Department of GI, General, Minimal Access and Bariatric Surgery

The Department of General, Minimal Access, GI & Bariatric Surgery is a highly specialised unit backed by best-in-class interventions and modalities. It’s committed to deliver the finest care to patients, with adherence to stringent quality control procedures. Every treatment plan is precisely curated in accordance with the specific needs of the patients, thereby giving a personalised touch for better outcomes. The department has dedicated surgical units and ICUs, fully equipped to handle the most complex cases.
General & Gastro-Intestinal (G.I) Surgery
General & G.I surgery is a surgical specialty that focusses on the abdominal area including the esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder and bile ducts. These operations could be performed using the open technique or laparoscopic surgery. General Surgery, in addition, also deals with diseases involving the skin, soft tissue, piles, fissure and hernias.
Laparoscopic Surgery
Laparoscopic Surgery, also sometimes referred as Minimal Access Surgery (MAS) / Minimally Invasive Surgery (MIS) / Keyhole Surgery or Pinhole Surgery results in smaller cuts, better cosmetic results, lesser pain and speedy recovery. In this technique, a long thin telescope is passed in the abdominal cavity. The telescope is attached to a camera, which carries the inside vision to an external LCD / LED monitor. Surgery is performed by watching the monitor and using long thin instruments. Patients often confuse Laparoscopic Surgery with Laser Surgery. Single Incision Laparoscopic Surgery (SILS) is also done in selected patients where operation is performed through only a single cut near navel and can minimise scars. Our team consists of the surgeons who are experts in this field of Laparoscopic Surgery.
Medical conditions that require surgery and come under this Department:
General Surgery: Consultants perform a variety of procedures including, but not limited to:

• Cholecystectomy - Removal of Gallbladder for symptoms of gallstones / polyps
• Hernia Repair

1. Inguinal
2. Umbilical
3. Incisional
4. Hiatal

• Minimal Invasive Procedures for Haemorrhoids (Piles) - M.I.P.H
• Video Assisted Anal Fistula Treatment (VAAFT)
• Laser Assisted Fistula Closure (FILAC)
• Closed Lateral Internal Sphincterotomy (Fissure Surgery)
• Appendectomy - Removal of Appendix
• Excision of Lumps and Bumps on skin such as Lipoma, Cyst, Tumours etc.

Laparoscopic Surgeries:

• Laparoscopic Cholecystectomy
• Laparoscopic Hernia Repair (Inguinal / Umbilical / Incisional / Ventral)
• Laparoscopic Fundoplication for Gastro Esophageal Reflux Disease (GERD) and Hiatus Hernia
• Laparoscopic Cardio Myotomy for Achalasia Cardia
• Laparoscopic Drainage of Pseudocyst of Pancreas
• Laparoscopic Surgery for Hydatid Cyst / Choledochal Cyst
• Laparoscopy for Gastric, GI & Colo-rectal Cancer
• Laparoscopy for Intestinal Stricture, Tuberculosis, Inflammatory Bowel Disease.
• Laparoscopic Solid Organ Surgery – for removal of Spleen, Adrenal Gland etc.
• Laparoscopy for unconfirmed abdominal problems - Diagnostic
• Laparoscopy for Trauma and Peritonitis

Gastro Intestinal Surgery (Gl Surgery)

Gastro Intestinal operation are usually complex surgical procedures requiring high degree of training and expertise. Surgery for Cancer of stomach, pancreas, colon and rectum are done with multidisciplinary care, like:

• Surgery for Cancer / Lesions of Esophagus (food pipe)
• Gastric Cancer Surgery – Gastrectomy 
• Stomach and Duodenal Lesions – GIST / Neuroendocrine Tumours
• Pancreatic Tumours - Whipple's Operation and Distal Pancreatectomy
• Surgery for Gallbladder Cancer
• Liver Surgery – for Tumours / Abscess / Cysts
• Biliary Surgery – for Biliary Fistula / Stricture, Stones in Bile Duct, etc 
• Surgery for Chronic Pancreatitis
• Surgery for Ulcerative Colitis
• Colon and Rectal Cancer Resections
• Surgery for Acute Severe Pancreatitis and Pancreatic Abscess / WOPN
• Splenectomy

Common Surgical Conditions
Gallstones
Patients who have gallstones usually complain with pain in the upper abdomen, gaseous distension and symptoms like acidity. Ultrasound of the abdomen is enough to confirm the diagnosis. Gallstones can cause serious complications like infection in the pancreas gland (Pancreatitis), pus inside the gallbladder (Empyema), etc. besides being occult harbourers of cancers.
Laparoscopic Cholecystectomy
It’s the gold standard and provides complete care. It is one of the most common operations performed. Patients require to stay only for a day in the hospital. They are able to resume normal diet and activity one day after surgery. No long-term harmful effects are seen after the gallbladder removal. It is a myth that people with gallbladder removal have to undergo any dietary restrictions.
Appendix

                                       

Infection in the appendix (Appendicitis) can potentially affect all age groups. The pain usually starts in the umbilical area and then spreads to the right lower abdomen. It should be treated promptly as it may burst and cause the spread of infection and collection of pus. Sometimes, the patients come with a lump and then a conservative treatment with medicines is started. Patient is then called for surgery later known as 'Interval Appendectomy'. Most of the time it can be simply treated with a keyhole surgery – Laparoscopic Appendectomy. 

