Surgery: Archives

Piles November 9, 2021

Miph- Latest Treatment Option For Piles

Hemorrhoids are one of the most common anorectal disorders; according to NCBI it affects around 25% to 30% of the population. People of all ages, genders, races, and ethnicities are affected. Piles become increasingly common as people become older, affecting more than half of those over the age of 50. Hemorrhoids are very common, so don’t be shy to get help! Hemorrhoids are bulging, inflated veins that occur in the anus and rectum (Back passage). They can be unpleasant, painful, and cause rectal bleeding. Hemorrhoids, are natural cushions we’re all are born with, although they don’t bother us at first. They only cause uncomfortable symptoms when they become swollen and enlarged, then known as swollen piles.

Hemorrhoids (Piles) are a topic that most people avoid discussing and prefer being silent about. But being silent may prevent you from receiving treatment for a common ailment and which can land you up in severity. Your doctor isn’t shy about bringing up the subject of haemorrhoids, so discuss freely.

When to see the doctor?

Most people think of hemorrhoids as a minor problem, it can be very painful. It is important to know when to treat hemorrhoids on your own and when to seek help, as it can avoid unnecessary complications.

Make an appointment with your doctor if you’re having any of the following symptoms related to your hemorrhoids:

You notice bright red blood on your toilet paper or have rectal bleeding.
Your rectum or anus is causing you agony and discomfort.
You’ve tried over-the-counter medications for more than a week and they haven’t helped you.
You experience a maroon or dark tar-colored bowel movement, which could be an indication of bleeding.
You feel mass outside your back passage

If your rectal bleeding won’t stop and you’re feeling dizzy or faint, it’s a medical emergency that necessitates a visit to the Emergency room (ER).

How do doctors treat Haemorrhoids?

Hemorrhoids are treated by doctors in the office, in an outpatient clinic, or a hospital. Treatment depends on severity. For an initial stage of piles lifestyle changes can help you if given at on right time. For mild piles office procedures can help you. But for severe piles surgery is the only option.

Office procedures for very mild piles:

Rubber band ligation: Rubber band ligation is a treatment that surgeons employ to treat internal hemorrhoids that are bleeding or prolapsing. A doctor wraps a specific type of rubber band around haemorrhoid’s base. The band stops the blood supply. Within a week, the banded component of hemorrhoid shrivels and slumps.
Sclerotherapy: In this therapy, a surgeon injects a special chemical into haemorrhoids, which causes the haemorrhoid to shrink, while also stopping it from bleeding.
Photocoagulation with infrared light: A doctor employs an infrared light instrument to treat internal hemorrhoids. Scar tissue forms as a result of the infrared light’s heat, cutting off the blood supply and reducing hemorrhoids.
Electrocoagulation: A doctor inserts an electric current into an internal hemorrhoid with an instrument. Scar tissue forms as a result of the electric current, cutting off the blood supply and reducing hemorrhoids.

Surgical procedures for moderate to severe piles:

Haemorrhoidectomy: A haemorrhoidectomy is a procedure in which a surgeon removes the prolapse of hemorrhoids (which is coming out from the back opening) by cutting it directly with a scalpel, scissors, or electrical energy source.
MIPH (Minimally invasive procedure for Hemorrhoid): Internal hemorrhoid tissue is removed and the prolapse of the internal hemorrhoid is pulled back into the anus by using a special stapling circular device.

Today, let us know more about MIPH

MIPH (Minimally invasive procedure for Hemorrhoid) or Stapled haemorrhoidopexy is a surgical procedure for treating hemorrhoids. It is the preferred therapy for third and fourth-degree hemorrhoids (a severe form of piles that protrude with straining and are visible on physical examination outside the anal margin. The manual reduction must be done on a regular or irregular basis). Stapled haemorrhoidectomy is a misnomer because the procedure removes the unusually slack and enlarged tissue which supports hemorrhoids that have caused the hemorrhoids to prolapse downward, rather than the hemorrhoids themselves.

