PREPARING FOR LAPAROSCOPIC SURGERY BY DR PRADEEP JAIN

Dr Pradeep Jain — Laparoscopic surgery is a form of minimal access surgery, which involves making a very small incision on the body of the patient and using a thin and lighted tube to pass through this incision, in order to perform the procedure. The most common problem where this procedure is used is for abdominal disorders like gall bladder stones and gynecological troubles in women such as fibroids and cysts in female reproductive organs. Laparoscopy surgery has become a feasible alternative to open surgeries as well as laparotomy surgeries, which involve larger incisions in the abdominal areas. The treason for popularity of laparoscopy is that it is less complicated and expensive as compared to conventional surgery as there is no hospitalization required in such cases and wherever required, the length of hospital stay is very short. Additionally, the surgery is less painful and complicated and the recovery time is much shorter than conventional techniques.

Laparoscopic Surgery

Preparation of Laparoscopic Surgery

Though laparoscopic surgery is a simple and easy procedure, still some preparation is needed for making it a success. Here are some tips to prepare yourselves for a laparoscopic surgery in india:

1. Being armed with proper knowledge and information about the procedure is the first step for being prepared for it. The patient has full right to ask all kinds of questions from his surgeon, as well as clarify his doubts before the surgery is performed. Proper understanding will remove his phobia and make him more comfortable about the surgery as well as confident about the doctor who is going to perform it.

2. They should also inform the surgeon about all the medical conditions he is undergoing such as diabetes and hypertension. The surgeon also needs to be informed about the medication he is taking regularly, such as aspirin, which may hamper the blood clotting process after the surgery. This will enable the doctor to tackle any complications which may surface during the surgery.

3. The patient must not eat or drink anything at least eight hours before the surgery, as in case of other types of surgeries. The operation is done under anesthesia and the patient must also discuss the possibility of drug allergies with the anesthesiologist.

4. Another thing which the patient needs to take care of on the day of the surgery is not to wear any valuable jewelry as it has to be taken off during the process. Also, he needs to take off stuff like dentures, contact lenses and glasses during the procedure.

5. Finally, the patient must take into consideration that fact that laparoscopic surgeries are mostly done on outpatient basis and he is most likely to be discharged on the same day. Since the patient might not feel strong enough after the surgery, he must arrange for a friend or family member to drive him home after the procedure is completed.

In a nutshell, laparoscopic surgery is a much simpler process for the patient as it offers very speedy recovery. But being well prepared can make things even easier for the patient.

Dr. Pradeep Jain has wide experience of GI, GI Once and Minimal Invasive Surgery.

Details @ http://www.dr-pradeep-jain.in/

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CARCINOMA ESOPHAGUS – ESOPHAGEAL CANCER TREATMENT By Dr Pradeep Jain

Carcinoma Esophagus

The esophagus is a muscular tube also known as food pipe in general public transmits food material from mouth (base of pharynx) to the stomach. Carcinoma of esophagus is one of the deadliest malignancies of human body. The incidence of this malignancy is increasing in general population due to life style modification as well as changes in environment.

Carcinoma of esophagus is divided into two types –

1. Squamous cell carcinoma – Cancer that forms in tissues lining the esophagus. Mostly found in upper and middle 1/3rd of esophagus. Incidence increases with age with most common age group between 55-60 years with male preponderance.

2. Adenocarcinoma – cancer that begins in esophageal lining cell that secret mucus. Most commonly found in lower esophagus and at the meeting point of esophagus and stomach. Commonly presented in patients with age group 50 years or younger.

Risk factors for Esophageal malignancy –

1. Smoking and alcohol – smoking for a long duration and chronic alcohol consumption

2. Esophageal inner mucosal lining damage from physical agents –

  • long term ingestion of hot liquids
  • caustic ingestion (corrosive poisoning)
  • radiation induced damage

3. Carcinogens in food and water – nitrates, nitrite, nitrosamine,
smoked opiates, fungal toxins in pickled
4. Obesity – increased risk for adenocarcinoma of esophagus. Incidence of gastroesophageal reflux increased in obesity due to lax lower esophageal junction to stomach which leads to Barrett’s esophagus. If condition is not reverted with time Barrett’s esophagus turns into malignancy.
5. Chronic iron deficiency anemia in females leading to plummer Vinson Syndrome
6. Congenital hyperkeratosis of palms and sole
7. Helicobactor pylori infection
8. Achalasia Cardia – long standing
9. Dietary deficiencies of molybdenum, Zinc, Vitamin A

Symptoms of esophageal malignancy

1. Dysphagia – Dysphagia is the most common presentation. Patient may have difficulty in swallowing of solid food in early stage of disease and solid as well as
liquid food in the late stage of disease. 2. Weight loss – recent onset and significant.
3. Coughing and choking during meal.
4. Change in voice – hoarseness.
5. Weakness and easy fatigability.
6. Pain behind sternum – occasional
7. Heart burn and reflux
8. Malena and sometimes haematemesis.