Hernia
                                                      
Any abnormal bulge in the body which increases on coughing / straining or reduces in size on lying down clearly indicates a hernia. It is commonly seen in the groin region (Inguinal & Femoral), abdominal wall or previous surgical sites. A hernia occurs because of weakness or defect in the muscles. it can occur in all age groups.
An abdominal Hernia is like a bag which can contain intestine / intra-abdominal fat or abdominal organ. There is always a risk of the intestine or fat (Omentum) getting trapped there and becoming strangulated requiring emergency surgery.
All hernia should be repaired as soon as possible. The hernia repair surgery can be accomplished with the placement of barriers (Mesh) which give strength to the musculature and prevents recurrence.
Fortunately, all the hernia surgeries can now be performed with the technology of laparoscopy avoiding big cuts, it also reduces the risk of infection / failure of surgery.
Generally, patients are required to be in the hospital for one day and they can resume normal activities within a week but strenuous exercise and heavy weight lifting has to be avoided for a couple of months after surgery.
Perianal Surgery (Piles / Fissure / Fistula) 
Perianal problems are a set of frequently encountered surgical conditions. Patient problems like painful defecation (fissures), bleeding through the rectum (piles), or perianal pus discharge (fistula). Most problems require an examination for correct diagnosis.
Fissure or crack in the perianal area can be acute or chronic. Temporary relief can be obtained medically but repeated episodes of pain or bleeding with passing stool have to be treated with minimally invasive procedures like 'Lateral Sphincterotomy'.
Piles or Haemorrhoids are the distended veins in rectum which burst on increased pressure and lead to fresh bleeding like a splash.

         

                           
 'Proctoscopy' - or internal examination of rectum with an instrument is required to correctly diagnose the problem. Over time the piles can grow big and prolapse out of the anus causing pain and discomfort.
Traditionally, the surgery for Piles has been painful with big open cuts and extremely discomforting. However, these days, the surgery can be performed using a 'Stapler' so that there are no external cuts or stitches. This procedure is called 'Minimally Invasive Procedure for Haemorrhoids (MIPH)’ or ‘Stapled Haemorr-hoidopexy'. In selected cases, LASER surgery for piles can be done which has similar recovery to MIPH.
Painful swelling around the anus is likely to be due to pus collection. All abscesses have to be drained with a cut and then appropriate medical treatment is initiated. A spontaneous and surgically drained abscess may lead to an inside-outside communicating track which is called 'Anal Fistula', Majority of the patients will have repeated episodes of swelling and pain followed by some pus discharge. Traditional surgery means cutting a large amount of tissue to remove the entire track and healing often takes two weeks or more. In recent times, LASER and "Video Assisted Anal Fistula Treatment (VAAFT)” are also getting popular to avoid big wounds. In the VAAFT, a tract is visualised and burnt using a small telescope. The internal opening of the tract is closed by staplers / sutures. The advantages are much lesser pain, fewer dressings, and early recovery. However, these patients may have to undergo repeated endoscopic track ablation. 
Patients are advised to take plenty of liquid, high fibre diet (Salads / Vegetables / Fruits), and laxatives to avoid constipation, which often is the root cause of these conditions.
Pre-Operative Preparation
All patients undergoing a surgical procedure under regional or general anaesthesia need to undergo a basic set of investigations to check for their fitness to undergo the operation. Many times, the help of another expert like a physician or cardiologist will be required when there are associated medical problems like Diabetes, Hypertension, Coronary Artery Disease, etc.
The risk of anaesthesia and surgery will depend on the pre-existing medical conditions, age, magnitude and nature of surgery etc. Please ask your doctors for any specific risks. No medical treatment is totally risk-free. However, any operation is undertaken when the benefits far outweigh the risks and complications. All patients are required to sign an informed consent form before undergoing surgery. At least 6 to 8 hours of complete fasting are required prior to surgery. Typically, the patients are asked to stay fasting after midnight on the previous day. It is a good practice to take a bath with soap and water for the morning of surgery. Local hair removal by shaving or depilatory cream will be necessary. The patient will be shifted about half an hour prior to surgery. Occasionally, there may be delays from the prefixed time due to unavoidable circumstances.
Pre-Operative Investigations for Pre-Anaesthetic Check (P.A.C) include:
Routine

• Haemogram
• Blood Sugar, HbA1C
• Liver Function Test with PT / INR
• Kidney Function Test
• Viral Markers (HBsAg, HCV, HIV)
• Urine Routine & M / E
• Chest X-ray
• ECG

Special

• Lipid Profile
• Echocardiography / T.M. T
• Thyroid Profile
• Pulmonary Function Test
• Upper G.I Endoscopy / Colonoscopy
• C. T Scan / M.R. I
• Others

