Frequently Asked Questions

UROLOGY

PROSTATE

WHAT IS THE FUNCTION OF A PROSTATE GLAND?
Prostate Gland is found only in men. It is located just below the bladder and behind the pubic bone that wraps around the urethra to help control the urine flow. During sexual intercourse, the seminal vesicles attached to the prostate produces a protein which forms semen. The prostate gland also secretes alkaline fluid which protects the sperm and helps it live longer.

• There are 3 types of infections in Prostate Gland:
• Prostatitis-bacterial
• Prostate Cancer
• Enlargement of the Prostate

WHICH ONE OUT OF THESE INFECTIONS IS THE MOST PAINFUL?
In case of a bacterial infection in the prostate gland, there is increased urinary frequency, a need to urinate a lot at night. It may also lead to pain in the genital area and the pelvis. One often gets chills, fever, nausea or even burning sensation while urinating. Acute bacterial prostatitis can also lead to bladder infections, or completely blocked urine flow in extreme cases.

Early Prostate cancer doesn't lead to any symptoms at all but if it grows larger, it may cause:

• Delayed or slow urinary stream
• Passing of urine more often than usual
• Difficulty while urinating, including straining to pass
• Blood in the urine or semen

WHAT IS THE TREATMENT FOR THE SAME?
Prostatitis can be treated with antibiotics. While enlargement of prostate gland with age can be treated with medicines initially but if these doesn't work then the patient can undergo a Laser Prostate surgery. In worst case scenario, hormone therapy can also help treat prostate cancer.

TREATMENT OF STONES

Stones may lead to thyroid gland infection, excessive pain in the genital area, blood in urine or may even lead to fever. Patients must undergo blood or urine tests frequently, to keep a check on the occurrence of stones. If the stones occur and are smaller in size, they can be removed through medicines but in case they are stuck in the urinary tract or are bigger in size, then it requires treatment with shock wave and laser therapy.

URINARY INFECTION

WHAT ARE THE SYMPTOMS OF URINARY INFECTION AND IS IT MORE COMMON IN FEMALES?
Urinary Tract Infection is more common in females. In urinary tract infection, the patients get severe burning while passing urine; they experience very frequent urination with urgency, lower abdomen pain and sometimes blood in the urine. If the infection reaches the kidney, the patient gets fever.

WHAT PRECAUTIONS SHOULD WE TAKE TO AVOID URINARY TRACT INFECTION?
As urinary tract infection is very common, we should take plenty of liquids orally and on very first attack of urinary tract infection we must consult the doctor who will get the urine routine/microscopy and culture/sensitivity done. One has to take certain precautions to avoid recurrence of urinary tract infection.

CANCER OF URINARY BLADDER

WHAT SHOULD WE DO IN CASE OF BLOOD IN URINE?
Blood in urine should never be neglected, the causes can be numerous. If blood is coming with pain then it can be stone or infection but if blood is coming without pain, it can be due to cancer of urinary bladder or TB of urinary system.

HOW DO YOU TREAT THE CANCER OF URINARY BLADDER?
If cancer of bladder is detected at an early stage, we remove it endoscopically and keep an eye on it on regular basis. If it has gone deep into the bladder muscle, it surely requires operation.

URINARY LEAK

IS LEAKAGE OF URINE VERY COMMON?
Leakage of urine without once knowledge is common in elderly ladies. They are of two types: first related to sneezing or coughing and the other one is when patient gets a desire to pass and can’t hold it till they can’t go to the washroom.

IS IT A VERY SERIOUS PROBLEM?
It is not a life threatening problem but it affects one's quality of life and can lead to social embarrassment too.

IS IT CURABLE?
These problems can be treated by medicine but if the leakage is very significant, it can be treated by a minor surgery.

ENT & COCHLEAR IMPLANT

AT WHAT AGE HEARING LOSS CAN BE DETECTED?

Nowadays, hearing loss can be detected even at birth with the help of objective tests like OAE which is available in our department

IF YOUR CHILD DOES NOT SPEAK AND HEAR SINCE BIRTH, WHAT IS THE BEST POSSIBLE MANAGEMENT?

If your child aged < 3 years does not speak and hear since birth, best possible treatment is Cochlear implantation. Cochlear implantation should be done as early as possible to rehabilitate the child to near normal in case of deaf and dumb children < 5 years of age.

IF YOU NOTICE PROGRESSIVE DECREASE IN HEARING OF YOUR CHILD, WHAT SHOULD BE DONE?

Show your child to ENT specialist as your child may be having serous otitis media which is a treatable condition.

WHAT IS THE MINIMUM AGE FOR COCHLEAR IMPLANTATION AT PRESENT?

Nowadays, Cochlear implantation is being done at the earliest age of 9 months and the implant lasts for life long.

IF THE CHILD BREATHS FROM MOUTH, GETS RECURRENT SORE THROAT ATTACK AND SNORES AT NIGHT, WHAT IS THE MOST PROBABLE DIAGNOSIS?

Most probable diagnosis is Chronic adenotonsillitis,the most common cause for Obstructive sleep apnea in children.

WHAT SHOULD BE DONE IF YOU HAVE HOARSENESS OF VOICE LASTING FOR >2 WEEKS?

Get yourself examined by an ENT specialist as u may be having vocal polyp which can be treated by MLS.

