Archive for March 2013

Bleeding, pain and prolapse on passing stool? Do not neglect

No. Although most of the symptoms of bleed and pain during defecation are due to piles and fissure, sometimes it may be due to more dangerous diseases such cancers, polyps and ulcerative colitis. Consult a doctor before assuming a simpler disease.


I have anal fistula. I have taken various medicines prescribed by alternative medical practitioners but it has not healed. I am scared of surgery since I have heard it is painful and fails most often.


Anal fistulas can be cure

Is all pain and bleeding in stools due to piles and fissure?

only by surgery. So don’t waste time and money on pills and creams. The fistula surgery has improved in recent times due to better MRI scans, techniques like VAAFT, LIFT, Seton and Plug for complex cases. Most cases can be sent home after a single day hospital stay with minimal pain and wound. The failure rate for a simple fistula is rare and 15% for complex fistulas. Also in traditional surgery there is a chance of damage to anal muscle that can lead to inability to hold stool. This is least likely in modern surgery.



I am suffering from piles since last 2 years and I have taken various alternative medicines but if I stop taking these, the problem starts within 2-3 days. How long do I have to take this?  Do I need surgery?

Most alternative medicines have no scientific basis or evidence. On the basis of scientific evidence, if you have smaller piles (grades one or two) they need injection or banding treatment.If you have grade three or grade four piles, you need surgery. Surgery can be open or stapler. I recommend stapler since the discomfort is less, and if I needed surgery I would (having done both types of operation extensively) choose staplers any time.


What is the modern treatment for rectal prolapse (the popping out of rectum on defecation) and colorectal cancers?

Nowadays rectal prolapse and colorectal cancers can be treated by laparoscopic surgery without the need for cutting the abdomen. This means less pain, less wound and a hospital stay of 2-3 days only.



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Bariatric Surgery can help the Obese Infertile


Infertility in females is a growing problem.  Statistics show that one in six couples are infertile. Forty percent of the problem lies in the females. One of the major influence or contributor to this problem is obesity.  If you look around or visit a fertility center, one would know that many of the patients are overweight or obese. It comes as no surprise as obesity is now fast becoming the number one problem in the world.

So why is obesity so important in fertility? 

Body fat is nowadays considered an endocrine organ responsible for producing various hormones. Some of these hormones work like birth control pills.  Hence the eggs production and release are impaired and results in infertility. This phenomenon is also seen in a condition called PCOD (polycystic ovarian disease), a major cause of infertility.

Another important and interesting observation seen in obese individuals is that some of the severely obese individuals are unable to perform a normal sexual act because of the sea of fat whichhides the external genitalia.

It is also evident from medical research that assisted reproduction (fertility treatment) is less likely to succeed in obese individuals.

So how does one help these infertile ladies with obesity?

Since obesity is the root cause of such infertility, it would be natural to consider that weight loss would logically improve the chances of fertility in these subjects. As a matter of fact this does happen in clinical practice. Medical literatures and researches are showing that weight loss is associated with improved chances of fertility either naturally or by assisted reproduction.

What is the role of Bariatric Surgery in infertility?

Weight loss achieved either by adoption of diet and lifestyle or by weight loss surgery (Bariatric Surgery) in cases of severe obesity have both shown favorable outcome. A new study of morbidly obese women suggests that Bariatric surgery may effectively treat one of the most common causes of infertility i.e. PCOD. It is noted that 50% of infertile women conceived within 2 years of their Bariatric surgery. Even the increased risk of miscarriage in obese women may decline after Bariatric surgery. Additionally, the risks of complications during pregnancy such as diabetes, hypertension are also diminished.

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What is new in surgery for Gallstones ?


Can gallstones be managed on medicines (without surgery)?


In certain situations, some patients with asymptomatic gallstones can be managed by “wait and watch” policy. Some studies suggest that the patient’s age at diagnosis may be a factor in this decision. The probabilityof symptoms and future surgery at the age of 70 is 15%. Hence the 85% of patients can be managed by an expectant approach.

A drug called UDCA with modest success can also manage some patients. But do not fall prey to many false claims of gallstone dissolutions by various unscientific methods.


Has gallstone surgery become safer?

Yes. Initially when laparoscopy had started for gall bladder, there were reports of more bile duct injuries. However the recent trends show that with improved technique, the surgery has become safer. In good experienced centers, it has almost become a day-care surgery.

However there is a word of caution. One should not think it is safe in all hands and centers. Do some research before handing your precious body to surgery. Most people are unaware of the factors they need to consider

So, how should we choose?

First, look for a center or surgeon with high volume of laparoscopic surgery. This will ensure a low complication rate.  Experience counts, you know. Although this is nowadays a safe surgery, complications like bile duct injury may have disastrous lifelong consequences.

Second, do some research on the outcome of patients from these centers. Did they have wound infections? A very rare complication after laparoscopic surgery, but may spell hell for the unfortunate few. The worst part is it is because of poor cleaning technique of laparoscopic instruments employed in some centers, something that may be beyond control of the surgeon. And it takes weeks to months to heal. Ask somebody who has had it.

To summarize, if you do need laparoscopic removal of gall bladder, choose not only on the basis of the cost or proximity of a center to your home, but choose on the basis of safety and comfort also. It will not necessarily come at a higher cost. But you need to know where to look. After all, your body is precious. Hand it over to somebody who thinks so too.


Can this surgery now be done by a new method-Scarless Surgery- instead of conventional 4 holes?

Yes, nowadays there is a new and modern technique in which special instruments can be used to leave no marks in the abdomen. The only wound is in the depth of the navel, which is not visible.


What are the advantages of Scarless Surgery?

The major advantage of Scarless Surgery is cosmesis. The reduced pain and a single day hospital stay are added benefits.


Who can benefit maximally from Scarless surgery?

Anyone who is concerned and conscious of not having the scars in the abdomen can have this surgery. This particularly allows women to wear saris where the scars of laparoscopic surgery may show. This is also extremely beneficial to young unmarried girls and people from the fashion industries that do not want any scars in their belly. People who cannot tolerate pain at all can also benefit from this technique. To see the video, how we do it visit my you tube page…….


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