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Dr. Patta Radhakrishna's Profile
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OPD in room 111, SIMS, Vadapalani.
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Day surgery for gall bladder stones
It is not uncommon to see an abdominal ultrasonogram report suggesting stones in the gall bladder when you visit your doctor for pain in the upper abdomen or indigsetion or chronic gas. Stones in the gall bladder is a more serious condition than stones in the kidneys. The GB stones can cause infection in the gall bladder presenting with severe pain abdomen, can also cause jaundice by blocking the bile passage into the intestine and rarely a near fatal condition called acute pancreatitis by blocking the mouth of the pancreatic duct..
There is no medical treatment for gall bladder stones and these patients will require laparoscopic removal of the gall bladder along with the stones.
This surgery is performed as a day care procedure where in the patient checks into the hospital at5.00 am .Surgery is done at 6.00am and the patient is discharged at 2.00pm. Effectively the patient is in the hospital for about 6 hours. They walk back home and will take a normal dinner that night. Pain killer medications are given for relief of pain if any.. These patients start their routine normal activity the day following surgery. In the las t 100 such operations we performed ,we had no problems with any patient and none of them have been re-admitted to the hopital. So I believe that laparoscopic gall bladder remoban can be safely operated on a day care basis and there is absolutely no need for the patient to saty in the hospital overnight.

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Robotic surgery in India
Robotic surgery is the newest addtion to the surgical armamentarium. here the operating surgeon makes use of a mechanical robot with four movable arms to operate on patients. Robot holds a telescope inserted into the human body through a small hole and moves it around on instrucctions from the surgeon who manipulates the robot from a distance looking into a 3D view console with excellent vision and zooming facility. Four other robotic arms wield different types of instruments used for that particular surgery. Surgeon moves these arm by manipulating ceratin pulleys with his hands sitting comfortably.Robotic surgery provides the surgeon as well as the patient maximum comfort and ergonomics. Because of high level of precision, error rates are extremely negligible. Robotic surgery is being extensively used in surgery of the prostate, uterus, rectum, esophagus etc.. with excellent results and drastically reduced hospital stay for the patient. India has about 12- 15 robots at the moment and the numbers are likely to multiply rapidly in the coming months.

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Prolapse of Rectum
Rectal prolapse is an uncommon condition akin to prolpase of utreus seen in some women after multiple childbirths. It is an abnormal protrusion of rectum outside of anus and it is quite grotesque for the patient himself and others to look at. The protrusion can range from a few centimeters to a foot or more.
This condition is often seen in children who are malnourished and suffering from chronic diarrhoea. and this protrusion can be pushed back into the pelvic cavity most of the times. Rectal prolapse in children is usually self limiting and doesnt require any treatment.
This condition is also seen in individuals with microcephaly(small undeveloped brain) and mental retardation.
Prolapse of rectum is also seen in some healthy adults who generally come to the clinic with a long history. They are usually in the habit of pushing the prolapse back into the rectum on their own. Constipation is a very common symptom and at times perienal pain and discomfort forces them to see a specialist. Ulceration and bleeding is not uncommon.

Medical management doesnt help. Most patients will require surgical treatment in the form of laparoscopic or open rectopexy wherein a synthetic wire mesh is used to anchor the rectum in the pelvis to prevent the rectum to slide down. results are usually good and a transient constipation may persist for a while after the surgery. Prolapsed rectum is a condition which should not be ignored and should be shown to a specialist ASAP.

Dr.Patta Radhakrishna MS MCh
Sr. Consultant Surgical Gastroenterologist &
laparoscopic surgeon
Apollo Hospitals(main), Chennai.

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Ventral (incisional) hernia
Ventral hernia (also called incisional hernia) is a defect in the abdominal wall presenting as a swelling in the abdomenwhich becomes prominent on coughing or straining. It is also called incisional hernia as this arises from a previous operation scar.
Ventral herniae are commonly seen after a caserean section, abdominal hysterectomy or peurperal sterilisation. Post-operative wound infection, obesity, chronic cough predispose to this condition.
Quite often the content of this hernia will be abdominal fat apron called the omentum. Ocassionally small or large intestine can also be a part of the hernia..
Smaller herniae may cause pain and sometime the contents of the hernia may get obstructed at the neck of hernia causing severe pain and needing emergency surgery.
Most of these herniae will require surgical treatment in the form of a mesh repair using a sophisticated synthetic mesh. These days majority of the ventral hernaie are operated by laparoscopic method with minimal pain and good outcomes.
These hernia have a tendency to recur needing re-operation. Certain good surgical principles if followed can prevent a recurrence.
Hence any unusal swelling in the abdominal wall should always be taken seriously and treated

Dr.Patta Radhakrishna MS MCh (gastro)
Consultant Surgical gastroenterologist
Apollo Hsopitals(main), Chennai.

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Acid injury of the food pipe
Consumption of bathroom cleaning acid is one of the most common methods of attempting suicide especially in young girls and most often this does not kill but leaves the patient in a very miserable state of affairs impairing their ability to swallow and subjecting them to multiple hospital visits, endoscopic treatment and quite often surgery. And not all of them will be cured by any of the medical and surgical measures.

Being easily available and cheap , bathroom cleaning acids are one of the commonest sources ingested for suicidal purposes. Accidental ingestion by toddlers and children is not uncommon.

These victims present with severe chest and abdominal pain, vomiting and burning sensation in the mouth which usually settles down in 2 - 3 days. They will then be able to swallow liquids and later solids. The real effect of acid injury to the food pipe will show after about 40-50 days after the incident when swallowing of liquids will also not be possible needing hospitalisation and treatment

The sordid saga will start from then on. Barium x-rays, endoscopic dilatation and often major abdominal surgery will be required to enable the patient to swallow. The involvement of mouth, voice box and upper food pipe makes surgery very difficult with poor outcomes. At times we resort ot silencing the voice box with a permanent tracheostomy to enable eating.

There will be huge drain on the family both emotionally and financially and the worst bit is that no one will have any sympathy to the patient.

Corrosive acid ingestion will not kill a person but will cause considerable damage. One has to be very careful with bathroom acids. these shouldnt be left in the bathroom within the reach of children.

Dr.Patta Radhakrishna MS MCh (GI Surgery)
Senior consultant Surgical Gastroenterologist
Apollo Hospitals, Chennai.

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