Best doctor for Hernia. Laparoscopic surgery for Inguinal, umbilical and Incisional hernia.

Anal cancer is rare, but the number of new cases is rising. According to the American Cancer Society, in 2017, there are likely to be about 8,200 new cases, of which 5,250 will affect women and 2,950 will affect men. Around 1,100 people are expected to die from anal cancer, including 650 women and 450 men. Various risk factors are linked to anal cancer, but infection with two types of the human papilloma virus (HPV) appear to underlie 79 percent of cases. Anal cancer is rare before the age of 35 years. The average age of diagnosis is in the early 60s. Men have a 1-in-500 chance of getting anal cancer, and the risk is slightly higher in women. Symptoms and signs Diagram of the sphincter Common symptoms of anal cancer may include rectal bleeding noticeable if there is blood on feces or toilet paper pain in the anal area lumps around the anus, which may be mistaken for piles, or hemorrhoids mucus or jelly-like discharge from the anus anal itching changes in bowel movements, including diarrhea, constipation, or thinning of stools fecal incontinence, or problems controlling bowel movements bloating women may experience lower back pain as the tumor presses on the vagina women may experience vaginal dryness. Causes In anal cancer, a tumor is created by the abnormal and uncontrolled growth of cells in the anus. The anus is the area at the very end of the gastrointestinal tract. The anal canal connects the rectum to the outside of the body. It is surrounded by a muscle known as the sphincter. The sphincter controls bowel movements by contracting and relaxing. The anus is the part where the anal canal opens to the outside. The anal canal is lined with squamous cells. These flat cells look like fish scales under the microscope. Most anal cancers develop from these squamous cells. Such cancers are known as squamous cell carcinomas. The point at which the anal canal meets the rectum is called the transitional zone. The transitional zone has squamous cells and glandular cells. These produce mucus which helps the stool, or feces, pass through the anus smoothly. Most anal cancers are squamous cell carcinomas, but adenocarcinoma can also develop from the glandular cells in the anus. Risk factors Multiple risk factors have been studied that are linked to anal cancer. They include any or a combination of the following: Human papilloma virus (HPV): Some types of HPV are closely linked to anal cancer. Around 79 percent of people with anal cancer have HPV 16 or 18, and 8 percent have other types of HPV. Multiple sexual partners: This activity increases the risk of contracting HPV, which, in turn, increases the risk of anal cancer, which is a known risk factor. Receptive anal intercourse: Men and women who receive anal intercourse have a higher risk of developing anal cancer. Men who are HIV-positive and who have sex with men are up to 90 times more likely to develop anal cancer, compared with the general population. Other cancers: Women who have had vaginal or cervical cancer, and men who have had penile cancer are at higher risk of developing anal cancer. This is also linked to HPV infection. Age: Anal cancer, like most cancers, are more likely to be detected at an older age. A weakened immune system: People with HIV or AIDS and those who are taking immunosuppressant medications after a transplant are at greater risk. Smoking: Smokers have a significantly higher risk of anal and other cancers than non-smokers. Benign anal lesions: Irritable bowel disease (IBD), hemorrhoids, fistulae, or cicatrices have been linked to anal cancer. Inflammation resulting from benign anal lesions may increase the risk. Treatment Treatment for anal cancer will depend on various factors, including how big the tumor is, whether or not it has spread, where it is, and the general health of the patient. Surgery, chemotherapy, and radiation therapy are the main options. Surgery The type of surgery depends on the size and position of the tumor. Resection The surgeon removes a small tumor and some surrounding tissue. This can only be done if the anal sphincter is not affected. After this procedure, the person will still be able to pass a bowel movement. Abdominoperineal resection The anus, rectum and a section of the bowel are surgically removed, and a colostomy will be established. In a colostomy, the end of the bowel is brought out to the surface of the abdomen. A bag is placed over the stoma, or the opening. The bag collects the stools outside the body. A person with a colostomy can lead a normal life, play sports, and be sexually active. Chemotherapy and radiotherapy Most patients will probably need chemotherapy, radiation therapy, or both. Radiation therapy may be combined with chemotherapy to destroy anal cancer cells. Treatments may be given together or one after the other. This approach increases the chance of retaining an intact anal sphincter. Survival and remission rates are good. Chemotherapy uses cytotoxic drugs that prevent the cancer cells from dividing. They are given orally or by injection. Radiotherapy uses high-energy rays that destroy the cancer cells. Radiation can be delivered internally or externally. Radiotherapy and chemotherapy have adverse effects, and combining them may make the side effects more acute. Side effects may include: diarrhea or constipation soreness and blistering around the target area, which is the anus a higher susceptibility to infections during treatment fatigue loss of appetite nausea or vomiting mouth ulcers or sore mouth loss of hair narrowing and dryness of the vagina a low white blood cell count, increasing the risk of infection anemia, due to a low red blood cell count a low platelet count, raising the risk of bruising or bleeding dry skin rashes muscle and nerve problems excessive coughing and sometimes breathing difficulties fertility problems

