Dr. Ravishankar offers the following SILS Surgeries.

Click on a surgery for more details, or scroll down to browse.

 

 

      Introduction to SLS

  

      Pre & Post Surgery                                                                                         

      Pain Management

                                                                        

                                                                      

       Appendectomy

 

       Gall Bladder Cholecystectomy

 

​       Liver Surgeries

         Liver Cysts 

         Partial Liver Resection

 

       Pancreas Resection

 

       Hernia Surgeries

 

​       Colon Surgeries

          Colectomy​

 

      Small Bowel Resection

          Strictures of Small Bowel

          Small Bowel Adhesions causing

          Intestine Obstruction

Pre Surgery

 

What should I expect on the day of surgery?

 

  • You usually arrive at the hospital the morning of the operation.

 

  • A qualified medical staff member will typically place a small needle or catheter into your vein to dispense medication during the surgery. Often pre-operative medications, such as antibiotics, may be given.

 

  • Your anaesthesia will last during and up to several hours following surgery.

 

  • Following the operation, you will be taken to the recovery room and remain there until you are fully awake.

 

  • Few patients may go home the same day of surgery, while others may need admission for a day or more post-operatively. The need to stay in the hospital will be determined according to the extent of the operative procedure and your general health.

 

 

Post Surgery

 

What to expect post surgery.

 

Based on the type of surgery, seriousness of the condition and general health, you will be allowed to have fluids to drink the same day and soft diet either on the same or following day. In some circumstances, these will have to be delayed.

 

  • You will need strong pain killers for the first two days and milder pain killers for the next 5 to 7 days.

 

  • You will be walking in the ward the same day or the following day and will be able to use the toilet.

 

  • You can have a shower the following day.

With the marriage of surgery and technology, applications of laparoscopic surgery/minimal access surgery are increasing exponentially. Over the last few years, Scarless Laporoscopic Surgery (SLS), also known as Single Incision Laparoscopic Surgery (SILS) has become popular, for good reason. 

 

SLS, being performed through the umbilicus, gives good access to all four quadrants of the abdomen and instrumentation for the same is well developed, and, available. This surgery has the advantage of not leaving behind any visible scars since the incision is made within the umbilicus and heals without any noticeable scars. Perhaps blood loss, pain and recovery time associated is also less as procedure performed is from 1 incision rather than 3 or 4 incisions. Dr. Ravishankar offers this surgery as an elective as well as in emergency cases. 

 

What is SLS

 

Scarless Laparoscopic Surgery is performed through the umbilicus with a single incision. This is an advanced minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single small cut in the umbilicus using instruments which can be inserted through a straight port and, once inside, can be roticulated to get appropriate angulation.

 

Why SLS

 

  • Lessen the trauma of access

  • Lessen the residual surgical scar

  • Ability to convert to standard lap surgery or open surgery when the need arises without compromise to patient safety

 

Advantages of SLS

 

  • Less post operative pain (1 instead of 4 cuts)

  • Less wound-related complications (1 instead of 4 cuts)

  • Faster recovery

  • Early return to work

  • Better cosmetic result – No visible scar like in multiport surgery or open surgery

The perception of pain is a common reason why patients see their physicians. Pain is also an important concern after surgery.

 

Treatment of postoperative (post surgical) pain


Over the past two decades there has been a significant improvement in the treatment of pain after surgery. Most patients are provided with excellent pain relief after surgery and experience only minimal discomfort. 

 

Good management of postoperative pain is very important not only for comfort reasons, but also to encourage the patient to carry out chest physiotherapy exercises such as utilizing the incentive spirometer to prevent post operative pneumonia and collapse of the lung that is otherwise common with a large abdominal incision that are often made for big operations on the pancreas and the liver.

Post Surgical Pain Control Techniques

 

The following techniques are utilized for control of post-surgical pain

 

  • Patient controlled analgesia (PCA)

    • In this technique the patient uses an infusion pump that contains morphine or morphine type of narcotic pain medication. The pump provides a small continuous dose of pain medication to the patient. In addition to that the patient can inject him/her self with an additional doses of pain medication to control the pain. This is an excellent technique for the management of post-operative pain and the vast majority of patients obtain satisfactory pain relief with this technique.