Diagnosis of esophageal malignancy

The patient is evaluated on the basis of history, symptoms and clinical signs. Along with routine blood test and X-ray some endoscopic and radiological investigations are done which include –

1. Barium sallow x- ray – thin barium is allowed to shallow and x-ray of esophagus taken. This shows the site and outline of tumor.

2. Endoscopy – the endoscope is passed through mouth to esophagus to see the inner lining of esophagus and tumor. If it shows any abnormal growth then a small piece of tissue from the growth is taken for confirmation of the diagnosis. These tissues are examined under a microscope for the presence of cancer.

3. Bronchoscopy – in cases of advanced tumor arising from upper ½ of esophageal an endoscope is passed into trachea (wind pipe) to rule out local spread of the tumor to lungs

4. Endoscopic Ultrasound – for early tumor endoscopic ultrasound is passed in esophagus to find out local spread of tumor.

5. For tumor staging radiological investigation like computed tomography (CT) scans of chest and abdomen and positron emission tomography (PET) scan are performed to determine outer spread of esophageal tumor to surrounding vital organs and distant spread to other organs.

6. Thoracoscopy and Laparoscopy – By this methods detection rate of lymphnodal and distal spread of esophageal malignancy is high.

Staging of esophageal tumors

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

According to AJCC Cancer Staging Manual, Seventh Edition (2010) cancer growth and spread can be staged by TNM system

Tumor (T) – means how deep the tumor has grown into the wall of the esophagus

Node (N) – tumor spread to lymph nodes

Metastasis (M) – metastasis (distal spread) to other part of the body

Based on combined results of T, N and M staging of cancer determined.

Tumor (T) is classified into
TX: tumor cannot be evaluated
T0: cancer is not detected in the esophagus
Tis: this is also called carcinoma in situ that means very early cancer
T1: tumor spread to the lamina propria and submucosal layers of esophagus
T2: tumor spread to muscular is propria
T3: tumor spread to the adventitia, the outer layer of the esophagus
T4: tumor has spread to surrounding structures of the esophagus, including the aorta, pericardium, large blood vessel, trachea, diaphragm, and pleural lining of the lung

Node (N) : N stands for Lymph nodes. Lymph nodes close to esophagus is called regional lymph nodes and those located in other part of body are distant lymph nodes.
NX: lymph nodes cannot be evaluated
N0: cancer cells not detected in lymph nodes
N1: cancer cells has spread to 1-2 lymph nodes in the chest, near the tumor
N2: cancer cells has spread to 3-6 lymph nodes in the chest, near the tumor
N3: cancer cells has spread to 7 or more lymph nodes in the chest, near the tumor

Distant metastasis (M):

this indicates whether the cancer cells has spread to other parts of the body
MX: Metastasis cannot be evaluated
M0: cancer cells has not spread to other parts of the body
M1: cancer cells has spread to another part of the body

Grading of esophageal tumor

G1: well differentiated
G2: mildly differentiated
G3: poorly differentiated
G4: not differentiated

Esophageal Cancer stageing

There are separate staging systems for both squamous cell carcinoma and adenocarcinoma of esophagus.

Staging of squamous cell carcinoma of the esophagus

Stage 0: Tis, N0, M0

Stage IA: T1, N0, M0

Stage IB:
T1, N0, M0
T2 or T3, N0, M0

Stage IIA:
T2 or T3, N0, M0
T2 or T3, N0, M0

Stage IIB:
T2 or T3, N0, M0
T1 or T2, N1, M0

Stage IIIA:
T1 or T2, N2, M0
T3, N1, M0
T4a, N0, M0

Stage IIIB:
T3, N2, M0

Stage IIIC:
T4a, N1 or N2, M0
T4b, any N, M0
any T, N3, M0

Stage IV : any T, any N, M1

Staging of adenocarcinoma of the esophagus

Stage 0: Tis, N0, M0

Stage IA: T1, N0, M0

Stage IB:
T1, N0, M0
T2, N0, M0

Stage IIA:
T2, N0, M0

Stage IIB: 
T3, N0, M0
T1 or T2, N1, M0

Stage IIIA:
T1 or T2, N2, M0
T3, N1, M0
T4a, N0, M0

Stage IIIB: 
T3, N2, M0

Stage IIIC: 
T4a, N1 or N2, M0
T4b, any N, M0
any T, N3, M0

Stage IV : any T, any N, M1

Treatment of Esophageal cancer

Patients with esophageal cancer are managed based on its staging. Overall general condition of the patients affects management.