OBSTETRICS & LAPAROSCOPIC GYNECOLOGY

INFERTILITY

Infertility should not be treated as a social stigma. It is no one’s fault. Society should be kind and supportive. Couples with known problems like low sperm count, polycystic ovaries, fibroid, endometriosis should see a doctor as soon as possible.

WHAT IS INFERTILITY?
When a couple is living a Conjugal life without practicing any form of contraceptive for 1 year and still has not conceived, then the couple is clinically known as Infertile couple.

IS INFERTILITY ONLY A FEMALE PROBLEM?
Infertility has both male and female factors, although male factor is 25%, whereas female factor is 75%, but still male factor if detected should be treated by Uroandrologist. The female partner should be treated by Gynaecologist. Both man and woman should equally participate in the treatment.

DOES INFERTILITY TREATMENT ONLY MEAN ASSISTED REPRODUCTIVE TECHNIQUE?
Assisted reproductive technique is the last resort. The couple should be thoroughly evaluated on the basis of history taking, clinical examination and investigations. IVF i.e. in – vitro – fertilization signifies fertilization of egg and sperm outside the body. Not all couples with infertility need IVF, but some cannot get pregnant without it, like the men with low sperm count and women with blocked tubes. These procedures are expensive. Results are not absolute.

ARE THERE SURGICAL WAYS OF TREATING INFERTILITY?
There are many pathological conditions which leads to female infertility like uterine polyp, fallopian tube blockage, submucous fibroids, uterus having two cavities, uterine synachae. These conditions have to be corrected surgically, otherwise even assisted reproductive technique will not yield any results.

DOES MALE INFERTILITY REQUIRE SURGICAL MANAGEMENT?
Common causes of male infertility are varicocele, undescended testis, testicular atrophy. These conditions have to be tackled surgically to improve the quality and quantity of sperms.

DOES LIFE STYLE OF MALE AFFECT FERTILITY?
Yes definitely male factors like obesity, tobacco use, smoking, alcohol use, heavy exercise, tight undergarments, exposure to hot environmental conditions, use of too many mobile phones can adversely affect fertility. Hence alleviation of these factors drastically improves fertility. Sometimes results are obtained with proper counseling and without further intervention.

DOES LIFE STYLE OF A FEMALE AFFECT FERTILITY?
Yes. Obesity, sedentary life style, exposure to radiation leads to infertility. Correction of these factors improve fertility significantly.

HYSTERECTOMY

A hysterectomy is a surgical procedure to remove the womb (uterus). You will no longer be able to get pregnant after the operation. If you haven't already gone through the menopause, you will also no longer have periods, regardless of your age. The menopause is when a woman's monthly periods stop, usually at around the age of 52.

WHY DO I NEED A HYSTERECTOMY?
Hysterectomies are carried out to treat conditions that affect the female reproductive system, including:
• heavy periods (menorrhagia)
• long-term pelvic pain
• non-cancerous tumours (fibroids)
• ovarian cancer, uterine cancer, cervical cancer or cancer of the fallopian tube

A hysterectomy is a major operation with a long recovery time and is only considered after alternative, less invasive, treatments have been tried.

THINGS TO CONSIDER
1. If you have a hysterectomy, as well as having your womb removed, you may have to decide whether to also have your cervix or ovaries removed.
2. Your decision will usually be based on your personal feelings, medical history and any recommendations your doctor may have.
3. You should be aware of the different types of hysterectomy and their implications.

The main types of hysterectomy are:
• Total hysterectomy – the womb and cervix (neck of the womb) are removed; this is the most commonly performed operation
• Subtotal hysterectomy – the main body of the womb is removed, leaving the cervix in place.
• Total hysterectomy with bilateral salpingo-oophorectomy – the womb, cervix, fallopian tubes (salpingectomy) and the ovaries (oophorectomy) are removed.
• Radical hysterectomy – the womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue.

There are three ways to carry out a hysterectomy:
• Vaginal hysterectomy – where the womb is removed through a cut in the top of the vagina.
• Abdominal hysterectomy – where the womb is removed through a cut in the lower abdomen.
• Laparoscopic hysterectomy (keyhole surgery) – where the womb is removed through several small cuts in the abdomen.

RECOVERING FROM A HYSTERECTOMY
A hysterectomy is a major operation. You can be in hospital for up to five days following surgery, and it takes about six to eight weeks to fully recover. Recovery times can also vary depending on the type of hysterectomy.

Rest as much as possible during this time and don't lift anything heavy, such as bags of shopping. You need time for your abdominal muscles and tissues to heal.

SURGICAL MENOPAUSE
If your ovaries are removed during a hysterectomy, you will go through the menopause immediately after the operation, regardless of your age. This is known as a surgical menopause.

If one or both of your ovaries are left intact, there's a chance you will experience the menopause within five years of having your operation.

POLYCYSTIC OVARIAN DISEASE

Polycystic ovarian disease is a very common lifestyle problem. It involves irregular periods, weight gain, acne and excessive hair growth. There are chances of having fertility issues and diabetes in later life too. It can be diagnosed by blood tests like hormonal profile and ultrasound and is treatable. Lifestyle modifications and medication help treating this very common problem.

MEDICAL ABORTION MEDICINES

Medical abortion medicines are becoming increasingly over-the-counter but it is dangerous to take these potentially dangerous medicines without supervision. There are specific indications and contraindications for taking it. It may cause excessive bleeding leading to hemorrhagic shock, incomplete abortion and failure to abort. It may cause infection too. So taking the medicine at the behest of the chemist is quite dangerous.

