Robotic Surgery

What is robot-assisted surgery?

Robot-assisted surgery is a type of minimally-invasive surgery completed through small incisions. The da Vinci surgical system uses high-definition, three-dimensional cameras that magnifies image 20 times coupled with specialized surgical tools that enable surgeons to operate with more precision and better control.

The robotic instruments have mechanical wrists that bend and rotate to mimic the movements of the human wrist thus allowing surgeons to make precise movements. Robotic software also negates the effect of surgeons’ hand tremors.

It is an effective minimally invasive alternative to both open surgery and laparoscopy. Surgeons undergo vigorous training with this system before being allowed to use it for surgery on patients. Moreover, there are many inbuilt safety checks in the system that decreases the chances of error. Patients can be rest assured knowing they’ll receive superior surgical care for the best possible outcome.

How robot-assisted surgery works

During robotic surgery, your surgeon inserts a tiny camera through a small incision in the surgical area. The camera sends a high-definition, 20 times magnified, 3D image of the surgical site to an external monitor in real time.

Using computer-assisted technology that guides specialized surgical instruments, your surgeon directs the robot with better control, precision, and range of motion than is possible with traditional surgery. A support team assists the surgeon with other surgical tasks.  Thus the use of a robotic system makes difficult steps easier for the surgeon by providing for a range of motion and more maneuverability in handling tissue and suturing.

Will the surgeon be with me in the operating room?

Many patients wonder who is operating on them: the robot or the surgeon.

Robot-assisted surgery is a system that enables surgeons to operate with precise, delicate motions by controlling the machine. The robot never makes decisions or performs incisions on its own — it only responds to your surgeon’s hand and finger movements.

Your surgeon is located at a console in the operating room near you and the experienced support staff, directing the procedure the entire time. The robot allows for greater precision than the human hand has on its own, and your surgeon is in charge the whole time.

Conditions that can be treated with robot-assisted surgery

The majority of gastrointestinal issues can be  addressed using robotic-assisted minimally invasive surgery, including:

  • Appendicitis
  • Hernias
  • Gallbladder disease and its cancer surgery
  • Gastroesophageal reflux disease (GERD)
  • Liver surgery
  • Surgery of the pancreas including surgery for cancer of the pancreas
  • Surgery for the colon and rectum including its cancers
  • Surgery for the esophagus, stomach, and intestine
  • Gastrointestinal and liver cancer surgery.

The benefits of robotic surgery

Robot-assisted surgery has many benefits. Patients experience these benefits both directly and indirectly. For example, because robot-assisted surgery is minimally invasive, a direct benefit to you is a shorter recovery time. And because the surgeon has better access to the operative area, an indirect benefit is a more precise surgery.

Other benefits include:

  • Smaller incisions
  • Greater range of motion and dexterity for the surgeon
  • High-resolution, the highly-magnified image of the operating field for better visualization during surgery
  • Shorter hospital stay
  • Lower risk of infection
  • Reduced risk of blood loss
  • Faster recovery with less pain
  • Minimal scarring
  • Better clinical outcomes

In addition, due to the enhanced control, flexibility, and precision that robot-assisted surgery offers, surgeons can complete complex or delicate procedures that may be difficult or impossible with traditional surgery.

Am I a candidate for robot-assisted surgery?

Although robotic surgery offers excellent outcomes for many patients, not everyone is a good candidate. The patient is recommended against robot-assisted surgery if:

  • You’re unable to have general anesthesia
  • You have significant scar tissue or other issues that prevent the cameras from visualizing the surgical area
  • You’ve been diagnosed with bleeding problems that put you at risk for surgery
  • You’re not a candidate for laparoscopic surgery

After a full evaluation of your condition and overall health, the surgical team in charge will determine if robot-assisted surgery is right for you.

