Gasteroenterology

Gastroenterology at Chandan Hospital is the branch of medicine focused on the digestive system and its disorders.

Diseases affecting the gastrointestinal tract, which include the organs from mouth into anus, along the alimentary canal, are the focus of this speciality. Gastroenterologists perform a number of diagnostic and therapeutic procedures including colonoscopy, endoscopy, endoscopic retrograde cholangiancreatography (ERCP), endoscopic ultrasound and liver biopsy.

Bariatric surgery

Bariatric surgery (weight loss surgery) includes a variety of procedures performed on people who have obesity. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestine to a small stomach pouch (gastric bypass surgery).

"Surgery should be considered as a treatment option for patients with a BMI of 40 kg/m2 or greater who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy) and who present with obesity-related comorbid conditions, such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidemia, and obstructive sleep apnea.

Classification of surgical procedures :

Procedures can be grouped in three main categories: blocking, restricting, and mixed.

Blocking procedures :

Some procedures block absorption of food, although they also reduce stomach size.

This operation is termed biliopancreatic diversion (BPD) or the Scopinaro procedure. Part of the stomach is resected, creating a smaller stomach (however the patient can eat a free diet as there is no restrictive component). The distal part of the small intestine is then connected to the pouch, bypassing the duodenum and jejunum.

Restrictive procedures :

Procedures that are restrictive shrink the size of the stomach or take up space inside the stomach, making people feel more full when they eat less.

Mixed procedures :

Mixed procedures apply block and restrict at the same time.

Endoscopy

An endoscope can consist of :

  • a rigid or flexible tube.
  • a light delivery system to illuminate the organ or object under inspection. The light source is normally outside the body and the light is typically directed via an optical fiber system.
  • a lens system transmitting the image from the objective lens to the viewer, typically a relay lens system in the case of rigid endoscopes or a bundle of fiberoptics in the case of a fiberscope.
  • an eyepiece. Modern instruments may be videoscopes, with no eyepiece. A camera transmits image to a screen for image capture.
  • an additional channel to allow entry of medical instruments or manipulators.

An endoscopy is used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imagingtechniques, endoscopes are inserted directly into the organ.

There are many types of endoscopes. A patient may be fully conscious or anaesthetised during the procedure. Most often the term endoscopy is used to refer to an examination of the upper part of the gastrointestinal tract, known as an esophagogastroduodenoscopy.

Medical uses:

  • investigation of symptoms, such as symptoms in the digestive system including nausea, vomiting, abdominal pain, difficulty swallowing, and gastrointestinal bleeding.
  • confirmation of a diagnosis, most commonly by performing a biopsy to check for conditions such as anemia, bleeding, inflammation, and cancers of the digestive system.
  • giving treatment, such as cauterization of a bleeding vessel, widening a narrow esophagus, clipping off a polyp or removing a foreign object.

Applications:

  • The gastrointestinal tract (GI tract):
    • oesophagus, stomach and duodenum (esophagogastroduodenoscopy)
    • small intestine (enteroscopy)
    • large intestine/colon (colonoscopy, sigmoidoscopy)
    • Magnification endoscopy
    • bile duct
      • endoscopic retrograde cholangiopancreatography (ERCP), duodenoscope-assisted cholangiopancreatoscopy, intraoperative cholangioscopy
  • rectum (rectoscopy) and anus (anoscopy), both also referred to as (proctoscopy)
  • The respiratory tract
    • The nose (rhinoscopy)
    • The lower respiratory tract (bronchoscopy)
  • The ear (otoscope)
  • The urinary tract (cystoscopy)
  • The female reproductive system (gynoscopy)
    • The cervix (colposcopy)
    • The uterus (hysteroscopy)
    • The fallopian tubes (falloposcopy)
  • Normally closed body cavities (through a small incision):
    • The abdominal or pelvic cavity (laparoscopy)
    • The interior of a joint (arthroscopy)
    • Organs of the chest (thoracoscopy and mediastinoscopy)

Endoscopy is used for many procedures:

  • During pregnancy
    • The amnion (amnioscopy)
    • The fetus (fetoscopy)
  • Plastic surgery
  • Panendoscopy (or triple endoscopy)
    • Combines laryngoscopy, esophagoscopy, and bronchoscopy
  • Orthopedic surgery
    • Hand surgery, such as endoscopic carpal tunnel release
    • Knee surgery, such as anterior cruciate ligament reconstruction
    • Epidural space (Epiduroscopy)
    • Bursae (Bursectomy)
  • Endodontic surgery
    • Maxillary sinus surgery
    • Apicoectomy
  • Endoscopic endonasal surgery
  • Endoscopic spinal surgery

Laser in Laparoscopic Surgery

Recently laser technology has gained wide-spread use within almost all fields, including laparoscopic surgery.

LASER IN TRANSURETHRAL RESECTION OF PROSTATE (TURP)

Endoscopic surgery for prostate inside the urinary bladder became possible after the electrosurgical modality was introduced. While cryo has also been used in this discipline, it has not established itself as a practical method. The YAG laser is now being introduced for certain coagulating processes in the bladder, with promising results. However, TURP remains an electrosurgical operation.

EXCAVATION OF TISSUE

The active electrosurgical electrode could be shaped into any form suiting the anatomical requirements. The tissue removal, specifically in tumor surgery with wire and band loop electrodes, is a practical and preventative method over tissue removal using the cold steel. he laserlight isn't suitable for tissue excavation.

OPEN-AIR COAGULATION WITH LASER AND ELECTROSURGERY

For this surgical treatment, both modalities are perhaps equally suitable, plus some favor the laser as a more predictable modality. However if the surgeon chooses the proper waveform, intensity, and electrode, he can produce predictable and delicate results. Dermatologists and gynecologists have demonstrated electrosurgery to be free of complications. If important parameters aren't carefully followed, neither electrosurgery nor laser modality is going to be free from difficulties. It is generally claimed how the laser beam is superior in pinpoint coagulations. Under the microscope, however, one can demonstrate that the micro-electrosurgical process may be equal and maybe simpler to apply if your microsurgical unit and electrodes are used.

COAGULATING WITH UNIPOLAR AND BIPOLAR FORCEPS

With proper use, electrosurgery procedures have become simpler, reducing operating time and loss of blood, especially when the electro-hemostat or forceps are used. With bipolar forceps and also the appropriate generator, the descriminating, delicate microsurgical procedures can be carried out.

LASER IN ENDOMETRIOSIS

Since endometrial tissue could be manipulated during laparoscopy, major surgery could be avoided. One method of tissue manipulation involves utilizing a carbon dioxide laser system. The benefit of this type of laser is the fact that there is minimal formation of scarring or tissue shrinking. The process is well-tolerated and required a brief hospital stay. Laser manipulation of endometrial tissue can be performed during the time of the initial laparoscopy, allowing patients to try conception sooner. No injuries or complications is brought on by the laser light treatments in Endometriosis in experienced hand.

SAFETY FOR PATIENT AND SURGEON

Each electrosurgical and laser modalities are secure in laparoscopic surgery when the devices are saved in perfect working condition and all sorts of technical requirements are fulfilled. Surgical accidents with both electrosurgery and laser have been reported. Most were brought on by insufficient attention and respect for proper requirements and treatments.