 

  • Epidural catheter

    • In selected patients an epidural catheter is placed and pain medication is delivered around the spinal nerves as they come out of the spinal cord. This type of treatment is similar to that used during labor and delivery by many obstetricians. This technique also provides excellent pain relief from postoperative pain and is an alternative to patient controlled analgesia.

 

  • Oral pain medications

    • A variety of oral pain medications are available that provide the transition from intravenous pain medication to oral pain medication.

Pain Management

 
 
 
 

Introduction to Scarless Laparoscopic Surgery

Pre & Post Surgery

SILS Technique of Incision
SILS Technique of Incision

SILS Technique of Port Insertion
SILS Technique of Port Insertion

SILS Hernia Mesh Laying
SILS Hernia Mesh Laying

SILS Technique of Incision
SILS Technique of Incision

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Appendectomy

What is the Appendix?

 

The appendix is a narrow, small, finger-shaped portion of the large intestine that generally hangs down from (within) the lower right side of the abdomen.

 

If the appendix becomes infected (appendicitis), in most cases the infected appendix must be surgically removed (emergency appendectomy) before a hole develops in the appendix (perforation) and spreads the infection to the entire abdominal space (peritonitis). It may also progress to gangrenous with risk to life and thus the important to have an appendicitis seen to immediately.

 

What is Appendicitis and what causes it? 

 

Appendicitis is a sudden inflammation of the appendix. Although the appendix does not seem to serve any purpose, it can become diseased and, if untreated, can rupture, causing infection and even death.

 

The cause of appendicitis is usually unknown. Appendicitis may occur after a viral infection in the digestive tract or when the tube connecting the large intestine and appendix is blocked or trapped by stool. It is thought that blockage of the opening of the appendix into the bowel by a hard, small stool fragment causes inflammation and infection of the appendix (appendicitis). The inflammation can cause infection, a blood clot (may lead to portal vein thrombosis), or rupture the appendix.

 

The infected appendix then must be surgically removed (emergency appendectomy) before a hole develops in the appendix and spreads the infection to the entire abdominal space.

 

What are the symptoms of Appendicitis?

 

  • Abdominal pain

    • Pain may begin in the upper-middle abdomen then develop to sharp localized pain and localise to right lower abdomen, lower abdomen or the whole of abdomen based on the severity of the condition.

  • Abdominal pain may be worse when walking or coughing

  • Fever usually occurs within several hours

  • Loss of appetite

  • Nausea

  • Vomiting

  • Constipation

  • Rectal tenderness

  • Chills and shaking

 

If you have these symptoms, see a doctor immediately!

 

The risk of rupture in the event of appendicitis, which may happen as soon as 48 to 72 hours after symptoms begin, is considered a medical emergency.

 

How is Appendicitis treated?

 

The best treatment is a surgical removal of the infected appendix. Mild appendicitis may sometimes be cured with antibiotics. More serious cases are treated with surgery to remove the appendix, called an appendectomy. Doctors either use an "open" technique or a minimally invasive approach to remove the appendix. 

 

 

What is a Scarless Laparoscopic Appendectomy?

 

The scarless laparoscopic appendicectomy is performed through a single, small incision within the belly button. Camera and instruments are inserted through the same hole and surgery is conducted through the single hole. The infected specimen (appendix) is removed through the same hole. As the cut is closed with absorbable sutures, not visible on the outside, there are no obvious visible scars as the wound heals. There is also no need to remove any sutures.

 

What are the benefits of Scarless Laparoscopic Appendectomy?

 

Most cases of acute appendicitis can be treated by means of scarless laparoscopic surgery. The main advantages include:

 

  • Less post-operative pain

  • Faster recovery and return to normal activity

  • Shorter hospital stay

  • Less post-operative wound related complications due to less number of cuts complications

  • Minimally sized incisions/scars hidden within the umbilicus

 

In most cases, patients can be discharged within 24 to 36 hours. In comparison, an open procedure requires the patient to stay in the hospital for two to five days.

 

Can every patient have a Scarless Laparoscopic Appendectomy?

 

Most patients (more than 95% of patients) can have scarless laparoscopic appendicectomy.

 

Scarless laparoscopic appendectomy may be more difficult in patients who have had previous lower abdominal surgery and in the cases of obese patients. Within this group of patients, there is a possibility of conversion to 4 key hole or open surgery. The elderly may also be at increased risk for complications with general anesthesia. We evaluate every patient to determine the appropriate type of surgery to perform. 

