FAQ'S

Dr. Siddharth Nigam
MBBS, MS, FIAGES, FALS (Robotic)
Senior Consultant General & Laparoscopic Surgeon

Clinic Adress – 125, First Floor, Splendor Trade Towers, Golf Course Extension Road, Sector 65, Gurugram.

Contact Number – 9910926147

Email – drsiddharthnigam@gmail.com

Laparoscopic Surgery (also known as Keyhole surgery , Minimal Access Surgery , Minimally Invasive Surgery , Endoscopic surgery).

Question 1 What is Laparoscopic Surgery ?

Answer. It is surgery of the abdomen , where in few small holes are made in the abdominal wall and using specialised instruments, the required operation is performed.

The benefits are as follows:
1. Less pain as size of incisions is much smaller.
2. Smaller incisions , 0.5 to 1 cm each , 3-4 in number depending upon the procedure.
3. Faster recovery and early discharge from the hospital , 1 to 2 days for most procedures.
4. Cosmetically superior to open surgery scar.
5. Less chance of post operative hernias.
6. Less pain as size of incisions is much smaller.
7. Earlier return to normal life and work.

Risks are as follows , most are common to any kind of surgery whether open or laparoscopic :
1. Chances of bleeding.
2. Infection.
3. Conversion to Open Procedure  – If for any unforeseen reason operation is not feasible by laparoscopic approach , then in the best interest of the patient , to avoid complications , surgery is converted to open procedure and the operation is completed.
4. Injury to surrounding structures.
5. Anaesthesia (General Anaesthesia) related complications.

It is done under General Anaesthesia.

Q. What are the surgeries that can be performed laparoscopically ? 
A. Common Laparoscopic general surgical procedures are :
1. Laparoscopic Cholecystectomy – Removal of gallbladder , commonly in case of symptomatic gall stones.
2. Laparoscopic Appendicectomy – Removal of appendix in case of acute appendicitis.
3. Laparoscopic Hernia Repair – Hernia repair in case of groin / incisional / umbilical / hiatus hernias .
4. Laparoscopic Varicocoelectomy – For Varicocoele.
5. Diagnostic Laparoscopy and biopsy – In cases where diagnosis is not confirmed by radiology investigations (X Ray ,Ultrasonogram , CT Scan , MRI).
6. Laparoscopic Bariatric Surgery (Weight Loss Surgeries) eg.  Laparoscopic Sleeve Gastrectomy , Laparoscopic Gastric Bypass.

Gallstones And Their Management.

Question 1 What is a gall bladder and it's function ?

Answer. Gall bladder is a pear shaped organ situated under the liver. It’s function is to store the bile which is produced by the liver . Bile helps in the digestion of fats. Gall bladder squeezes out the
bile , through the bile ducts into the intestines when one eats a fatty meal. 

Answer Gallstones or gall bladder stones , which are formed in the gall bladder when the bile contains too much cholesterol or bilirubin or when the gall bladder does not empty properly. They can be single or multiple ranging in size from very small to large (2-3 cms in size).

Answer Common symptoms are abdominal bloating , acidity , indigestion , nausea. In cases of severe infection ( acute calculous cholecystitis) , it can cause severe pain abdomen , vomiting , fever requiring hospitalisation. Sometimes gall stone do not cause any symptoms and are termed as ‘Silent’ stones.

Answer Gallstones are commonly diagnosed with the help of a Ultrasonogram of Abdomen. Certain blood tests are also done to see for obstruction / complications caused by gallstones eg. Liver Function Tests , Complete Blood Counts , Serum Amylase etc.

Answer Surgery is the mainstay of the treatment. Now days it is done by Laparoscopic method. Procedure is called Laparoscopic Cholecystectomy. In this the gall bladder along with the gall stones are removed. It is done through 3-4 small holes in abdomen. Patient is generally discharged the next day of the surgery. Patient can resume normal life in 2-3 days after operation.

Hernias And It's Management.

Question 1 What is a Hernia ?

Answer. Hernia is a protrusion of a body organ through a weak area or a natural orifice through which it does not pass normally. Although there are various kinds of hernias , but generally when one talks of a hernia they are referring to a groin hernia (inguinal hernia). It may be congenital (since birth) or acquired in nature. There is usually a bulge which may or may not be associated  with pain.

Answer Symptoms are bulge or swelling in the groin or anterior abdominal wall , which increases on walking , running , coughing or exertion and decreases on lying down. Swelling may or may not be associated with pain. If the pain is severe and the swelling does not reduce on lying down , then it may indicate that the hernia is getting complicated, which is known as strangulation.

Answer At present there is only surgical cure of a hernia ie. hernia repair by operation.

