GI surgery – Primax Gastro Institute & Superspeciality Hospital

GI surgery

🔪 GI Surgery – Precision Surgical Care for Digestive Disorders

At Primax Gastro Institute & Superspeciality Hospital, our Gastrointestinal (GI) Surgery Department is dedicated to providing advanced surgical solutions for complex digestive tract disorders. Led by a team of expert GI surgeons, we specialize in both routine and high-end laparoscopic procedures, ensuring faster recovery, minimal discomfort, and excellent clinical outcomes.

We perform a wide range of surgeries involving the esophagus, stomach, liver, pancreas, intestines, colon, and rectum, including cancer resections, hernia repairs, and gallbladder surgeries. Equipped with modular operation theatres, advanced surgical tools, and robust post-operative care, our department delivers safe, precise, and patient-centric surgical care.

Whether elective or emergency, every surgical case at Primax is managed with a focus on evidence-based practices, minimal access techniques, and holistic recovery.

Conditions

Esophagus also known as “food pipe” is an important organ of our digestive system. Its main role is to transfer food from mouth to stomach. Esophagus cancer usually occurs in middle to old age males and less commonly in females.

Signs and symptoms

Difficulty in swallowing. (sensation of food getting stuck in chest)
Blood in vomiting
Weight loss inspite of good appetite
Pain behind the chest bone in midline or heartburn

Risk factors

Smoking
Tobacco chewing
Age above 45 years
Men are more commonly affected
Alcohol intake
Diet low in fruits and green leafy vegetables
Certain infections like HPV
Obesity

What to do ?

Immediately contact your doctor. You might be asked to undergo endoscopy. Endoscopy is an OPD procedure requiring insertion of camera inside the food pipe to look at its lining and look for any ulcer or growth. Small samples (biopsy) can be taken for the purpose of examination. You may be required to undergo other tests like bronchoscopy or endoscopic ultrasound.

What Next if diagnosed with Esophagus cancer?

If you are diagnosed with esophagus cancer, you need to immediately start the treatment after due investigations like PET CT scan, CECT chest and abdomen.

Options of treatment?

Treatment of choice depends upon the location of cancer in Esophagus cancer. It requires a multidisciplinary approach which needs to be individualized. Various options are Surgery, Chemotherapy and Radiation. In advanced stages, stenting and in certain cases of bleeding, APC (Coagulation) of the tumor can be done

With experience of treating more than 100 esophagus cancers, we provide excellent Key hole surgery for esophagus which causes minimal pain and early recovery to the patients. With chemotherapy and radiotherapy, the results of treatment are excellent with excellent outcomes.

All you need to do is to have healthy diet and active lifestyle. Avoid alcohol and tobacco. And just in case you are suffering from cancer esophagus, dont lose hope and contact us

Esophageal cancer

Esophagus is the tube that carries food from throat to stomach. It acts as a carrier for food. Esophagus cancer arises from inner lining. In India, men are more commonly affected compared to women. It usually affects males of 40 to 60 years of age.

Risk factors of esophageal cancer

Smoking
Alcohol
Refulx disease
Obesity

Symptoms of esophageal cancer

Difficulty in swallowing
Cough especially on intake of liquids
Weight loss
Chest pain radiating to back
Change in voice
Noticing a lump in neck

Investigation

In a patient with difficulty in swallowing and weight loss, investigation of choice is upper GI endoscopy. A small piece is taken in case any doubtful growth is seen. In case cancer is confirmed, next step is to stage the disease.

For staging the disease (to know the exact spread of the disease), PET scan of whole body is done. It is latest modality by which we can quite exactly know the spread of disease.

Treatment options

Cancer of esophagus is an aggressive disease. Moreover, it is a debilitating disease because here a patient is not able to eat and weight loss occurs drastically. So first treatment aim is to resume the eating of the patient, either by putting a pipe through nose so that feeding can be given in the stomach. Rarely it requires a small operation by which pipe is inserted in small intestine.

