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 .

What is Anal Fistula?

An anal fistula is an abnormal tract between skin and the anus. Stool enters this tract and causes infection leading to discharge of pus from the wound near the anus.

What are low and high Anal Fistulas?

Fistulas are called low and high according to the position of the internal anal opening of the tract. High fistulas open above the anal sphincter- a muscle responsible for controlling defecation. Conventional surgery for high anal fistulas is therefore tricky and may result in injury of the anal sphincter.

What is the treatment of Anal Fistula?

Most patients would need surgery for their cure.

How is conventional surgery for anal fistula done?

Conventional surgery requires removal of the fistula tract leaving a large perianal wound that needs daily dressings for days to weeks. This method can be a potential source of danger since one may inadvertently damage the anal sphincter especially in patients with high anal fistula. Patients also need to take pain killers and antibiotics for many days after this procedure.

How is VAAFT done?

In the new method (known as VAAFT – Video Assisted Anal Fistula Treatment), the fistula tract is treated with a very small endoscope going through it, cleansing it and burning it. A stapler closes the internal opening so that stool cannot enter the tract. The fistula tract heals in most cases over the next few weeks. To view how this is done you can see the video of VAAFT on our you tube page.

What is the advantage of VAAFT?

The most significant advantage of VAAFT is that there is no wound, least pain and there is no risk of damage to anal sphincter muscle- since the surgery is done from inside. Most patients can be sent home on the same day and they can work from the next day. The best part is that it leaves behind no wounds to dress.

In which situations is VAAFT a good option?

Although VAAFT can be done in all cases, it is especially useful in cases with high fistula, complex and recurrent fistulas. The main advantage is that unlike in traditional procedure, there is no risk of injury to anal sphincter in VAAFT

Watch the video of VAAFT for Anal Fistula on YouTube.

Good question? Obviously, one is not asking all diabetics to be subjected to surgery. Instead it is proposed as an option for some of them. And that too, for those who are eligible as is ascertained by some tests.Lets start by finding out who needs to look for options other than medicines and insulin for controlling the blood sugar.Well, there may be different scenarios. First, a diabetic well controlled on medicines and lifestyle changes with no evidence of diabetic complications. Would this subject be a good candidate for surgery? An argument might be  why not? After all, surgery offers permanent cure whereas medicines do not. And he or she might get worse with time and develop complications (kidney failure, high blood pressure, heart ailments, eye complications, infections, etc). Then what? Is it not a good idea to offer surgical cure to all eligible?All true, but what if this patient was to have a complication from the surgery? What about the commitments required in terms of follow up after surgery? If a person is doing well with medicines, is it not a good idea to leave him or her alone. Maybe. Sounds fair.Unless, the patient is adequately informed and has decided for himself or herself to undergo surgery for a long lasting freedom of diabetes knowing fully well the risks and consequences of surgery.Well, the argument can continue.Let us examine other scenarios. A young person with lots of productive years left in life having diabetes uncontrolled on pills and insulin. Or, consider a diabetic who is rapidly developing its complications. What about these people? If a cure is possible, is it not right to offer them a choice? Is it not fair to let them have the option of diabetes surgery? Let them decide if they are willing to take the small risk associated with surgery and the necessary follow up. After all, a life free of medicines, insulin and complications is something every diabetic is looking for.There is a lot of evidence from scientific research in recent years that has clearly demonstrated the benefits of bariatric surgery on diabetes. Way back in 1995, Dr Pories shocked the world by reporting that bariatric surgery corrects diabetes within days after surgery much before significant weight loss has taken place. The claim challenged the established conventional belief that diabetes is a chronic non-remitting illness necessitating lifelong treatment with pills and insulin. Subsequent scientific research in this area established the role of small intestine as an important cause of type 2 diabetes. It also demonstrated the role of realignment of intestinal flow done in bariatric surgery as the mechanism for resolution of diabetes.A consensus summit in Rome in 2009 attended by most respected bodies in the world has recommended strongly the use of bariatric surgery for diabetes under stipulated guidelines. In a huge meta-analysis comprising of 135,246 patients by Henry Buchwald et al, 78.1% of diabetic patients showed complete resolution and 86.6% showed improvement.There is an increasing burden of diabetes in the world today. India is unfortunately the place where this disease is going to strike maximally. We, as humans will be better prepared to combat this problem if we incorporate this effective solution as part of diabetes management. After all, surgery is now offering cure for a disease, which was so long considered incurable.’,     To view how this is done you can see the video of   Bariatric surgery on our you tube page .

Watch Diabetes Surgery video on YouTube to know more.