Stomach Cancer

1. What are causes of stomach cancer?

Causes of stomach cancers are

  • Alcohol consumption
  • Smoking
  • Diet high in salt and processed meat and low in vegetables
  • Any previous stomach surgery
  • Conditions decreasing acid secretion in stomach
  • H.Pylori infection
  • Hereditary conditions like multiple polyps throughout GIT

2. What are the symptoms of stomach cancer?

  • Early satiety
  • Anemia
  • Recurrent Vomiting or blood in vomiting
  • Loss of appetite
  • Abdominal distension
  • Passing black-colored stools
  • Unexplained weight loss

3. Does cancer of stomach run in families?

Yes cancer of stomach can run in families especially in patient having multiple polyps
throughout gastrointestinal tract e.g, FAP, Lynch syndrome etc. first degree relatives of
these patient should undergo prophylactic screening endoscopy at young age.

4. How is stomach cancer diagnosed?

Stomach cancer is usually diagnosed by Imaging or endoscopy and biopsy. To establish
diagnosis endoscopy and biopsy is done. For staging purpose following investigations are
advised –

  • CECT Scan of abdomen
  • PET Scan of whole body
  • Endoscopic ultrasound

5. What is treatment of stomach cancer?

Treatment of stomach cancer depends upon stage of cancer and presentation of patient. In
case of patient who is unable to eat, surgery would be mainstay of treatment. While in patients with locally advanced disease chemoradiation followed by surgery is the treatment of choice. Surgery remain mainstay of treatment for stomach cancer.

6. What type of surgery is best for patient?

With advancement in technology and staplers stomach cancer is managed these days with
laparoscopy. Laparoscopy has been used widely for total or partial removal of stomach and
has been found to provide equal results with improved quality of life and early recovery in
these patients.
Robotic surgery is further advancement in surgical armamentarium that increases accuracy
of dissection thus improving results.

Liver cancer

Liver cancer is increasing day by day. Its probably due to increase in incidence of cirrhosis of liver that predisposes to liver cancer. Causes of cirrhosis of liver –

1. Alcohol
2. Viral hepatitis’
3. NASH – Non Alcoholic Steatohepatitis
4. Toxins
5. Autoimmune conditions- PBC, Autoimmune Hepatitis etc.

Above are main conditions that cause cirrhosis and predisposes to liver cancer. As the rate of obesity and Diabetes Mellitus is increasing all over world so is the rate of fatty liver and steatohepatitis (injury to liver) that predisposes to cirrhosis and thus liver cancer. So it becomes imperative for allpatients having above mentioned factors to be utmost careful in monitoring the progression of theirdisease to detect cancer at early stage.

FAQs

1. How can liver cancer be prevented?

Liver cancers can be prevented by keeping high risk patients under regular follow
with tumor markers and ultrasound examination. Patient at high risk of getting liver cancers
are mentioned above. So patients with above risk factors who have not progressed to
cirrhosis should be treated according to cause e.g; stopping alcohol, decreasing weight, good
control of diabetes, treating viral hepatitis etc.

2. What is peculiar about liver cancer and its treatment?

Liver cancers usually arise in patients with cirrhosis. This presents peculiar problem
as these patients have damaged liver in addition to tumor. Damaged liver further shrinks
treatment options for such patients. Moreover majority of these patients are unfit for any
form of treatment due to damaged liver. So treatment is tailored according to status of liver
disease and tumour size and location.

3. Is there any medical treatment of liver cancer?

Mainstay of treatment is surgery. Medical treatment is offered to only those cases that
cannot be offered any surgery


4. How can liver cancers be treated?

Best way to treat liver cancer is by surgery. Surgery can be

  • Resecting tumor or tumor bearing liver
  • Liver transplantation

First option is feasible only in normal livers or in cirrhotic with small tumours. In patients
with cirrhosis best treatment option is liver transplant provided tumor load is within one specific
range. Liver transplantation takes care of diseased liver and tumor simultaneously and thus provides best chances of prolonged life.


