Hernia: Hernia is medical term coined when an internal organ or tissue of the body moves into another body area which does not belong to it. Hiatus is the opening in the diaphragm-the muscular wall that splits the chest cavity from the abdomen. Hiatal hernia occurs when the stomach protrude in to the chest via the hiatal opening. Patients usually do not have any symptoms but some might have heart burn which related to GERD. Patients experiencing heart burn may have chest pain which can be mistaken or confused with the angina or heart attack. So it foremost important to get accurate diagnosis in time to prevent the further complications.
Hiatal Hernias can be classified in to two types:
- Sliding hiatus hernia: It is the commonest type characterised by the sliding of stomach along with the small part of oesophagus into the chest through hiatus.
- Paraesophageal Hernia:It is less common though serious form of hernia in which the section of the stomach press through the hiatus protruding it adjacent to the oesophagus. It is dangerous as it can make the stomach strangled, viz. shutting off the blood supply to the stomach.
Treatment Option-The following are the option to treat hiatal hernia-
- Drug therapy: It is taken mostly to relieve the associated heartburn and acid reflux. The commonly prescribed medicines are To reduce the acid production: H-2-receptor blockers, including cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) and ranitidine (Zantac 75).To neutralize acid: Gelusil, Maalox, Mylanta, Rolaids and Tums for quick relief.To stop acid production and healing of oesophagus: Proton pump inhibitors including lansoprazole (Prevacid 24HR) and omeprazole (Prilosec OTC).
- Surgical interventions: In most of the cases, surgery is not required but it is done in emergency situation like paraesophageal hernias. In the surgical procedure the surgeon either pulls your stomach down to the original place that makes the hiatus smaller, reconstruct the weak sphincter of oesophagus or remove the hernia sac completely.This can be done using one of the following procedure-
- Thoracotomy: In this surgery is done through a single incision on your chest wall.
- Laprotomy: surgery is done through an incision in the abdomen.
- Laparoscopic: Surgery is performed using the small camera and surgical tools which are inserted in the abdomen through multiple small incisions. This is the minimally invasive technique.
Piles: Piles are haemorrhoids that have become inflamed. Haemorrhoids are masses, clumps, cushions of tissue in the rectum, the last part of the intestine, commonly known as anus. Haemorrhoids are full of blood vessels, support tissue, muscle and elastic fibres. You may be surprised, but we all have them. It is only when the haemorrhoidal cushions become too big (inflamed) that problem occur - when this happens they are called piles or pathological haemorrhoids. Some of the common symptoms of piles are:Loss of blood while passing stools,Itchiness, redness or soreness around the anus, Pain and mucus discharge while emptying the bowels, Feeling of bowel fullness even after defecation, Feeling of hard lump around the anus, which is often very painful. Piles can either be in the inside or outside the anus. Internal piles typically are 2 to 4cm above the opening of the anus and are much more common. External piles occur on the outside edge of the anus.Although piles can be treated and managed with medications, high fibres diet and large fluid intake, but sometimes they can develop other complications which need surgical intervention
Treatment options-With the exception of enhancing your diet which is most important factor to treat and prevent the occurrence of piles, the following are the other treatment options for treating haemorrhoids.
- Improving dietary habits. Intake of high fibre diet including vegetables, fruits, cereals and plenty amount of water helps in soft bowel movements with easy and regular motions.
- Drug therapy and medications including the astringent ointments, laxatives and suppositories to shrink the haemorrhoids.
- Banding and ligation of haemorrhoids using proctoscope to shrink the size of haemorrhoids.
- Surgery: The commonly performed surgical procedures are -
- Haemorrhoidectomy - haemorrhoidectomy is the procedure during which the excess tissue that is causing the bleeding is surgically removed. The surgery can be done under local/ spinal or general anaesthesia. Haemorrhoidectomy results in complete removal of piles.
- Haemorrhoid stapling -haemorrhoid stapling, also known as Hemorrhoidopexy, is the procedure where blood flow to the haemorrhoids is blocked with the help of staples thereby causing the tissue to shrink and shed off. This procedure is less time consuming and less painful than haemorrhoidectomy. Other minimally invasive options for reducing the size of or removing haemorrhoids include:
- Sclerotherapy: Sclerotherapy entails injecting a medicine in the haemorrhoids resulting them to shrink and eventually shrivel up.
- Laser: in this a specialized and defined laser beam is used to let the tissue burn away causing pain relief.
