Cutting Edge Technology

Removing the gallbladder (cholecystectomy) is the only way to treat gallstones. This can be done by conventional (open) method or a well established endoscopic (laparoscopic) method which is now the 'Gold Standard'.

The surgery is called Laparoscopic Cholecystectomy

In this operation, the surgeon makes few tiny incisions in the abdomen and inserts surgical instruments and a miniature telescope with a mounted 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 vessels. The gallbladder is then removed through one of the small incisions. Recovery usually occurs within a day in the hospital, followed by few days of rest at home.

Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fewer wound complications.

If the surgeon finds any difficulty in the laparoscopic procedure, the operating team may decide to switch over to open surgery. It is called 'open' surgery because the surgeon has to make a 5 to 8 inch incision in the abdomen to remove the gallbladder. Open surgery is now required in less than 0.1 percent gallbladder operations at our institute.

Endoscopic Hernia repair is being increasingly performed by surgeons practicing minimal access surgery. At Max Institute of Minimal Access Metabolic and Bariatric surgery, we offer surgical treatment for the four most commonly found types of Hernia – Inguinal Hernia, Incisional Hernia, Umbilical Hernia and Ventral Hernia.

With the help of latest technology and infrastructure, we have acquired a niche in performing laparoscopic surgery (also known as Minimal Access surgery/Endoscopic Surgery) for hernias.

What are the advantages of laparoscopic/endoscopic surgery over the conventional methods?

• Endoscopic surgery causes less pain and patients are mobile within few hours after the procedure
• Patients can resume all activities much earlier and go back to work with 5-7 days
• Both sides can be operated on during the same sitting without causing any extra pain or stay
• Endoscopic surgeries have excellent cosmetic results

The treatment of acute Appendicitis is surgical removal of Appendix popularly known as Appedicectomy.

At Max Institute of Minimal Access Metabolic and Bariatric Surgery we perform laparoscopic Appendicectomy making three tiny incisions through which the telescope and instruments are introduced and appendix is removed.

Anorectal symptoms and conditions are common and may be caused due to a range of conditions. however, due to lack of awareness and fear of embarrassment patients hesitate from seeking medical help. Common anal conditions, if ignored, may cause severe implications and therefore one should always consult a specialist in case of persistant symptoms.

Common anal Conditions

• Anal Fistula (low, high or complex)
• Piles (internal or external)
• Anal Fissures
• Rectal Prolapse

Common Symptoms

• Anal pain
• Bleeding per rectum
• Pus discharge from anal verge
• Anal pruritus (itching)
• Passage of mucus per rectum
• Constipation or fecal obstruction
• Mass protruding from anal verge

At Max Institute of Minimal Access Metabolic and Bariatric Surgery, diagnosis of anal conditions is a matter of a few hours. The examination is done in an outpatient setting and based on the results further treatment is suggested. Read below to find out more on diagnosis and treatment of each condition.

• Anal Fistula
• Piles
• Anal Fissures
• Rectal Prolapse

Anal Fistula

Max Institute of Minimal Access, Metabolic & Bariatric Surgery is the First Centre in Asia-Pacific region to adopt this technique. It has done pioneering work in this field and now is acclaimed to be a high volume Centre of Excellence for teaching and training surgeons from across the World.

What is Anal Fistula?

Anal Fistula is a common anorectal problem in which an abnormal connection develops between the inner aurface of the anal canal and the skin around the anal verge.

Why do fistulas develop?

Fistulae are blockage of the outlet of the anal canal which causes secretions to accumulate inside and an abscess can form eventually leading to pain and infection.

How are fistulae treated?

The treatment depends on where the fistula lies. At Max Healthcare, we specialise in Minimally-Invasive Fistula Treatment that is an innovative technique.

Advantages of Minimally-invasive Anal Fistula Treatment (MAFT) technique

• No surgical wounds on the buttocks or in the peri-anal region
• No damage to the anal sphincters
• Less pre-operative investigations to ascertain type of fistula
• Early recovery
• Can be done as a Day-Care procedure
• Possibilities of localization of the internal fistula opening (key point in all fistula surgical treatments)
• Fistulous tract can be completely destroyed from within without damaging any other tissues

What are piles?

Piles or hemorrhoids are swollen blood vessels in the anal passage. There are two circular bunches of veins, one inside the anal canal and the second at the anal verge. Accordingly they are called internal and external hemorrhoids

Why do piles develop?

There are certain conditions which predispose to formation of piles. These are

• Excessive straining while passing stools e.g. chronic constipation, low fibre diet, poor bowel habits
• Increased backward pressure on pelvic blood vessels e.g. Pregnancy, pelvic tumors

Diagnosis is usually done by direct examination and proctoscopy. A colonoscopy may sometimes be advised if a mass lesion or other pathology is suspected in the colon.

At Max Healthcare, we follow the minimally invasive technique for treatment.

Advantages of Minimally Invasive procedures for Piles

• Minimal post operative pain
• Much faster recovery
• Shorter hospital stay
• Less post operative discomfort
• No dressings
• Early resumption of normal activities

What is an anal fissure?