THE MAGICAL I-PILL OR THE EMERGENCY CONTRACEPTIVE PILL

The magical i-pill or the emergency contraceptive pill should be used only if your regular contraceptive method fails like slipping or leaking of a condom, unprotected sex or in the unfortunate cases of sexual molestation. Unfortunately, most people especially the young unmarried girls think that an i-pill is a regular contraceptive and can be taken several times in a single cycle. Rather, it has side effects like headache, nausea, vomiting and irregular menstrual cycles.

It works against pregnancy in 85% cases but it may fail too. Sometimes it can lead to ectopic pregnancy as well, so one needs to be more aware and educated before relying on this so-called magic pill.

PAP SMEAR IN THE SCREENING FOR CERVICAL CANCER

There are new guidelines for use of Pap smear in the screening for cervical cancer. Screening should begin at 21 years of age irrespective of one's sexual history and must continue after every 3 years and not annually.

Screening for HPV should be done concomitantly only if pap smears are abnormal. This does not hold true for women with dysplasia, cervical cancers etc. where more frequent screening is required.

NEONATOLOGY & PAEDIATRICS

BREASTFEEDING: BREAST MILK IS THE BEST FOOD FOR YOUR BABY

I. HOW DO I KNOW THAT MY BABY IS WELL ATTACHED TO MY BREAST?

The following are the signs of good attachment:
• The baby’s face is facing the breast
• The nipple and the most of the areola is inside the baby’s mouth
• The chin is touching the breast
• The nose is not blocked by breast
• You do not feel any pain

II. MY BABY GOES TO SLEEP WHILE FEEDING. WHAT SHOULD I DO?

Most babies will close their eyes and appear to sleep after feeding for a few minutes. As long as the baby is making sucking movements in between, there is no need to do anything. If the baby goes to sleep and you feel that (s)he has not fed sufficiently (20-25 minutes), you may gently tickle him/her on the soles of the feet or the ears.

III. HOW DO I KNOW THAT MY BABY IS GETTING ENOUGH BREASTMILK?

A baby who is receiving adequate feeds will
• Sleep for 2-3 hours after a feed
• Make 6-7 wet nappies in 24 hours
• Gain weight

IV. WHAT CARE SHOULD I TAKE OF MY BREASTS DURING FEEDING?

In order to avoid pain, soreness and cracks in the nipples, the following steps may be helpful:
• Ensure that the baby is attached well to the breasts during feeding
• Wear a bra
• Do not wash or wipe the breasts/ nipples/ areola. Bathing once a day is sufficient.
• Do not apply any ointments to the breast. Instead, apply few drops of your breast milk to the areola and nipple after you feed the baby. You may also apply coconut oil to the nipple after feeding. These should not be cleaned before the next feed.
• While detaching the bay from the breast, you may put a finger into the baby’s mouth from the corner to break the strong seal and open his/her mouth.

V. WHILE FEEDING THE BAY FROM ONE BREAST, MY OTHER BREAST STATS LEAKING MILK. WHAT SHOULD I DO?

It is normal to have a little milk coming out of the other breast while feeding from one breast. Do not switch breasts during feeding. Try to give one complete feed from one breast at one time.

VI. MY MILK WAS NOT COMING WELL ON THE FIRST TWO DAYS AFTER MY BABY WAS BORN. IS THIS NORMAL? DO I NEED TO GIVE MY BABY ANY OTHER FOOD?

It is normal for most mothers to produce a very small quantity of a thick, creamy milk in the first one or two days after the baby is born. This “milk” is known as colostrum and is very valuable to the baby for improving his/her immunity (resistance against diseases). The quantity that comes is more than enough for the baby and no additional liquids like water, glucose, animal milk, honey, ghutti etc needs to be given.

VII. FOR HOW LONG SHOULD I BREASTFEED MY BABY?

Your baby should receive exclusive breastfeeds for the first six month of life (exclusive means that the baby should not be given water even in summer, vitamins, ghutti or any feeds in addition to your milk). Thereafter, your baby’s doctor will advise complementary foods that can be given in addition to breastfeeding. Breastfeeding should be continued for at least one year and if possible for two years.

VIII. IS IT OK TO GIVE MY BABY A BOTTLE ONCE IN A WHILE?

Putting any other nipple other than yours into the baby’s mouth creates “nipple confusion” and makes the baby reject the breast over a period of time. Also, bottles, despite all modern techniques and gadgets, are impossible to clean thoroughly. You should therefore avoid using a bottle to feed your baby. If, for some reason, you are not able to breastfeed your baby, the best alternative to a bottle is to feed with a cup and spoon.

IX. I HAVE TWINS. CAN I BREASTFEED BOTH OF THEM?

Breastfeeding twins require more work, more dedication and can be exhausting, but it can also be twice as rewarding! You may worry you won’t produce enough milk, but remember, increased suckling means increased milk being produced. While feeding twins can lead to sore nipples, proper latching and medical advice can help reduce problems. A flexible feeding schedule is a good idea, and is alternating breasts with every feeding, especially if one twin is a stronger feeder. Eating small meals more often and drinking more water or other fluids helps. Catch up on your sleep when the babies are sleeping. And ask your family to help with the chores as you spend time with your babies.