In cases of tumor deemed unresectable or patient is unfit for transplant, interventional
radiology provides solution for tumor treatment by

A. Radiofrequency ablation that has same results as surgery in cirrhotics,
B. Tumor chemoembolization
C. Internal tumor radiation by TARE

5. Which specialist is best to treat liver cancer?

Before starting any treatment liver or liver transplant surgeon must be contacted. Liver
surgeon is best person to evaluate patients fitness and tumour resectability and can provide
tailored approach that is best suited for patient’s condition as mentioned above.

Gall bladder Cancer

1. What are causes of gall bladder cancer?

Known causative factors for gall bladder cancer are

  • Gall Stones
  • Gall bladder Polyps
  • Porclein gall bladder
  • Obesity
  • Old age
  • Choledochal cyst
  • Abnormalities of union of bile and pancreatic duct
  • Primary sclerosing cholangitis
  • Ethnicity
  • People residing in high-risk area eg., Chile, along plains of river Ganges etc.

2. What are signs and symptoms of gall bladder cancer?

Gall bladder cancer can present with very non-specific signs and symptoms. Majority times it is
detected incidentally on imaging. Patient may present with

  • Pain
  • Jaundice
  • Loss of weight
  • Loss of appetite
  • Distension of abdomen

3. How can gall bladder cancer be detected?

Gall bladder cancer usually are detected on imaging. Ultrasound abdomen is first lie of
investigation that can show irregular thickening of gall baldder wall. These findings are
confirmed by multiphasic CECT abdomen that can show condition of gall bladder and
surrounding enlarged lymph nodes.

4. Are gall bladder polyps cancerous?

Small gall bladder polyps are non cancerous. Any polyp larger than 1 cm in size harbour
higher chances of malignancy and is an indication of surgery.

5. How can gall bladder cancer be prevented?

Gall bladder cancer cannot be prevented . There are no ways by which gallbladder cancer can be prevented except for prophylactic cholecystectomy in area of high endemicity eg., Chile ,
where prophylactic cholecystectomy had been shown to decrease incident of gall bladder
cancer.

6. What is treatment of gall bladder cancer?

Main treatment of gall bladder cancer is surgery is it is feasible. Complete resection of gall
bladder cancer is the only chance of providing long term survival. Usually majority of patients
present with advanced disease that cannot be resected and can be offered palliative treatment
only. Resectability if usually assessed best by liver/gastrointestinal surgeon who is experienced
in liver surgery. Assessment by liver surgeon can make advanced disease resectable by proper
planning with help of interventional radiologist. Chemotherapy has a role in pallative setting or
after resection of tumor by surgery.

Esophagus Cancer

1. What are causes of esophagus cancer?

Risk factors for esophagus carcinoma are

  • Alcohol consumption
  • Smoking
  • Gastroesophageal reflux disease
  • Obesity
  • Barrett esophagus

2. What are types of esophagus cancer?

There are predominantly two types of esophagus cancers based on microscopic examination of tumor sample

  • Squamous cell carcinoma
  • Adenocarcinoma

Few other types of carcinoma can affect esophagus but are uncommon -e.g, smallcell carcinoma, neuroendocrine tumor, sarcomas etc.

3. What are symptoms of esophagus cancer?

Usual presenting symptoms are

  • Difficulty in swallowing
  • Stickiness of food while swallowing
  • Retrosternal discomfort
  • Pain chest
  • Chronic cough especially while swallowing
  • Weight loss
  • Hoarseness of voice

4. How can esophagus cancer be detected?

First line of investigation for diagnosis are

  • Barium swallow
  • Upper GI endoscopy and biopsy

These two tests not only provide us diagnosis but also tells us about location of tumor that will further decide future course of action for treatment. Biopsy provides us with tissue diagnosis regarding type of cancer as mentioned above.

5. What are tests to be done before starting any form of therapy?

After diagnosis staging investigation are required to grossly stage the disease and planfurther treatment

  • CT scan of chest and upper abdomen
  • Endoscopic ultrasound (EUS)
  • Whole body PET Scan
  • Bronchoscopy depending upon location of tumor

6. What is treatment of esophagus cancer?

Surgery has been mainstay of treatment for carcinoma esophagus. But long term survival was poor. With recent advent of few chemotherapeutic agents along with radiation the rapyhas really improved overall survival and outcomes. Even in patients with locally advanced disease chemoradiation has resulted in down staging of tumor and increased resection rate as well as survival rates. So now according to protocol patient usually under goes chemoradiation first followed by surgery.