 

How is Scarless Laparoscopic Appendectomy Performed?

 

The words “laparoscopic” and “open” appendectomy describes the techniques a surgeon uses to gain access to the internal surgery site.

 

Most scarless laparoscopic appendectomies start the same way. A small cut is made within the belly button and a single incison laparoscopic surgery device is fitted into this cut. A laparoscope (a tiny telescope connected to a video camera) is inserted through a cannula in this device, giving the surgeon a magnified view of the patient’s internal organs on a television monitor. Several other cannulas are inserted through the same device to allow the surgeon to work inside and remove the appendix. In less than 10 % the surgery may have to be converted to 4 key hole surgery and in less than 3% to an open surgery for any of the following reasons.

 

  • Extensive infection and/or abscess

  • A perforated appendix

  • Obesity

  • A history of prior abdominal surgery causing dense scar tissue

  • Inability to visualize organs

  • Bleeding problems during the operation

 

The decision to perform the open procedure is a judgment made by your surgeon either before or during the surgery. The decision to convert the surgery to an open procedure is strictly based on patient safety.

Gall Bladder Cholecystectomy

What is a Cholecystectomy?

 

Cholecystectomy is a surgery to remove the gallbladder, which collects and stores bile, a digestive fluid made in the liver. 

Cholecystectomy may be necessary in the event of gallstones present and in blocking the flow of bile.

 

What are Gallstones?

 

Gallstones are hard, pebble-like deposits that form inside the gallbladder. Gallstones may be as small as a grain of sand or as large as a golf ball. There are 2 types of gallstones:

 

  • Cholesterol Stones​

    • Stones made out of cholesterol.

Gallstones made out of cholesterol are by

far the most common type. Cholesterol

gallstones have nothing to do with the

cholesterol levels in the blood.

 

  • Pigment Stones

    • ​Stones made from too much bilirubin in

the bile. Bile is a liquid made in the liver

that helps the body digest fats. Bile is made

up of water, cholesterol, bile salts, and

other chemicals, such as bilirubin. Such

stones are called pigment stones.

 

  • Mixed Stones

    • ​Some Gallstones have both components

of cholesterol stones and pigment and are

known as mixed stones. They form the

commonest type of stones that we see in

our practice.

 

Causes

 

Gallstones are more common in women and people over age 40. Gallstones may also run in families. The cause of gallstones varies. The following also make you more likely to develop gallstones:

 

  • Failure of the gallbladder to empty bile properly (this is more likely to happen during pregnancy)

  • Medical conditions that cause the liver to make too much bilirubin, such as chronic haemolytic anaemia, including sickle cell anaemia

  • Liver cirrhosis and biliary tract infections (pigmented stones)

  • Diabetes

  • Bone marrow or solid organ transplant

  • Rapid weight loss, particularly eating a very low-calorie diet

  • Receiving nutrition through a vein for a long period of time (intravenous feedings)

 

Symptoms

 

Many people with gallstones have never had any symptoms. The gallstones are often discovered when having a routine x-ray, abdominal surgery, or other medical procedure. However, if a large stone blocks either the cystic duct or common bile duct (called choledocholithiasis), you may have a cramping pain in the middle to right upper abdomen. This is known as biliary colic. The pain goes away if the stone passes into the first part of the small intestine (the duodenum). Symptoms that may occur include:

 

  • Pain in the right upper or middle upper abdomen: 

    • May go away and come back

    • May be sharp, cramping, or dull

    • May spread to the back or below the right shoulder blade

    • Occurs within minutes of a meal to within few hours

  • Fever

  • Yellowing of skin and whites of the eyes (jaundice)

 

Additional symptoms that may occur with this disease include:

 

  • Abdominal fullness

  • Clay-coloured stools

  • Nausea and vomiting

  •  

It is important to see a doctor if you have symptoms of gallstones. Gallstones are found in many people with gallbladder cancer. The association varies between 3% to 9% based on the geographical location.

 

Outlook (Prognosis)

 

Gallstones develop in many people without causing symptoms. Nearly all patients who develop symptoms need surgery for Gallstones.