Post-Operative Period
After surgery, the patient is kept in observation for some time for monitoring of pulse, blood Pressure, oxygen saturation, etc. This period is usually 1 to 2 hours but it varies as per our anaesthetist’s assessment. The patient may require to be shifted to ICU for longer observation if the need arises. Typically, the patients are asked to stay fasting for 4 to 8 hours after surgery. Liquid diet may be resumed on the same day and a soft or normal diet can be started from the next day, this also varies according to the nature of the surgery and patients’ ability to accept it orally. On the day of discharge, it takes about 4 hours between the time your Senior Consultant advises the discharge and all formalities completion.
Surgical Care at Sanar Group of Hospitals
All our surgeons have a background of extensive surgical training and practice at leading 
government and private hospitals. They have experience of thousands of successful operations to their credit. They bring with them the best surgical practices and protocols. Sanar International Hospitals is equipped with modern operation theatres, endoscopy systems, the latest anaesthesia machines, and ICUs. These help us to deal with all advanced and complex surgical work. We understand that even a minor surgical procedure is associated with a lot of anxiety and it is our constant endeavour to make the patients’ experience comfortable.
The expert team of Bariatric Surgeons at Sanar International Hospitals provides a long-term and successful solution to the people with a severe level of obesity. Although obesity can be managed with regular diet control, exercise, and other lifestyle changes, but once the BMI gets to the level of morbid obesity, bariatric surgery becomes a choice. The department is highly focused on a comprehensive cure of obesity with the right evaluation and treatments.
Obesity and BMI Calculation: 
The World Health Organisation (W.H.O.), along with other national and International medical and scientific societies recognise obesity as a chronic progressive disease resulting from multiple environmental and genetic factors. It is no longer a cosmetic issue caused by overeating and a lack of self-control. Due to its progressive nature, obesity requires life-long treatment and control.
What is Body Mass Index?
The Body Mass Index (BMI) is a common means to measure obesity. It is measured with an individual’s height and weight. It can be determined by using a BMI chart or can be calculated according to a simple formula.

Category	BMI	Health Risk
Normal	18.5 - 24.9	Minimal
Overweight	25 - 29.9	Increased
Obese	30 - 34.9	High
Severely Obese	35 - 39.9	Very High
Morbid Obese	40+	Extremely High

Once Body Mass Index (BMI) increases; weight-related issues may affect one’s quality of life with:

• Depression
• Disability
• Sexual problems
• Shame and guilt
• Social isolation
• Lower work achievement

Obesity and its effects:    
Obesity basically refers to the accumulation of fat in one’s body, which potentially causes several types of damage to the body. People with     severe obesity are more likely to catch other diseases like:

• Metabolic Syndrome — a combination of high blood sugar, high blood pressure, high triglycerides, and low HDL cholesterol.
• High Triglycerides and low High-Density Lipoprotein (HDL) cholesterol
• Type 2 Diabetes
• High Blood Pressure
• Heart Disease
• Stroke
• Cancer
• Breathing disorders, including Sleep Apnoea, a potentially serious sleep disorder in which breathing repeatedly stops and starts
• Gallbladder disease
• Gynaecological problems, such as infertility and irregular periods
• Erectile dysfunction and sexual health issues
• Non-alcoholic fatty liver disease, a condition in which fat builds up in the liver and can cause inflammation or scarring
• Osteoarthritis

What are the options to cure obesity?
Diet, Exercise, and Behaviour modifications are the integral parts of the treatment of obesity. The good news is that even modest weight loss can help to improve or prevent the health problems associated with obesity. However, once obesity becomes severe, there is a high likelihood of failure with conventional measures. The NIH (National Institute of Health) recognises bariatric surgery (weight-loss surgery) as the only effective treatment to combat severe obesity and maintain weight loss in the long term.
What is Bariatric Surgery?

Bariatric Surgery is about a set of procedures that cause weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or with a combination of both gastric restriction and malabsorption. Bariatric procedures also cause desirable hormonal changes for effective health benefits. Most weight loss surgeries today are performed using minimally invasive techniques or laparoscopic surgery, and patients can walk soon after the surgery. The hospital stay usually remains for 2 to 3 days.
Commonly performed procedures popular today are Laparoscopic Sleeve Gastrectomy and Gastric Bypass Surgery and some can be performed with Minimally Invasive Keyhole Surgery.

Common Procedures:

Benefits of Bariatric Surgery:

• Effective weight loss, which is measurable to the tune of more than 30kg (not merely 5 - 10 kg)
• Long-term maintenance of weight loss with major studies showing more than 50% EWL (Excess Body Weight Loss) maintained for more than 16 years.
• Resolution of obesity-related illnesses like Diabetes, Hypertension, Sleep Apnoea, Osteoarthritis, and improvement in cardiac function.
• Improved longevity: Many studies have shown improved longevity after Bariatric Surgery (comparing them with the individuals who were eligible for the surgery but did not undergo it). 
• Improved quality of life: In addition to longevity and significant improvement in health, weight loss improves the overall quality of life which leaves a positive impact on almost every aspect like self-esteem, social interaction, employment, and sexual function. Singlehood and issues like depression and anxiety are also significantly reduced following Bariatric Surgery.