7. What if the type of surgery done for esophageal cancer?

Esophagus cancer is treated by minimally invasive methods now. Thoraco- laparoscopi cresection of esophagus with reconstruction by stomach tube is method of choice for cancer of esophagus. Robotic surgery is further advancement in surgical armamentarium that increases safety of surgery and improves outcome. With minimally invasive methods side effects of surgery has been reduced to minimum and patient’s recovery is enhanced.

8. What are side effects of treatment of esophagus cancer?

The patient can have side effects due to radiation, chemotherapy or surgery. Side effects due tochemoradiation are

  • Nausea /vomiting
  • Difficulty in swallowing
  • Chest pain
  • Loss of appetite
  • Decreased cell counts
  • Mouth ulcers

Complications after surgery can be

  • Hoarseness of voice due to nerve injury- its usually temporary and recovers with time
  • Swallowing problems due to uncoordinated effects of swallowing reflex
  • Injury to trachea, blood vessels, thoracic duct (incidence has reduced considerablyafter using minimally invasive methods)
  • Lung complications (reduced significantly with laparoscopic approach)

Liver Cancer Treatment Surgery Chandigarh

What are the symptoms of liver cancer?

Symptoms of liver cancer vary widely and may include

  • Fatigue
  • Jaundice (yellowness of the skin)
  • Pain
  • Easy bruising or bleeding
  • Swelling of abdomen
  • Weight loss.
  • What are the risk factors for liver cancer?

    • Viral hepatitis such as hepatitis B and C
    • Regular alcohol consumption
    • Cirrhosis – cirrhosis due to any cause increases the risk of liver cancer
    • Diabetes – It can result in fatty liver disease and thus leading to hepatitis and predisposes to cancer.
    • Non alcoholic fatty liver disease – it can lead to inflammation of liver cell thus predisposing to formation of cancer.
    • Hereditary conditions like hemochromatosis( iron deposition in liver), Wilson disease ( copper deposition in liver)
    • Aflatoxins – consumption of food product infected with fungus producing aflatoxins can also produce liver cancer

    How can liver cancer be prevented?

    Prevention is very important when it comes to a disease like liver cancer. The underlying cause of liver cancer is often liver inflammation and the development of a condition called Cirrhosis.  In addition to avoidance of drugs and alcohol, infection (such as Hepatitis B or C) and obesity can contribute to the development of liver cancer.

    Steps to minimize these risks include

    • Vaccination against hepatitis B for those at risk,
    • Prompt treatment for patients infected with hepatitis C,
    • Maintaining a healthy weight through diet and exercise.
    • Avoidance of alcohol
    • Good control of diabetes.

    How is liver cancer detected?

    Patients diagnosed at an earlier stage have better outcomes. There are many strategies that are used to detect liver cancer, including.

  • Frequent imaging studies (ultrasoundcomputed tomography scanmagnetic resonance imagining) in high risk patients.
  •  Routine physical exams with blood testing in high risk patients.
  • Several researchers are looking to find the one blood test that will help identify liver cancer much sooner. Until that time, we continue to remain vigilant and screen with a variety of methods to try to catch this disease as early as possible.

    Are fatty liver disease and liver cancer related?

    Fatty liver disease progressing onto non-alcoholic fatty liver disease(NAFLD) and non-alcoholic steatohepatitis(NASH) can result in cirrhosis of the liver. Cirrhosis of the liver predisposes the patient to liver cancer. The fatty liver itself does not predispose a patient to cancer however if it is controlled at an early stage before it progresses onto cirrhosis then the risk of liver cancer is negligible.

    What is the optimal treatment of liver cancers?

