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What is the conventional treatment of Diabetes?

Diabetes is conventionally treated by a low sugar diet, physical activity and medicines that lower sugar levels in the blood. In advanced stages, insulin is also needed.

What are the complications of Diabetes?

There can be long-term complications in the Eye, Kidneys, Nerves, Heart, Brain and Limbs – practically every part of the body- in diabetes. This is because of chronic cell starvation – sugar staying in the blood and not entering the cells. This may result in eye surgery for cataract, stenting for heart disease, strokes, dialysis for kidney disease, infections, loss of limb, etc. And all this can still happen despite medical treatment of diabetes.

What is Surgery to “cure” Diabetes?

Recent research has shown that the small intestines play a major part in diabetes. When food comes in contact with certain part of the gut such as the duodenum, it releases certain hormones that are responsible for inactivity of insulin. Based on such knowledge, operations have been devised to reroute the food in the gut by altering its path. This results in the “cure” of diabetes. It is also called bariatric or metabolic surgery.

Who are the candidates for surgery to “cure” diabetes?

Diabetic patients who have are obese, have diabetes for less than 5 years and are not on insulin, have the best chance of resolution of diabetes from the surgery.

How is the surgery done? What is the cost of the surgery and is it cost-effective?

It is a laparoscopic surgery requiring a 2-day hospital stay. The cost of the surgery varies from 2-5 lakhs INR depending on the procedure, technology and the class of accommodation. If one calculates the expenditure of medications, tests and the risks of complications, one may find this price cost-effective.

How effective is the surgery to resolve diabetes?

So effective is the diabetes surgery that it has been hailed as the most important discovery of the decade. Many patients are exchanging their life of medications with a single shot surgery. The disease that was till recently considered incurable is now being considered “potentially curable”.

Watch the video on Diabetic Surgery on YouTube.

What is Chronic Pancreatitis?

Chronic pancreatitis is a diseaseof the pancreas in which the pancreas gets progressively destroyed. It is seen in patients who consume alcohol or harbor stones. Sometimes, it runs in families and sometimes there is no reason to be found.

How do they present?

They present with recurrent pain in upper abdomen usually after meals, indigestion and sometimes diabetes.They may multiple hospital admissions for their pain.

What is the Treatment of Chronic Pancreatitis?

The treatment of chronic pancreatitis is done by medical, endoscopic and surgical methods.  The main idea is to relieve pain, improve pancreatic function, and manage complications.

What are the Medical approaches to Chronic Pancreatitis?

They comprise of

1. Analgesics for pain relief
2. Pancreatic enzyme supplementation to aid in digestion and giving pancreatic “rest”.
3. Avoiding Alcohol
4. Nerve blocks under CT scan guidance- by injecting drugs that block pain-carrying nerves of the pancreas. Multiple sessions may be needed in this starategy.
5. Endoscopy- Sometimes, the pancreatic duct can get narrowed that require dilatation with plastic pipes put during endoscopy (Stenting)
6. Lithotripsy- Sometimes the pancreatic duct gets blocked by stones that need to be broken down by shock waves. This is called lithotripsy and is available in few centers. Both endoscopic stent and lithotripsy helps in restoring the flow of digestive juices.

When is Surgery done for Chronic Pancreatitis?

Surgery is usually reserved for people with chronic pancreatitis who have pain that does not respond to other treatments mentioned above.

It is reserved for patients whose CT/ MRI scan reports show dilated pancreatic ducts or a tumor/ cyst formation.

A surgical procedure called pancreaticojejunostomy relieves blockage and pressure in the pancreatic ducts. It alleviates pain in about 80 percent of people.  The objective of the surgery is to relieve blockage by stones and narrowing and hence help in diminishing the pressure on the pancreatic cells. This, in turn, helps in restoring the flow of digestive juices and preventing cell damage.  Sometimes, when a tumor like formation is seen in the head of the pancreas, its removal is also carried out- this is called “Coring”.

