general surgeries Archives - Dr NandaRajneesh

What is Pilonidal sinus?

Pilonidal sinus is midline opening formed by a cyst or an abscess near the tailbone that often contains hair, dirt and skin debris.

How does it occur?

It is thought that the combination of buttock friction and shearing forces in that area causes broken hairs which collect there and drill through the midline skin and enter the skin by the suction created by movement of the buttocks. The body considers this hair foreign and launches an immune response against it and this immune response forms the cyst around your hair.

What are the risk factors of Pilonidal sinus?

obesity – having a body mass index (BMI) of 30 or above

age – pilonidal sinuses can occur at any age, but are more common in young adults between the ages of 15 and 40

having an above-average amount of body hair, which may be why more men are affected than women

having coarse and curly body hair

a previous injury to the affected area of skin – for example, from a fall

having a deep cleft between your buttocks

having a family history of the condition – more than one-third of people have a family member with the condition

having a job involving a lot of driving or sitting down for long periods

What are the symptoms of Pilonidal sinus?

At first you may notice a small, dimple-like depression on the surface of your skin. However, once the depression becomes infected, it will quickly develop into a cyst or an abscess.

Signs and symptoms of infection are-

pain when sitting or standing

swelling of the cyst

reddened, sore skin around the area

pus or blood draining from the abscess, causing a foul odour

hair protruding from the lesion

formation of more than one sinus tract, or holes in the skin

How do you treat Pilonidal sinus?

Conservative treatment- In those whose symptoms are relatively minor, simple cleaning out of the tracks and removal of all hair, with regular shaving of the area and strict hygiene, may be recommended.

Incision and drainage- This is done in acute exacerbation of the disease.

Before this procedure, your doctor will give you a local anaesthetic. They will then use a scalpel to open the abscess. They will clean away any hair, blood, and pus from inside the abscess. Your doctor will pack the wound with sterile dressing and allow it to heal from the inside out. The wound usually heals within four weeks, and many patients don’t require any further treatment.

Surgery- Surgery is the treatment of choice in chronic or recurring abscesses or sinuses.

What are the surgical treatments available?

Limberg Flap- The rhomboid (Limberg) flap. The flap design places the longitudinal axis of the rhomboid excision parallel to the line of minimal skin tension

Irrespective of procedure, postoperative wound care is important and centres around elimination of hair (ingrown, local or other) from the wound.

How can you prevent the recurrence of Pilonidal sinuses?

You can prevent recurrence by washing the area on a daily basis with a mild soap, making sure all soap is removed, keeping the area completely dry, and avoiding sitting for long periods.

Shaving of hair on the back and the buttock area.

Permanent laser treatment also can be helpful.

What is abdominoplasty?

Abdominoplasty or “tummy tuck” is a cosmetic surgery procedure used to make the abdomen thinner and more firm. The surgery involves the removal of excess skin and fat from the middle and lower abdomen in order to tighten the muscle and fascia of the abdominal wall. This type of surgery is usually sought by patients with loose or sagging tissues after pregnancy or major weight loss.On whom can abdominoplasty be done?
A tummy tuck is suitable for men and women who are in good health.
Women who have had several pregnancies may find the procedure useful for tightening their abdominal muscles and reducing skin. It is done in something called as Divarication of recti. For some women, pregnancy can cause abdominal separation called divarication of recti. It is a condition where the right and left sides of the rectus abdominis, the so called ‘six-pack’ muscles, spread apart at the stomach midline.

A tummy tuck is also an option for men or women who were once obese and still have excess fat deposits or loose skin around the belly.

On whom it shouldn’t be done?
If you’re a woman who plans to get pregnant, then you may want to postpone a tummy tuck until you’re done having children. During surgery, your vertical muscles are tightened, and future pregnancies can separate those muscles.
Are you planning to lose a lot of weight? Then a tummy tuck also is not for you. A tummy tuck should be a last resort after you’ve tried everything else. It should not be used as an alternative to weight loss.
You should also consider the appearance of scars after a tummy tuck. You can talk about scar placement and length with the doctor before the surgery.