COMMON PROBLEMS WHILE BREASTFEEDING

I. HOW DO I DEAL WITH ENGORGEMENT OF BREASTS?

Your breast may get engorged with milk in the first few days after birth. The breast may become hard, swollen and painful. Try to put the baby frequently to the breast for short periods of time or express the milk from the breast by hand or pump. This may be fed to the baby using a cup and spoon. Warm compresses applied to the breast and warm showers may help. Your doctor may also prescribe a medicine to reduce the pain.

II. WHAT IS THE TREATMENT FOR SORE NIPPLES?

Nipples may get sore or cracked if :
• The baby is not well attached to the breast during feeding.
• Frequent washing or wiping the areola and nipple, especially with soap
• If the baby is forcibly pulled off from the breast while sucking

You can treat sore nipples by expressing the milk from the breast (and feeding it to the baby by cup and spoon), application of breastmilk or coconut oil to the areola and nipple, and medications for pain. Once the nipples start to heal, put the baby to the breast for short periods of time, ensuring that the baby is well attached to the breast.

III. MY BABY SPITS OUT MILK AFTER FEED. IS IT A PROBLEM?

Some babies spit out a small quantity of milk during feeding, burping or while being handled. This milk may or may not be curdled. This normal behaviour, known as possetting, does not require any treatment.

APPENDIX SURGERY - LAPAROSCOPIC APPENDECTOMY

WHAT IS THE BENEFIT OF LAPAROSCOPIC APPENDECTOMY?

Laparoscopic appendectomy provide less postoperative morbidity. Most cases of acute appendicitis can be treated laparoscopically. Laparoscopic appendectomy is a useful method for reducing hospital stay, complications and return to normal activity. The main advantages are: Less post-operative pain Faster recovery Short hospital stay Less post-operative complications like wound infection and adhesion Cost-effective in working group.

HOW IS AN APPENDECTOMY PERFORMED?

In a minimally invasive laparoscopic appendectomy, an endoscope and a few surgical instruments are inserted through a series of small incisions so the appendix can be removed with less pain and a shorter recovery period. The camera on the endoscope allows the surgeon to confirm the presence of appendicitis and perform the surgery without making a large incision. Patients return home in as little as one day, although a week's recovery may be necessary if the appendix is perforated or peritonitis has occurred.

ARE THERE LONG-TERM CONSEQUENCES OF APPENDECTOMY?

It is not clear if the appendix has an important role in the body in older children and adults. There are no major, long-term health problems resulting from removing the appendix although a slight increase in some diseases has been noted, for example, Crohn's disease.

WHAT ARE THE POTENTIAL RISKS AND COMPLICATIONS OF AN APPENDECTOMY?

Some possible complications of this procedure include: Infection of the skin Leakage from the bowel causing fistula or abscess, possibly requiring colostomy Prolonged intestinal ileus (paralysis of intestinal function) Very rare complications include: Bleeding requiring transfusion or re-operation Injury to surrounding structures, including ureter and small intestine Adverse reaction to the anesthesia Blood clots and pulmonary embolism Any complication can lead to additional procedures, re-operation and prolonged recovery.

IS EVERY PATIENT FIT FOR LAPAROSCOPIC APPENDECTOMY?

Most surgeons would not recommend laparoscopic appendicectomy in those with pre-existing disease conditions. Patients with cardiac diseases and COPD should not be considered a good candidate for laparoscopic appendectomy. Laparoscopic appendectomy may also be more difficult in patients who have had previous lower abdominal surgery. The elderly may also be at increased risk for complications with general anaesthesia combined with pneumoperitoneum.

ARE THERE ANY POTENTIAL COMPLICATIONS FROM APPENDECTOMY?

Complications become more common the more the diagnosis and treatment are delayed. Complications include perforation of the intestines, gangrene (tissue death) of the intestines, peritonitis, and intrabdominal abscess.

WHAT CAN I EXPECT IN TERMS OF RECOVERY FROM AN APPENDECTOMY?

Every case is different, but the following are averages: Back to top Narcotic pain medicine is necessary for 3-5 days after discharge. You should not lift anything heavier than 10lbs for 30 days. You may resume aerobic exercise in 14 - 21 days. You will probably need 2 - 4 weeks off of work.

BARIATRIC – OBESITY SURGERY

WHAT IS BARIATRIC SURGERY?

Surgery performed on obese patients for reduction of weight & also for relief from co-morbidities like diabetes , hypertension and sleep apnoea. Bariatric surgery, which is also known as Bypass surgery, Gastric banding, Obesity surgery or more popularly known as weight loss surgery, is a type of procedure performed on people who are dangerously obese, for the purpose of losing weight. This weight loss is usually achieved by reducing the size of the stomach with an implanted medical device (gastric banding) or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery).

WHAT ARE TYPES OF BARIATRIC SURGERY?

1. Gastric Plication
2. Adjustable gastric band
3. Sleeve gastrectomy
4. Gastric bypass surgery

WHAT IS LAPROSCOPIC GASTRIC PLICATION?

Laparoscopic Gastric Plication, involves sewing one or more large folds in your stomach. During the Laparoscopic Gastric Plication the stomach volume is reduced about 70% which makes the stomach able to hold less and may help you eat less. There is no cutting, stapling, or removal of the stomach or intestines during the Gastric Plication. The Gastric Plication may potentially be reversed or converted to another procedure if needed. The Laparoscopic Gastric Plication procedure is relatively new, and considered investigational as a primary procedure for weight loss. Gastric Plication as an option if you have a BMI over 27 with one or more significant co-morbid medical conditions which are generally expected to be improved, reversed, or resolved by weight loss.