What is a bowel perforation or hole in your colon and what are the symptoms? Who is at risk? And how is a perforation treated? Overview Your colon is composed of layers of smooth muscle and mucous membranes. The innermost layer, called the mucosa, is soft and pliant—similar to the tissues in your mouth. Bowel perforations occur when a hole is made in this lining, often as a result of colon surgery or serious bowel disease. A hole in the colon then allows the contents of the colon to leak into the usually sterile contents of your abdominal cavity. Symptoms The symptoms of a bowel perforation can vary and may come on slowly or rapidly depending on the underlying cause. Symptoms may include: Abdominal pain (often severe and diffuse) Severe abdominal cramping Bloating Nausea and vomiting A change in your bowel movements or habits. Rectal bleeding Fever (usually not immediately) Chills Fatigue Risk Factors Scientists have found that a number of factors may increase your risk of developing a bowel perforation. These include both factors involved in surgery or a procedure (iatrogenic causes) and bowel diseases characterized by inflammation. Risk factors may include: Recent or prior abdominal. Recent or prior pelvic surgery. Age greater than 75. History of multiple medical problems. Trauma to the abdomen or pelvis (such as in an automobile accident.) A history of diverticular disease. A history of inflammatory bowel disease. Colon cancer Use of the monoclonal antibody immunotherapy drug ipilimumab. Pelvic adhesions (scar tissue, usually related to previous surgeries.) Female gender (women typically have a more flexible colon, which can lead to accidental perforation during medical procedures, including a colonoscopy.) Diagnostic and surgical procedures involving the digestive tract, abdomen, or pelvis. Risk factors for a perforation during a colonoscopy include being female, older age, a history of diverticular disease, and bowel obstructions. Causes Bowel perforations may occur spontaneously (unexpectedly) as a result of a medical condition or instead be a complication of various diagnostic and surgical procedures which accidentally create a hole in the colon. Trauma, especially blunt trauma to the abdomen, is also an important cause of bowel perforations. Procedure associated causes include: Enema – An improperly or forcefully inserted rectal tube for an enema can rip or push through the colon lining. Bowel preparation for colonoscopy - Rarely, the bowel preparation for a colonoscopy can result in a perforation. This is more common in people with a history of constipation. Sigmoidoscopy – Although the endoscope for a flexible sigmoidoscopy is flexible, perforation remains a risk, but a rare one. Colonoscopy – The tip of the endoscope has the potential to push through the inner lining of the colon, although this is a rare complication of the procedure and is not seen in the virtual colonoscopy. Perforation of the bowel associated with a colonoscopy is more common in those who have the severe acute disease of the bowel as well as those who are on steroid medications. The colonoscopy perforation rate appears to be around 1 in 1400 people who have screening colonoscopies and 1 of 1000 people who have a therapeutic colonoscopy (for example, to remove a polyp.) Abdominal or pelvic surgery, particularly colon surgery as for colon cancer. Causes of spontaneous bowel perforation (those unrelated to surgery or procedures) include: Inflammatory bowel disease/colitis such as Crohn's disease and ulcerative colitis. The lifetime risk of a bowel perforation with Crohn's disease is between one and three percent, making this a very common cause. Severe bowel obstruction, especially when the colon is "weakened" by diverticular disease, another process, or cancer. Trauma. Ischemic bowel disease (when the blood supply to the colon is compromised.) Colon cancer. Foreign body ingestion - Most commonly due to the ingestion of fish bones, and bone fragments, as well as non-food items. Severe bowel impaction. Diagnosis If your doctor suspects a bowel perforation, she can order tests to confirm her suspicion. A simple abdominal x-ray may show gas outside the colon but is not often diagnostic. A CT scan of your abdomen with or without contrast or a barium enema or swallow may be needed. A complete blood count may show an elevation of your white blood cell count if the perforation has been present for a while, or evidence of anemia due to bleeding. Small perforations may sometimes take several imaging studies and time to accurately diagnose. Treatment Perforation of the bowel is considered a medical emergency and requires immediate treatment. Left untreated, the contents of the bowel can leak out and cause inflammation, infection and even abscesses in your abdomen. The technical name for this is peritonitis, which is a painful precursor to sepsis—or a body-wide infection. The majority of perforations are surgically repaired. Depending on the location and size of the tear, the doctor might be able to fix it through an endoscope, similar to the one used during a colonoscopy—but this is not an option for everyone. Open bowel surgery may or may not result in a stoma and colostomy: an artificial opening outside of your stomach where stool drains into a small bag until the bowel is healed. Complications Complications of untreated perforation may include: Bleeding Infection (peritonitis and sepsis) Death Complications depend on a person's general health, as well as the amount of time it has taken to diagnose and treat the perforation. Recovery During your initial recovery period, you will not be able to drink or eat anything by mouth. This is called resting the bowels and allows the inner lining time to heal properly. You will also have a nasogastric tube in place to drain the contents of your stomach for a period of time. You may receive intravenous antibiotics and nutrition for a few days if you're in the hospital. Although you may be anxious to return to your normal routine, it's important that you give your colon time to heal properly, and follow your doctor's orders. The Bottom Line Bowel perforation may occur spontaneously, such as with inflammatory bowel disease, or during surgery or diagnostic tests. Symptoms may come on rapidly, or instead slowly, and should be considered in anyone who has risk factors for a perforation combined with risk factors for the condition. When caught early, there are different treatment options available, but even with surgery (which is most often required) the bowel can often be preserved and repaired without a colostomy. Recovery can take time, both for healing, and to correct and risk factors which led to the perforation.

