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MINIMAL ACCESS BARIATRIC & GI SURGERY

 
Laparoscopic Cholecystectomy (Gall Bladder Surgery)

Laparoscopic removal of Gall Bladder is called as Lap Cholecystectomy. This is very common surgery and removal of Gall Bladder Laparoscopically is most safe and effective way to treat Gall Bladder Stone. We are among the few surgeons who are doing this surgery by Single Incision also (SILS) Technique.
This is done under General anaesthesia procedure is surgery 30mins or less. After Gall Bladder is removed, the Bile will flow Liver through common Bile Duct to intestine and will mix up into food. No side effect of removing GB on food.


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Advantages of Lap Chloe:

Common Bile Duct Stones (Laparoscopic & Endoscopically)

Bile Duct Stone is known as choledocholithiasis. This means the stone is present in Common Bile Duct. Stone can be formed in Bile Duct and Gall Bladder once stone is stuck in Bile Duct it causes blockage and requires the interaction to remove the stone else it will cause damage to liver or pancreases.
We provide the world's latest minimally invasive Technique to deal with Bile Duct Stones.

Symptoms of Bile Duct Stones:


Treated Bile Duct Stones:

Laparoscopic Hernia Surgery (All types of Hernia)

Hernia is bulging or tearing of inner layer of abdominal wall when it gets weakened. Through which Balloon like Swelling comes out containing intestinal content, intestinal or abdomen. This causes abdominal pain and other serious symptoms. Both sexes can have hernia. There are two reasons of hernia:

 

Direct & Indirect Ingunial Hernia
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Ventral Hernia
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Symptoms of Hernia:

Laparoscopic Hernia Repair (Minimally Access Surgery)

Laparoscopic Hernia repair is most safe and reliable in comparison to open Hernia repair when perform for expert in Laparoscopic Surgery.
Lap hernia repair is done, decrease GA by making few small incisions is made between Belly button and by inserting laparoscopic the scars are very small which disappear after few days. Through these small incisions Hernia Surgery is done and mesh is placed to correct the Hernia defect and fixed with fixation device.

Advantages of lap Hernia:

LAPAROSCOPIC APPENDECTOMY

The appendix is vestigial organ the inflammation of Appendix is called Appendicitis. Appendicitis is tubular structure of about 3-4 inch long.
Acute Appendicitis is an emergency once it develops patient need to undergo emergency Lap Appendectomy else it may get pert orated and may cause peritonitis i.e.: spillage of infections material into abdominal cavity. If not treated it can be fatal i.e.: dangerous to life.

Only surgery is the treatment of Appendicitis called as Appendectomy. Procedure is done by laparoscopic or mini laparoscopy using 5mm telescope or 3mm telescope by small 3 insecisions. We are amongst few centres in Delhi who is doing mini laparoscopy and SILS procedure for appendix. Procedure is 30 mins. Patient can be discharge next day.


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Symptoms of AC Appendicitis:

ANAL FISSURE

Anal fissure is creaks or tear in Rectal and Anal Mucosa. It may be acute or chronic. Anal fissure is primary due to trauma.

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Symptoms

Treatment:

This is minimally invasive surgery to treat the patient of Rectal Prophase and patient having obstructive defecation syndrome (ODS).
In this procedure excess of rectal tissue is removed by tiring two staplers. One for above and another for below prophase mass. This is advancement of stapled Haemorrhoidectomy to remove Excess Rectal Tissue.

VAAFT (Video Assisted Anal Fistula Treatment) Surgery

VAAFT is the recent and best way to treat Recurrent and High Fistula in Ano. VAAFT is a day care procedure. Refuses Expertise to do the procedure. It is having a 7mm scope and other tiny instruments to do the procedure and a electro cautery which burns the fistulas tract and give which seals. Results and extremely good.