 

Possible Complications of Gallstones / Delaying Surgery

 

Blockage of the cystic duct or common bile duct by gallstones may cause the following problems:

 

  • Acute cholecystitis

  • Cholangitis

  • Cholecystitis - chronic

  • Choledocholithiasis

  • Pancreatitis

Investigations and Tests

 

Tests used to detect gallstones or gallbladder inflammation include the following, based on the severity of disease and any associated complications:

 

  • Abdominal ultrasound

  • Abdominal CT scan

  • Endoscopic retrograde cholangiopancreatography (ERCP)

  • Gallbladder radionuclide scan

  • Endoscopic ultrasound

  • Magnetic resonance cholangiopancreatography (MRCP)

  • Percutaneous transhepatic cholangiogram (PTCA)

 

Your doctor may order the following blood tests:

 

  • Full Blood Count

  • Renal Panel

  • PT/PTT

  • Liver function tests

  • Pancreatic enzymes

 

Surgeries Available

 

Some people have gallstones and have never had any symptoms. The gallstones may not be found until an ultrasound is done for another reason. Surgery may not be needed unless symptoms begin. In general, patients who have symptoms will need surgery either right away, or after a short period of time. Types of surgery include:

 

  • In the past, open cholecystectomy (gallbladder removal) was the usual procedure for uncomplicated cases. However, this is done less often now.

  • A technique called laparoscopic cholecystectomy is commonly used now. This procedure uses smaller surgical cuts, which allows for a faster recovery. Patients are often sent home from the hospital on the same day as surgery, or the next morning.

  • The most recent technique is the Scarless Laparoscopic Cholecystectomy. In this technique pain is least as surgery is preformed through a single, small key hole-sized cut and there are no obvious scars, as the incision is made within the belly button.

  • Endoscopic retrograde cholangiopancreatography (ERCP) and a procedure called sphincterotomy may be done to locate or treat gallstones which have passed into the bile duct causing blockage to the bile duct with jaundice, cholangitis and or pancreatitis.

 

Medication

 

Medicines called chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UDCA, ursodiol) may be given in pill form to dissolve cholesterol gallstones. However, they may take 2 years or longer to work, and the stones may return after treatment ends. Also these drugs work only in the presence of pure cholesterol stones.

 

Potential Benefits in a Scarless Laparoscopic Cholecystectomy

 

  • Better cosmesis with no externally visible scar

  • Earlier return to activities of daily living

  • Earlier return to work

  • 1 incision instead of 4 hence, less pain

  • 1 incision instead of 4 hence less risk of related complications

 

When to Contact a Medical Professional

 

Contact us if you have:

 

  • Pain in the right upper part of your abdomen

  • Yellowing of the skin or whites of the eyes 

 

Prevention

 

There is no known way to prevent gallstones. If you have gallstone symptoms, eating a low-fat diet and losing weight may help you control symptoms.

 

Alternative Names

 

Cholelithiasis

Gallbladder attack

Biliary colic

Gallstone attack

Bile calculus

Biliary calculus

 

 
 

Liver Surgeries

Surgery for Liver Cysts

 

Benefits of laparoscopic procedures include less post operative discomfort & pain since the incisions are much smaller, quicker recovery times, shorter hospital stays, earlier return to full activities and much smaller scars. Furthermore, there may be less internal scarring when the procedures are performed in a minimally invasive fashion compared to standard open surgery.

The laparoscopic procedures performed on the liver are:

 

  • Radiofrequency ablation of liver tumors

  • Wedge resection of the liver for liver metastasis

  • Removal of left half of the left lobe of the liver (in selected patients)

  • Removal of right half of liver (in selected patients)

  • Drainage of liver abscess

  • Drainage or removal of liver cysts

 

SLS Liver Cyst Drainage

 

Cysts in the liver are frequently found in normal people.

Liver cysts should only be treated if they are causing significant symptoms to the patient.

The symptoms found with liver cysts include: 

 

  • Pain

  • Bleeding into the cysts causing pain

  • Digestive complaints that are unexplained by other findings.

 

If a liver cyst requires treatment, surgical treatment should include removal of the wall of the cyst. Removal of the fluid only from the cyst is not recommended since the cyst fills up rapidly after the procedure. Furthermore this procedure puts the patient at risk for infection of the cyst.

 

We offer the following laparoscopic approaches to patients who require treatment of liver cysts. The procedure involves removing part of the wall of the cyst so that the liquid that is in the cyst can freely drain into the abdominal cavity. The body then removes the liquid from the abdominal cavity.