A circular, short hollow tube is introduced into the anal canal for stapled haemorrhoidopexy. A suture (a long thread) is woven circumferentially through the anal canal above the internal hemorrhoids through this tube. The stapler (a disposable instrument with a circular stapling device at the end) is inserted into the hollow tube, and the suture ends are brought together and pulled inside the stapler along with prolapsed hemorrhoids. Stapler when fired causes cutting of slack tissue and stapling of hemorrhoids back to their original position.

Patients who undergo a minimally invasive procedure for hemorrhoids (MIPH)/ Stapled Haemorrhoidopexy benefit from the following:

Return to work as soon as possible
There is very little discomfort
There are no cuts, hence there are no dressings required
There are no follow-ups
Released from the hospital in a day

Comparison between MIPH and Conventional Haemorrhoidectomy

Haemorrhoidectomy is a procedure that removes hemorrhoids from the body. You will be given general or spinal anesthesia to prevent you from feeling discomfort. Around hemorrhoids, incisions are made in the tissue. To prevent bleeding, the enlarged vein inside the hemorrhoid is tied off, and the hemorrhoid is removed. It is possible to suture the surgical area to shut it or leave it exposed. The wound is covered with medicated gauze. A knife (scalpel), an electric tool (cautery pencil), or a laser can be used to do surgery. In most cases, the procedure is performed in a surgical center. You’ll probably return home the next day or more.

Stapler Haemorrhoidectomy / MIPH (Minimally Invasive Procedure for PILES) is a procedure where an expert surgeon employs stapling equipment to remove a portion of the pile mass with a staple gun, addressing two major concerns: bleeding and prolapsed hemorrhoids. The titanium staples not only cut but also seal at the same time, which lowers bleeding and post-operative pain. Because no extra incision on the lower region of the anal canal is necessary, the patient does not require any post-operative dressing. A patient can return home the same day and resume normal life in a day or two.

The most prevalent complaints of piles are painless rectum bleeding and haemorrhoidal prolapse, painful defecation. When compared to open haemorrhoidectomy, the average length of surgery for MIPH and post-operative bleeding is much shorter. The postoperative pain score and subsequent need for analgesics are significantly lower in the MIPH. MIPH patients have a faster average wound healing time and a quicker return to routine activities. Less recurrence or incontinence is observed. Similarly, there are no significant differences in long-term problems between MIPH and traditional open haemorrhoidectomy in patients with MIPH.

MIPH is a frequently used and safe procedure for grade III and IV hemorrhoids. It results in less pain, a shorter hospital stay, and fewer early postoperative problems. Wound healing and return to normal activities are faster, and long-term problems are not significantly different.

Knee Replacement October 27, 2021

5 Things To Know About Robotic Knee Replacement Surgery

Knee replacement, also known as knee arthroplasty, is a surgical procedure done to reverse knee damage, to relieve pain and disability caused by conditions such as arthritis. For people suffering from severe knee pain caused by osteoarthritis, rheumatoid arthritis, or any other similar ailment, knee replacement surgery may be able to offer relief. Whether you need to undergo a surgical procedure or not is a decision that you and your doctor will collectively take.

The procedure for knee replacement involves cutting away the damaged bone and cartilage and replacing it with an artificial joint made of metal or plastic polymer.

The treatment methods for arthritis and other conditions as such are advancing day by day and providing better and more optimal long-term relief. This is where the futuristic robotic knee replacement surgery comes in. A lot of people have queries about the procedure and its after-effects. Here are 5 important things you should know about Robotic Knee Replacement Surgery.

A robot does not perform the surgery

The robotic technology’s state-of-the-art 3D software lets your surgeon design and plan the surgery much in advance, making necessary adjustments in real-time to provide a more precise alignment of the implant as compared to conventional non-robotic partial knee replacement.

While up to 20% of patients are not happy with the outcome following Knee Replacement surgery, the use of a robot as an additional surgical tool helps the surgeon during all stages of the knee replacement surgery and helps in delivering the best possible outcome.