Main treatment options of cancer of esophagus are surgery, chemotherapy and radiation. It is a multimodality approach for the patient which actually gives best results

We have got extensive experience of treating cancer esophagus patients. Surgery is the mainstay and now a days it can be done through key hole (laparoscopic) surgery. Recovery of the patient is excellent and postoperative complications are minimal. We have both the options of 3D laparoscopy and conventional key hole surgery.

hiatus hernia is a very common problem affecting the Indian population. Normally, esophagus is a part of chest cavity and stomach is part of the abdomen. They both are separated by a layer of muscles and fibrous tissue known as diaphragm. Esophagus passes through a small opening in the diaphragm from chest inside the abdomen. Rarely, there may be increase in size of this defect . As result of which, stomach is pulled up in side the chest cavity.

Types of hiatus hernia

Sliding Hiatus hernia
Para esophageal Hiatus Hernia
Combined para esophageal and sliding hernia

What are the symptoms of hiatus hernia?

burning in the chest
regurgitation of food in the mouth
pain in the upper abdomen
Difficulty in swallowing
It may rarely be associated with severe pain in chest
Patient may have blood in vomitus

Hiatus hernia causes

Some children have large hiatus by birth.
Due to trauma, there can be damage to diaphragm leading to hiatus hernia
With age also in few people, the size of the hiatus increases
If the pressure in the belly increases, it can forcefully increase the size of hiatus leading to hernia.

Diagnosis

Diagnosis is mainly done by gastroenterologist using endoscopy. Other diagnostic tests are CT scan of the chest and abdomen. Barium studies also may be of help where CT scan is not available. Rare testing modalities which may help in deciding the treatment plan are 24 hr pH monitoring studies.

Treatment

It is usually managed by medicines. Various antacids and other medicines are given to decrease the acid output of the stomach. This helps in treating most of the patients as they are relieved of their symptoms. However if the symptoms become refractory, patients may require surgery. surgery for hiatus hernia is very tricky and requires an extensive experience and technical expertise. We have to keep in mind while performing surgery that the patient not only is improved of his present symptoms but may not develop the complications like difficulty in eating.

Rarely, complications of hiatus hernia can occur when adjacent organs also slide in the abdominal cavity.

We have an extensive experience in handling hiatus hernia. With use of minimally invasive techniques, patients can either be discharged next day or maximum in two days. If you are suffering from the above mentioned symptoms, you need to get yourself examined as early as possible. Timely intervention can result in excellent outcomes.

Heartburn: Causes, Symptoms, and Treatment

Heartburn is a common digestive symptom characterized by a burning sensation in the chest, often accompanied by acid reflux. It occurs when stomach acid flows back into the esophagus (food pipe), irritating its lining. While occasional heartburn is normal, frequent or severe heartburn may indicate an underlying condition like Gastroesophageal Reflux Disease (GERD), requiring medical attention.

What Causes Heartburn?

Heartburn occurs due to weakening or dysfunction of the lower esophageal sphincter (LES)—the muscle that prevents stomach acid from flowing back into the esophagus. Common triggers include:

Spicy, fatty, or fried foods
Caffeine, chocolate, and carbonated beverages
Excessive alcohol consumption
Large meals or lying down soon after eating
Obesity and excess abdominal pressure
Smoking (weakens the LES)
Pregnancy (hormonal changes and pressure on the stomach)
Certain medications (NSAIDs, calcium channel blockers, etc.)

Symptoms of Heartburn

Burning sensation in the chest (typically after eating, worse at night)
Sour or bitter taste in the mouth (acid regurgitation)
Difficulty swallowing (in severe cases)
Chronic cough, sore throat, or hoarseness (from acid irritation)
Discomfort worsens when lying down or bending over

If heartburn occurs frequently (more than twice a week) or is associated with chronic cough, chest pain, or difficulty swallowing, it may indicate GERD and requires medical evaluation.