WHAT IS ADJUSTABLE GASTRIC BAND SURGERY?

The restriction of the stomach also can be created using a silicone band, which can be adjusted by addition or removal of saline through a port placed just under the skin. This operation can be performed laparoscopically, and is commonly referred to as a "lap band". Weight loss is predominantly due to the restriction of nutrient intake that is created by the small gastric pouch and the narrow outlet. It is considered one of the safest procedures performed today.

WHAT IS SLEEVE GASTRECTOMY SURGERY?

Sleeve gastrectomy, or gastric sleeve, is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach, following the major curve. The open edges are then attached together (typically with surgical staples, sutures, or both) to leave the stomach shaped more like a tube, or a sleeve, with a banana shape. The procedure permanently reduces the size of the stomach. The procedure is performed laparoscopically and is not reversible.

WHAT IS GASTRIC BYPASS SURGERY?

A common form of gastric bypass surgery is the Roux-en-Y gastric bypass. Here, a small stomach pouch is created with a stapler device, and connected to the distal small intestine. The upper part of the small intestine is then reattached in a Y-shaped configuration.

This procedure will help a patient to lose weight, and also more importantly will stop the longer term urges to regain weight by modifying the appetite drives and food cravings.

Gastric bypass procedures (GBP) are any of a group of similar operations that first divides the stomach into a small upper pouch and a much larger lower "remnant" pouch and then re-arranges the small intestine to connect to both. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different GBP names. Any GBP leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and physical response to food.

The operation is prescribed to treat morbid obesity (defined as a body mass index greater than 40), type 2 diabetes, hypertension,sleep apnea, and other comorbid conditions. Bariatric surgery is the term encompassing all of the surgical treatments for morbid obesity, not just gastric bypasses, which make up only one class of such operations. The resulting weight loss, typically dramatic, markedly reduces comorbidities. The long-term mortality rate of gastric bypass patients has been shown to be reduced by up to 40%.[1][2] As with all surgery, complications may occur. A study from 2005 to 2006 revealed that 15% of patients experience complications as a result of gastric bypass, and 0.5% of patients died within six months of surgery due to complications.

LIVING WITH GASTRIC BYPASS

Gastric bypass surgery has an emotional and physiological impact on the individual. Many who have undergone the surgery suffer from depression in the following months as a result of a change in the role food plays in their emotional well-being. Strict limitations on the diet can place great emotional strain on the patient. Energy levels in the period following the surgery can be low, both due to the restriction of food intake and negative changes in emotional state. It may take as long as three months for emotional levels to rebound. Muscular weakness in the months following surgery is also common. This is caused by a number of factors, including a restriction on protein intake, a resulting loss in muscle mass and decline in energy levels. Muscle weakness may result in balance problems, difficulty climbing stairs or lifting heavy objects, and increased fatigue following simple physical tasks. Many of these issues pass over time as food intake gradually increases. However, the first months following the surgery can be very difficult, an issue not often mentioned by physicians suggesting the surgery The benefits and risks of this surgery are well established; however, the psychological effects are not well understood.

Even if physical activity is increased patients may still harbor long term psychological effects due to excess skin and fat. Often bypass surgery is followed up with "body lifts" of skin and liposuction of fatty deposits. These extra surgeries have their own inherent risks but are even more dangerous when coupled with the typical nutritional deficiences that accompany convalescing gastric bypass patients.

RESULTS & HEALTH BENEFITS OF GASTRIC BYPASS

Weight loss of 65–80% of excess body weight is typical of most large series of gastric bypass operations reported. The medically more significant effects include a dramatic reduction in comorbid conditions:
• Hyperlipidemia is corrected in over 70% of patients.
• Essential hypertension is relieved in over 70% of patients, and medication requirements are usually reduced in the remainder.
• Obstructive sleep apnea improves markedly with weight loss and bariatric surgery may be curative for sleep apnea. Snoring also reduces in most patients.
• Type 2 diabetes is reversed in up to 90% of patients usually leading to a normal blood-sugar level without medication, sometimes within days of surgery.]Furthermore, Type 2 diabetes is prevented by more than 30-fold in patients with pre-diabetes.
• Gastroesophageal reflux disease is relieved in almost all patients.
• Venous thromboembolic disease signs such as leg swelling are typically alleviated.
• Lower-back pain and joint pain are typically relieved or improved in nearly all patients.

A study in a large comparative series of patients showed an 89% reduction in mortality over the five years following surgery, compared to a non-surgically treated group of patients.

Concurrently, most patients are able to enjoy greater participation in family and social activities.

HOW LONG DOES THE PROCEDURE TAKE?
The procedure is under general anaesthetic and takes on average one and a half hours.

POST SURGERY
The morning after surgery the patient should be able to walk around his/her private room, use the bathroom and shower. (S)he should be able to sit comfortably and drink tea, smoothies or milk. Pain should be well controlled with soluble painkillers. Some patients are keen to go home the day after surgery but most prefer to stay and relax in the hospital and return home after the second night.

HOW MUCH WEIGHT CAN ONE EXPECT TO LOSE?
Following gastric bypass patients will lose about 80% of their excess weight. If a person weighs 20 stone but their ideal weight is 10 stone, then the excess weight they are carrying is 10 stone. Following gastric bypass if they lose 80% of this excess weight, that will equal 8 stone of weight loss. Therefore following gastric bypass this persons weight will decrease from 20 stone to the 12 stone level within nine to twelve months of surgery and remain at this level long term.

