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Gallstones 1. Is the cause of #Gallstones & kidney Stones same? No, although stones do occur in variety of organs & the causes are all different. Stones may occur in Gall bladder, Kidneys, Pancreas, Salivary Gland, Urinary bladder etc 2. Can Gallstones be prevented with Diet? There is no concrete evidence that Gallstones can be “prevented” by diet, as the occurrence of Gallstones include numerous other factors as well. 3. Is there difference between small multiple stones or single large stone disease? The stone-patterns seen are Small multiple stones (less than 10mm), Single large stone (greater than 10mm) & A combination of above. Small stones have greater propensity to cause blocked passages & resultant Infections, attributed to ability to slip ahead, whereas large stones have been associated with Gallbladder Cancer. 4. Can Gall stones cause #cancer? Yes, specially in stone size > 3cm. Of note is the fact that 80-90 % Cancer of Gall Bladder have Gall stones, with very high risk associated with #Porcelain Gall Bladder. 5. Which organs can get diseased/affected due to Gall Stones? Gall stones may affect the following organs Gall bladder (Acute #Cholecystitis, #Empyema, Carcinoma Gall bladder etc) Liver & Common Bile Duct (Obstructive #Jaundice etc) Pancreas (#Pancreatitis etc) Small intestines (Fistula & Obstruction) 6. How effective is #Ayurvedic Medicines & #Homoeopathy for Gallstones? There are NO scientific evidences proving any long term positive effects of Alternative Therapies. They should be used with extreme caution with strict monitoring & Ultrasound Follow-up. Laparoscopic Cholecystectomy remains THE ONLY standard of care & permanent solution for Gall stones. 7. How would removal of Gall bladder effect my digestive capacity? Removal of Gall bladder wont have any negative effect on digestion. On the contrary, relief from the symptoms arising due to gallstones might help in better ability to eat & digest. 8. Eating #Fatty food is banned after Cholecystectomy? Patients are asked to avoid Fatty food for about a week after Surgery, following which a normal diet can be resumed. Low fat should be continued as a healthy habit though. 9. Its difficult to gain weight after Cholecystectomy? Cholecystectomy has NO implications on weight trends. 10. Can Gallstones be removed with #Endoscopy? Endoscopic Retrograde Cholangio-Pancreatography – #ERCP is used when Gallstones drop into the Common Bile Duct from the Gall Bladder, for clearance of the biliary canal – the common bile duct in cases of Obstructive Jaundice & #Cholangitis or #BiliaryPancreatitis. But endoscopic removal of stones from gall bladder isn’t scientific, hence not practiced. 11. Can Gallstones be dissolved or broken, like kidney Stones? Shock wave #Lithotripsy is modality used to break stones into small pieces. It has been used in the past, unsuccessfully, with very high chances of complications, hence not recommended. 12. Is Open Surgery better or #Laparoscopic Surgery? Unless there are specific contra-indications, Laparoscopic Surgery has distinct advantages over Open Surgery. Laparoscopic Cholecystectomy is the Standard of care for Gall Stone Disease. If you have been detected with Gall Stones, suffer from any of the complications or have been advised Surgery kindly schedule an appointment with Dr Vishal Soni @ Zydus Hospitals, Ahmedabad, Gujarat.