Stapled Haemorrhoidectomy MIPH (Minimally invasive Procedure For Piles)

Haemorrhoids is collection of swelling vein along with the prolapsed mulosa. This is also called as piles in simple words. If Haemorrhoids mass is inside called internal Haemorrhoids and if vein is swollen outside called external Haemorrhoids. Normally patient has both internal and external Haemorrhoids.

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Symptoms of Haemorrhoids:

MIPH allows following advantages:

In MIPH a stapling device removes the piles mass. It cuts and staples at the same time so no bleeding is there after surgery. This device is invented by Dr. Antonio Longo IN 1995.

Oesophagectomy (Cancer of Oesophagus)

Oesophagus is also called as food pipe. The surgery to remove a part of Oesophagus or complete removal is called Oesophagectomy. We are doing Oesophagectomy by minimally invasive technique. Laparoscopically removal of oesophagus or part of it and using stomach or part of large intestine to reconstruct it depending upon the stage of tumour Oesophagectomy is decided.

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There are 3 types of Oesophagectomy techniques.

Laparoscopic Surgery for Hiatus Hernia. (FUNDOPLICATION)

Laparoscopic Hiatus Hernia repair with Nissan's fundophcatious (for Hiatus Hernia and reflux). Hiatus hernia is a disease in which there is a chronic heart burn because of acid reflux from stomach to oesophagus due to in competent lower oesophagus sphincter. In Hiatus Hernia when stomach or its part slides into chest this causes and refluxes. We are doing this procedure very commonly.
This procedure is done laparoscopic ally in which Gastroesophageal junction is dissected hiatus is repaired with sutures or Mesh Depending upon the size of detect in crura and a wrap from the top of stomach to the lower end of stomach to treat a artificial value which prevents the refuse.

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Advantages:

Indication:

Laparoscopic Achalasia Cardia Surgery

Achalasia Cardia is disorder in which there is inability of pumping action of wall of food pipe and also there is loss of ability of valve to relax in response to the food these results into affected undigested food and drinks in food pipe. The main cause of achalasia is degeneration of nerve cells in Oesophagus the exact reason of which is not known.

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Dysphasia and weight loss

Laparoscopic procedure for Achalasia Cardiac is most effective treatment in which muscles of Sphincter is cut under direct vision called Hillers.

Cardiomyotomy

Done laparoscopy with 3-4 small holes in abdomen and it is combined with anti- Refluxed procedure also 1.5- 2 hrs duration of surgery. Hospital stays 2-3days.

Whipple's procedure

Pancreatic cancer is the common cancer which is having poor prognosis. Till the time it shows the symptoms it spreads longer before. Whipple's procedure is a complex surgery which extends the life of patient and has the possibility of curing Pancreatic/ Periampullary Cancer as well. The life Expectancy op patient of Pancreatic Cancer depends upon the site and stage of tumour. The Pt. survival definitely increases by Whipple's procedure.
Whipple's procedure is routinely performed in an centre. In this procedure Head of Pancreases duodenum (Portion of Common Bile Duct, Gall Bladder and sometimes part of stomach) is removed and reconstruction is done. Very few patients are eligible by laparoscopic Whipple's procedure.


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Liver Resections

Surgically removal of part/segment of liver is called liver resection. This procedure is done in case of liver cancer, metastatic growth from colon, rectal cancers: GB Cancers and Certain Begin tumour of liver.

Laparoscopic Liver Cyst Excision (Hydatid & Simple cyst)

All type of liver cysts,we are dealing by laparoscopy.Most commonly hydatid cyst of liver.

Surgery For Portal Hyper Tension

Whenever there is increase in pressure in portal vein it leads to hypertension of vein which carries blood from digestive organs to liver. This portal Hypertension is caused due to blockage in blood flow passing through liver.
This portal Hypertension leads to develop large veins across Oesophagus and stomach to bypass the blockage which leads to vesical Bleed.
First step to step bleeding is medical treatment and endoscopic technique like Sclerotherapy, Banding and Balloon Temponade if failed then minimal invasive or surgical shunt procedure is done. Surgical procedure which is commonly used is:

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Laparoscopy For Pancreatic Pseudocyst

Pancreas is very important organ located behind the stomach. It is spongy tad pole shaped organ having function of making enzymes which helps in digestion of the food and hormone to regulate the blood sugar level.
In case of pancreatitis or pancreatic injury, pancreatic ducts get blocked which leads to formation of pancreatic pseudo cyst.