Alcohol has been in the center of a lot of research in the past few decades for a lot of reasons. While nobody with a sane sense of mind questions the vices of smoking, the sensible drinkers have hotly contested the alcohol debate. Let us analyze whether there is any wisdom in alcohol drinking.So why do people drink? Most drink in the hope of havinga good time. Alcohol removes inhibitions of an individual making the person loosen up and be more talkative. Many people use alcohol to escape from their problems, or to change their personalities. But are all these desirable? Do we want to loosen up in front of friends and family and at times strangers and behave weirdly or even misbehave? Is there any way to deal with problems but to face them? Would escape help? Obviously no.After years of consumption- and this is the dangerous part- manyareunable to control their drinkingand may suffer problems at work or in school. This loss of control over drinking is perhaps one of the greatest social menace especially for children of an alcoholic parent. It is estimated that 6.6 million children under the age of 18 live in households with at least one alcoholic parent.Medically speaking, alcohol causes damage to the liver and kidneys. Even a small amount starts the problem. The system considers alcohol as a poison and works really hard to remove it from the vicinity. This overworks the liver and kidneys and prevents them from doing their primary job of metabolizing food. This is one of the major reasons how alcohol causes obesity.Alcohol causes health hazards when some medicines are taken. For instance a combination of aspirin and alcohol can provoke bleeding from the stomach. Taken with long usage of analgesics, it can damage the liver.Imbibing alcoholic beverages may get you in trouble with the law. Some people become mean and unreasonable. All they want to do after taking a drink is fight.Alcohol consumption is a major factor promoting obesity as explained above. In fact we at BMI- our one stop center for Obesity Management at Belle Vue Clinic- we discourage patients to have alcohol especially if they are to undergo Bariatric surgery (surgery for severe obesity). Eating high calorie snacks, little activity and smoking often go together with a drinking session, which compounds the problem as each on their own have been linked to weight increase. 
If the family and friends of an alcoholic are concerned about the problem, the alcoholic should be too. Sadly most of the times, the alcoholic does not even realize he or she has a problem. That makes remedial measures even more difficultTo the proponents of sensible drinking, I have to say that alcohol consumption is analogous to the proverbial

Nobody wants to listen to bad news. That is why, we do not want to accept any deadly diagnosis such as cancer (a term which should be replaced by ”tumor” so as not to scare people). We also want to believe anybody who gives us a hope of treatment by easy methods even if they are unscientific and irrational. Let us look at the example of MrAgarwal (name changed), who had been having bleeding in his stools for the last 4 months. He had been to a doctor who advised him a colonoscopy, a test where a pipe with a camera at the tip, is inserted through the anus and examines the last one-meter of the foodpipe. He did not follow the advice, which he found too indignified. Instead he went to a local quack who advised him to take some pills. When he did not receive any benefit in the next two months, he underwent colonoscopy reluctantly. To his dismay, there was a tumor in his foodpipe a foot from his anus. He came to us and was promptly operated. The biopsy proved it to be an advanced tumor. Sadly, if he had been detected and operated earlier, he might have been cured.Take the example of MrsJaiswal (name changed),who was suffering from jaundice for the past one month. She was investigated in our clinic and found to be having a pancreatic tumor. We put in a temporary pipe in her bile duct for temporary reduction of her jaundice and advised her for surgery 1 week later. When this was communicated to her and her family, they refused to believe it. They were made to believe that a herbal medicine could cure her in three months time. They were of the opinion that if that failed, then only they would subject her to undergo surgery. All our appeals for early surgery fell on deaf ears. When she was subjected to a CT scan three months later her tumor had spread to the liver. Nothing could be done to save her from the clutches of death 3 months later.These are very common occurences in practice. The main reason behind this is fear. The fear of disease and death makes us irrational. The term “cancer” plays havoc in our minds. It spells doom. Nobody is ready to accept that it can happen to anyone. It is an unfortunate incident in anyone’s life. But isn’t the tsunami in Japan unfortunate too? Don’t we accept it? Turning away from the problem (any problem in life for that matter) does not make the problem disappear. It allows it to grow.The other major fear is the fear of pain and discomfort from surgery, chemotherapy and radiotherapy. The last two decades have seen a mammoth progress in the field of cancer treatment. Many of the operations for tumors of the abdomen can be done by laparoscopy (operation through holes eliminating the need of cutting the abdomen). This means less pain, more comfort and early return to work. A good center would also provide pain specialists to minimize the pain in the postoperative period in case of open surgeries. The complication rates have been brought down largely with usage of modern technology. For instance, after excising the diseased segment of foodpipe, the joining of two ends can be done with staplers that reduce the incidence of wound infection. Modern gadgets to cut liver can reduce blood loss avoiding blood transfusion, a potentially hazardous affair.A good counseling by your doctor is of immense importance. Ask your doctor regarding the disease, its prognosis, and treatment options. Learn more about the tumor to have a realistic expectation. Also, be aware of the treatment options and find out if your center has the facilities.Knowledge and awareness of tumor treatment should bring a change in the way society looks at cancers, or should we say” tumors”. Accepting and facing it scientifically and staying away from the unscientific remedies are the first steps in the right direction.’,    To see the video, how we do it visit my you tube page…….