Peri-Anal Sepsis Fistula in Ano Can I avoid #Surgery & not get operated? Anal #Fistula once formed, persists for life, unless treated. In case of #Ischiorectal or a #Perianal #Abscess it would increase In size & ultimately rupture from the weakest portion in the wall. These are purely Surgical Illnesses needing some form of intervention for complete cure. Is #MRI Pelvis a must? It’s a standard advice to all our patients to undergo MRI of Pelvis. Although a thorough clinical examination can give plenty information. Having a cross-sectional study helps in better treatment planning, risk stratification & understanding. Hence recommended. Is #Sigmoidoscopy / #Colonoscopy a must? Not in all patients. However if there is a history of Abdominal Pain, Weight loss, Bleeding in Stool then its worthwhile getting the colon thoroughly checked. Is #Laser the best treatment? The inquiry & preference for LASER originate from an incorrect myth that it’s a pain free & side-effect less modality! Few points here, its not a new technique but an energy source and has been there around since decades. The use doesn’t guarantee pain-free state. There are few fistula where the use is recommended! Other techniques like #VAAFT, #LIFT etc which have emerged over last decade & been used successfully. We use the concept of PersonalSpaceSurgery to decide the best possible treatment & surgical approach for you. How bad can the pain be after surgery? It can range from mild to severe. There are plenty of factors that come into picture for the same. But in any situation we ensure that the pain is taken care of & the patient is comfortable. Can pain be prevented or minimized? Yes. With newer & advanced techniques, we can precisely predict which patients are likely to develop issues with pain & manage them proactively. Our #Algologist (Pain Specialist – Dr Milan Mehta) is internationally trained in managing these cases to ensure a pain-free recovery Will there be any incontinence? The techniques of surgery we rely on, ensure a fine balance between Sphincter Preservation & avoidance of recurrence. All our efforts are focused on ensuring continence & it remains central to the care offered. The above concerns are duly addressed in our Approach to the entire spectrum of Fistulous Disease with #PersonalSpaceSurgery. Is Personal Space Surgery a new Surgical Technique? #PSS is an aggregation of all our efforts in managing patients with various Peri-Anal Conditions, including Anal Fistula Disease. It includes Investigations, Treatment planning, Surgery & Post-Operative Care. It ensures best possible outcomes. How tough is wound care & can I do it at home? The standard post-operative recovery involves stay in the hospital for a day or two where wound care is done under strict supervision. Meanwhile the patient & the family members actively participate in wound care & continue it at home, very comfortably. We have a team of trained & experienced Staff to help the patient at home with wound care. Its very rare for the patient to have to visit hospital for daily Wound Care. Does it recur? Very rarely. Cure from fistula has two components – Surgical & Patient healing. Patient healing can be influenced only in a limited fashion & all surgical techniques have a limitation too. Our recurrence rates match global standards & stand at less than 1%. Can I eat normally after Surgery? Absolutely Yes. The Surgery is planned in such a way that the bodily functions & the wound would not interfere in daily food habits. Almost all our patients go back to normal full diet in less than a week after surgery. Schedule an OPD appointment to get yourself evaluated & to inquire regarding Personal Space Surgery @ Zydus Hospitals, Ahmedabad, Gujarat.

1. How do I know that I have an Anal #Fissure? Fissure-in-Ano presents as episodes of Pain & Bleeding while passing Stool. People who suffer, tend to be well aware & usually self manage by alteration in the food & bowel habits to avoid the painful bowel movement. The usual duration of symptoms is 10-15 days, followed by gradual improvement only to recur again in about 3-4 months. Typically, this happens 3-4 times every year until medical opinion is sought. 2. What is better, Liquid or Bulk forming #laxatives? During an acute painful episode, its unwise to increase in stool bulk, thus Bulk forming laxatives are best avoided during ACUTE EPISODE. Here laxatives like Liquid Paraffin, Lactulose, Lactitol can be used. Once the episodes settle and there is no spasm, Ispaghula Husk can be used. 3. Which #Ointment is best? There are numerous Ointments with a wide variety of Drug combinations available. Its best to use one after a complete Surgical Consultation. All these would contain some numbing agent, a muscle relaxant. Steroid containing Ointments are best avoided. 4. Role of #Sitz Bath? The concept is to use heat to relax the muscles that have gone into spasm, by sitting immersed in a Tub full of water. Plain heated water (Temperature as per individual preference) works best. No need to add Betadine / Savlon / Dettol.   A frequency of 2 times a day & time duration of about 15 mins is adequate. There are numerous Ointments with a wide variety of Drug combinations available. Its best to use one after a complete Surgical Consultation. All these would contain some numbing agent, a muscle relaxant. Steroid containing Ointments are best avoided. 5. Is #Surgery the only treatment? Anal Fissure Anal Fissure Only about 5% patients need Surgery, which means 95% times a surgery can easily be avoided. A thorough evaluation using our concept of Personal Space Surgery & a curated treatment can help avoid a Surgery in great majority & achieve optimum results when Surgery is necessary. The Surgery described is called as #LateralInternalSphincterotomy. It can be performed in Open or Closed fashion. 