    In general, the basic approach of any cancer therapy can also apply to liver cancer. The treatment of the local disease. In liver cancer, we often address the local disease with:

  • Surgery (removal of the tumor) – treatment of choice for patients
    without cirrhosis of the liver.
  • Liver transplantation – it is the treatment of choice in patients with
    cirrhosis provided tumor size and number criteria are met. It takes
    care of cirrhosis of the liver also.
  • Radiation therapy
  • Local ablation of the tumor by radiofrequency
  • Catheter-directed chemotherapy or embolization.
  • Are herbal medicines recommended to treat liver cancer?

    The term ‘herbal medicine’ can represent thousands of compounds. Unfortunately, most are not rigorously tested or regulated by the companies that produce them, so real evidence of any benefit is not known. In fact, they may have harmful side effects that one comes to know only after using them.

    Should I be worried if I have a cyst on my liver?

    There is often nothing to worry about with simple cysts in the liver. They can be quite common. When we find cysts that are growing, we will often take extra care to ensure that

    • There is not an associated tumor causing the growth
    • That cyst is not causing problems.

    This is often discussed over time with your hepatologist and/or liver surgeon who can help in differentiating malignant ( cancerous) cysts from nonmalignant ones.

    What should I do if some lesion is found in the liver on a regular check-up?

    Lesions in the liver on ultrasound can be of many types

    Non-cancerous

    • Hemangioma ( abnormal formation of blood vessels)
    • Abscess ( pus collection in liver)
    • Granulomas in liver- because of TB , Sarcoidosis etc.
    • Cysts of liver – that can be simple cyst or hydatid cysts ( worm infestation)

    Cancerous

    • Primary liver cancer
    • Metastatic tumor from some other organ- liver is most common site of spread of tumors from other abdominal organs.
    • Neuroendocrine tumor of liver
    • Malignant cysts of liver

    A hepatologist or liver surgeon can help you in guiding you towards diagnosis and treatment by carrying out relevant investigations.

    If a parent had/has liver cancer, are their children at greater risk of getting it?

    In some cases, yes, a parent with liver cancer can raise your personal risk e.g in hereditary disease as Hemochromatosis, or Wilson’s disease. However, this is not true for the majority of patients. It’s always good to talk to your primary care doctor about your concerns or questions.

     Hepato Biliary Surgery

    What is hepato biliary system?

    Hepatobiliary system involves combination of liver and its ductal system(hepatic ducts, bile duct and gall bladder) draining bile (juice secreted by liver) from liver to intestine.

    What are diseases that can affect hepatobiliary system that require surgery?

    Hepato biliary disease treatment is best achieved by multimodality approach with involvement of Medical gastroenterologist, Interventional radiologist and Hepatobiliary surgeon. Diseases that require surgery are

    1. Liver cancer
    2. Cysts of liver
    3. Cancer from other organs that have spread to liver
    4. Stones in liver and bile duct ( can be treated with endoscopy also)
    5. Neuroendocrine tumor in liver.
    6. Liver abscess
    7. Tumors of bile duct ( cholangiocarcinoma)
    8. Gall bladder cancer
    9. Shunt surgery for bleeding varices;
    10. Bile duct stricture and fistula

    How hepatobiliary surgeon can score over general and oncosurgeons in treating these diseases?

    Hepato biliary system is very complex system that involves not only dealing with liver but also its complex blood supply and bile ductal system. As surgery is main modality of treatment so every effort is made to convert the unresectable tumors to resectable stage with help of radiology and other interventions. This is possible only if case is initially assessed by hepatobiliary surgeon who can plan resection in such a way that tumor is also removed completely and adequate amount of liver is also left that is compatible with survival.

    How much liver can be removed safely?

    In patients with normal liver around 75% of liver can be removed safely and person can lead normal life. However in case of diseased liver e.g cirrhosis , jaundice etc ,more amount of liver needs to be left behind for person to lead normal life.

    Is it safe to operate on patients with jaundice or with liver disease?