How is it done?
Abdominoplasty operations vary in scope and are frequently subdivided into categories. Depending on the extent of the surgery, a complete abdominoplasty can take from 1 to 5 hours. A partial abdominoplasty (mini-tuck abdominoplasty) can be completed between 1 and 2 hours.
Complete abdominoplasty
In general, a complete (or full) abdominoplasty follows these steps:

An incision is made from hip to hip just above the pubic area.

Another incision is made to free the navel from the surrounding skin.

The skin is detached from the abdominal wall to reveal the muscles and fascia to be tightened. The muscle fascia wall is tightened with sutures.

Liposuction is often used to refine the transition zones of the abdominal sculpture.

A dressing and sometimes a compression garment are applied and any excess fluid from the site is drained.

Partial abdominoplasty
A partial (or mini) abdominoplasty proceeds as follows:

A smaller incision is made.

The skin and fat of the lower abdomen are detached in a more limited fashion from the muscle fascia. The skin is stretched down and excess skin removed.

Sometimes the belly button stalk is divided from the muscle below and the belly button slid down lower on the abdominal wall.

Sometimes a portion of the abdominal muscle fascia wall is tightened.

Liposuction is often used to contour the transition zone.

The flap is stitched back into place.

Before After

Possible Complications
You will have pain and swelling in the days following surgery. Your doctor will prescribe pain medicine and tell you how to best handle the pain. You may be sore for a few weeks.
You may also experience numbness, bruising, and tiredness during that time.
As with any surgery, there are risks. Though they’re rare, complications can include infection, bleeding under the skin flap, or blood clots. You may be more likely to have complications if you have poor circulation, diabetes, or heart, lung, or liver disease.
A tummy tuck leaves scars. Though they may fade slightly, they will never completely disappear. Your surgeon may recommend certain creams or ointments to use after you’ve completely healed to help with scars.

What is fissure-in-ano or Anal fissure?
An anal fissure or rectal fissure is a break or tear in the skin of the anal canal. It may occur when passing large or hard stools, straining during childbirth, or experiencing bouts of diarrhea. The crack in the skin exposes the muscle tissue underneath, causing severe pain and bleeding during and after bowel movements.

What are the causes of Anal fissure?
Most anal fissures are caused by stretching of the anal mucosa beyond its capability. An anal fissure most often occurs when passing large or hard stools. Chronic constipation or frequent diarrhea can also tear the skin around the anus.

Other common causes of anal fissures include:

Childbirth trauma in women

Sexual Activities

Crohn’s disease

Ulcerative colitis

Poor toileting in young children.

Decreased blood flow to the anorectal area

Overly tight or spastic anal sphincter muscle

What are the symptoms of Anal fissure?
An anal fissure may cause one or more of the following symptoms:

a visible tear in the skin around the anus

a skin tag, or small lump of skin, next to the tear

sharp pain in the anal area during bowel movements

burning or itching in the anal area

streaks of blood on stools or on tissue paper after wiping

How is anal fissure diagnosed?
Anal fissure is usually diagnosed simply by examining the area around the anus. However, digital rectal examination can also be performed to confirm the diagnosis. During this exam, the doctor will insert an endoscope or anoscope into your rectum to make it easier to see the tear. These medical instruments are thin tubes with attached cameras and lights that allow doctors to inspect the anal canal. Using an anoscope may also help your doctor find other causes of anal or rectal pain such as hemorrhoids.
What are the treatment options for Anal fissure?
Non-surgical treatments are recommended initially for acute and chronic anal fissures. These include topical nitroglycerin or calcium channel blockers (e.g. diltiazem), or injection of botulinum toxin into the anal sphincter. Other measures include warm sitz baths, topical anesthetics, high-fiber diet and stool softeners.

Sitz Bath

Surgery-
Surgical procedures are generally reserved for people with anal fissure who have tried medical therapy for at least one to three months and have not healed. It is not the first option in treatment.
Lateral internal sphincterotomy
Lateral internal sphincterotomy (LIS) is the surgical procedure of choice for anal fissures due to its simplicity and its high success rate (~95%). In this procedure the internal anal sphincter is partially divided in order to reduce spasming and thus improve the blood supply to the perianal area. This improvement in the blood supply helps to heal the fissure, and the weakening of the sphincter is also believed to reduce the potential for recurrence.[citation needed] The procedure is generally performed as a day surgery after the patient is given general anesthesia. The pain from the sphincterotomy is usually mild and is often less than the pain of the fissure itself. Patients often return to normal activity within one week.
Fissurectomy
A fissurectomy is another surgery that can be used to treat anal fissures. This procedure produces the same result as a sphincterotomy, except that during this surgery, the edges of the fissure are also surgically removed, as are any skin tags that may have occurred in conjunction with chronic tears. A cauterizing tool is then used to seal the entire area of the wound. The muscle is not cut.