In the future, cell damage that produce diabetes may also benefit from “islet transplantation”.

How safe and effective is the Surgery for Chronic Pancreatitis?

This surgery is very safe with complication rates of less than 2%. The majority of the patients, when selected well have significant and sustained pain relief. In patients fulfilling the criterion, surgery should always be a strong option.

What is Heartburn?

Heartburn is the feeling of burning sensation in the upper abdomen or the central chest. This happens when the stomach acid enters the esophagus (foodpipe in the chest). This can happen when the muscle at the junction of esophagus and the stomach gets weaker and hence is unable to prevent the reverse flow of food and acid from the stomach to the esophagus.

Occasional heartburn isn’t dangerous, but chronic heartburn or gastroesophageal reflux disease (GERD) can sometimes lead to serious problems.

What causes Heartburn?

Two excesses often contribute to this problem: too much food in the stomach (overeating) or too much pressure on the stomach (frequently from obesity, pregnancy, or constipation).

Certain foods such as tomatoes, citrus fruits, garlic, onions, chocolate, coffee and peppermint can also cause it. Meals high in fats and oils (animal or vegetable) often lead to heartburn, as do certain medications.

Stress and lack of sleep can increase acid production and can cause heartburn.

Addictions such as smoking and alcohol are major contributors.

The correctable medical problem that can be responsible is Hiatus Hernia.

What is a Hiatus hernia?

In a hiatus hernia, a part of the stomach that should normally be in the abdomen protrudes through the diaphragm into the chest (See picture). This hernia allows food and acid abnormally to travel upwards and may produce symptoms.

What are the symptoms in Hiatus hernia?

These individuals experience heartburn when acid produced in stomach enters the chest. They also experience the distressful symptom of regurgitation (feeling of food coming up in the throat) when food travels into the chest due to this wide defect. Some hiatus hernias can lead to dysphagia (difficulty in swallowing) too.

What causes a Hiatal Hernia?

Most of the time, the cause is not known. A person may be born with a larger hiatal opening. Increased pressure in the abdomen such as from pregnancy, coughing, or straining during bowel movements may also play a role. Being overweight and obese is a definite risk factor for hiatus hernia.

How is a Hiatal Hernia Diagnosed?

A hiatal hernia can be diagnosed with a specialized X-ray (using a barium swallow or with endoscopy.

What is the first-line treatment of Hiatus Hernia and GERD (heartburns)?

Most heartburns with or without hiatus hernia can be controlled by dietary changes and medicines. Surgery is required if these measures fail.

When Is Hiatal Hernia Surgery Necessary?

Hiatus hernia surgery is needed if symptoms of GERD and regurgitation cannot be controlled effectively by medicines. Also, if the hiatal hernia (in the paraesophageal variety) is in danger of becoming constricted or strangulated (so that the blood supply is cut off), surgery may be needed to reduce the hernia, meaning put it back where it belongs.

Hiatal hernia surgery can nowadays be performed as a laparoscopic procedure. The advantages of laparoscopic surgery include smaller incisions, less pain, a one day hospital stay and a more rapid recovery.

Nobody wants to listen to bad news. That is why, we do not want to accept any deadly diagnosis such as cancer (a term which should be replaced by ”tumor” so as not to scare people). We also want to believe anybody who gives us a hope of treatment by easy methods even if they are unscientific and irrational.

These are very common occurences  in practice. The main reason behind this is fear. The fear of disease and death makes us irrational. The term “cancer” plays havoc in our minds. It spells doom. Nobody is ready to accept that it can happen to anyone. It is an unfortunate incident in anyone’s life. But isn’t the tsunami unfortunate too? Don’t we accept it? Turning away from the problem (any problem in life for that matter) does not make the problem disappear. It allows it to grow.

Let us take acquire some knowledge about these abdominal cancers. They can arise from the stomach, liver, bile duct, gall bladder, pancreas and colon. Amongst these cancers, the colon cancers are the slowest to grow and offer the best opportunity for cure.