    Before operating upon patient with jaundice every effort is made to lower jaundice by various means e.g stenting, putting catheter in liver to drain bile duct. After bilirubin decreases to near normal levels then surgery is planned.

    Why liver or biliary surgery complex?

    Liver is a solid organ in which complex network of small bile ducts and blood vessels are hidden. Also bile duct and blood vessels are very closely associated outside liver. So tumors of liver and bile duct very commonly involve these blood vessels thus making surgery complex. Moreover as they are hidden inside liver, surgery is planned by preoperative imaging and intraoperative marking that is possible for surgeon regularly involved in doing hepatobiliary surgery. These planes have to be followed otherwise lot of bleeding can happen that is dangerous for patient.

    Who should consult hepatobiliary surgeon?

    Any patient suffering from any of diseases mentioned above should always consult hepatobiliary surgeon before starting upon any form of treatment. As assessment by hepatobiliary surgeon increases chance of cure by resecting even advanced tumors.

    Do hepatobiliary surgeon treat gall baldder diseases also?

    Yes. Gall bladder is an important component of hepatobiliary system is most commonly diseased organ due increased prevalence of stone disease. Hepatobiliary surgeon treats gall bladder diseases more effectively as he is ready for all surprises that can be encountered with gall bladder diseases that are not detected before surgery e.g complicated gall bladder disease, ruptured gall bladder detected during surgery, gall bladder cancer detected during surgery etc. Hepatobiliary surgeon would be able to deal with all this during surgery.

    Does hepatobiliary surgeon treat CBD Stones also?

    Majority of stones in bile duct are managed by endoscopy done by medical gastroenterologist but in some cases stones are very large in size and are very high in numbers then surgery can be better choice of treatment in form of removal of stones or providing bypass to prevent recurrent stone formation.

    Acute and Chronic Pancreatitis Difference and Treatment

    What is the difference between acute pancreatitis and chronic pancreatitis?

    Acute pancreatitis is an isolated episode of abdominal pain accompanied by elevations
    in blood enzyme levels. Essentially, it describes active inflammation of the pancreas.
    More than 80 percent of the cases of acute pancreatitis are related to biliary stones or
    alcohol use. Acute pancreatitis may lead to chronic pancreatitis.

    Chronic pancreatitis is a painful disease of the pancreas in which inflammation has resolved, but with resultant damage to the gland characterized by fibrosis, calcification and ductal inflammation. It is possible for patients with chronic pancreatitis to have episodes of acute pancreatitis.

    What causes chronic pancreatitis?

    The most common cause of chronic pancreatitis are

    1. Alcohol consumption.
    2. Hyperparathyroidism (increased secretion from the parathyroid glands)
    3. Trauma to the pancreas.
    4. Tropical pancreatitis, a variant of chronic pancreatitis, is seen in tropical parts of
      Asia and Africa, and can affect children between 12 and 15 years of age.
    5. Recurrent acute pancreatitis..

    What are the symptoms of chronic pancreatitis?

    Symptoms of chronic pancreatitis range widely

    • Acute abdominal pain ranging from severe to mild radiating to back. The pain of chronic pancreatitis often radiates to the back, although it may radiate to both upper and lower quadrants. Sitting up and leaning forward may relieve or reduce discomfort
    • Vomiting
    • Epigastric tenderness
    • Weight loss
    • Steatorrhea( passing of undigested fat in stools)
    • Glucose intolerance/ Diabetes
    • Diarrhea which may be chronic (six or more bowel movements per day). The diarrhea is a result of fat malabsorption, which results in bulky, foul-smelling stools that may appear oily and float (steatorrhea).

    How is chronic pancreatitis diagnosed?

    Chronic pancreatitis is best diagnosed using historical information, serum enzymes,
    exocrine function and radiographic studies (X-rays), ultrasound abdomen, CT/MRI scan.
    Tests of exocrine function (fat absorption) are helpful.

    Are there any particular complications that result from chronic pancreatitis?

