It is interesting to ask ourselves that if the great Napolean did not have piles , would he have won more battles. Although it is difficult to answer this question but it is easy to address the more common queries that laymen have regarding piles. Let us see what science has to say regarding these.

Question 1.

Are all bleeding in stools due to piles?

No. Most bleeding in stools are due to piles but there are many other important cases of bleeding. Bleeding in stools can be due to anal fissure, dysentery, cancers, ulcerative colitis, etc.

Question 2.

When should I see a doctor?

If you have been bleeding for two to three times in a year and it is painlessthen you may not see a doctor. However if you bleed more, it is painful, there is associated alteration of bowel habits, stools are not yellow or if stool is mixed with blood then you definitely need to see a doctor. These symptoms mean that one may be harboring a bad disease requiring urgent attention. Colonoscopy (examination of the foodpipe through anus) would be mandatory in these cases. Many people deny themselves this test because they feel it is indignified. This is a grave mistake and must be avoided.

Question 3.

Would piles always require surgery?

It is possible to manage piles medically in most patients. Only in some cases when the bleeding is excessive, piles become painful, and the anus starts coming out (prolapse), it becomes necessary to operate.

Question 4.

Is piles surgery painful?

Traditional surgery for piles results in a painful wound at the anal opening necessitating daily dressings for weeks. This means increased hospital stay and delayed return to normal activities and work. This has become unacceptable in the modern world and leads patients to look for alternative treatments such as magic herbs, ointments, strange diets, etc. Look around and you will see excessive proliferation of these “piles shops” promising immediate cure. The sad part is common people usually fall prey to these false promises. Such unscientific remedies however do not give lasting benefits and leaves the patient frustrated in most instances.

Modern surgery for piles (stapler surgery) is a painless procedure where the patient can go home the same day. The patient can join work the very next day and can return to normal activities immediately.

Question 5.

If my bleeding in stools are due to cancer can I be cured and still pass my stools from my anus?

If the patient reports early, it is possible to cure cancers of foodpipe. It is also possible to preserve anus and do these surgery by laparoscopy in most cases in good centers.

Watch the video on Stapler Surgery for piles on YouTube.

Pancreas is an important organ in the human body responsible for digestive process and production of insulin that maintains normal glucose levels in our body. Diseases in the pancreas therefore lead to indigestion and diabetes.

Since the pancreas has a good nerve supply, its disease presents with pain in upper abdomen and the back. Pancreatic diseases can also present with jaundice when they compress the bile duct.

The following diseases can affect the Pancreas:

1. Pancreatitis- this disease can happen suddenly or stay in some patients for life. The latter is usually seen in patients consuming alcohol but it may happen without any known cause. When they happen suddenly (sometimes due to gallstone disease or  alcohol ), it may be either a mild disease  recovering in a week or it may have a severe course (where the pancreas undergoes self destruction) needing treatment (drugs and surgery) for weeks and months. In many cases, the patient may not even survive.
2. Cysts- usually seen in the younger population, a timely  detection  and surgical intervention can completely eradicate the disease.
3. Tumors/ Cancers- they have  a good outcome only if detected early.
4. Stones are not uncommon in the pancreas. Many patients can be treated on medical therapy, some require endoscopy and few need surgery.

Although some of the diseases need only monitoring, some require medical, endoscopic or surgical treatment.

Surgery of the Pancreas is not easy. It requires skill, expertise and more importantly, sound judgement. It is important for a                                                                                       common  man to know the following points regarding surgery of the various conditions in the pancreas:

1. Pancreatic surgery has been made more comfortable by use of laparoscopy in many situations. A Pancreatic pseudocyst and pancreatic stones, for example are good cases for laparoscopic treatment whereby a patient can have minimal pain, no wound complications and can go home within a couple of days.
2. Whipples procedure- done for tumors/ cysts of pancreatic head- used to be a formidable procedure in the past with significant complication rates. Recently the operation has been made quite safe with improvement in technique and technology.
3. Sometimes in acute pancreatitis, much of the organ can undergo auto-destruction and get infected. This is life threatening and may need removal (Necrosectomy) from the body for the survival of the patient.  Recently these surgeries can be increasingly performed by endoscopy or laparoscopy in select circumstances. Only experts should perform this surgery under laid down principles for reasonable outcome.

While patients and their relatives get increasingly concerned hearing and reading about pancreatic surgery, the good news is that it is becoming increasingly safer and more comfortable to perform these operations. This is due to technology such as laparoscopy and endoscopy, availability of improved IV nutrition and some antibiotics. Surgical expertise has also increased that has brought down the complication rate drastically.To see the surgical video, how we do it visit my you tube page…….

The only thing the patient needs to do is to recognize his disease early and get treated by the right doctor.

Sometimes hernia surgery can be frustrating because it can fail and patient comes back with recurrence. The reasons of failure of the surgery could be due to technique, giant defects, previous failed operation, mesh not used, obesity, etc.  In planning for the second surgery in these complex hernias it is important to correct these factors- if possible- before going ahead with another operation.

There will be many procedures to choose from. However it is believed that these complex hernias should be repaired with a mesh- an artificial flat knitted material – if the failure is to be kept low. There has been astounding progress in the field of production of mesh. They are nowadays designed to provide more comfort and flexibility to the patient while keeping the failure rate low.

The second issue is to place the mesh in the right place. It can be placed just beneath the skin or behind the muscle by conventional open technique. Or the mesh can be placed inside the abdomen by Laparoscopic method. It is believed that keeping the mesh deeper inside the body leads to less chances of failure. Hence many surgeons have shifted to putting the mesh inside the abdomen by Laparoscopic method.

Another important issue in hernia is obesity. It has been observed that hernia surgery fails more often in obese patients. It has been advocated that hernia surgery should be performed after weight reduction if failure is to be avoided. This could mean dieting, physical activity or even bariatric surgery- stomach stapling surgery for severe obesity. In a severely obese patient with hernia, bariatric surgery could produce significant weight loss. After a few months when this has been achieved hernia surgery can be done and this approach has been shown to be more successful.

However there are some situations when hernia defects are so big thatconventional or laparoscopic surgery is not possible, even dangerous. A new technique- Component Separation Technique- addresses these issues and is proving to be more successful.

In 1990,Ramirezintroduced the “components separation technique” to bridge the giant hernia defect without the use of prosthetic material. Although initially it was not popular, there is renewed interest in this technique recently to tackle complex hernias. The technique is based on enlargement of the abdominal wall surface by separation and advancement of the muscular layers. In this way, defects of up to 20 cm at the waistline can be bridged. No mesh may be needed in this procedure. This is in contrast to previous beliefs that mesh is vital for the success of hernia repair.

Another modification of this technique is the “sandwich technique”. After the gap is closed in component separation technique, two meshes- one from outside and one from inside- can be placed to strengthen the defect.  This is a novel idea, which is getting further evaluation.

Hernia surgery is evolving and there is huge development in the science of mesh, technique and treatment strategy- all of which aim to decrease the failure rate and provide more comfort to the patient at the same time.

These developments are good news for those patients who have complex hernias. They now have something to cheer about. To view how this is done you can see the video of   Hernias on our you tube page .