Hemorrhoids are varicose (enlarged and swollen) veins around the outside of the anus or in the lower rectum. The rectum is the last part of the bowel that leads to the anus, the opening at the end of the bowel where fecal matter leaves the body. Everyone has hemorrhoidal tissue in this area that’s made up of blood vessels, connective tissue, and some muscle. These “cushions” don’t always become enlarged or distended, but as we age, this phenomenon becomes more common — causing what we call hemorrhoids, also known as piles. Hemorrhoids can be caused in a number of ways, often by straining to make a bowel movement. Lifting heavy objects, along with other activities that may cause straining, can also lead to hemorrhoids. Experiencing increased pressure during pregnancy and being overweight are other contributing factors. Hemorrhoids may be painful and particularly bothersome if they are recurrent, but they are not dangerous or life-threatening, and symptoms usually go away within a few days. There are plenty of effective ways to treat them, as well as options for the less common types of hemorrhoids that may be more problematic.

Anal Fistula When an irregular false tract occurs between the inside of the rectum and the outside skin surface, an Anal Fistula forms. The anal fistula is classified according to the condition of the tract and the relation of the internal opening to the anal sphincter muscle. Most commonly, this condition develops because of an anal abscess that went untreated. The anal abscess itself is usually the result of a small gland that becomes infected. The most common symptoms are pain, recurrent swelling, pus discharge and discomfort during the discharge of stool. The most common treatment in India is a surgical treatment; the most common method is the minimally invasive Video Assisted Anal Fistula Treatment. Symptoms What are the typical symptoms of anal-fistula? Swelling around the anal area Redness around the rectal area Pus drainage Rectal pain. Causes What causes anal fistulas? It usually occurs as a result of some damage to the tissue around the anus. It begins as a sort of inflammation in the rectal area. Later, it becomes an abscess which gets regularly infected and reinfected by faeces. This causes the fistula to form near the anus. If the fistula seals over, pus can start accumulating. Because of this pus-drain, anal fistulas can be very painful. Anal fistulas usually occur because of: An injury caused by constipation Anal glands becoming infected Crohn’s disease Abscess of the large intestine