    Yes. Nutrient malabsorption, diabetes mellitus are main complications of chronic pancreatitis. Patients with chronic pancreatitis are also at increased risk of chronic pancreatitis.

    Malabsorption is faulty absorption of nutrients from the digestive tract. In chronic pancreatitis, malabsorption occurs after the capacity for enzyme secretion is reduced by more than 90 percent. Fat absorption suffers to maximum extent in case of chronic pancreatitis.

    Chronic pancreatitis affects the endocrine function of the pancreas, responsible for insulin and glucagon production.

    Diabetes is common in patients with chronic pancreatitis, and the incidence increases over time with the progression of the disease. Approximately 45 percent of patients with chronic pancreatitis will develop diabetes. Fortunately, the pancreatic form of diabetes is usually mild and the usual complications (retinopathy, nephropathy and vasculopathy) are uncommon. Neuropathic complications may occur with continued alcohol abuse or malnutrition.

    How is chronic pancreatitis treated?

    Treatment for chronic pancreatitis includes medical, endoscopic and surgical therapy.

    Can patients expect long-term relief of pain after surgery?

    Surgical intervention provides long-term relief of pain in 90 percent of patients. When
    patients have exhausted other avenues of treatment for pain relief, surgery should be
    considered.

    If I have chronic pancreatitis and am being treated, can I expect a full recovery from this disease?

    The changes of chronic pancreatitis are not reversible. However, it is possible to have
    control of pain and steatorrhea with medical, endoscopic, percutaneous or surgical
    treatment. Surgery provides the best relief of pain in short as well as long term. In
    addition to pain relief , surgery can slow down destruction of pancreas thus delaying
    onset of diabetes mellitus and malabsoption.

    Colorectal Surgery

    What are types of colorectal surgery?

    Colorectal surgeries are of various types depending on part of colon or rectum removed.

    Types of colorectal surgeries are –

    1. Hemicolectomy – removal of half of colon – right or left
    2. Segemental resection of colon – removal of part of colon
    3. Subtotal colectomy – removal of whole colon leaving small part behind
    4. Total colectomy – removal of whole colon
    5. Proctocolectomy- removal of whole colon and rectum
    6. Anterior resection – removal of part of rectum
    7. APR – Removal of rectum and anus.
    8. Rectopexy for rectal prolapse

     All these are types of surgeries done for various indications –

    1. Cancer of colon
    2. Cancer of rectum
    3. Colitis
    4. Benign tumor of colon or rectum.
    5. Colonic perforation
    6. Diverticulitis
    7. Rectal prolapse

    What is Colorectal surgery recovery time?

    Laparoscopic colorectal surgery  is gold standard in today’s time. Open colorectal surgery is thing of past these days. Just like laparoscopy is gold standard for gall bladder removal, laparoscopy is gold standard for colorectal surgery. since introduction of laparoscopy in colorectal surgery recovery time has decreased considerably and patients are usually discharged from hospital within 3-5 days as compared to 7-10 days after open surgery. Patient is able to eat and move around early as compared to open surgery.  Shorter hospital stay also decreases cost of colorectal surgery. 

    Risks involved in colorectal surgery?

    Various risks involved with colorectal surgery are

    1. Bleeding after surgery – very rare
    2. Leak from anastomosis ( joints of intestine)
    3. Infection
    4. Injury to ureter ( urine pipe)
    5. Urinary bladder disturbance due to nerve injury ( especially after rectal surgery)

    Facts and Myths About Gall Bladder Surgery

    facts-about-gall-bladder-surgery

    Gall bladder diseases are very common these days. These diseases range from innocuous gall stones to cancer of the gall bladder which has a very dismal prognosis. As a GASTROINTESTINAL SURGEON with HEPATOBILIARY experience we daily see cases from one extreme to another. The majority are simple gall stones and are managed at the periphery, however, what we receive are ones that are either left to be referred to as higher-level or are complicated ones. Many a times we also deal with cases that are operated elsewhere and become complicated and are then referred to us.