How can you prevent these fissures?

keeping the anal area dry

cleansing the anal area gently with mild soap and warm water

avoiding constipation by drinking plenty of fluids, eating fibrous foods, and exercising regularly

treating diarrhea immediately

What is Recto-vaginal fistula?

A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina.Rectovaginal fistula may be extremely debilitating. If the opening between the rectum and vagina is wide it will allow both flatulence and faeces to escape through the vagina, leading to faecal incontinence. There is an association with recurrent urinary and vaginal infections. This type of fistula can cause paediatricians to misdiagnose imperforate anus. The severity of the symptoms will depend on the size of fistula. Most often, it appears after about one week or so after delivery.

What are the causes of rectovaginal fistulas?
A rectovaginal fistula may form as a result of:

Injuries during childbirth. Delivery-related injuries are the most common cause of rectovaginal fistulas. These may happen following a long, difficult, or obstructed labor. These types of fistulas may also involve injury to your anal sphincter, the rings of muscle at the end of the rectum that help you hold in stool.

Crohn’s disease. The second most common cause of rectovaginal fistulas, Crohn’s disease is an inflammatory bowel disease in which the digestive tract lining is inflamed.

Cancer or radiation treatment in your pelvic area. A fistula caused by radiation usually forms within six months to two years after treatment.

Surgery involving your vagina, perineum, rectum or anus. The fistula may develop as a result of an injury during surgery or a leak or infection that develops afterward.

Other causes- Rarely, a rectovaginal fistula may be caused by infections.

What are the symptoms of these fistulas?
Depending on the fistula’s size and location, you may have minor symptoms or significant problems with continence and hygiene. Signs and symptoms of a rectovaginal fistula may include:

Passage of gas, stool or pus from your vagina

Foul-smelling vaginal discharge

Recurrent vaginal or urinary tract infections

Irritation or pain in the vulva, vagina and the area between your vagina and anus (perineum)

Pain during sexual intercourse

How are these fistulas diagnosed?

Physical examination and correlating it with the patients symptoms.

Contrast tests- these tests use a contrast material to show the vagina or the bowel on an X-ray image.

Blue dye test- This test involves placing a tampon into your vagina, then injecting blue dye into your rectum. Blue staining on the tampon indicates a fistula.

Computerized tomography (CT) scan.

Magnetic resonance imaging (MRI).

Other tests- if your doctor suspects you have inflammatory bowel disease, he or she may order a colonoscopy to view your colon. During the procedure, your doctor can take small samples of tissue (biopsy) for lab analysis, which can help confirm Crohn’s disease.

How is rectovaginal fistula treated?
After diagnosing rectovaginal fistula, it is best to wait for around 3 months to allow the inflammation to subside. For low fistulae, a vaginal approach is best, while an abdominal repair would be necessary for a high fistula at the posterior fornix.
Surgery-
A circular incision is made around the fistula and vagina is separated from the underlying rectum with a sharp circumferential dissection. The entire fistulous tract, along with a small rim of rectal mucosa is incised. The rectal wall is then closed extramucosally. Most rectovaginal fistulas will need surgery to fix.Medications such as antibiotics and Infliximab might be prescribed to help close the rectovaginal fistula or prepare for surgery.

Lifestyle modifications to prevent infectionsGood hygiene can help ease discomfort and reduce the chance of vaginal or urinary tract infections while waiting for repair. Other home remedies for people living with a rectovaginal fistula include:Wash with water- Shower or gently wash your outer genital area with just warm water each time you experience vaginal discharge or passage of stool.Avoid irritants- Soap can dry and irritate your skin, but you may need a gentle unscented soap in moderation. Avoid harsh or scented soap and scented tampons and pads. Vaginal douches can increase your chance of infection.Dry thoroughly- Allow the area to air-dry after washing, or gently pat the area dry with a clean cloth or towel.Avoid rubbing with dry toilet paper- Pre-moistened, alcohol-free, unscented towelettes or wipes or moistened cotton balls are a good alternative.Wear cotton underwear and loose clothing- Tight clothing can restrict airflow and worsen skin problems. Change soiled underwear quickly. Products such as absorbent pads, disposable underwear or adult diapers can help if you’re passing liquid or stool, but be sure they have an absorbent wicking layer on top

What are piles?