GALL BLADDER REMOVAL – LAPAROSCOPIC CHOLECYSTECTOMY

Gall bladder removal is one of the most commonly performed surgical procedures in the United States. Today, gallbladder surgery is performed laparoscopically. The medical name for this procedure is Laparoscopic Cholecystectomy.

WHAT IS THE GALLBLADDER?

• The gallbladder is a pear-shaped organ that rests beneath the right side of the liver.
• Its main purpose is to collect and concentrate a digestive liquid (bile) produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through narrow tubular channels (bile ducts) into the small intestine.
• Removal of the gallbladder is not associated with any impairment of digestion in most people.

WHAT CAUSES GALLBLADDER PROBLEMS?

• Gallbladder problems are usually caused by the presence of gallstones: small hard masses consisting primarily of cholesterol and bile salts that form in the gallbladder or in the bile duct.
• It is uncertain why some people form gallstones.
• There is no known means to prevent gallstones.
• These stones may block the flow of bile out of the gallbladder, causing it to swell and resulting in sharp abdominal pain, vomiting, indigestion and, occasionally, fever.
• If the gallstone blocks the common bile duct, jaundice (a yellowing of the skin) can occur.

HOW ARE THESE PROBLEMS FOUND AND TREATED?

Ultrasound is most commonly used to find gallstones.
• In a few more complex cases, other X-ray tests may be used to evaluate gallbladder disease.
• Gallstones do not go away on their own. Some can be temporarily managed with drugs or by making dietary adjustments, such as reducing fat intake. This treatment has a low, short-term success rate. Symptoms will eventually continue unless the gallbladder is removed.
• Surgical removal of the gallbladder is the time honored and safest treatment of gallbladder disease.

WHAT ARE THE ADVANTAGES OF PERFORMING CHOLECYSTECTOMY LAPAROSCOPICALLY?

• Rather than a five to seven inch incision, the operation requires only four small openings in the abdomen.
• Patients usually have minimal post-operative pain.
• Patients usually experience faster recovery than open gallbladder surgery patients.
• Most patients go home within one day and enjoy a quicker return to normal activities.

ARE YOU A CANDIDATE FOR LAPAROSCOPIC GALLBLADDER REMOVAL?

Although there are many advantages to laparoscopy, the procedure may not be appropriate for some patients who have had previous upper abdominal surgery or who have some pre-existing medical conditions. A thorough medical evaluation by your personal physician, in consultation with a surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal is an appropriate procedure for you.

WHAT PREPARATION IS REQUIRED?

The following includes typical events that may occur prior to laparoscopic surgery; however, since each patient and surgeon is unique, what will actually occur may be different:
• Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
• After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
• Your surgeon may request that you completely empty your colon and cleanse your intestines prior to surgery. You may be requested to drink clear liquids, only, for one or several days prior to surgery.
• It is recommended that you shower the night before or morning of the operation.
• After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
• Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
• Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
• Quit smoking and arrange for any help you may need at home.

HOW IS LAPAROSCOPIC GALLBLADDER REMOVAL PERFORMED?

• Under general anesthesia, so the patient is asleep throughout the procedure.
• Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen in the area of the belly-button.
• A laparoscope (a tiny telescope) connected to a special camera is inserted through the cannula, giving the surgeon a magnified view of the patient’s internal organs on a television screen.
• Other cannulas are inserted which allow your surgeon to delicately separate the gallbladder from its attachments and then remove it through one of the openings.
• Many surgeons perform an X-ray, called a cholangiogram, to identify stones, which may be located in the bile channels, or to insure that structures have been identified.
• If the surgeon finds one or more stones in the common bile duct, (s)he may remove them with a special scope, may choose to have them removed later through a second minimally invasive procedure, or may convert to an open operation in order to remove all the stones during the operation.
• After the surgeon removes the gallbladder, the small incisions are closed with a stitch or two or with surgical tape.

WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED OR COMPLETED BY THE LAPAROSCOPIC METHOD?

In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the “open” procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation.

The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.

WHAT SHOULD I EXPECT AFTER LAPAROSCOPIC GALLBLADDER SURGERY?

• Gall bladder removal is a major abdominal operation and a certain amount of postoperative pain occurs. Nausea and vomiting are not uncommon.
• Once liquids or a diet is tolerated, patients leave the hospital the same day or day following the laparoscopic gallbladder surgery.
• Activity is dependent on how the patient feels. Walking is encouraged. Patients can remove the dressings and shower the day after the operation.
• Patients will probably be able to return to normal activities within a week’s time, including driving, walking up stairs, light lifting and working.
• In general, recovery should be progressive, once the patient is at home.
• The onset of fever, yellow skin or eyes, worsening abdominal pain, distention, persistent nausea or vomiting, or drainage from the incision are indications that a complication may have occurred. Your surgeon should be contacted in these instances.
• Most patients who have a laparoscopic gallbladder removal go home from the hospital the day after surgery. Some may even go home the same day the operation is performed.
• Most patients can return to work within seven days following the laparoscopic procedure depending on the nature of your job. Patients with administrative or desk jobs usually return in a few days while those involved in manual labor or heavy lifting may require a bit more time. Patients undergoing the open procedure usually resume normal activities in four to six weeks.
• Make an appointment with your surgeon within 2 weeks following your operation

WHAT COMPLICATIONS CAN OCCUR?

