A gold standard treatment for benign gall bladder diseases like gall stone (Cholelithiasis), gall bladder cholesterol polyps and biliary dyskinesia.

FACTS:

• Presence of gall stone is a pathological status and definitive line of treatment is surgical removal of gall bladder along with stones.


• Presence of stone can lead to pus filled gall bladder (Empyema), gangrene of gall bladder, Obstructive jaundice (due to slippage of stone in common bile duct), to life treating disease like acute pancreatitis and cancer.


• Multiple small stones will lead to Empyema, obstructive jaundice and pancreatitis.


• Large, solitary will lead to cancerous diseases.


• Convectional Laparoscopic surgery is done with 3-4 small holes.


• Single incision multiport Cholecystectomy is possible in selected number of cases.


• Polyps in the gall bladder are usually cholesterol granules (an early stage of gall stone) thus surgery is required.


• Polyps increasing in size or more than 1cm size are prone to undergo cancerous charges.


• 95-99% of cases can be dealt by laparoscopy method and others are treated by conventional open method.

MYTHS:

• Removal of gall bladder does not affect digestive system, as flow of bile is maintained from liver with sphincter control at ampulla of Vatar.

FACTS:

• An acute appendicitis is a clinical diagnosis supported by CBC & USG report.
• CT-scan is rarely required to diagnose it and if diagnosed on CT-scan it is a late diagnosis.
• If diagnosed correctly it requires surgery to prevent complications of delayed surgery.
• If diagnosed there is no role of observation at home, remain on liquid diet, antibiotics and so on.
• Early stage can safely be treated by Laparoscopy with faster recovery.

• Can safely be done, if patient is fit for general anesthesia.
• Contra lateral (opposite) side hernia can be diagnosed and treated at the same time; chances of contra lateral hernias are about 50%.
• A large size of mesh is used to cover all potential spaces to cover.
• Minimal or no pain, faster recovery and early resumption to work is mainstay of this method.

Small hernias are repaired by Laparoscopy (IPOM or IPOM+) but large or complicated hernia’s are repaired by various advance procedures like hybrid approach, component separation, TAR procedure and Myo-cutaneous flaps. They are repaired by using a variety of meshes and tackers to strengthen abdominal wall.

Used to repair hiatus hernia, para-esophageal hernia, reflux diseases. A loose value at gastro-esophageal junction is repaired to prevent regurgitation of stomach content into Esophagus, preventing damage due to esophagus.

Obesity along with Diabetes, Hypertension, Arthritis, Snoring and so on are Increasing due to our life-style modifications. It is becoming a disease and needs attention. Non-respondents to dietary control and exercises needs surgical procedures which are safely carried out laparoscopically.

• Sleeve Gastrectomy.
• Gastric by-pass procedures.
• Expected weight loss is about 50-70% of excess body weight in 1-3 years of time with amelioration of co-morbidities. A prior consultation with dietician is must before seeking a bariatric surgeon's opinion.

• Liver resections.
• Splenectomy.
• Pancreatic pseudo cyst & distal Pancreatectomy.
• Colonic resection for diverticulitis, cancer and tuberculosis.

Surgery is never complete without Thyroid, Para- Thyroid and Adrenal gland surgeries.

A gland situated in the front compartment of neck region. It presents as a solitary nodule, multiple nodules or as a hyper- functioning gland. Occasionally pressure symptoms like change in voice or difficulty in swallowing may be the first symptom. Cancers of thyroid gland is again a threat but if treated in time is fully curable. If indicated it's a safe surgery in experienced hands, however in few cases post-operative change of voice can be there, which improves within 6months to 18 months.

These are usually two pairs of gland situated behind the thyroid gland. They are of 2-3 mm size each and control the calcium metabolism of body. Enlargement and hyper functioning of one or more glands is seen in patients with:-

• Recurrent episodes of urinary calculi or multiple times urinary stone surgery.
• Osteoporosis of bones or bony cysts.
• Recurrent episodes of acute abdominal pain, peptic ulcer disease or Pancreatitis.
• Patients after exhaustive investigations are labelled as a psycho-somatic disease.
• Simple investigations like raised serum calcium, raised parathyroid hormone levels, sonography of neck and sestamibi scan can detect the hyper functioning gland, which warrants surgical removal.

It is performed by minimal access surgery, after the patient is fully investigated by an Endocrinologist.