6. Would the surgery hamper the control of Stool (Continence)? Lateral Internal #Sphincterotomy is division of the internal (Autonomous) muscle that results in relief from Spasm & narrowing. The External Sphincter remains intact. More so the defect in internal muscle gets bridged by fibrosis in due course of time. Thus, any clinically significant incontinence to Stool or Flatus is rarely encountered. 7. How useful is #Botox Injection in treatment? Anal Fissure Botulinum Toxin (Botox) has been used to relieve the spasm of the Internal Sphincter by injection into the muscle causing temporary paralysis (Up to 6 months).   However, the biggest issue (Side effect) with use is that if both (Internal & External) sphincters get paralyzed, there will be incontinence to stool which cant be reversed by any means & may take up to 6 months to recover. Due to safer alternatives, its not routinely prescribed. 8. What is Key-Hole Defect? It’s a complication when a Surgeon chooses to do Lateral Internal Sphincterotomy through the Fissure itself or performs a Fissurectomy. The Fissure behaves like a chronic wound with precarious blood supply. The wound thus may never heal and result into a permanent defect. Thus, the sphincter division is performed at sides (Lateral) rather than front or back & Fissurectomy should be avoided. 9. Can it recur? Very rarely, esp. if the constipation-bowel habits & diet changes haven’t been followed up. These changes to be followed are not temporary but lifelong. Even if there is recurrence, once the surgery is done the fissures tend to be very mild 10. Cost of Surgery & details? The recommended surgery is Examination Under Anaesthesia with Lateral Internal Sphincterotomy. The usual cost would be about 45-50 thousand in a Single Occupancy Room. The usual length of stay is 1 day. Resumption of Daily routine & Diet is from next day. There is no wound that needs any complex dressings. If you suffer from Anal Fissure symptoms, have been diagnosed or advised Surgery for the same schedule an appointment with Dr Vishal Soni @ Zydus Hospitals, Ahmedabad, Gujarat for evaluation & treatment options.

Hemorrhoids 1. Are Hemorrhoidal vessels normally seen? Yes, there are a bunch of normal vessels present at the Ano-rectal Junction. They contribute to better control (Continence) of Stool. Only when one suffers from #Constipation & Straining at stool for a long duration these small vessels enlarge & stretch to become Hemorrhoids. 2. Can i avoid Hemorrhoid Surgery? As a matter of fact only about 5% patients with Hemorrhoids need Surgery. For a single bleeding/prolapsed Internal hemorrhoid there are pain-free Office procedures like Rubber Band Ligation (#RBL) before a major surgery is adviced. 3. Is #Ayurvedic & #Homeopathic Treatment worth trying? Any Practitioner who can do complete examination, do a Per-Rectal Check-up, Advice regarding need for Sigmoidoscopy or Colonoscopy, Can Diagnose Inflammatory Bowel Disease, understands the Anatomy, Patho-Physiology & knows how to manage complications can be consulted. 4. Is Per-Rectal examination a must? 100%. Its would be highly inappropriate to prescribe any treatment unless an examination has been done. If there is a co-existent condition like an Anal #Fissure then the examination can be carried out in few days, but complete examination is a must! 5. Is #Laser the best modality? I see patients with very high infatuation with #LASER, in part due to marketing by the Manufacturing companies and also the practitioners who purchase them. The fact that its NOT a new/latest technology isn’t discussed. Also, use of LASER not a completely pain-free modality. The option is good in selected patients and should be discussed with the Surgeon instead of demanding it. Ultimately #LASER is an energy source and many more such sources & other latest techniques like DG-HAL etc exist. 6. Is #Stapler Surgery the best? Stapler Hemorrhoidopexy works by excision & stapling of a segment of the layer that holds hemorrhoidal vessels using a disposable Stapling Device. It works great in patients with Grade 3 Internal Hemorrhoids with or without External Components. However, its use cant be recommended as universal for all the patients. We developed a concept of Personal Space Surgery precisely to answer the question about the best treatment option for you. 7. What happens if I don’t opt for Surgery, when I have been adviced? The possible complications of Hemorrhoids can be Severe Bleeding & #Anemia, #Ulcerations, #Thrombosis of Hemorrhoids, Pain while passing stool & progressive swelling. The larger the hemorrhoids, extensive the surgery gets. Also the healing & recovery time also get subsequently influenced. 8. After Surgery what can I eat? Depends on what Surgery has been done, but ultimately all our patients resume normal diet after the healing process completes. 9. Is there a chance that I will lose my stool control (#Continence) permanently after Surgery? We ensure that when we operate, the Sphincter function is well preserved & such events are avoided at all costs. 10. Can #Hemorrhoids recur? Yes, as these arise from normal veins that get distended & stretched, if the causes of constipation & straining are not addressed the hemorrhoids may recur. The chances are about 2-5% If you suffer from symptoms suggestive of Hemorrhoids or have been adviced a Surgery, consult Dr Vishal Soni for expert opinion & for possibility of medical management.   OPD services at Zydus Hospitals, Ahmedabad, Gujarat or through Tele-Consultation.