas duct thereby causing something called as gall stone pancreatic. So, this is another very severe problem. As we all know, gall bladder cancer is quite common these days. In 4% of the cases, the gall stones are the causes of gallbladder cancer. So, for a simple disease like a gall bladder stone, if not treated at the immediate time this can land up into very very severe problems. now once the diagnosis is confirmed it is a simple surgery called as lap coly cystectomy in which we remove the gallbladder in very small three to four cuts that is called the laparoscopic surgery. The same surgery was previously done with a big cut that’s called the laparotomy, cutting open the whole abdomen and then removing the gall bladder. Now it is done by three or four small cuts. In fact, my specialization is getting the same surgery done by a single incision in the ablycus. In which there is one cut in the navel and no cut anywhere else in the abdomen and hence the surgical cut is hardly seen. Probably, even after two months, the surgeon will also not be able to make out whether any surgery is done on the patient or not. The scar is hardly seen and it is very cleverly hidden in the ablycus.

So, for any further information or any question that you want to ask I am available at lybrate.

You can log onto lybrate or even text me or video chat with me on lybrate and I will be more than happy to clear all your doubts regarding any surgical disease and help you in the best way I can.