Stage I –

Tis and T1aN0 stage – 
Endoscopic therapy like mucosal resection or submucosal dissection with the help of endoscopic ultrasound (EUS),

Photodynamic therapy,
Radiofrequency ablation
T1b N0 & T2 N0 stage – Surgery (esophagectomy) to remove the part of esophagus that contains the cancer

Stages II-III –

Chemoradiation followed by surgery (trimodal therapy)
Patient with squamous cell carcinoma with well preserved general condition chemotherapy and radiotherapy started before definitive surgery.
Patients with adenocarcinoma of lower end esophagus where stomach meet (gastroesophageal junction) are only chemotherapy is given before surgery. For smaller tumor (< 2 cm) only surgery is advised.
Patients with serious co-morbidities who are not candidate for surgery are managed with chemoradiation.

Stage IV –

Chemotherapy/ Radiotherapy or symptomatic and supportive care Treatment is given only for palliation to relieve the symptoms like pain, difficulties in swallowing etc.

Esophageal stenting (plastic/metallic) is done in situations where the patient is totally dysphagic and having esophagobroncheal fistula.
Patient who are unable to tolerate oral feeds a nasogastric tube may be required to continue feeding.
Some times gastrostomy/jejunostomy tube is required where patients become intolerant to nasogastric tube or tend to aspirate food.
Laser therapy is done in cases in which esophagus is totally occluded by cancer and the cancer cannot be removed by surgery. The relief of a blockage by laser can help to reduce dysphagia and pain

Chemotherapy:

Chemotherapy may be given after surgery (adjuvant) to reduce risk of recurrence or before surgery (neoadjuvant) to down stage the disease.
Chemotherapy is cisplatin-based (or carboplatin or oxaliplatin) every three weeks with fluorouracil (5-FU) either continuously or every three weeks.
Recently epirubicin regimens is used in advanced nonresectable cancer.
Patients with adenocarcinoma with HER2 positive treated with targeted targeted therapy like trastuzumab.

Radiotherapy :

Radiotherapy is given before, during or after chemotherapy or surgery. It is also used in palliation to control pain.

Surgery is contraindications in following situation :

1. Locally advanced cancer engulfing adjacent vital structures like trachea, lung, pericardium, aorta recurrent laryngeal nerve
2. Esophageal Cancer with wide dissemination ( metastasis) to distant lymph nodes and vital organs
3. Severe co-morbidity involving cardiovascular and respiratory system

Surgical options :

Surgery is performed by either open or minimal invasive method depending upon patient’s general condition and availability of experts. Now a days minimal invasive approach of esophagectomy has become very popular among surgeons because of low surgical morbidity, short hospital stay and similar onchological outcomes.

Types of esophagectomy-

1. Transhiatal esophagectomy (THE)
2. Transthoracic esophagectomy (TTE) – thoraco abdominal Mc Keown’s & Ivor Lewis esophagectomy 

In thoracoabdominal approach – both the abdominal and thoracic cavities opened together.

Ivor Lewis esophagectomy – two-stage approach involves an initial laparotomy and construction of a gastric tube, followed by a right thoracotomy to excise the tumor and create an esophagogastric anastomosis

McKeown esophagectomy – three-stage approach which include incision in the neck to complete the cervical anastomosis.

Details @ http://www.dr-pradeep-jain.in/

DR PRADEEP JAIN -WEIGHT LOSS SURGERY OR BARIATRIC SURGERY

Weight Loss Surgery or Bariatric Surgery

Bariatric surgery refers to the treatment of obesity. It is the best possible approach for those who cannot lose weight through exercise and diet alone. Being obese can invite number of health issues including high blood pressure, diabetes, joint problems and sleep apnea. Losing weight through surgical option typically results in dramatic and quick weight loss and significantly decreases the obesity related health issues like diabetes.