Improved accuracy

Robotic assistance technology enhances the surgeon’s expertise, preventing accidental surrounding tissue damage aiding in greater precision during surgery. It helps the surgeon to pre-plan bone cuts and implant sizes, unique to your anatomy.

The 3D images of the knee obtained through a CT scan help the surgeon to specialize and prepare for the surgery. These images help the doctor to plan for the optimal type of implant and the accurate placement of the same. Robotic knee replacement surgery acts as a guide, helping your surgeon to follow a laid-out plan much in advance, as compared to traditional knee replacement surgery.

Faster Recovery

The robotic arm helps with lesser tissue trauma as well as minimal bone and blood loss, as it follows the specified dimensions set before surgery. This helps with faster recovery and lesser post-operative pain. It also allows the implant to be placed with precision, therefore increasing the overall longevity of the new joint. Due to greater accuracy, there are fewer complications and hence a lower chance of revision surgery.

Candidature varies

If you are a candidate for traditional knee replacement surgery, chances are you are a likely candidate for robotic knee replacement surgery. It is equally important to talk with your doctor to evaluate your surgical and non-surgical options.

Depending on the severity of your condition, your doctor may or may not recommend surgery. They might also recommend less invasive treatment methods first like anti-inflammatory medications, weight loss through diet or exercise, physical therapy, cortisone shots, and or knee braces. If these are unable to help significantly, knee replacement surgery may help. Robotic knee replacement means more accurate implant positioning, which is a plus for middle-aged patients who can undergo knee replacement surgery and get back to their usual active lifestyle.

Having said that, it is always recommended to discuss all the possible options with your surgeon, irrespective of your age, and then opt for knee replacement surgery is suggested.

Lesser Risk

With traditional surgery, there is only a 2% chance that serious complications may occur. Robotic knee replacement surgery comes with the same risks as traditional knee replacement surgery, namely:

Infections

Nerve damage

Allergic reactions to the materials used in the artificial joints

Deep vein thrombosis (blood clots)

Although robotic knee replacement procedures require a smaller incision and potentially can be performed with greater accuracy, doctors are hopeful that these risks can be significantly reduced.

Because knee replacement surgeries have been using the traditional approach way longer than the robotic approach, more benefits of robotic joint replacement surgery are yet to be understood and validated with data. Need for more research is essential to determine whether or not robotic-assisted technology is as effective for total knee replacement. Robotic Knee Replacement Surgery is all about optimal execution and implant positioning, which leads to a better and faster recovery. So, make sure you take your doctor’s advice and make an informed decision.

Knee Replacement October 7, 2021

Traditional Vs Robotic Knee Replacement Surgery

Do you often skip taking the stairs and opt for elevators because of your knee pain? Does walking few meters feels like too much? If so then you are not alone, you are one of the millions of people who have been suffering from chronic knee pain. There is no point in sugar-coating it as we all know knee pain ruins the fun in life. The positive news is there are options available for those who are suffering from pain. At first, most doctors will try to treat in non-invasive ways that are non-steroidal anti-inflammatory drugs, therapy, or these days even stem cell-derived growth factor injection but if your knee pain is disabling and alternative treatments are not working, knee replacement surgery might be the best route for you.

A knee replacement surgery can be life-altering for patients with knee pain. This surgery eliminates pain and helps restore mobility so that the patients can resume their active lifestyle. A knee replacement surgery might sound intimidating but advanced technology has made this procedure more effective with the best outcomes. This can be performed in a conventional way where the surgeon seats the implants manually or with the assistance of a robotic arm controlled by the surgeon. Let us understand the difference between these procedures so that they can help you be more at ease.

Traditional Knee Replacement Surgery

Traditional knee replacement surgery has been existing for more than 70 years. This technique typically replaces only a part of the joint. Based on the x-ray an experienced surgeon will carefully examine the correct alignment and positioning for the metal implant. The surgeon then cements the prosthesis and all this is done manually by a surgeon. This replaces the damaged part of the knee which results in more natural feeling and movement. It facilitates quicker recovery and returns to normal activities.

