Other Surgeries

Types Of Surgeries

Anti Reflux Surgery For Gerd / Hiatal Hernia (Laparoscopic & Robotic)

What is GERD/ Hiatus Hernia?

Gastro-esophageal reflux disease, commonly referred to as acidity, is a disease where juices from the stomach flow backwards into the esophagus (i.e. food pipe) instead of flowing downwards. This occurs due to loosening of the junction between the food pipe and the stomach. Due to this, the patient experiences nausea, vomiting, and a burning sensation in the chest and upper abdomen.

If this continues excessively, the patient may develop a HIATUS HERNIA, in which the stomach moves from its normal position within the abdomen into the chest cavity, and symptoms worsen. This is due to enlargement of the natural defect in the diaphragm, which is the muscle that separates the chest and abdominal cavities. If the condition is allowed to persist, other organs may migrate along with the stomach into the chest, worsening the heart and lung functions.

How is it treated?

Patients need to undergo an Upper GI Endoscopy and/or manometry. After this, patients may be given a course of medical treatment in the form of antacids. In severe cases, patients need to undergo surgery, to correct the anatomical abnormality.

What surgery is performed?

An anti reflux procedure is known as a FUNDOPLICATION. This involves wrapping of the stomach around the lower end of the food pipe in order to tighten the junction. This may be either total (NISSEN’S FUNDOPLICATION) or partial (DOR or TOUPET).

Who is a candidate for this surgery?

Patients who have severe disease, or intractable symptoms despite maximal medical therapy are candidates for this procedure.

How is the surgery performed?

The surgery can be performed laparoscopically or robotically. Both involve making 4-5 small cuts on the abdomen with the patient under general anaesthesia. Robotic assisted surgery gives better long-term relief in comparison to laparoscopic repair for chronic large hiatal herniae.

Heller's Cardiomyotomy For Achalasia Cardia

What is achalasia cardia?

This is a condition in which the junction between the stomach and esophagus (i.e. food pipe) becomes too tight (opposite to that in GERD), not allowing food to pass down from the esophagus to the stomach. Due to this, the patient develops chest pain while swallowing food.

How is it treated?

Achalasia cardia is best treated surgically for a long lasting result. The surgery involves splitting of the muscles at the junction of the esophagus and stomach, in order to loosen the junction. An anti reflux procedure maybe added in order to prevent GERD.

How is the surgery performed?

The surgery can be performed laparoscopically or robotically, making 4 small cuts on the abdomen. Robotics is especially better than laparoscopy for long term relief.

Splenectomy

What is splenectomy?

Splenectomy is the surgical removal of the spleen. The spleen functions as a blood purifying organ, removing dead platelets, red blood cells and white blood cells. It also plays an important role in maintaining the body’s immunity to fight infections.
Cases in which the spleen isn’t functioning properly, or is injured, require a splenectomy.

What are the indications for splenectomy?

Removal of the spleen is indicated in cases of:

  • High grade trauma to the spleen,
  • Haematological malignancies involving the spleen,
  • Idiopathic thrombocytopenic purpura,
  • Excessively large spleen due to various medical diseases.

Usually your haematologist can guide you regarding the need for a splenectomy.

How is the surgery performed?

Splenectomy can be performed laparoscopically or robotically, making 4 small cuts and 1 large cut (3-6 cm) to remove the spleen.
In certain cases, the spleen may be massively enlarged. In such cases, a minimally invasive approach may not be feasible, and a conventional open surgery maybe performed. This involves making a very large cut on the abdomen. Robotic splenectomy allows a higher chance of preservation of the tail of the pancreas thus decreasing the risk of the patient becoming a type II diabetic due the tail as a whole or in part, being disconnected during the procedure. Hence considered a better alternative to laparoscopic splenectomy.

Pancreatectomy

What is Pancreatectomy?

Pancreatectomy is the surgical removal of all or part of the pancreas. Pancreas is one of the main endocrinal organs in the body, most notable for producing insulin and other digestive juices. It may be partially or completely removed, depending on the underlying disease location.
A partial pancreatectomy is known as WHIPPLE PROCEDURE, in which part of the duodenum (i.e. uppermost part of the small intestine) is removed along with the head of the pancreas, or a DISTAL PANCREATECTOMY in which the tail of the pancreas is removed with or without the spleen. A CENTRAL PANCREATECTOMY (in which only the central portion of the pancreas is removed) or a TOTAL PANCREATECTOMY (removal of the entire pancreas) may be needed in special circumstances.