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Symptoms of Pancreatic Pseudo cyst:

Small Pseudo cyst can be treated consecutively. However when big it refuse follow up treatment.

Most of the cyst refuse surgical interaction. Laparoscopy is the best mode of surgically treated the pseudo cyst.

Laparoscopic For Splenectomy

Laparoscopic splenectomy is a key hole surgery to remove all or a part of your spleen. The spleen is a bean-shaped organ found under the ribs on the left upper side of stomach. The function of spleen is to remove old and damaged blood cells as blood passes through it and also makes immune system cells, known as lymphocytes, which help to fight germs and infections.

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When Splenectomy is advised?

When spleen is damages, it swells and block the flow of blood in your abdomen, causing problems in the multi organs of a body; the most affected is liver. Laparoscopic Surgery of spleen or Splenectomy helps to normalize the flow of blood & to stop the destruction of blood cells. One has to go for this surgery, before condition gets worse or when symptoms appear.
Our team has the expertise of conducting many successful laparoscopic splenectomy with support of his multi- disciplinary & state of the art infrastructure. In a case, the damage to the spleen is too much or the spleen is too big, open splenectomy may be advised by doctor. With surgery, the symptoms may be relieved and further damage to other organs prevented.
Advantages of Laparoscopic Splenectomy?

Laparoscopic For Rectal Prolapse

What is rectal prolapse?
In rectal prolapsed, the lower end of the colon which located just above the anus is called rectum, becomes stretched out and protrudes out of the anus. This condition of rectum is the weakness of the anal sphincter muscle and most of times associated with rectal prolapse, leading to holding stool, leakage of stool or mucus. This condition can be seen in both males and females: however, it has been observed that the incidents rectal prolapse are most common in women than men.
We are, having vast experience to managing & treating complex case of rectal prolapse & we are one of the best Laparoscopic Surgeons in India. After seeing case of Rectal Prolapse. The Rectal Prolapse procedure is aim to repair the prolapse using "keyhole" surgery or minimal access surgery (laparoscopic ally) using state-of-the-art technology our team of doctors perform delicate and complex operations.

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Benefits:

Laparoscopic Colorectal Surgery

We are proud to offer Laparoscopic surgery (surgery through small incisions with the help of special instruments and cameras) for many colorectal disorders. Laparoscopic surgery offers lower rates of wound complications with benefits of less pain and shorter postoperative.

Laparoscopic lleocecectomy

For patients with Crohn's Disease or other conditions, the end of the small intestine (ileum) and the first portion of the colon (cecum0 can be removed to excise a diseased segment. This can often be performed laparoscopic ally with several small incision.

Laparoscopic Right Colectomy

This procedure may be done for a cancer or tumours of the first portion of the colon or for some disease of the appendix. The small intestine is reconnected to the colon after a segment has been excised.

Laparoscopic Left hemi Colectomy

This may be performed for cancers of the tumours of the colon or for diverticulitis. A segment of the colon is removed and the ends reconnected.

Laparoscopic Sigmoid Colectomy

The sigmoid colon is most frequently involved in diverticulitis. Removal of this portion of the colon involves reconnection of the colon to the rectum. The sigmoid may also be removed for cancer or tumours.

Laparoscopic Low Anterior Resection

Removal of some or all of the rectum using Laparoscopic approach is now offered to many patients with rectal cancer or tumours. At times, these procedures require a temporary diverting "protective" ileostomy to allow for healing of these low connections without stool moving through this area.

Laparoscopic Total Proctocolectomy

For some patients with Ulcerative colitis, the entire colon and rectum may be removed laparoscopic ally. Following removal, creation of a pouch using the small intestine may allow one to avoid a permanent end ileostomy.