Conventional knee replacement surgery started a revolution in the medical sector and with advanced research and development new forms of surgery have come up to benefit the patients in a better and effective way. It is one step ahead of traditional knee replacement surgery. With the intervention of robotics in medical science it has given another direction, it has touched the orthopedic sector and has proven beneficial in bringing effective results for the patients undergoing robotic knee replacement surgery.

Traditional Knee Replacement Surgery

Heart Attack September 28, 2021

USE HEART TO CONNECT – WORLD HEART DAY

World Heart Day is celebrated on 29^th September every year, to spread awareness on Cardiovascular Diseases and other heart conditions, while emphasizing the importance of heart health and how to maintain it.

Cardiovascular Diseases (CVDs) are the leading cause of death globally, and claim about 17.9 million lives approximately every year, according to the World Health Organization (WHO). World Heart Day provides an ideal platform for those suffering from CVDs to fight against it and reduce the global burden of the disease.

Created by the World Heart Federation, World Heart Day is a global campaign that informs people about the risk of cardiovascular diseases and highlights the actions one can take to keep heart diseases at bay.

World Heart Day 2021

This year, the theme of World Heart Day is Use Heart to Connect, which urges everyone to use their knowledge, influence, and the power of digital media to connect to the global community and ensure that everyone gets a chance to live a heart-healthy life.

COVID-19 has brought about a drastic change in the world and has posed a serious threat to everyone, making us increasingly aware of the importance to protect our health as well as that of our loved ones. For those living with CVD, COVID-19 has put them in a compromising situation, as they are at a higher risk of contracting the virus.

The goal of World Heart Day 2021 is to harness the power of digital health to improve awareness of the prevention and management of CVD, on a global level, with the help of three key pillars – equity, prevention, and community

Equity:

Due to the lack of internet facilities among half the world’s population, awareness on CVD prevention, treatment, and control are unavailable. It is important to use technology and data to bridge this gap with the use of digital tools and enable better prevention, diagnosis, and treatment of heart-related diseases.

Prevention:

Prevention is better than cure, To maintains a healthy heart, follow a healthy diet, avoid alcohol and tobacco abuse and follow a regular exercise regimen. If you are diagnosed with an underlying health condition such as diabetes, high blood pressure, obesity, or more, ensure regular check-ups with your medical practitioner.

Community:

According to the World Heart Federation, over 520 million people are living with CVD across the globe, and have been severely affected due to the COVID-19 pandemic, as they are highly prone to the infection, and have to be isolated. This has resulted in missing medical follow-ups and appointments, lack of contact with people, and reduced exercise. Through digital networks, those who are vulnerable can easily connect with their families, friends, and even doctors for support.

What are Cardiovascular Diseases (CVDs)?

Cardiovascular Diseases (CVDs) refer to the set of conditions that affect the functioning of the heart and blood vessels such as:

Arrhythmia:

Arrhythmias refers to abnormal heart rhythms. In this condition, the heart either beats too slow or too fast. Bradycardia occurs when the heart rate is too slow (less than 60 beats per minute) and Tachycardia occurs when the heart rate is too fast (more than 60 beats per minute). When an arrhythmia occurs, the heart may not be able to pump enough blood required by the body.

Aortic Disease:

Aorta is the large artery through which oxygen-rich blood flows to the rest of the body. Sometimes, the aorta may widen or tear, which leads to a condition called Atherosclerosis. This condition develops when plaque builds up in the walls of the arteries, making blood flow difficult. This may even lead to a heart attack or stroke.

Heart Attack:

This occurs when blood flow to a part of the heart is blocked by a blood clot, leading to a lack of oxygen.

What are the risk factors of CVDs?

Some of the major risk factors of Cardiovascular Disease include:

High cholesterol levels
Diabetes
Lack of physical activity
Tobacco consumption
COVID-19

How can you prevent Cardiovascular Diseases?