Who needs a pancreatectomy?

This surgery is most commonly performed for tumours of the pancreas, which may be benign or malignant. Some cases of chronic pancreatitis may also need a MODIFIED PARTIAL PANCREATECTOMY.
In some situations, like acute or chronic pancreatitis, a PANCREATIC PSEUDOCYST may form. This may also need surgical correction in the form of surgical CYSTO-ENTEROSTOMY.

How is this surgery performed?

Pancreatectomies may be performed laparoscopically or robotically. In cases of malignant disease (i.e. cancer of the pancreas), a conventional open surgery involving a large cut on the abdomen may be required to clear the whole disease. Robotic assisted distal pancreatectomy or splenectomy has the added advantage of increased incidence of preservation of the spleen and the tail of the pancreas respectively in comparison of laparoscopic technique for the same surgery due to higher precision and accuracy.

Cholecystectomy

What is cholecystectomy?

Cholecystectomy is surgical removal of the gall bladder. The gall bladder is an organ situated below the liver that works as a storehouse of bile (digestive juice from the liver). If the gall bladder function becomes deranged, it forms gallstones or gets infected. In these cases, it has to be removed from the body. Removal of the gall bladder is perfectly compatible with normal life, and does not cause any disturbance in normal body function.

Who is a candidate for this surgery?

If you have any of the following, you need a cholecystectomy:

  • Symptomatic gallstones (abdominal pain, nausea)
  • Large asymptomatic gallstones (> 1 cm in size)
  • Acute/ chronic cholecystitis (i.e. infection of the gall bladder)
  • Gall bladder polyps/ tumours

How is the surgery performed?

The surgery can be performed laparoscopically or robotically, making 3-4 small cuts on the abdomen. This is also done as a single port procedure for cosmetic reasons (especially in young unmarried women). Usually patients recover within a day and can be discharged the day after the surgery.

Choledochal Cyst Excision

What is a choledochal cyst?

Choledochal cyst is a rare entity in which the biliary tract, which runs from the liver to the duodenum (small intestine), becomes swollen. Because of this, the patient experiences abdominal pain, nausea, vomiting, fever, jaundice or even pancreatitis. This is a premalignant condition, which means that if left alone, there is a high risk of developing cancer in the biliary tree.

How is it treated?

The only way to treat a choledochal cyst is by surgery. This involves removal of the affected part of the biliary tree followed by restoration of normal anatomy. The extent and type of surgery depends upon the type of choledochal cyst.

How is the surgery performed?

The surgery can be done by minimally invasive techniques, i.e. laparoscopically or robotically. This usually involves making 4-5 small cuts on the abdomen. Recovery usually takes 2-3 days, and patients can be discharged on the 3rd or 4th day. If done robotically, the recovery period may be even shorter, and the risk of biliary stricture formation is lowered.
In unusual cases, like very large cysts or malignant cysts, a conventional open approach may be required.

Inguinal, Femoral & Ventral Hernia Repair

What is a hernia?

A hernia is an abnormal protrusion of abdominal contents through a weakness in the abdominal muscle wall. In other words, this means that the intestines that are normally located within the abdomen tend to protrude out through any muscular defects in the abdominal wall. As a result of this, patients often notice a swelling that increases on standing or coughing, and reduces on lying down in bed.
If the hernia continues to progress, the swelling may become prominent at all times, and the defect continues to grow in size. This causes pain, and may cause obstruction of the intestines within the hernia.

What are the types of hernia?

Hernia can be of various types depending on the region where it occurs. Most commonly, it occurs in the groin, where it is known as an INGUINAL HERNIA. Other than this, FEMORAL (below the groin in the upper part of the thigh), UMBILICAL (in the navel), EPIGASTRIC/ VENTRAL (in the midline of the abdomen), and INCISIONAL (at the site of a scar) are the common types.
Rarely, a hernia may be seen in the loin, pelvis, or within the abdominal cavity itself (INTERNAL HERNIA).

How is the surgery performed?

The surgery can be performed laparoscopically, robotically, or by the conventional open method. Minimally invasive techniques involve making 3-4 small cuts on the abdomen, and the open method involves making 1 large cut on top of the hernia swelling. In majority of the cases, a synthetic mesh has to be placed over the defect, so that it gains strength and prevents the formation of another hernia.
Patients recover quite quickly with any of these techniques, and can be discharged the day after the surgery.
Large abdominal wall incisional hernias can be treated very well with robotic surgery as well and show very rapid recovery and early discharge with minimal pain after the surgery.