Abdominal Adhesions

Abdominal Adhesions occur in the abdominal area and may involve pelvic organs, intestine tissues and ovaries. Abdominal adhesions also occur from abdominal incisions or infections like appendicitis, Crohn’s disease, diverticulitis, endometriosis, pelvic inflammatory disease, etc. It is more common in open surgeries than laparoscopic surgeries. It is less common in laparoscopic surgeries because the cuts are smaller. So laparoscopic surgeries are preferred over open surgeries. Lot of abdominal surgeries can be performed laparoscopically, eg. laparoscopic appendectomy, laparoscopic cholecystectomy, laparoscopic gastrojejunostomy, laparoscopic gastroplasty, etc

The symptoms vary depending on the organs and tissues that are involved. If the intestinal tissues are involved in adhesions the symptoms include severe cramping pain and limit the gut movement.  Partial or complete bowel obstruction is caused when a segment of the bowel is tapered by an adhesion. This causes severe pain, nausea and vomiting.

In more severe cases of adhesions, the entire abdominal cavity along with the reproductive organs and intestines are distorted with adhesions. Large and thick bands of adhesions lead to a frozen state of the abdominal area and will necessitate complex surgical procedures.  

Adhesiolysis

Adhesiolysis is a procedure performed to break up and remove adhesions. It is a minimally-invasive procedure. This procedure is also called Lysis of Adhesions. The treatment helps to treat adhesions that cause chronic pain and inflammation.  Antibiotics and medications are prescribed to reduce the chances of infection and to control the pain and discomfort caused by the procedure.

Adhesiolysis procedure comes with some risks such as infection, headache, dural puncture, swelling, increasing pain, excessive bleeding, or discharge from the incision site. The doctor provides special instructions and medications that have to be followed without fail to reduce the risk of complication.

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It is an astonishing fact that the number of people having Diabetes Mellitus (DM) is increasing day by day. Asians have higher incidence of Diabetes, due to genetic reason. Life style changes and food habits contribute to this increase. Diabetes affects all organs in the body like eye, brain, heart, kidney & limb vessels. These lead to early death.

•  Heart attack at an early age
•  Stroke
•  Kidney disease leading to kidney failure, which may require dialysis. 45% of dialysis patients are contribution of diabetes.
•  Nerve damage which can lead to digestive and bladder problems sexual dysfunction and numbness or tingling in the legs.
•  Foot problems including ulcers and poor circulation that can lead to amputation.
•  Eye complications such as glaucoma, cataract, and retinopathy, that can lead to blindness

International Diabetic federation has approved bariatric surgery as preferred and effective treatment of diabetes; benefits of surgery being long lasting remission of diabetes; control of other associated illnesses and cost effectiveness.

NEJM (New England Journal of Medicine) rates metabolic surgery to cure Diabetes as the most important innovation of 2012.

Keyhole Surgery for Type 2 Diabetes Resolution

Type 2 Diabetes is the result of

•  Increased demand for insulin due to higher quantity of food eaten.
•  Reduced production of insulin due to fat deposition in pancreas or pancreatic cell hypo function
•  Glucose supply from liver (neoglucogenesis) due to fatty liver and
•  Most importantly insulin resistance (the insulin available in the body is not able to take care of the glucose due to excess fat in the body).

It is now clear the intestinal hormone (GLP1) levels can regulate the insulin production in pancreas. Hence by increasing GLP1 level in the gut, diabetes can be controlled. GLP1 is produced in large quantities by terminal portion of small intestine. Partially digested food reaching this region increases the production of this hormone. There are other neurohormonal gut mechanisms as well, working in favour to control of diabetes.

By keyhole surgery the stomach size is brought down hence excess food intake will be reduced and gastric emptying is accelerated. Last portion of small intestine is brought towards the stomach that helps in bringing partially digested food into the small intestine rapidly, thus increasing GLP1 level and there by increasing insulin levels. Obese diabetics require modified sleeve gastrectomy alone while non obese diabetics require sleeve gastrectomy and ileal interposition. The weight reduction and associated fat loss will also increase insulin activity. These surgeries are found to increase insulin performance and give long standing resolution of diabetes.

Keyhole Surgeries for Resolution of Obesity

 Laparoscopic Sleeve Gastrectomy ( > 30 BMI Patients).

Laparoscopic Gastric Banding.

Gastric Bypass.

Modified sleeve gastrectomy & Ileal Interposition (25 to 30 BMI patients).

Intragastric Balloon for Weight Reduction

 Click here to Read on Intragastric Balloon Placement.

Minimally Invasive Hybrid Surgery for Ileal Interposition

MIHSII is an innovative technique in which sleeve gastrectomy is performed laparoscopically, followed by extracorporeal ileal interposition performed through a 5-cm midline incision. MIHSII is a cost-effective and minimal procedure for the resolution of T2DM in patients with BMI <30 kg/m².

MIHSII Procedure diagram

Is Type 2 Diabetes Surgery feasible for you?