There are several risk factors associated with CVDs such as the family history of heart diseases, that cannot be prevented or helped. However, certain risk factors such as high blood pressure, diabetes, cholesterol levels can be treated on time, reducing the risk of CVDs. If you are a frequent consumer of tobacco and alcohol, reducing the consumption of these can also help prevent heart diseases. It is also important to make several lifestyle changes such as a regular physical activity routine and incorporating a healthy diet, which will also help keep heart diseases at bay.

Some tips to keep the heart healthy

Now that we know the importance of keeping the heart healthy and how CVDs can affect our health drastically, here are some tips one can follow to ensure that the heart remains in a good shape. They are:

Eat Healthy: Avoid foods that are extremely rich in fat content, and eat fiber-rich foods. Also, make sure that you eat in moderation.

Get Active: It is also important to have a regular exercise routine and stay physically active. Also incorporate regular movement if your job requires you to sit at a desk for long hours, and maintain a healthy weight.

Quit Smoking: It is a well-known fact that smoking is one of the main causes and risk factors of heart disease. If you are a regular smoker, quit smoking immediately and avoid the risk of CVD.

Overall, it is extremely necessary to maintain your health and go for regular follow-ups if you have underlying conditions such as diabetes or high blood pressure. Though there are several treatment methods for different types of heart diseases, making certain lifestyle changes will ensure that you don’t develop the risk of CVDs at all. Remember, prevention is always better than cure!

Aortic Stenosis/TAVR/TAVI September 18, 2021

Dr. Karun Behal – Prevalence Of Aortic Stenosis In Elderly Population

When it comes to ailments of the heart, Aortic Stenosis (AS) is one of the most common diseases, especially when it comes to senior citizens. It occurs when the opening of the aortic valve gets narrowed. Through the right intervention, Aortic Stenosis can be tackled. But to do so, one needs to know what the ailment entails.

As mentioned, Aortic Stenosis is a disease that is more likely to occur among the elderly. That is why, on the eve of Senior Citizens Day, Dr. Karun Behal (MD, DM – Cardiology), Senior Consultant – Cardiology, Fortis Mohali, held a live session online where the specialist shared some vital insights on the ailment and various interventions that can be used to surpass it. Read on to know these key pointers from the live session.

To start with, what is Aortic Stenosis?

In aortic stenosis, the Aortic valve doesn’t open completely, restricting the blood flow from the left ventricle of the heart to the aorta and the rest of the body. It may also affect the pressure in the left atrium.

The aortic valve has three leaflets, and it separates the aorta from the left ventricle. The main function of the aortic valve is to open and allow blood flow from the left ventricle of the heart to the aorta, through which blood flows to the rest of the body. It also prevents the backflow of blood from the aorta to the left ventricle. Aortic stenosis happens when the valve doesn’t open up completely, which in turn reduces or blocks the blood flow. Dr. Behal also mentioned that aortic stenosis is more prevalent in the elderly population.

How is Aortic Stenosis diagnosed?

Dr. Behal opined that to treat this condition, it is important to determine if the symptoms are mild, moderate, or severe. Depending on the severity of the condition, the right treatment method is suggested.

Aortic stenosis can be diagnosed clinically, where your doctor will use a stethoscope to look out for heart murmurs that may suggest an aortic valve condition. The doctor may also run several tests such as Echocardiography, which uses sound waves to create images of your heart. Echocardiography can also show the doctor how blood flows through the heart valves, and if there is an interference in the blood flow.

What are the symptoms of Aortic Stenosis that one needs to look out for?

Most cases of aortic stenosis are asymptomatic, or the symptoms are visible only during the later stages. Some of the most common symptoms of aortic stenosis are:

Heaviness/pain in the chest while indulging in physical activities
Shortness of breath
Fatigue
Dizziness
Palpitations

If these above-mentioned symptoms are persistent, it is important to talk to your medical practitioner immediately to diagnose aortic stenosis.