Complications of Untreated Heartburn

Chronic acid reflux can lead to:

Esophagitis – Inflammation of the esophagus
Esophageal Strictures – Narrowing of the esophagus due to scarring
Barrett’s Esophagus – A precancerous condition caused by long-term acid exposure
Esophageal Cancer – In rare, advanced cases

Diagnosis of Heartburn and Acid Reflux

At Primax Gastro institute, we use advanced diagnostic tools to assess acid reflux severity:

Endoscopy (Upper GI Endoscopy) – To check for esophageal damage.
pH Monitoring – Measures acid reflux episodes over 24 hours.
Esophageal Manometry – Evaluates esophageal muscle function.

Treatment & Management of Heartburn

1.⁠⁠Lifestyle & Dietary Modifications

Eat smaller meals and avoid eating 2–3 hours before bedtime.
Avoid trigger foods (spicy, fried, acidic, and carbonated drinks).
Lose weight if overweight to reduce abdominal pressure.
Quit smoking & limit alcohol consumption.
Sleep with head elevated (use a wedge pillow or raise the bed).

2.⁠⁠Medications for Heartburn

Antacids (e.g., calcium carbonate, magnesium hydroxide) Provides quick relief.
H2-receptor blockers (e.g., ranitidine, famotidine) – Reduces acid production.
Proton Pump Inhibitors (PPIs) (e.g., omeprazole, pantoprazole) – More effective for frequent or severe reflux.
Prokinetic agents (e.g., domperidone, metoclopramide) – Improve stomach emptying in certain cases.

3.⁠⁠Advanced Treatment for Chronic Reflux

For severe or treatment-resistant GERD, advanced endoscopic and surgical options are available at Primax Gastro institute:

Fundoplication Surgery – Strengthens the LES to prevent reflux.
Endoscopic Procedures – Newer techniques like transoral incisionless fundoplication (TIF), ARMS

Why Choose Primax Gastro institutefor Heartburn Treatment?

At Primax Gastro institute, we provide a comprehensive and personalized approach to treating heartburn and acid reflux. Our expert gastroenterologists use cutting-edge diagnostic techniques and minimally invasive treatments to ensure lasting relief and prevent complications.

If you experience frequent or severe heartburn, consult our specialists at Primax Gastro Institute & Super Speciality Hospital [9666460009]to take the first step toward long-term relief and digestive health.

Bariatric (weight loss) Surgery

Obesity in India is defined as body mass index [BMI: Weight (kg)/ Height (m)2] more than 27.5 kg/m2 (normal BMI is between 18 to 23 kg/m2). Obesity is both a lifestyle disorder and can be genetic also. and people with BMI more than 32.5 kg/m2 and 37.5 kg/m2 are defined as severely obese and morbidly obese respectively. Obesity is a chronic disease with accumulation of excessive body fat and subsequent risk for development of medical conditions like diabetes mellitus (DM), hypertension (HT), obstructive sleep apnoea (OSA), degenerative joint disease, hyperlipidemia (HPL), hyperuricemia, fatty liver, depression, polycystic ovarian disease (PCOD) and asthma to name a few. Thus obesity adversely affects all the organs and lead to constellation of symptoms referred to as Metabolic Syndrome of Obesity. People with morbid obesity (BMI > 37.5 kg/m2) have 50% to 100% higher mortality rates. There is also emotional effect of obesity where obese patient suffers neglect from society and thus are prone to develop mental symptom like depression, anxiety and eating disorders. So Bariatric surgery or weight loss surgery or metabolic surgery is a life style modification surgery which not only reduces weight but through its hormonal effect it cures/ controls the medical conditions associated with it. Its effect on glucose control and other metabolic problems is striking, which can be seen soon after the procedure and even before there is significant reduction in weight.