An anal fissure is a small tear or cut in the skin at the anal opening. Fissures typically cause pain and often bleed. Fissures are quite common, but are often confused with other causes of pain and bleeding, such as hemorrhoids. Most fissures occur along the mid-line - the top or bottom - of the anus.

What are the symptoms of an anal fissure?

The typical symptoms of an anal fissure are pain during or after defecation and fresh bleeding. The pain may be severe enough to cause the patients to avoid defecation.

What causes an anal fissure?

• Injury: Most commonly due to a hard, dry bowel movement. Many women during childbirth develop an anal fissure
• Digital insertion (during examination)
• Foreign body insertion
• Anal intercourse

A fissure may also develop following diarrhea or inflammatory conditions of the anal area.

How can a fissure be treated?

The principle of treating an anal fissure is relieving the anal spasm and correcting the constipation. At least 50 percent of anal fissures heal by medical management alone.

• Drinking more fluids.
• Eating a high-fiber diet to avoid constipation.
• Using stool softeners.
• Allowing enough time for a bowel movement
• Sitz baths (soaking anal area in plain warm water)
• Avoid foods that may not be well-digested (i.e., nuts, popcorn, tortilla chips)
• Topical ointments

Medical treatment of an acute anal fissure may take a few days or weeks, while healing of a chronic anal fissure may take more than 6 weeks.

In case a fissure does not heal should be reexamined to determine if an underlying problem exist that prevents healing.

What is rectal prolapse?

A condition where in the rectum (distal most part of large intestine just above the anal canal) protrudes out of the anal opening due to stretching or disruption of its attachments to the posterior abdominal wall.

Causes of rectal prolapse?

The primary cause of rectal prolapse remains unclear. Predisposing factors include:

• Prolonged straining while passing stools (chronic constipation)
• Multiple pregnancies
• Neurological illnesses causing muscular weakness or connective tissue disorders (genetic predisposition)

It is often seen in the elderly as aging causes the supporting ligaments to stretch the anal sphincter muscle to weaken.Diagnosis of rectal prolapse is made on history and physical examination. In case of an internal rectal prolapse sometimes a defecography is required.

How is Rectal Prolapse Treated?

Rectal prolapse occurring in children, during pregnancy and following childbirth are known to correct spontaneously and most often do not require any intervention. In most cases however surgery is required to correct rectal prolapse in adults and in some children. There are 2 procedures described for repair of rectal prolapse- Perineal Approach and Abdominal Approach.

Both procedures can be performed by Laparoscopic approach.

• Lesser post operative pain
• Early recovery
• Excellent cosmetic results
• Chance to rule out any other pathology present in the same surgical sitting

Post operative instructions and information

Pls Note: This information is not a substitute to medical advice. Please consult your doctor before you start something new.

Wish you a speedy recovery!

• After the operation you will be kept in the recovery room. This period may vary from few minutes to few hours. The anaesthetist decides about your shifting to room. The decision depends on many technical factors.
• You will be sleepy immediately after the operation due to sedation given during anaesthesia and during the recovery period.
• You may have some discomfort when coming out of the effect of sedation. It gradually reduces to a tolerable level within a few minutes without any pain killer. However, if necessary you may ask for pain killer injections/tablets. You should try to avoid these drugs because they produce drowsiness and you may sleep for a longer period which is not desirable.
• You may feel nauseated in the immediate post-operative period, and you may even vomit which should not cause any worry. This generally gets over after few hours.
• You are generally allowed to have sips of water immediately after the operation and liquids on day of operation. In case of vomiting the liquid intake may be stopped and restarted after 30 minutes. The liquids may include water / cold drinks / tea / coffee / milk / juices or some clear soups.
• You are allowed to have normal home cooked meals of your choice from the next morning at breakfast.
• You should have small frequent meals for few days after operation following which you can resume your normal diet gradually. This is vital because you may feel bloated and distended if the quantity of food is in large quantities at a time.
• You should try to move the limbs and can sit up immediately after operation. You should also go to the toilet on your own. There are no restrictions whatsoever for the physical movement. In fact majority of the patients will feel much better after they have started the movement. The pain also dramatically reduces once you start sitting up, moving and walking.
• There is no restriction on your physical activity. You are allowed to walk as soon as you recover from your sleep. There is no restriction on climbing of stairs, lifting weight etc. You may even drive two wheelers or car as soon as you feel fit. This infact is one of the major advantages of the laparoscopic procedure.
• You will be discharged on the same day or next day of operation unless there is some associated medical/social problems. You are advised to visit again for follow up after 2-5 days when the dressings are removed. You should avoid wetting the dressings unless they are waterproof. After the removal of dressing, you can have normal bath with soap and water.
• In very few cases there may be some bloody/whitish discharge from the wound in the post operative period. This should not bother you because it is generally harmless. You can wipe the discharge and apply band-aid so as to avoid staining the clothes. If it is more you should report to the surgeon during the next visit. Please feel free to ask any question that may come to your mind.