There are number of surgical procedures available to achieve weight loss. Dr. Pradeep Jain at Fortis Hospital specialized in bariatric surgery or weight loss surgery such as Laparoscopic Gastric Bypass, Laparoscopic Adjustable Gastric Banding and Laparoscopic Sleeve Gastrectomy.

After going through your medical history and diagnosis report, Dr Pradeep Jain Fortis Hospital will recommend an appropriate weight loss surgery.

Precautions after weight loss surgery

  • You will on liquid diet for about 2 weeks
  • You need to eat small meals, slowly and chew properly
  • You need to maintain adequate hydration
  • You must take daily recommended vitamin supplements
  • Some may experience hair thinning that can improve by the adequate intake of protein and biotin supplements.
  • You must do daily workout and must make right choice for your diet to ensure not to regain more weight
  • You must regular follow up with your doctor, at least visit once in 3 months.

Laparoscopic Surgeries

Dr. Pradeep Jain is an experienced and specialized laparoscopic surgeon using high definition technology and precision equipment to perform laparoscopic treatments of gastrointestinal tract. Having years of experience and knowledge means better results for patients. Unlike conventional open surgeries, the laparoscopic surgeries involve:

  • Early discharge from hospital
  • Speedy recovery and early back to work
  • Less pain
  • Remarkably reduced bleeding
  • Smaller or fewer scars

Dr. Pradeep Jain Fortis Hospital Review performs several kinds of laparoscopic surgeries including:

Laparoscopic Esophagectomy Surgery: The laparoscopic esophagectomy surgery is a minimal invasive surgery used to remove part or all esophagus due to the presence of cancer in it or also done for other non- cancerous conditions that makes esophagus non- functional. Esophagus is a tube presents in the throat and allow food to pass through it to stomach. After its removal, the esophagus is rebuilt from the part of large intestine or stomach. During the surgery, esophagus and stomach both are mobilized and doctor cut your stomach into the tube shape with the help of surgical staples. Several other ways are also available to perform this surgery Dr Pradeep Jain Fortis Hospital will recommend you which is best for you.

Laparoscopic Pancreatic surgery: Pancreatic surgery involves removing part or all of pancreas however, there are three types of surgery used to remove tumor of pancreas depending on the individual condition. Dr. Pradeep Jain Fortis Hospital performs whipple procedure for pancreatic, duodenal cancers or bile duct. He also performs laparoscopic distal pancreatectomy for pancreas cancer, pseudocysts and chronic pancreatitis or pancreatic cysts. Additionally pancreatic necrosectomy is done either by retroperitoneal or transperitoneal approach.

Laparoscopic Colorectal Surgery: Laparoscopic colorectal, hemicolectomy, APR and anterior resection is done for cancer of colon or rectum. The laparoscopic technique to treat these cancers are almost become a standard if performed by trained, professional and experienced surgeon likeDr. Pradeep Jain Fortis Hospital. The result of the procedure is same as of conventional open surgery however, complications and recovery are lower. Other indications include surgery for inflammatory bowel diseases such as colonic tuberculosis and rectopexy.

Laparoscopic Liver Surgeries: The laparoscopic liver surgeries are most commonly recommended for the presence of mass like abnormal growth and tumor. The liver surgeries are feasible with laparoscopic techniques but demanding technical expertise Dr. Pradeep Jain Fortis Hospital. The surgery can be done for primary and secondary tumors, cysts and hemangiomas etc.

Gastro-Intestinal Cancers

The term Gastro-Intestinal Cancer is refers to the cancer group that affect the human digestive system including gallbladder, stomach, liver, pancreas, oesophagus and bowel. It is the most common form of cancer and do not segregate between women and men. Just like any other health issue, the treatment for GI cancer will major depends on the cancer type, its stage and other health factors.

Although there are no specific symptoms that directly points towards cancers, some strong indicators include sever loss of weight and appetite, lump in abdomen, intestinal obstruction in elderly, alteration in bowel habits, prolonged bleeding from the GI tract and sudden detection of diabetes with weight loss etc.