How is Aortic Stenosis treated?

Initially, aortic stenosis was treated through medications such as pain killers, blood thinners, and medicines that kept cholesterol levels and blood pressure in check, but it did not work on people with severe aortic stenosis. But nowadays, with the advancements in the medical field, severe aortic stenosis can be treated. Some of the most common treatment methods for aortic stenosis are:

Surgical Aortic Valve Replacement (SAVR): Surgery is one of the most popular methods to treat aortic stenosis. This is usually done through an incision in the chest. People who have undergone surgery for aortic stenosis have a better survival rate. However, surgery may not be recommended to elderly patients with aortic stenosis as it may lead to several health complications.

Transcatheter Aortic Valve Replacement (TAVR): This is a less invasive procedure for those who are at a higher risk of complications from surgical aortic valve replacement. In this procedure, the damaged valve is replaced with a bioprosthetic valve.

What are the advantages of TAVR?

TAVR is a huge advancement in the field of medical sciences in the past 15-20 years. Due to its less invasive nature, TAVR has replaced open-heart surgeries. At first, TAVR was recommended to only those patients who were unfit for surgery. An open heart surgery involves attaching a heart-lung bypass machine to the patient and opening the chest cavity, which may lead to several complications. Post-surgery, the patient would have to be under observation for 10-12 days, and the recovery would take about 1 – 2 months.

However, with TAVR, the chances of complications are reduced, and the patient can be discharged within 2-3 days of the procedure. The rate of recovery is also faster compared to SAVR. However, SAVR is cost-efficient in comparison to TAVR.

Many patients and caregivers who had joined in on the session had questions for Dr. Behal, especially on the long-term consequences of the ailment. Here are a few of them.

Can Aortic Stenosis cause sudden death?

Yes, aortic stenosis can cause sudden death, as the symptoms are not visible in the earlier stages. The patients do not recognize the signs until the later stages, during which treatment might be difficult, which may lead to sudden heart failure. The patients need to be mindful of the early signs and approach the doctor immediately to run diagnostic tests.

Does mild Aortic Stenosis require surgery?

No. SAVR and TAVR are recommended for those who are diagnosed with severe aortic stenosis. Mild and moderate symptoms can be treated with medications. However, the patient must frequently follow up with the medical practitioner to ensure that the symptoms do not worsen.

How long does a TAVI valve last?

In SAVR, two different types of valves are used – biological valves and prosthetic valves. Biological valves are made of animal tissues and last for about 10-15 years, while prosthetic valves are made of metal and last for about 20-25 years.

In TAVR, biological valves are used, and they last for 10-15 years.

What is the survival rate in Aortic Stenosis patients?

Aortic stenosis can either be asymptomatic or symptomatic. If the patient is asymptomatic and responds well to stress tests and other diagnostic tests, the outlook is positive, almost equivalent to the normal healthy adult population.

However, if the symptoms are severe, the outlook is negative. At this stage, it is important to run tests such as echocardiography to determine the damage done to the valve, and the treatment must be administered immediately.

What is the minimum age to undergo TAVI?

Initially, people above the age of 65 – 70 are considered for TAVI. And it is advisable for everyone above 75 to only opt for TAVR as the procedure is less invasive.

Does TAVR have any side effects?

Though TAVR is less invasive as compared to SAVR, there are several risks and complications associated with the procedure:

Internal bleeding
Pain
Stroke
Arrhythmia, requiring pacemaker implantation
Death

Who qualifies for the TAVR procedure?

TAVR is mostly recommended to patients who display severe symptoms. After being diagnosed with aortic stenosis, it is necessary to discuss with your heart surgeon about the advantages and disadvantages of SAVR and TAVR, to decide the right treatment method for you. Sometimes, TAVR is also recommended for patients with moderate symptoms.

While diseases like Aortic Stenosis are indeed common, leading a healthy lifestyle & timely intervention by your doctor can help go a long way in keeping the disease at bay!