Hemorrhoids, also called piles, are enlarged veins around the rectum or in the anus. They are extremely common – about 50% of people over the age of fifty have had hemorrhoids at some point in their life – and are most common in people over the age of thirty. They may extend outside as prolapse in advanced stages.

Although they can be irritating, uncomfortable, and painful, hemorrhoids rarely cause more serious problems

What are causes of piles?

Hemorrhoids are caused by excessive pressure on the veins in the pelvic and rectal area. The pressure causes the veins to swell and become distended. Straining during bowel movements is the most common cause of excessive pressure on the veins and prolapsed of the rectal mucosa. Hemorrhoids can be caused by chronic constipation or diarrhea, a tendency to rush to complete a bowel movement, or unhealthy bowel functions caused by overuse of laxatives or enemas.

Hemorrhoids are also more common among overweight people, those who must sit or stand for prolonged periods, those who regularly lift heavy objects, and those who consume diets low in fiber and water.

Another common cause of hemorrhoids is pregnancy and childbirth. Many pregnant women develop hemorrhoids during the last six months of pregnancy because of increased pressure on the veins in the pelvic area. Straining to push the child out during birth is another common cause of hemorrhoids.

What are symptoms of piles?

Bleeding while passing motion. Reducible swellings while passing motion or in later stages irreducible swelling in later stages. Can present with anemia and weakness.

How do you diagnose piles?

If you are experiencing rectal bleeding, it is extremely important to visit a doctor. Although it may be a symptom of hemorrhoids, rectal bleeding can also be a symptom of a number of far more serious conditions, including colorectal cancer. Hemorrhoids are generally diagnosed via a physical exam.

Swellings in and around anal canal in advanced stages of piles. Pile are graded according to size. In grade IV masses come out and do not go back.

How do you treat piles?

Treatment of hemorrhoids depends on their severity and the degree of discomfort the cause. Many cases of hemorrhoids, particularly those resulting from pregnancy and/or childbirth, resolve themselves on their own with a minimum of treatment others may become chronic.

Home treatment is effective for many cases of external hemorrhoids. Sitting in a warm bath several times daily can sooth itching and relieve symptoms. Gradually increasing the amount of fiber and fluids (non-alcoholic) in your diet can also help relieve symptoms. Fiber and water soften stools and increase their softness, bulk, and regularity, decreasing pressure on the veins and causing less straining. Studies have shown that drinking six to eight glasses of water a day and consuming a diet high in whole grains, fresh fruit (preferably with the skin), dried or stewed fruit, and fresh vegetables leads to a lower chance of developing hemorrhoids and some relief of symptoms for those already suffering from them.

Dietary supplements can also assist with increasing the amount of fiber in your diet. Regular exercise can also increase the regularity and softness of your stools. For pregnant women, a special treatment is to lie on your left side for about 20 minutes every 4 to 6 hours. This decreases pressure on the main vein draining the lower half of the body.

Most internal hemorrhoids can be treated with the same home treatment measures as external hemorrhoids. Severe cases may be treated with a variety of methods intended to shrink, destroy, or remove the hemorrhoidal tissue. These include:

Non- surgical procedures such as

Scarring the tissue around them (coagulation therapy)

Injecting a solution into pile mass

Banding tiny rubber bands around pile mass and cutting off blood supply

IRC (Infra Red Coagulation)

What are the surgical treatments available for piles?

Anemia with grade I and Grade II or symptomatic Grade III and Grade IV surgery is the only option

Conventional surgery
Pile masses are cut and there is wound which needs to be take care for two to three weeks. May require stay in the hospital.

Minimal invasive surgery for piles(stapled haemorrhoidectomy)Pile mass is lifted and fixed to the place where it belongs. Circumferential mucosectomy is done in painless area. Blood supply to piles is taken off. No open wound after surgery and no pain leading to faster recovery. This procedure can be done as day care where individual is discharged on same day.