While there are risks associated with any kind of operation, the vast majority of laparoscopic gallbladder patients experiences few or no complications and quickly return to normal activities. It is important to remember that before undergoing any type of surgery–whether laparoscopic or open you should ask your surgeon about his/her training and experience.

Complications of laparoscopic cholecystectomy are infrequent, but include bleeding, infection, pneumonia, blood clots, or heart problems. Unintended injury to adjacent structures such as the common bile duct or small bowel may occur and may require another surgical procedure to repair it. Bile leakage into the abdomen from the tubular channels leading from the liver to the intestine may rarely occur.

Numerous medical studies show that the complication rate for laparoscopic gallbladder surgery is comparable to the complication rate for open gallbladder surgery when performed by a properly trained surgeon.

HERNIA REMOVAL - LAPAROSCOPIC HERNIORRHAPHY

WHAT IS HERNIA?

A hernia is a weakness in the abdominal wall resulting in abnormal protrusion of abdominal contents (e.g. intestines) through the defect. Hernias enlarge over time and may become incarcerated (fail to reduce) or strangulated (loss of hernia contents due to lack of blood supply). A hernia should be surgically repaired. Although most hernias occur in the groin (eighty-percent), they may also be located in the navel, upper-inner thigh, and along previous abdominal incisions.

WHAT TO EXPECT AFTER SURGERY?

• Most people who have laparoscopic hernia repair surgery are able to go home the same day.
• Recovery time is about 1 to 2 weeks.
• You most likely can return to light activity after 1 to 2 weeks.
• Strenuous exercise should wait until after 4 weeks of recovery.
• Studies have found that people have less pain after laparoscopic hernia repair than after open hernia surgery.

WHY IT IS DONE?

Surgical repair is recommended for inguinal hernias that are causing pain or other symptoms and for hernias that are incarcerated or strangulated. Surgery is always recommended for inguinal hernias in children.

Laparoscopic surgery repair may not be appropriate for people who:
• Have an incarcerated hernia.
• Cannot tolerate general anesthesia.
• Have bleeding disorders such as hemophilia or idiopathic thrombocytopenic purpura (ITP).
• Are taking medicines to prevent blood clotting (blood thinners or anticoagulants, such as warfarin).
• Have had many abdominal surgeries. Scar tissue may make the surgery harder to do through the laparoscope.
• Have severe lung diseases such as emphysema . The carbon dioxide used to inflate the abdomen may interfere with their breathing.
• Are pregnant.
• Are extremely obese.

Laparoscopic hernia repair usually is not done on children. But a laparoscope may be used during open hernia repairs in children to explore the opposite groin for a hernia. This can be done by inserting the laparoscope into the side that is being operated on and looking at the opposite side. If a hernia is present, the surgeon can repair both sides during the same operation.

HOW WELL IT WORKS?

The chance of a hernia coming back after laparoscopic surgery ranges from 1 to 10 out of 100 surgeries done.

Laparoscopic surgery has the following advantages over open hernia repair:
• Some people may prefer laparoscopic hernia repair because it causes less pain and they are able to return to work more quickly than they would after open repair surgery.
• Repair of a recurrent hernia often is easier using laparoscopic techniques than using open surgery.
• It is possible to check for and repair a second hernia on the opposite side at the time of the operation.
• Because smaller incisions are used, laparoscopy may be more appealing for cosmetic reasons.

WHAT TO THINK ABOUT?

Laparoscopic hernia repair is different from open surgery in the following ways:
• A laparoscopic repair requires several small incisions instead of a single larger cut.
• If hernias are on both sides, both hernias can be repaired at the same time without the need for a second large incision. Laparoscopic surgery allows the surgeon to examine both groin areas and all sites of hernias for defects. Also, the patch or mesh can be placed over all possible areas of weakness, helping prevent a hernia from recurring in the same spot or developing in a different spot.
• General anesthesia is needed for laparoscopic repair. Open hernia repair can be done under general, spinal, or local anesthesia.
• Laparoscopic repair of a hernia is more expensive than open surgery because of the higher cost of the slightly longer operating-room time and the cost of laparoscopic technology

DERMATOLOGY & SKIN SERVICES, HAIR SERVICES, PLASTIC SURGERY

BODY CONTOURING SURGERY

Heredity, changes in the body over time such as weight gain or loss, pregnancy, and even aging can result in a change in our body’s proportions and curves that may affect both our body image and our self-confidence. Reshaping disproportionate curves or reducing unwanted fat cannot always be achieved through weight loss and exercise alone.

Body contouring surgery can reshape your body features that cannot be improved by any other measures. Body contouring can dramatically improve the shape and proportion of the body, enhancing your appearance and boosting your self-confidence.

Areas treated by body contouring include the neck, upper arms, female and male breasts, abdomen, flanks, back, hips, buttocks, thighs, knees and ankles.

Type of surgeries may range from simple liposuction, abdominoplasty (tummy tuck), body lift surgeries.

Patient selection is the most important thing and type of surgery should be chosen according to the BMI of the person, age, quality of skin, and personal variations after educating the patient and explaining pros and cons of each procedure.

BREAST RECONSTRUCTION

Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or any other condition.

The creation of a new breast can dramatically improve one’s self-image, self-confidence and quality of life. This surgery can give you a relatively natural-looking breast.

Breast reconstruction can be done by tissue expansion implants or by the help of our own body tissue (flap surgeries) depending upon the patients choice and body characteristics.

