PROCEDURES

• Breast Surgery
• Colorectal Surgery
• Endocrine Surgery
• Endoscopy
• Gall Stones
• Hepatobiliary Surgery
• Hernia
• Reflux surgery
• Conditions & Procedures

Attitudes about women's breasts have always been influenced by fashion trends. In the Twenties, women bound their breasts; in the Forties, more volume was desirable; then, in the Sixties, a less restricted look was popular. Contemporary styles reflect a trend toward fuller, yet natural-looking lines. But regardless of your breast size, all healthy breasts have the same basic anatomy. When you're considering breast reduction, it helps to know your anatomy so you can make informed choices with your surgeon's guidance.

• Breast tissue is made up of glands that produce milk during pregnancy.
• Fat provides protective padding for the milk-producing glands.
• The areola is the pigmented tissue that surrounds each nipple.
• Chest muscles contract and expand so you can move your arms.
• The rib cage houses vital organs like your heart and lungs.
• The Inframammary fold is the crease where your chest wall meets your breast.

Pain - breast; Mastalgia; Mastodynia; Breast tenderness

Breast pain involves any discomfort or pain in the breast, such as premenstrual tenderness.

There are many possible causes for breast pain. For example, hormonal fluctuations related to menstruation or pregnancy are often responsible for breast tenderness. Some degree of swelling and tenderness just before your period is normal. The question is how tolerable (or intolerable) the discomfort is to you.

Although many women with pain in one or both breasts understandably fear breast cancer, breast pain is NOT a common symptom of cancer.

Boys and men have breast tissue. If a male has breast tissue that is visible, this is called gynecomastia. As a normal part of development, adolescent boys can have some breast swelling and tenderness. Like breast tenderness in women, this is due to hormonal changes.

    * Anal Abscess/Fistula  Image
    * Anal Cancer
    * Anal Fissure
    * Anal Warts
    * Bowel Incontinence
    * Colonoscopy
    * Virtual Colonoscopy
    * Colorectal Cancer
    * Colorectal Cancer Surgery - Follow-up Evaluation
    * Constipation
    * Crohn's Disease
    * Diverticular Disease
    * Hemorrhoids
    * Irritable Bowel Syndrome
    * Ostomy
    * Pilonidal Disease
    * Polyps of the Colon & Rectum
    * Pruritus Ani
    * Rectal Prolapse
    * Rectocele
    * Ulcerative Colitis

 A gallstone, is a lump of hard material usually range in size from a grain of sand to 3-4 cms. They are formed inside the gall bladder formed as a result of precipitation of cholesterol and bile salts from the bile.

• Cholesterol stones
• Pigment stones
• Mixed stones - the most common type. They are comprised of cholesterol and salts.

Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.

Pigment stones are small, dark stones made of bilirubin. The exact cause is not known. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anaemia in which too much bilirubin is formed.

Other causes are related to excess excretion of cholesterol by liver through bile. They include the following:

• Gender. Women between 20 and 60 years of age are twice as likely to develop gallstones as men.
• Obesity. Obesity is a major risk factor for gallstones, especially in women.
• Oestrogen. Excess oestrogen from pregnancy, hormone replacement therapy, or birth control pills
• Cholesterol-lowering drugs.
• Diabetes. People with diabetes generally have high levels of fatty acids called triglycerides.
• Rapid weight loss. As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.

Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called "silent stones." Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis is important.

Symptoms may vary and often follow fatty meals, and they may occur during the night.

Abdominal bloating
Recurring intolerance of fatty foods
Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours
Pain in the back between the shoulder blades
Pain under the right shoulder
Nausea or vomiting

Indigestion & belching

Ultrasound is the most sensitive and specific test for gallstones.

Other diagnostic tests may include:

• Computed tomography (CT) scan may show the gallstones or complications.

• Endoscopic retrograde cholangiopancreatography (ERCP). The patient swallows an endoscope--a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. ERCP is used to locate and remove stones in the ducts.

• Blood tests. Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice.

Bile-duct blockage and infection caused by stones in the biliary tract can be a life-threatening illness. With prompt diagnosis and treatment, the outcome is usually very good.

The obstruction caused by gall stone may lead to Biliary colic, Inflammation of gall bladder (Cholecystitis) . Other complications may include:

• Cirrhosis- Cirrhosis is the result of chronic liver disease that causes scarring of the liver (fibrosis - nodular regeneration) and liver dysfunction.
• Cholangitis- Cholangitis is an infection of the common bile duct, which carries bile (which helps in digestion) from the liver to the gallbladder and then to the intestines.

Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. The most common operation is called laparoscopic cholecystectomy. For this operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close up view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures.

If gallstones are in the bile ducts, the physician (usually a gastroenterologist) may use endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove them before or during the gallbladder surgery.

What are hernias all about?

A hernia is an opening or weakness in the abdominal wall. The abdominal wall is made up of muscle layers and if these layers weaken the abdominal contents and their lining can protrude through the wall causing a bulge. This bulge is made up of the abdominal lining (peritoneum), tissue, or organ membrane that normally holds an organ in place. Hernias occur more frequently in certain parts of the body such as the abdominal wall, groin, upper thigh (femoral), and belly button region. They can also occur in any place where you have had an incision from previous surgery.

How do I get hernia?

Hernias can be present at birth or occur over time due to stress and strain on the abdominal wall. Most hernias become apparent later in life because it takes time for the hernial sac to enlarge enough for tissue to fall into it.

There are different types of hernias based on their location. The most common types are listed below.

1. Inguinal hernia - These are the most common type of hernias and there are two main types of Inguinal Hernias. They are called Direct and Indirect hernias. These hernias can appear as a bulge in the groin or protrude into the top of the scrotum depending on the exact type and size of hernia that is present.
2. A Direct Inguinal hernia is a protrusion of abdominal contents and it's lining (peritoneum) through the lower abdominal wall.
3. An Indirect Inguinal hernia is a protrusion of abdominal contents and it's lining (peritoneum) through the inguinal canal. The Inguinal canal is a series of small openings like a passage way, through the layers of the abdominal wall in the groin, which the blood supply and vas deferens for the testicles in the male travel. In the female, the round ligament of the uterus is the only structure that travels through the inguinal canal. The inguinal canal is recognized as one of the several weak points in the abdominal wall where a hernia could develop. Inguinal hernias are more common in men than women.
4. Femoral hernia - This type of groin hernia can appear as a bulge in the upper thigh. A femoral hernia is a loop of intestine, or another part of the abdominal contents, that has been forced out of the abdomen through a channel called the "femoral canal" - a tube-shaped passage at the top and front of the thigh. This type of hernia tends to occur in older people and is more common in women than in men.
5. Incisional hernia - Is a Hernia that has formed through an incision (scar) from previous abdominal surgery that a patient has undergone.
6. Umbilical hernia - Umbilical hernia is a small bulge around the umbilicus (belly button). An umbilical hernia in an infant is caused by the incomplete closure of the muscles around the umbilicus.
7. Hiatus hernia - Normally, the stomach is completely below the diaphragm. A hiatus hernia is when part of the stomach slides through the diaphragm, the muscular sheet that separates the lungs and chest from the abdomen.

Risk Factors for Hernias in general include:

• Family history of hernias
• Overweight or Obesity
• Undescended testes in an infant male
• Any condition that increases the abdominal pressure is a potential risk factor for abdominal hernias

Some examples include: chronic coughing, chronic constipation, enlarged prostate causing straining with urination, and carrying or pushing heavy loads at work or sport for instance.

Why should hernias be repaired?

Once a hernia has developed it will tend to enlarge and cause discomfort. If a loop of bowel gets caught in the hernia it may become obstructed or its blood supply may be cut off. This could then become a life-threatening situation. Since hernias can be repaired effectively and with minimal risk most surgeons therefore recommend that hernias be repaired when diagnosed unless there are other serious medical problems.

What are my options?

Wearing a truss or binder may temporarily alleviate symptoms but will not cure the hernia. Only surgery corrects the defect in the belly wall.

Traditional repair techniques involve pulling together muscles and ligaments for reinforcement. Since muscles are soft and movable, while ligaments remain rigid and stationary, these structures can separate over time causing hernia recurrence. In fact, approximately 10% of hernias do recur.

How are hernias repaired?

The standard method of hernia repair involves making an incision in the abdominal wall. Normal healthy tissues are cut until the area of weakness is found. This area, the hernia, is then repaired with sutures (stitches). Usually a prosthetic material such as nylon is used to strengthen the area of weakness. (A nylon mesh patch or plug). Finally the skin and other healthy tissues that were cut at the beginning are stitched back together to complete the repair.

How does the laparoscopic method differ?

With the laparoscopic repair the defect in the abdominal wall is repaired from the inside of the abdominal cavity. This method is usually only used for groin hernias. Instead of closing or patching the repair from the outside the patch is secured in place from the inside. This eliminates the necessity of cutting the skin and normal tissues of the groin to get down to and repair the hernia.