    So today in this blog I would like to discuss gall bladder diseases with a special focus on stone diseases. The most commonly asked questions in the patient’s mind are

    How are stones formed?

    Bile is juice produced by the liver and stored in the gall bladder and released when food reaches the small intestine. It is composed of bile salts, and pigments, and they are kept in solution form by mixing with cholesterol. So any change that disturbs this proportion of each component required to keep these in solution form can result in the formation of stones. For example diet rich in fats can result in high cholesterol components and can result in stone formation.

    How can we prevent formation of gall stones?

    Gall stones are usually formed by a mismatch in the concentration of cholesterol and bile salts in bile. So a balanced diet that is low in fats can help in decreasing the chances of gall stone formation.

    What are risks associated with gall stones?

    Gall stones can cause pain by themselves. They can result in jaundice if a stone slips into bile duct. It can cause pancreatitis which can be mild or life-threatening. The gall bladder neck can be blocked by stone resulting in huge distension of the gall bladder thus causing pain and can result in pus formation in the gall bladder. Large stones in gall bladder are risk factors for cancer of gall bladder.

    If they are not causing any trouble, should I undergo surgery?

    These are called asymptomatic stones. Asymptomatic stones usually do not require surgery unless
    a. Patient is having low immunity
    b. The patient is living in a place where medical facilities are meager.
    c. Patient is undergoing surgery of abdomen for some other reason
    Relative indications are
    i. Multiple small stones
    ii. Diabetic patient
    iii. Large stone

    Can we just remove stones and leave gall bladder behind?

    We have to remove the gall bladder as its functionally abnormal and stones would reform. Moreover cut on gall bladder heal very poorly.

    Will removal of the gall bladder affect my digestion?

    There is no effect on digestion if the gall bladder is removed. Body adapts to removal of gall bladder very well and digestion is not affected at all.

    What are dietary restrictions after gall bladder surgery?

    There is no dietary restriction and the patient can have a normal diet as before. Digestive system adapts well to removal of gall bladder and there is no effect on the digestion of food.

    Is it major surgery?

    Gall bladder removal surgery is performed by laparoscopy. It is successful in more than 99% of cases. Occasionally it is done by open surgery if anatomy is difficult or there is a risk of injury to important structures. But as the experience of the surgeon increases chances of conversion to open procedure decrease.

    Is it very painful?

    Laparoscopy surgery is done through small cuts made on your tummy ranging from 0.5-1 cm. these are small cuts and pain is minimum.

    Should we undergo open or laparoscopic surgery?

    That is to be decided by the surgeon operating upon you. As mentioned above large majority of procedures can be done by laparoscopy and needs open surgery only if surgery is difficult or in the presence of gall bladder cancer.

    How long does it take to remove gall bladder?

    Surgery is never about time. It is better to finish the procedure safely than quickly. It may take from 10 mintues to an hour depending upon anatomy.

    What are the risks of surgery?

    Apart from anaesthesia risk that depends upon general condition of patient gall bladder surgery carries minimum risk. Still there is a small but real risk of bleeding, injury to bile duct or injury to bowel.

    How long does it take to recover and get back to normal life?

    Gall bladder surgery is usually done as daycare surgery and the patient is send home same evening of surgery. The patient is up about a Few hours after surgery and starts his normal routine within a few days of surgery.

    How does the experience of the surgeon matter in gall bladder surgery?

    The experienced surgeon has fewer conversion rate and the chances of complication are less. Surgeon experienced in hepatobiliary or gastrointestinal surgery can handle the majority of complications on table and can provide better outcome in difficult cases.

    Why some people are unsatisfied after gall bladder surgery?

    Gallstones can cause abdominal pain, bloating, or discomfort after food intake and the complications listed above. Symptoms such as indigestion, heartburn, constipation and increased frequency of stools are very common in the general population and are not related to gallstones. Mostly when the patients / treating doctors try to correlate these symptoms with gallstones it leads to unhappiness as these symptoms may not get relieved by the removal of the gall bladder. So proper patient selection and counseling can help avoid the unsatisfied patient.