MUMMY MAKE OVER

During pregnancy, the abdomen expands, the breasts enlarge and women gain weight. After pregnancy and despite weight loss, exercise and diet, women can still be troubled by loose skin on the abdomen and sagging and deflated breasts.

Mummy makeovers help women regain their pre-pregnancy shape and confidence.

Liposuction & Tummy tucks are popular procedures among new mothers, as is breast augmentation to restore volume loss, and breast lifts (mastopexy) to reduce sagging. Having breast augmentation or a breast lift does not affect your ability to breastfeed other children in the future.

SPIDER VEINS AND VARICOSE VEINS

Spider veins (telangiectasias) are small purple to red blood vessels most commonly visible on the leg, ankle or foot.

Varicose veins are larger, deeper veins that are usually lumpy and sometimes deeper purple in color. Varicose veins may sometimes cause leg discomfort.

One of the most advance methods of treating varicose veins is Endovenus Laser ablation of varicose veins with very fast recovery and longer lasting results.

I’M A 36 YEAR OLD MALE & LOSING HAIR ESPECIALLY FROM CENTRAL HEAD. WHAT IS YOUR ADVICE ON BALDNESS IN THIS AREA?

If you’ve already developed bald patch then hair transplantation is the answer to your problem in which we transplant hair follicles in bald area. They keep on growing like natural hair. You can cut, shampoo or trim them and they will grow back again, just like in normal cases.

I’M A 26 YEAR OLD FEMALE. I HAVE VERY SMALL BREASTS BECAUSE OF WHICH I FEEL LESS CONFIDENT. CAN ANYTHING BE DONE ABOUT THE SIZE AS I’M NOT ABLE TO GET MARRIED? I’M FACING REJECTIONS. CAN I GET BREAST IMPLANTS DONE? ARE THEY SAFE?

Yes, breast enlargement/augmentation with the help of an implant is a safe procedure. Procedure takes around 1-1.5 hours & you can return back home the same day. Whether the implant is inserted behind the muscle or behind the gland, it doesn’t interfere with normal physiological functions of breast like pregnancy & breast feeding. Latest advancements in implant quality & technology ensure that it is a completely safe procedure. At Adiva, we make use of USFDA approved mentors/implants. We will also give you a life time safety card which is USFDA approved.

I’M A 42 YEAR OLD FEMALE AND HAVE FAT DEPOSITION ON TUMMY, HIPS & THIGHS. THIS FAT IS RESISTANT TO EXERCISE & DIET REGIME. PLEASE SUGGEST WHAT CAN I DO?

You can opt for hymen repair/hymenoplasty in which your torn hymen is repaired back again & tightened up. Procedure takes only 45 mins-1 hour & is done under local anesthesia. You can return back home after 2-3 hours. You can start your normal routine work from the next day. However, stretching exercises of legs should be avoided for 3 weeks.

THE TOP 10 MYTHS ABOUT HAIR TRANSPLANTATION

MYTH: Many techniques which one to choose
TRUTH: Technically there are only two types of hair transplant techniques: FUT and FUE. Rest is all variants of the same. It’s important to understand which one is best for you.

MYTH: Hair transplantation can fall out
TRUTH: Follicular units are impossible to dislodge after the first day when the healing mechanisms have set in. In the first 24 hours, follicular units are kept in place by tiny blood clots which are strong enough to withstand most forces but it is important to take it easy during this period.

MYTH: People will be able to tell that you've had a hair transplant
TRUTH: The principle of transplanting hair as follicular units (which is the most basic natural grouping of hair) allows the transplanted hair to follow the patterns of native hair giving a natural result. Even a soft hair line can be achieved using single follicular unit graft to blend the area seamlessly.

MYTH: FUE is better than FUT with the strip technique
TRUTH: There are advantages and disadvantages of both treatments. No single study comparing their cosmetic results, graft take or patient satisfaction exists.

MYTH: Transplanted hair requires extra care
TRUTH: In fact, transplanted hair can be treated like normal, and be cut, dyed and styled as you would otherwise.

MYTH: Hair transplant looks 'pluggy'
TRUTH: This was true earlier but now advanced individual follicular units can also be transplanted to give your hair a softer natural look.

MYTH: Anyone with hair loss can have a hair transplant
TRUTH: This is a common misconception. Certain attributes need to be met before hair transplantation is feasible. This includes having a known, stable or predictable pattern of hair loss, availability of enough donor hair, good skin elasticity and good healing potential. Suitability for hair transplantation can only be assessed after consulting a hair restoration surgeon.

MYTH: Hair from another person can be used
TRUTH: Unfortunately, using someone else's hair is rejected and hair from the same individual should only be used.

MYTH: The results from hair transplant technique are immediate
TRUTH: It is common for transplanted follicular units to shed hair a month after surgery. The follicular units then enter anagen, such that you should be able to see hair growth in the mirror in about 4 months. The final result of hair transplantation takes about 12 months to become fully appreciable.

MYTH: It is better to have the transplantation done at a younger age
TRUTH: Part of performing hair restoration surgery is to predict future loss and to make sure the transplant you have will blend in with this. Otherwise, there could be isolated areas of transplanted hair in one particular area that would continue to bald, making you look odd and unnatural. The future pattern of hair loss is much easier to determine in individuals who are over 30. That said, transplants can and are done in younger individuals but this varies on a case by case basis.