 

  • Radiofrequency ablation of liver tumors

  • Laparoscopic liver resection (removal)

  • Laparoscopic wedge resection of the liver

  • Laparoscopic left lateral segment removal

  • Laparoscopic right hepatectomy

Partial Liver Resection

 

Every patient with a liver tumor should be evaluated for a resection. It is the only chance for cure. Removing the tumor will rid the body of the cancer and also prevent further spread to other regions. Unfortunately, not all patients are eligible for a liver resection.

 

The liver is a privileged organ in that it has the ability to regenerate if part of it is removed and this allows surgeons to operate upon it successfully. In patients with colon cancer that has spread to the liver, liver resection can cure 25 - 45% of the patients. Patients may also develop metastatic colorectal cancer to both the lungs and liver. In select patients, simultaneous resection of metastases from the lung and liver can provide significant benefit.

 

Other indications for liver resection are metastases from other sites such as breast, kidney, lung, selected tumors of the pancreas and small intestine and sarcomas. Although these diagnoses are controversial indications, 2 year survival rates of 90% have been obtained. This improved survival occurs in patients who respond to chemotherapy and have disease only in the liver. Other indications for resection are tumors that originated in the liver, called hepatocellular cancer and cholangiocarcinoma.

 

A variety of liver resections can be performed. The options range from resection of a lobe (left or right) to segments (or small portions) of the liver. Resection of segments of the liver (called segmentectomy) permits a surgeon to effectively treat multiple liver tumors.

 

How long will the surgery last?

What is the usual length of stay in hospital?

 

A liver resection can take 4 - 6 hours to perform. In the majority of patients, a liver resection does not require a blood transfusion. The patient will be able to drink fluids on the second post-operative day and often is discharged in 8 - 10 days. The patient will be able to drink fluids on the first post-operative day and often is discharged in 4 - 6 days if the hepatectomy is performed laparoscopically as laparoscopic hepatectomy or keyhole surgery liver resection.

 

Fact

 

Dr. Ravishankar performed the first in-house laparoscopic hepatectomy at National University Hospital in Singapore, paving the way for establishment of advanced laparoscopic hepatobiliary surgery.

 
 

Pancreas Resection

Hernia Surgeries

Segment coming soon

Inguinal (Groin) Hernia

 

What is

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Umbilical (Belly Button) Hernia

 

An umbilical hernia occurs when part of the intestine protrudes through the umbilical opening in the abdominal muscles. In children, many umbilical hernias close on their own by age 1 or 2, though some take longer to heal. To prevent complications, umbilical hernias that don't disappear by age 4 or those that appear during adulthood may need surgical repair. An umbilical hernia creates a soft swelling or bulge near the navel (umbilicus).

 

Consult your doctor/surgeon if you suspect that you have an umbilical hernia. Prompt diagnosis and treatment can help prevent complications. Seek emergency care if you have an umbilical hernia and the following:

 

  • You appear to be in pain or have pain

  • You begin to vomit

  • The bulge becomes tender, swollen or discolored

 

Possible causes of Umbilical Hernia include:

 

During pregnancy, the umbilical cord passes through a small opening in the baby's abdominal muscles. The opening normally closes just after birth. If the muscles don't join together completely in the midline of the abdomen, this weakness in the abdominal wall may cause an umbilical hernia at birth or later in life.

 

In adults, too much abdominal pressure can cause an umbilical hernia, including:

 

  • Obesity

  • Multiple pregnancies

  • Fluid in the abdominal cavity (ascites)

  • Previous abdominal surgery

  • Chronic peritoneal dialysis

 

Complications can occur when the protruding abdominal tissue becomes trapped (incarcerated) and can no longer be pushed back into the abdominal cavity. This reduces the blood supply to the section of trapped intestine and can lead to umbilical pain and tissue damage. If the trapped portion of intestine is completely cut off from the blood supply (strangulated hernia), tissue death (gangrene) may occur. Infection may spread throughout the abdominal cavity, causing a life-threatening situation. Adults with umbilical hernia are somewhat more likely to experience incarceration or obstruction of the intestines. Emergency surgery is typically required to treat these complications.

 

Diagnosis of an umbilical hernia is made during a physical exam. Sometimes imaging studies — such as an abdominal ultrasound or CT scan — are used to screen for complications.

 

Ventral (Incisional) Hernia

 

When a ventral (also called incisional) hernia occurs, it usually arises in the abdominal wall where a previous surgical incision was made. In this area the abdominal muscles have weakened; this results in a bulge or a tear. Other sites that ventral hernias can develop are the belly button (umbilicus) or any other area of the abdominal wall.