These procedures are helpful in patients with Type 2 diabetes, in whom pancreas is capable of producing good level of insulin. These are having much better result in those with more than ideal weight and in those with diabetes of shorter duration (few years) than in those who have already damaged their end organs like kidney, eye, heart, etc. So it is better to undergo this procedure before pancreas fails significantly and before end organs damage starts. It is highly appreciable for a diabetic patient to know that cure is possible. In Type I diabetes (where pancreas is not functioning at all or has antibodies against insulin) these surgeries are not helpful.

85% to 90% of diabetic patients treated by these surgeries are cured of diabetes. Other 10 to 15% also could reduce their medications significantly. In addition to diabetic control the other benefits are loss of excess weight and control of cholesterol, sleep apnoea, joint pains, cardiac disease, hypertension, kidney disorders, eye problems etc. It definitely improves quality of life and reduces cancer risk, infertility & mortality (early death).

All these procedure are done under general anaesthesia and patient will be observed for 4 days in hospital. These are done by laparoscopic and minimally invasive methods using equipments like staplers & harmonic scalpel. Hence, patients will be highly comfortable and can resume normal activity in a few days time.

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What is Endoscopic Thyroidectomy?

The benefit of this procedure is that this is a minimally invasive approach (ie., the surgery is performed through a keyhole incision). Other benefits include safety and precision. That is the video camera inserted through the keyhole incision provides a magnified view of the internal structures. Thus the surgeon can perform the surgery by viewing a magnified view of the internal structures on a computer monitor. This increases safety and the surgeon performs the surgery with precision. The greatest benefit is that the neck remains free of scar as the thyroidectomy is performed endoscopically via incisions made at the axilla. The smallest of scars produced are hidden beneath the inner clothes at the axilla. This is a great cosmetic advantage.

Endoscopic Thyroidectomy can be performed for all types of Thyroid Surgery. The main types of thyroid surgery are:

Total thyroidectomy (removing all of the thyroid gland)
Lobectomy or hemithyroidectomy (removing half of the thyroid gland)
Near-total thyroidectomy (removing most of the thyroid gland but leaving a little tissue on one side)
Isthmusectomy (removal of the central part of the thyroid gland) is performed

Thyroid abnormalities are common among women. As per American Thyroid Association , approximately 90% of all thyroid nodules are benign. Ultrasound of the neck or if needed FNAC (fine-needle aspiration cytology) is used in patients diagnosed with single or multiple thyroid nodules. If malignancy is suspected as per the ultrasound report or the FNAC, then surgery is the advised solution regardless of the size of the swelling. Thyroidectomy is recommended for nodules larger than 4 cm even if the USG and FNAC suggest benign swelling. Depending on the patient history, physical examination as well as the USG and FNAC findings, the surgeon may decide to offer a hemithyroidectomy or total thyroidectomy in consultation with the patient.

Endoscopic Thyroidectomy – How it is performed?

• Using a keyhole ( laparoscopic surgery techniques), a scope is inserted with instruments at the axilla to remove all or part of your thyroid gland.
• The operation is carried out with special instruments using a camera to guide the surgeon. The camera allows the surgeron to visualize the internal structures with magnification, precision and clarity on a monitor.
• After the thyroid gland is detached from the trachea, the specimen is placed in a specimen bag.
• You will have a small drain in the wound which will be removed after a few days.
• At the end, thyroid gland, part or whole, is removed through one of the incisions.
• The incisions are then closed.

Image Showing Endoscopic Thyroidectomy 
Incision made near the axilla

In Endoscopic Thyroidectomy a video camera is inserted via the axilla and visualized on the screen

Endoscopic Thyroidectomy – Image Showing Video Camera with Light to visualize internal structures

Endoscopic Thyroidectomy – Internal Structures visualized through video camera

Open Thyroidectomy

Open Thyroidectomy is the conventional way of performing thyroidectomy. When thyroidectomy is done through the open method, a transverse incision measuring 12–15 cm in length is made on the neck. A large cut is made across the neck or a full cut is required even to remove a small part of the thyroid, even for one side removal leaving behind an ugly scar in the neck with pain, discomfort and delayed recovery. Women find these scars uncomfortable and cosmetically unacceptable. Thyroid disorders and found common in women. Minimal access approaches to thyroid surgery result in a reduction in size or elimination of the scar of the neck.

Scar on performing open thyroidectomy at the neck

Cuts on the neck while performing open thyroidectomy

Open Thyroidectomy – For removal of a large Thyroid

Large Thyroid Removed by Open Thyroidectomy

Endoscopic Thyroidectomy Vs. Open Thyroidectomy

Endoscopic Thyroidectomy – The Advantages

• Scarless Thyroid Surgery – No Scar on Neck
• Minimally invasive – No need for a large cut on the neck
•  Short Hospital Stay – Recovery Time 2 days

Endoscopic Thyroidectomy at Kochi is performed regularly at VPS Lakeshore Hospital by minimally invasive surgery team headed by Dr. R. Padmakumar who is one of the Best Thyroid Surgeon in India.

What Patients Have to Say

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