Whatever be the origin of the cancer, all abdominal tumors are best treated by surgery. If the CT scan shows the tumor has not spread to other areas, the correct treatment is to remove the tumor appropriately with surgery. If the tumor cannot be taken out by surgery, the outcome is poor. The surgery when done appropriately by trained surgeons gives us the best chance for cure and long survival. Recent development permits us to use laparoscopy in some cancers such as the colon thereby imparting more comfort to the patient without compromising on the tumor clearance.  The advent of modern technology has considerably reduced the complication rates. For instance, after excising the diseased segment of foodpipe, the joining of two ends can be done with staplers that reduce the incidence of wound infection. In case of the liver cancer surgery, the use of Modern gadgets can reduce blood loss considerably. This translates into less blood transfusion, less complications and prolonged survival. In cancers of the pancreas, the complication rate that was once high, has been reduced by improvised techniques of pancreatic anastomosis. Gallbladder cancers when detected by accidental pathological diagnosis after a cholecystectomy, have a good outcome when operated early and correctly.

The research in cancer in the last decade has resulted in better cancer medicines (chemotherapy) and radiotherapy techniques. We can now use them in some situations before surgery to make a large tumor smaller and amenable to surgical removal. Chemotherapy and radiotherapy can also be used after surgery in some cases to improve survival.

However, if we were to talk about one single step that makes a difference in the treatment of abdominal cancers, it is the appropriately performed surgery. So getting an effective and early surgery is crucial.

A good counseling by your doctor is of immense importance. Ask your doctor regarding the disease, its prognosis, and treatment options. Learn more about the tumor to have a realistic expectation. Knowledge and awareness of tumor treatment should bring a change in the way society looks at cancers, or should we say ” tumors”. Accepting and facing it scientifically and staying away from the unscientific remedies are the first steps in the right direction. A good surgery is the best possible method to cure wherever possible.

Mrs Swati (name changed), 45 years old woman had already been operated three times for her hernia. Despite that, she was suffering from it again leaving her with a large ugly bulge with scars that aggravated on standing. She had to wear a belt to hide it and could not wear saris too.  She had to give up on her dancing that she was fond of. Her doctor told her that the hernia contained foodpipe that could turn dangerous anytime. Also, she had gaineda lot of weight as she gave up dancing. Her doctor explained that she should lose weight before getting the surgery done. She was scared of operations, having undergone three times earlier. She was also disgusted with the ugliness of the scars because of the previous operations. She wanted a comfortable and reliable solution to her problem.

She visited us with this request two years back and consulted us for her sorry condition. We understood her plight. A detailed evaluation of her condition was done and cause of failure of previous operations ascertained.

It was found that the first two surgeries were done without a mesh (an artificial sheet that bridges the defect without causing harm to the body). The mesh is now known to be an essential method to reduce failures from hernia surgery. The third surgery was done by traditional approach and a defect was missed. The patient’s excess weight along with the above mentioned factorswere responsible for the failure of the surgery.

We explained to her that we would need to reduce her weight first by diet. Then we would go for laparoscopic surgery during which we would look for all the defects from inside and cover it with the largest possible mesh from underneath. This should her chances of failure. The part that she liked the most was that in the laparoscopic procedure, there would befewer scars, less pain and less chances of would infections.

We also gave her the options of various modern meshes and fixation devices available for hernias. The modern meshes would be softer and more pliable that would give her more comfort. The newer fixation devices would get absorbed in her body with time adding to the comfort.

She agreed to the plan, lost some weight and got operated two years back. Her large bulge at the lower belly due to the hernia is now all gone. She has taken up dancing once again that she used to love.

It is distressful for the patients with hernia when their surgery fails. Patients should know their options of hernia surgery and the types of modern mesh that are available before submitting themselves for surgery. Hernia patients who are obese should get their weight reduced ideally before taking the surgery. All this should reduce the failures in Hernia surgery.

Watch the Video on Hernia Surgery on our YouTube.

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.