 

Causes of a ventral hernia includes an incision having been made in your abdominal wall. This will always be an area of potential weakness. Hernias can develop at these sites due to heavy straining, aging, injury or following an infection at that site following surgery. They can occur immediately following surgery or may not become apparent for years later following the procedure.

 

Preparations for a scarless laparoscopic ventral hernia surgery include:

 

  • Unlike inguinal hernia, incisional hernia repairs require overnight stay or longer in the ward, based on the case and will be discussed at the time of assessment in the clinic.

  • Preoperative preparation includes blood work, medical evaluation, chest x-ray and an ECG depending on your age and medical condition.

  • It is recommended that you shower the night before or morning of the operation.

  • Based on your case you may need bowel preparation for the surgery.

  • After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery. (This is adjusted depending on the time of surgery)

  • Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.

 

Treatment for incisional hernia can be selected from a few options:

 

  • The use of an abdominal wall binder is occasionally prescribed but often, ineffective.

  • Incisional hernias do not go away on their own and may enlarge with time.

  • One of the following 3 surgical procedures is preferred

 

The traditional approach is done through an incision in the abdominal wall. It may go through part or all of a previous incision, skin, an underlying fatty layer and into the abdomen. The surgeon may choose to sew your natural tissue back together, but frequently, it requires the placement of mesh (screen) in or on the abdominal wall for a sound closure. This technique is most often performed under a general anesthetic.

 

The second approach is a laparoscopic incisional hernia repair. In this approach, a laparoscope (a tiny telescope with a television camera attached) is inserted through a cannula (a small hollow tube).

The laparoscope and TV camera allow the surgeon to view the hernia from the inside. Other small incisions will be required for other small cannulas for placement of other instruments to remove any scar tissue and to insert a surgical mesh into the abdomen. This mesh, or screen, is fixed under the hernia defect to the strong tissues of the abdominal wall. It is held in place with special surgical tacks and in many instances, sutures. Usually, three or four 1/4 inch to 1/2 inch incisions are necessary. The sutures, which go through the entire thickness of the abdominal wall, are placed through smaller incisions around the circumference of the mesh. This technique is also usually performed under general anesthesia.

 

The third approach is a scarless laparoscopic ventral (incisional) hernia repair. This is similar to other laparoscopic procedures.

What is a Hernia?

 

A hernia occurs when the layers of the abdominal muscle have weakened, resulting in a bulge or tear. In the same way that an inner tube pushes through a damaged tire, the inner lining of the abdomen pushes through the weakened area of the abdominal wall to form a small balloon-like sac. This can allow a loop of intestine or abdominal tissue to push into the sac. The hernia can cause severe pain and potentially serious problems that could require emergency surgery.

 

Both men and women can get a hernia. You may be born with a hernia (congenital) or develop one over time. A hernia does not get better over time, nor will it go away by itself.

 

How do I know if I have a Hernia?

 

The common areas where hernias occur are in the groin (inguinal), belly button (umbilical), and the site of a previous operation (incisional).

 

It is usually easy to recognize a hernia. You may notice a bulge under the skin. You may feel pain when you lift heavy objects, cough, and strain during urination or bowel movements, or during prolonged standing or sitting.

 

The pain may be sharp and immediate or a dull ache that gets worse toward the end of the day. Severe, continuous pain, redness, and tenderness are signs that the hernia may be entrapped or strangulated. These symptoms are cause for concern and immediate contact of your physician or surgeon is essential as it may lead to life threatening complications.

 

What causes a Hernia?

 

The wall of the abdomen has natural areas of potential weakness. Hernias can develop at these or other areas due to heavy strain on the abdominal wall, aging, injury, an old incision or a weakness present from birth. Anyone can develop a hernia at any age. Most hernias in children are congenital. In adults, a natural weakness or strain from heavy lifting, persistent coughing, and difficulty with bowel movements or urination can cause the abdominal wall to weaken or separate.