- Rubber band ligation: This involves placing an elastic band around the bottom of the pile inside the anus leading to discontinuation of the blood supply, resulting in the death of the tissue and it eventually falls off.
Gall Bladder: Gallbladder is the small pear shaped sac like organ present under the liver that collects the bile (digestive juice) manufactured by the liver. This bile is then released from the gall bladder as and when required which helps in breakdown of the dietary fats thus assisting in digestion. Allbladder stones are the most common problem of the digestive system and affects a large percentage of population. Around 15% of the people above the age 50 years are known to suffer from gall bladder stones. More common in females and overweight individuals, gall stones are the small biliary calculi that are formed by cholesterol, bile pigments or calcium salts. Gallstones are formed when there is excessive cholesterol in the bile, the crystallisation of which results in incomplete emptying of the gall bladder.
Treatment options-The gallstones can be symptomatic or asymptomatic. Asymptomatic gall stones, or the gallstones which do not cause any symptoms, do not need any medical intervention. But the surgeons would advise you to remove the gall bladder if you are prone to develop complications of gallstones. Following are the treatment options that highly depend on the size and site of the stones.
- Medication: It is rarely advised treatment mode, in which medicines are given to dissolve the stones. It has side effects and low success rates.
- Dietary modifications: This includes reducing and excluding the intake of fatty foods and dairy products which can help prevent the symptoms.
- Lithotripsy: This is done in small number of cases in which the patients have small and soft stones. The sound waves produced by the lithotripsy machine are used to break the gall stones, which are then either removed through intervention or are excreted out of the body naturally.
- Surgical intervention: This is the most widely adopted intervention in which either the entire gall bladder or only the gall stones from the bile duct are removed using different techniques. As gall bladder is not a vital organ, so one can manage and live normal life without having it. The surgery is medically known as cholecystectomy.The surgical interventions for removal of gall bladder include:
- Laparoscopic Cholecystectomy: This the minimally invasive surgery (keyhole surgery) in which the surgeon makes small incision on the skin and with the help of guided camera, gall bladder is located and using the specialized surgical tool, gall bladder is removed through one of the incisions.
- Open surgery: It is commonly referred as laparotomy. Open surgery is indicated in individuals who already have undergone previous abdominal surgery or who have bleeding disorder. In this, the gall bladder is removed by making wider incision in the abdomen, through which the gall bladder is removed.
Appendix: Appendix is a small, finger shaped, 3-1/2 inch long organ located in the first part of the large intestine, also known as colon. It is a vestigial organ, which means, it has no known function in the body and there are no apparent consequences when it is removed.Appendicitis is very difficult to diagnose particularly in old age people and children. The person suffering from appendicitis may experience pain surrounding the belly button which is minimal at first but gradually becomes severe and sharp and most often the pain is radiated to the right side of lower abdomen and become localized.Other common symptoms are fever, nausea, vomiting, diarrhoea, constipation and decreased appetite.
Treatment Option-Appendectomy refers to removal of the appendix, which is the standard medical treatment to treat appendicitis. The surgery should be done at the earliest upon diagnosis to prevent the rupture of the appendix. Appendectomy can be done using either of the two surgical interventions.
- Laparotomy or open appendectomy-In this the appendix is removed by making single and large incision on the right side of the lower abdomen. The reason for opting the open surgery are;If extensive infection is present, If the patient is obese, Any history of other abdominal surgery, Perforating appendix, Bleeding problems.
- Laparoscopic appendectomy-This is the most preferred surgical procedure as it is minimally invasive and offers quicker recover, less scarring and shorter hospital stay as compared to standard approach. In this the appendix is accessed and removed using specialized surgical instruments through several small incisions thus minimizing the risk of infection and scarring with better recovery.
GERD: GERD, also known as Gastro-esophageal reflux disease or acid reflux disorder refers to the condition characterized by the back flow(reflux) of the stomach content like stomach acid and bile in to the oesophagus. The oesophagus is the hollow, muscular organ that carries food and liquids from the throat to the stomach.
- Fundoplication: This is the standard surgical intervention to tighten and strengthen the LES. In this, the higher part of the stomach is draped around the outer side of the lower part of oesophagus to give strength to LES.
- Open fundoplication surgery: Open Fundoplication surgery is done when either it is not possible or not safe to perform the laparoscopic surgery. The reasons can be many, which include history of prior abdominal surgery, obesity or bleeding during the operation. The surgeon is the best person to decide which procedure is best suited for you.