When the skin of the anus gets cut or damaged, that is called an anal fissure. It is very similar to what happens when our dry lips get chaffed. Fissures typically bleed and cause pain, which is why they are often confused with haemorrhoids/ piles. When the anal muscles are stretched too far, it usually causes strain on the anus. This can occur to people who suffer from constipation or prolonged diarrhoea. It also occurs for older patients due to decreased blood flow to the anal area. It is not uncommon for women to develop anal fissures after giving birth as well. And it can also happen to people who have Crohn’s disease. With more severe cases of anus tearing, an external lump will form on the anus. These are the sentinel piles tell-tale of chronic fissures. The issue of anal fissures can be solved by medicine or by surgery and also by laparoscopic treatment. Symptoms Some signs and symptoms of anal fissures : Pain during bowel movement Pain after the bowel movements Blood on the stool or toilet paper Anal itching Visible damage to the skin of the anus A small lump that’s close to the anal fissure. Treatments Chemical Sphincterotomy Chemical Sphincterotomy is basically a Botox Injection for anal fissures; it is a very common Treatment for Anal Fissures. If the anal fissure doesn’t heal, it’s usually because of the spasm of the internal anal sphincter muscle which reduces blood supply to that area and further aggravation occurs to the fissure during the passage of motion through a spasmodic anal canal. The Botox is injected into the anal sphincter. This injection is used to prevent spasm and cause temporary paralytic relaxation until the tissues are renewed. The effects last for three months and the anal fissure heals during that time. Percutaneous Closed Lateral Internal Sphincterotomy This surgery, popularly known as CLIS, is a quick minimal invasive surgical method performed by specialized doctors under local anaesthesia that is used to treat chronic anal fissures. It is performed on the internal part of the anal muscle, the internal anal sphincter. The surgical procedure basically lowers the pressure of the internal anal sphincter and the spasm is reduced by dividing this internal anal sphincter. The fissure is healed because anal spasm is lowered and blood flow to the area is improved. Due to the closed technique, the wound is smaller and it heals faster.

An Inguinal Hernia is a gap in the strong tissue in the abdomen which holds the stomach muscles. It occurs in the abdominal muscles and weakens them which cause a bulge in the stomach. Hernia causes discomfort and pain in the stomach. Both men and women can get inguinal hernia. Symptoms of Inguinal Hernia: It can cause a severe pain in abdomen especially in pelvis region. The later symptoms also result in swelling and severe pain in the testicles or groin area. Apart from that the patients who are suffering from inguinal hernia have a problem in walking straight and straining the abdominal muscles by lifting up some things. Diagnosis: The diagnosis of this type of hernia is physical examination as the doctor can see and feel the bulge. For further diagnosis other tests like ultrasound and CT scan is also done. Treatment and Recovery: The surgery of inguinal hernia is done with laparoscopic approach with the help of instrument called laparoscope. Small incisions are made in the abdomen to insert the laparoscope and treat the hernia. This technique is also known as keyhole surgery. Patient takes about 1 to 2 weeks to get properly recover after the surgery. They have to wait atleast for 4 weeks to start exercising after the operation.

Umbilical hernia is a bulge form in abdomen. In children, it is healed on its own but if this disease occurs in adults then a surgery is needed. The surgery of Umbilical hernia is done by laparoscopic surgery and is less risky. Symptoms: Umbilical hernia is called so because these types of hernia are present near the umbilicus area or the naval area of the abdomen. When occurred in children of around 2 to 3 years, it can be seen that it heals on their own. The common symptom of this type of hernia is discomfort and severe pain. Patient suffering from umbilical hernia have severe pain and have a bulge in near the naval area. They have difficulty in lifting things. Diagnosis of Umbilical Hernia: Physical examination is done. The doctor will see if the hernia can be reduced. Further diagnosis is done with the help of X-ray and ultrasound. Treatment and Recovery: Surgeon does an incision at the naval area of the abdomen where the bulge is present. They push the tissue back inside the stomach wall. Time taken for surgery is approximately an hour. The recovery is fast as the approach used here is laparoscopic approach.

Appendicitis is the swelling of the appendix which is present in the right side of the abdominal region. It is generally a 5-10 cm tube connected to the large intestine. If it is not treated at the right time it can burst out, spilling infection in the abdominal cavity that can be more fatal. Appendicitis can occur anytime between the age of 10 to 30. Both men and women can suffer from this condition. The infectious material or the puss which is formed inside the appendix can be more dangerous to life as it spreads in the entire abdominal cavity. Patient suffering from appendicitis ignore this because it seems like a common stomach pain. There are many causes that can cause appendicitis out of which one common cause is the blockage or obstruction in appendix. Obstruction can cause due to the bacteria multiply inside the organ causing the increase in the infection inside the appendix forming a puss. Symptoms: Patient suffering from appendicitis commonly have a pain in the right side of the abdomen. A raise temperature, means, they may feel that they are having fever. Nausea and vomiting, other symptoms includes abdominal swelling, inability to pass wind, painful urination. Dr Jiten Chowdhry notes that these treatments can cause appendix to burst if the patient is suffering from appendicitis. If you have tenderness in the right side of the consult a doctor. Diagnosis: Abdominal examination is done to detect the inflammation. A urine test is done. Rectal examination, CT scan and blood test is done to diagnose the appendicitis condition properly. Treatment and Recovery: Laparoscopic surgery is performed where a small incision is done in the lower right side. The recovery time is very short and the patient can get discharged within 3 to 4 days of the surgery.