 

When to call your Doctor

 

Be sure to call your physician or surgeon if you develop any of the following:

 

  • Persistent fever over 101 degrees F (39 C)

  • Bleeding

  • Increasing abdominal or groin swelling

  • Pain that is not relieved by your medications

  • Persistent nausea or vomiting

  • Inability to urinate

  • Chills

  • Persistent cough or shortness of breath

  • Purulent drainage (pus) from any incision

  • Redness surrounding any of your incisions that is worsening or getting bigger

  • You are unable to eat or drink liquids

 

Scarless Laparoscopic Hernia Repair

 

Scarless laparoscopic umbilical hernia repair is similar to other laparoscopic procedures. General anaesthesia is given, and a small single incision is made within the suprapubic hair line to hide the line of incision (about 2cm). The abdomen is inflated with air so that the surgeon can see the abdominal organs. A thin, lit scope, called a laparoscope, is inserted through the single incison laparoscopic surgery device fitted into the incision. The instruments to repair the hernia are inserted through the same small incision. The defect is dissected, area cleaned and the Mesh (dual layer paritex mesh) is then placed over the defect to reinforce the abdominal wall. The wound is finally closed with absorbable sutures which do not need removing. No obvious scars are seen once the line of incision is fully healed.

 

Am I a candidate for Scarless Laparoscopic Hernia Repair?

 

Only after a thorough examination can it be determined whether a scarless laparoscopic hernia repair is right for you. The procedure may not be best for some patients who have had previous extensive abdominal surgery or who have hernias in unusual or difficult to approach locations, or any other underlying medical conditions.

 

How Well It Works

 

People prefer Scarless (Single Incision) Laparoscopic Hernia Repair Surgery over open hernia repair for the following reasons:

 

  • Less pain and able to return to work quicker than they would after a 4 key hole or open repair surgery.

  • Repair of a recurrent hernia is often easier utilizing laparoscopic techniques than open surgery.

  • In the event of a second hernia, it is possible to check for and repair a second hernia on the opposite side at the time of the surgery.

  • Because a smaller, single incision is used, scarless laparoscopic hernia repair may be more appealing for cosmetic reasons.

 

Comparison Notes

 

Scarless Laparoscopic Hernia Repair differs from open surgery in the following ways:

 

  • A scarless laparoscopic hernia repair requires a single small incision instead of several small incisions or a single larger cut.

  • If hernias are on both sides, both hernias can be repaired at the same time without the need for a second large incision or more multiple incisions. Scarless Laparoscopic surgery allows the surgeon to examine both groin areas and all sites of hernias for defects. In addition, the patch or mesh can be placed over all possible areas of weakness, helping prevent a hernia from recurring in the same spot or developing in a different spot.

  • Scarless laparoscopic hernia repair is slightly more expensive than a 4 key hole laparoscopic surgery or open surgery because of the increased costs of the disposable surgery instruments.

Colon Surgeries

Small Bowel Resection

 

Colectomy

 

Colectomy is the surgical resection of any extent of the large intestine (colon).

 

When does a patient require a colectomy?

 

Some of the most common indications for colectomy are:

 

  • Colon cancer Early stages may be suitable for single incision laparoscopic surgery.

  • Diverticulitis and diverticular disease of the large intestine.

  • Inflammatory bowel disease such as ulcerative colitis or Crohn's disease.

  • Prophylactic colectomy can be indicated in some forms of polyposis, Lynch syndrome and certain cases of inflammatory bowel disease because of high risk for development of colorectal cancer.

  • Bowel infarction.

  • Typhlitis ( some selective cases of inflammation of caecum – right part of large intestine).

 

Types of Colectomy:

 

  • Right hemicolectomy and left hemicolectomy refer to the resection of the ascending colon (right) and the descending colon (left), respectively. When part of the transverse colon is also resected, it may be referred to as an extended hemicolectomy.

  • Transverse colectomy is also possible, though uncommon.

  • Sigmoidectomy is a resection of the sigmoid colon. When a sigmoidectomy is followed by terminal colostomy and closure of the rectal stump, it is called a Hartmann operation.

  • When the entire colon is removed, this is called a total colectomy.

  • Subtotal colectomy is resection of part of the colon or a resection of the entire colon without complete resection of the rectum.

Small Bowel Resection

 

Small Bowel resection consists of the surgical resection of any extent of the small intestine.

 

Common indications for small bowel resection.

 

  • Strictures of small bowel

  • Perforation of small bowel

  • Adhesions to small bowel causing intestinal obstruction

  • Meckel’s diverticulitis

  • Small bowel gangrene

  • Part of another surgery to remove cancer