Answer. The common factors are as follows :
     a. Lifting very heavy weights regularly.
     b. Straining due to chronic constipation , prostate enlargement.
     c. Excessive cough.
     d. Smoking which causes deficiency of collagen tissue leading to weakness of abdominal wall

Answer. The aim of hernia surgery is twofold :
a. To replace the protruded organ back into abdominal cavity.
b. To repair the weak abdominal wall through which protrusion occurs.

 

Answer. There are two ways of doing a hernia repair :
      a. Open Repair (conventional) .
      b. Laparoscopic repair.
Based upon the patient , type of hernia , size of hernia and various other factors the surgeon decides on which type of repair is best for the patient.

 

Answer. Open repairs are usually done under Spinal or Local anaesthesia. Laparoscopic repairs are performed under General Anaesthesia.

 

Answer. Usually the operation takes around 40 – 45 minutes.

 

Answer. Usually uncomplicated hernia repairs are done as Day Care Surgeries ie. patient goes home the same day. But sometimes admission for one day is required.

 

Answer. Usually within 5-7 days after surgery.

 

Answer. The  following may occur :
      a. Size of hernia keeps on increasing.
      b. Pain increases.
      c.  It may get strangulated ie. bowel may get stuck and due to decreased blood supply may become gangrenous. In this condition major surgery may be required which involves opening up of the abdomen (laparotomy) , and then removing the gangrenous bowel. It is an emergency surgery. It is a dangerous and life threatening condition.

 

Answer. Usually after 10 days.

Answer. Following are the precautions :
       a.  Avoid heavy weight lifting till 2 months after surgery. By heavy we mean anything more than 8-10 kgs.
       b. Avoid constipation , straining when passing stools. For this a laxative is also prescribed post surgery.
       c. Avoid straining while passing urine , if due to prostate enlargement in men , should be managed.

Answer. After 10 days.

 

Answer. Once a hernia has been diagnosed it should be operated upon as soon as possible , else the chances of complications increase, as mentioned above.

 

Haemorrhoids (Piles) and It's Management

Question 1 What are haemorrhoids?

Answer. Haemorrhoids and Piles are the same thing. Haemorrhoids are dilated or swollen blood vessels located in and around the anus. They are of two types ;
    a. Internal haemorrhoids , located inside the anus.
    b. External haemorrhoids , located on the exterior opening of the anus , these can also be felt by the patient.

Answer. Symptoms of haemorrhoids are as follows. All may or may not be seen in every patient :
       a. Bleeding from anus while passing stools.
       b. Pain associated with bleeding.
       c. Itching around anus.
       d. Swelling palpable at anal opening , or swelling comes out after passing stools then reduces on it’s own or may need to be manually reduced.

 

Answer. Management of hernias is by two methods :
      a. Conservative management – using medicines , dietary and lifestyle changes.
      b. Operative management – by surgery.

Answer. Surgery is required when no relief is obtained by medicines or when the symptoms are severe like large amount of bleeding , huge piles .

Answer. Advantages of stapler are:  
     a. Faster recovery. 
     b. Minimal discomfort . 
     c. No external cuts . 
     d. No dressings required.

Answer. Though there are a few procedures but the commonest are the following two :
      a.  Conventional haemorrhoidectomy, where haemorrhoids are excised .
      b.  Stapler haemorrhoidectomy where haemorrhoid tissue is removed using a device called Stapler. It is a new procedure and has gained immense popularity.

 

Pilonidal Sinus and It's Management

Question 1 What is a pilonidal sinus?
Answer. Pilonidal sinus is a condition where there is one or more holes or openings in the natal cleft (area between the buttocks around the tailbone) . It may be associated with hairs protruding out of the opening.  It may be painful associated with pus discharge from the opening.

Answer. It is usually seen in obese , hairy men. As sometimes due to sweat accumulation and lack of proper hygiene of the region can lead to infections (abscesses) which can further lead to pilonidal sinus (if not managed well).

Answer. First is clinical examination by a General Surgeon. Sometimes MRI is also used to know more details about the sinus.

 

Answer. Surgery is the treatment of choice. There are two methods :
a. Open Procedure – In this the pilonidal sinus is excised and the wound is left open to heal with regular dressings.
b. Closed Technique – In this after removal of pilonidal sinus , the wound is closed with stitches.

 

Answer. Closed technique is preferred as post removal of sinus , wound is closed , stitches are removed around 10th day. In the open procedure patient has to get regular dressings which are sometimes painful and wound also may take long time to heal.      

Please remember, the information provided here is not a substitute for
professional medical advice. It is indicative of what happens in a general
sense, and may not be applicable to every patient. If you need further
information, please ask your doctor.

Scroll to Top