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General surgery is frequently performed to alleviate suffering when a cure is unlikely to be achieved through medication alone. General Surgery also includes routine and simple procedures performed in a physician's office, as vasectomy, or for more complicated operative procedures requiring a skilled medical team in a proper hospital setting, such as laparoscopic cholecystectomy (removal of the gallbladder). |
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Areas of the body treated by general surgery include the stomach, liver, intestines, appendix, breasts, thyroid gland, salivary glands, some arteries and veins, and the skin. The brain, heart, lungs, eyes, feet, kidneys, bladder, and reproductive organs, to name only a few, are areas that require specialized surgical repair. |
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Laparoscopic surgery, also called Minimally Invasive Surgery (MIS), Keyhole surgery, or Pinhole surgery. This is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5cm) as compared to larger incisions needed in traditional surgical procedures. Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy. |
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There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include: |
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Reduced blood loss, which reduces the risk of needing a blood transfusion. |
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Smaller incision, which reduces pain and shortens recovery time. |
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Less pain, leading to less pain medication needed. |
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Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living. |
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Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections. |
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The process of minimally invasive surgery has been augmented by specialized tools for decades. However, in recent years, electronic tools have been developed to aid surgeons. Some of the features include: |
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Visual magnification - use of a large viewing screen improves visibility. |
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Stabilization - Electromechanical damping of vibrations, due to machinery or shaky human hands. |
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Simulators - use of specialized virtual reality training tools to improve physicians' proficiency in surgery. |
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Reduced number of incisions. |
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General Surgery at Shalby |
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All general surgical operations are done Shalby Hosptials. |
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Many surgeries like Hernia and Piles surgeries are done as 'Day Care Surgeries'. |
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Advanced Laparoscopy and Endoscopy equipment makes minimally invasive surgeries possible. |
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Four dedicated general surgery operationn theatres with state of the art post operative intensive care units. |
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Piles Surgery |
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| Before Surgery |
Stapler |
After Surgery |
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What is Piles? |
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Piles is often feared as the tumour of the anus. Actually, piles is not tumourous and not dangerous. It is a simple enlarged / engorged blood vessel(s) of the anus. It is also called haemorrhoids in medical terminology. It is the dilatation (varicosity) of the haemorrhoidal plexus (veins of anus). It appears as bluish or purple coloured swellings due to stagnated blood. Piles may cause symptoms like bleeding, itching, pain and lump feeling in the anus.
Blood vessels are supposed to suffer with varicosity, when there is obstruction or resistance/ sluggish or reduced or back flow of blood / valvelessness, etc. Varicosity is often noticed in the legs of pregnant women or policemen or in persons whose job/habit is to stand continuously for a prolonged period. Veins of the legs are most commonly affected with varicosity, since it is the most dependent part of the body, where the gravitational force constantly gives pressure with stagnation. Other than varicosity of legs, the next commonest spot of varicosity is the anus since it has a cluster of loosely supported blood vessels anastamosing (joining) systemic & portal (liver) circulation. These blood vessels have no valves to avoid back flow and is more prone to varicosity.
Piles patients mostly suffer silently with their complaints due to shyness to explain or show the thing to the doctor. They bear the pain and complaints as far as possible and go for treatment only in unbearable conditions, which usually leads them directly to the surgeon’s table. Every complaint should be treated then and there, for easy cure and to avoid progress of the disease into complications. Also, nowadays piles is often misspelled for all anal complaints (fissures, fistulas, rectal tumours, prolapsed anus, etc.) Every complaint should be clearly analysed by examination and investigation before being diagnosed and treated. |
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Incidences – Piles is very commonly seen nowadays. Women have higher incidence than men. The reason behind it is not clearly known. It is more commonly seen in adolescent age group and aged persons who all seem to be more tensed. There must be a relation between piles and tension/psychological factors. Its incidences is more common in persons who deviate more from nature in diet, living style and sitting habits. Sufferers are mostly. |
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- Long sitting travellers
- Sedentary workers
- Alcoholics and those who suffer from liver disorders
- One who suffers often from constipation or diarrhoea
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Anal architecture - is designed in such a manner to control even the release of air (flatus) and watery stools i.e., airtight and leak-proof. It is well-formed with internal sphincter and external sphincter muscles. Anal canal is anatomically divided into two parts (namely upper part and lower part) by Hilton’s line (bluish pink ring). This upper anal part originates from the endoderm and is covered with mucous membranes. The nerve supply of the upper part is supplied from the autonomic nervous system which doesn’t have any pain sensitive nerve fibres. The lower part of the anal canal originates from ectoderm and is covered by skin. Unlike the upper part, it is supplied by spinal nerves which have pain sensitive nerve fibres. The blood supply to upper part of the anus is supplied by superior haemorrhoidal plexus and the lower part is supplied with inferior haemorrhoidal plexus. The occurrence of swelling/varicosity in the anus (piles) is more common in 3 O’, 7 O’ & 11 O’ clock position of anus which are all supposed to be weak points of the anus. |