Dr. Pradeep Jain Fortis Hospital is a specialized and experienced Gastro-Intestinal surgeon performing

  • Colo Rectal Cancer
  • Gastric cancers
  • Pancreatic cancers
  • Liver cancer

Details @ http://dr-pradeep-jain.in/

Importance of Finding an Oncology Specialist by Dr Pradeep Jain Review

Dr. Pradeep Jain Reviews – Cancer is a tough battle to wage, but you can turn things in your favor by finding the right doctors and specialists to help you fight the disease and win against it. The fact is that the choice is not just concerned to an oncologist, but a whole team of specialists such as surgical oncologist, radiation oncologist and medical oncologist, who look after the areas of surgery, radiation therapy and medication and cancer therapy respectively. Some other people involved in cancer treatment are dieticians, nurses and therapists, to name just a few. The most important thing is that all these people need to work together as a team, which is usually made available by specialized institutes dealing with treatment of this deadly disease.

Why is it important to find an oncology specialist?

Cancer is a complex disease, with a treatment that is even more complex, requiring a combination of therapies such as surgery, chemotherapy, radiation and medication. A trained and experienced oncologist is the one who is totally equipped to handle the complexities of the disease as well as its treatment for his patient. These specialists have specializes skills as well as judgment needed for carrying out the treatment process. Oncologists may deal with special types of cancers, such as those of breast, liver, ovaries, uterus, pancreas and colon, and accordingly they are suitable for treatment of the patients suffering from that kind of cancer. Continue reading

Minimal Access Surgery – Dr. Pradeep Jain Fortis Hospital, Reviews

Dr. Pradeep Jain – Generally, folks are obsessed with the backaches and there is no specific reason specified behind the pain. Earlier, it is known as the sign of your old age, though, now the meaning has been totally changed, yes, this time there is no matter that someone has been grown up or still young, but the backache has been a hassle of everyone. And the vital reasons come, not having a healthy diet, calcium & protein less meal, not doing exercise, sedentary lifestyle & living a hectic life. Having such circumstances, you work continue without taking rest so that you suffer with an excoriating back pain.

Continue reading

Dr Pradeep Jain – The Things as a Remedy to Colorectal Cancer

Dr. Pradeep Jain This cancer, also known by different names as colorectal, bowel and stomach cancer, is getting too dangerous and because of not spotting in its first stage, many people are suffering from it. However, every kind of cancer is the cause of distress but nothing could be solved without any remedy of the disease and because the cure of this cancer is significantly less than others so that keep following to every step of awareness, you can get rid of it.

However, no particular sign or symptoms can identify this disease, but it has some symptoms, which directly point towards cancer, and you can take an action as soon as possible. These signs are Continue reading

Dr. Pradeep Jain – What is Pancreatic Cancer?

A tumor, located in any part of the body, is called cancer and that’s why there is no limited name specification about the cancer. Now is the time when people as well as doctors are hearing new cancer, earlier people were informed about few cancers, but now many cancers have been reported and pancreatic cancer is also one of them.

Pancreatic cancer is also very typical to handle, because in most of the cases, it’s never detected, until it reaches its advanced level, because its symptoms are too generic. Whether many technology or medicines has been treated, but in the case of this cancer, theses technologies get failed or may not succeed, because once it diagnoses at its advanced level than the patient hardly survived 5 to 6 months.

What is pancreatic cancer?

A human body has many organs and pancreatic is also one of them, actually it is located behind of the stomach or upper side of the abdomen. Actually, this is called a gland or node and this is too active gland, which helps to digest the food in the body and to control the blood sugar, means due to this you can be saved from sugar also.

Causes of reaching a high level or producing in a body

Every disease has its origin and some symptoms also, through the disease can be developed, so that to detect any disease, we have to consider on some points. Whether, pancreatic cancer is also known as a silent killer because it comes only with its danger level not before. Yet there are some factors and with them it increases rapidly. Continue reading

Dr. Pradeep Jain – Surgeons & How Research Can Help

Personal health everyone on the earth needs some care and it undergoes with some problems in between times. Proper medical care is need whenever problems occur and immediate health care steps must be taken according to doctor’s advices. Particularly some of the serious problems cannot be managed with normal medications or treatments. Perhaps surgery or operations is referred by expert doctors after some research on the problems. If ailments persist with long term suffer and not adjusted by routing treatments, then it is just needed for getting a surgery for the affected part of the body.

Abnormal conditions and situations in the body need to be corrected by Surgeons with proper procedures. Body and its organs are full of mechanism controlled by various operating systems and regulated with different kinds of superior components. Any outer or inner part of the body is affected by a problem, it must be researched first. After getting a complete knowledge of the disease and the current health conditions of the patient then only a surgeon suggests for the surgery. Continue reading