Laparoscopic Colostomy or IIoestomy

There are situations when diversion of the fecal stream is required. During this procedure, a portion of the intestine is brought out to the skin level so that the stool can be diverted away from bowel downstream.

Laparoscopic Rectopexy

Rectal prolapse is a condition where the rectum bulges out of the anal opening. Repair of rectal prolapse can be accomplishes laparoscopic ally in many cases. The goal of ECU surgeon is to provide safe and effective treatment for each patient.At times, it may be advantageous or safest to have a somewhat larger incision to have a particular procedure. In this case, each of the above operations may be accomplished with open techniques.

Other Procedures

Combined Laparoscopic/ Endoscopic Resections
For benign tumours, which may not able to be removed with colonoscopy alone, at times surgeons may combine colonoscopy with Laparoscopic techniques to remove an advanced polyp or benign tumour.

Trans- Anal Excision
For benign tumours of the middle and lower rectum, excision using instruments through the anus may be offered. This avoids all scars on the skin and allows for a very fast recovery following surgery.

Recovery
This depends on the type of surgery performed. Discharge may be on the day of surgery or up to a week after surgery depending on each patient's particular situation. With Laparoscopic techniques, discharge within 3 days of surgery is common even with major operations. Patients are expected to be out of bed and walking in the first day after surgery. This early mobility helps make early discharge possible.

LAGB (Laparoscopic Adjustable Gastric Banding)

LAGB is one of the safest reliable and minimally invasive Bariatric Procedure. We have done many LAGB in which a gastric band is put around the top portion of the stomach through small incisions leaving a small space available for food. This results in feeling of full stomach after eating only small quantity of food. These results in weight loss of the patient in short duration. This Band can be adjustable time to time and even revised according to patient's need.

Characteristics of LAGB

 
LAP SLEEVE GASTRECTOMY

In this procedure about 85% of the stomach is removed laparoscopic ally. In this procedure the stomach is reshape into the form of tube or sleeve. The function of stomach is preserved by not alterative the outlet valve and valve of the stomach.

We have performed hundreds of Lap Sleeve Gastrectomy with Excellent results. The excessive stomach is removed and about 15-20% of original stomach is removed inside in tube shape. This is a restrictive procedure without altering the absorption of Minerals & Vitamins. It reduces the chance of developing ulcer.

Types of Procedures

 
LAP GASTRIC BYPASS

Gastric Bypass is most Common Bariatric Procedure. This is also called as "Roux- en-Y-Gastric Bypass" (RYGB). This is believed to the Gold Slandered Procedure by American Society for Metabolic & Bariatric Surgery and National Institute of Health. We perform RYGB Routinely with Multidisciplinary team with excellent results.

This is done laparoscopic ally by 5 small incisions. A small stomach pouch is created which restricts the food intake. Then a section of small intestine is cut and attached to small stomach pouch allowing the food to bypass the lower stomach. By restricting food intake and by decreasing the absorption of food by excluding most of the stomach, duodenum and upper intestine from contact with food & by re-routing food directly from pouch into the small intestine this procedure has excellent results in reducing weight loss in obese patient. In this procedure food is by passed through newly created channel and reduces the amount of calories and nutrients as the body absorbers.

In Gastric Bypass Type-2 DM is resolved 84% increased in BP-75% and high cholesterol -95%.

 
Mini Gastric Bypass

It is a Laparoscopic Gastric Bypass. In which size of stomach is reduced and small intestine is attached to Pouch of Stomach. Compare to Roux-en-Y Gastric Bypass weight loss is similar.



 
Revisional Laparoscopic Bariatric

This procedure is for the patient who has already under gone Bariatric Surgery. But somehow if desired weight loss is not achieved or any other complication has occurred because of previous surgery the Revisional Bariatric Surgery is done. Revisional Surgery carries higher risk of pre operative complications as compare to previous surgery but it is safer to do by a experienced surgeon and high volume canters.

Procedures for Revision

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