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Types of Piles |
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Piles is classified in two ways. |
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Internal piles |
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lies inside the anus. Usually internal piles originates from superior haemorrhoidal plexus of the upper part of anal canal and lies above the Hilton’s line. This type usually will not be painful, since it lies in the upper part of anal canal, which lacks pain-sensitive nerve innervations. |
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External piles |
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lies outside the anus. External piles originates from inferior haemorrhoidal plexus of the lower part of the anal canal i.e. it lies lower to the Hilton’s line. This type of external piles is most painful, since the lower part of the anal canal has pain-sensitive nerve fibres. Some piles patients may have both types. Piles can also be classified as |
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Primary piles |
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Occurs due to hereditary reason without any causative factor or obstruction. |
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Secondary piles |
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Occurs in continuation with other diseases or obstruction to portal circulation like liver disorders, portal hypertension due to obstruction, rectal or pelvic tumours, cancer, spleenomegally, etc. |
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Prolapsed piles |
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is the piles which gets descend from the place of origin, i.e. internal piles descends to get visualised as external piles. This prolapsed piles should be cared for in the initial period itself or otherwise it may get strangulated and develop into gangrene. In the initial period, the protrusion gets inside or recedes without any assistance after passing stool, but in due course, the protruded mass will not recede even with the assistance of fingers. |
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Commonly suspected causes for development of piles Pressure in the blood vessels may be due to; |
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Obstruction |
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Physiological – Pregnancy and delivery can cause temporary increase of venous pressure and thus piles can occur. |
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Pathological - Liver and portal vein disorders, pelvic or rectal tumours, cancer, etc., can cause obstruction and lead to piles. |
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Erect postures of man – Animals are flat, but humans had become erect by evolution. This has been considered a major factor for development of piles. |
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Hereditary – piles is often found to run in families. |
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Physical strain – pressure exerted while passing stool, coughing continuously for a prolonged time, weight lifting, etc., can also cause piles & tendency to prolapse and relapse. |
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Foods – Low fibre diet, more Spices, alcohol, lesser intake of water can produce hard stool, which may need of more strain in defecation and thus lead to piles. |
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Defecation – Both constipation and diarrhoea can cause piles. The strain for passing the stool is the main reason for the development of piles in both cases. |
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Habits of alcohol, sedentary life and drugs can also cause piles Worries and mental strain can also cause havoc to the intestines and anus. |
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Hernia Surgery |
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What is Hernia?
A hernia is a protrusion of a structure, through an opening in the wall. The hernia has 3 parts: the orifice through which it herniates, the hernial sac, and its contents. |
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Types of Hernia
Hernia can be classified in a different way:
- Congenital – by birth i.e., development disorders
- Infantile – during infant stage due to weakness
- Senile – due to weakness in elderly persons
- Traumatic – due to injury or strain
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| Inguinal Hernia |
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| Different Herniae |
Different Herniae |
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Further, it can be classified as:
- Bulging
- Sliding
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It can also be classified as:
- Reducible – which get back easily to original position
- Non-reducible – which will not get reduced due to strangulation or obstruction
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According to region
- Inguinal
- Femoral
- Umbilical
- Epigastric
- Hiatus
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| Trapped Hernia |
Strangulated Hernia |
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| Inguinal Hernia (Complete) |
Prolene Hernia System (PHS) |
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| Hernial Path leading to testicle |
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Why do Hernias occur?
Hernia can occur due to strain which can increase the abdominal pressure such as
- Weight lifting
- Gaining weight
- Chronic cough
- Passing urine with great difficulty (enlarged prostate)
- Straining at stool due to constipation, piles, fissure, etc.
- Taking full and heavy meal
- Pregnancy
- Problems occurred due to operation of stomach
- Defect in wall since birth
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PROLENE HERNIA SYSTEM
Developed by M/s ETHICON, after years of research, the two layered mesh Prolene Hernia system - popularly known as PHS, is in the shape of a button. It is inserted at the spot of the Hernia.
The advantages of the use of PROLENE HERNIA SYSTEM (PHS) are:
- The chances of repeated Hernia problems will not occur in patients operated with PROLENE Hernia system.
- It is a tissue tension free repair which provides early recovery.
- Hospitalization is only for a day for patients operated with PROLENE Hernia system.
- Patient can be operated under local anesthesia.
- Patient can resume all work after few hours of surgery.
- There are no stitches and so there is no need of dressing.
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