Bariatric surgery is indicated if a patient is morbidly obese (BMI > 37.5 kg/m2) or severely obese (BMI > 32.5 kg/m2) with seriously related diseases like DM, HT, OSA and others as explained above. It can be safely done in patients between 18 to 65 years of age who have failed weight loss alternatives like dieting, exercise and behavior modification programs and who are committed to healthy life style. The patient not only reduces extra fat but many obesity related conditions like Diabetes, high blood pressure, sleep apnea, heart diseases are resolved or significantly improved. PCOD and resulting infertility is also greatly improved. Patient can become pregnant after 18 months to 2 years after surgery and Overall quality of life is improved in 95% of patients and mortality is reduced in 89% of patients.

There are various ways for doing bariatric surgery like Sleeve gastrectomy which restricts the food intake and Gastric Bypass (Roux- en-y and Mini Gastric Bypass) which also limits the absorption of ingested food. All the bariatric surgeries are done laparoscopically by making several small incisions (4 to 6) ranging from 5 to 15mm, through which the surgeon inserts laparoscopic instruments to perform the surgery. Patients usually go home two to three days after surgery.

Laparoscopic Sleeve Gastrectomy (Fig 1) is accomplished by cutting away the outer portion of the stomach, leaving a small tube or sleeve of stomach. This reduces the stomach volume by about 80%. The stomach is now like a hockey stick shaped organ, which holds less food and produces less acid. In addition, the part of the stomach that produces the hormone implicated in hunger (Ghrelin) is also removed and therefore there is a component of appetite suppression. In

Laparoscopic roux en y gastric bypass (Fig 2), a small stomach pouch (25-30 ml) is created with a stapler device, and connected to the distal small intestine. The upper part of the small intestine is then reattached in a Y-shaped configuration.

Laparoscopic Mini Gastric bypass (Fig 3) consists of forming a long gastric tube and attaching it 200 cm down to small bowel with single anastomosis. Unlike conventional gastric bypass it has fewer early and long term complications and can achieve weight loss similar to it. The disadvantage is bile reflux which is mentioned but practically very few patients observe it.

Nowadays with the advent of new stapling devices, the risks associated with the procedure are negligible and are like any other laparoscopic surgery. Patient can go home after 2 to3 days and start their routine work after 1 week and strenuous activity after 6 weeks. The diet after surgery goes through various phases starting from all liquid diet to semisolid to complete diet over 6 to 8 weeks. The complete diet is small in amount and has to be taken more frequently and food has to be chewed properly and patient has to avoid intake of water, liquids 30 minutes before and after meals. The striking control of Diabetes is seen soon after the surgery and even before any significant weight loss. The theories suggested are diet control immediately after surgery as patient is on liquid sugar free diet and hormonal changes (Ghrelin and Integrins) which produce satiety and have similar actions like insulin. Also when person reduces weight they are more mobile and whatever Insulin they are producing works better as there is reduction in Insulin resistance. Also the weight loss produced is sustainable and it has been shown that surgery improves patient’s desire and dedication for a healthy and better life. Apart from change in appearance, surgery brings new hope, improves self confidence and positivity in patient’s thought process. Thus this surgery changes life style and gives new unimaginable dimensions to life.

WHY BARIATRIC SURGERY?

People often confuse bariatric surgery with liposuction and when they hear that diet will be less, they think that dieting alone will work but bariatric surgery offers you fast and more sustained Weight loss due to hormonal changes associated with it. Not only after bariatric surgery people who are binge eaters, stop eating excess food but due to hormonal changes, the diseases associated with obesity like Type 2 Diabetes Mellitus, Hypertension, Obstructive sleep apnea, PCOD (infertility), and others show marked improvement, that some of the patients may not need even medicines for their diseases, so bariatric surgery adds healthy years to your life.
Liposuction is not a weight loss procedure but rather it produces inch loss and is a cosmetic procedure and not for morbidly obese and no disease is controlled after it and food craving is same.
In dieting, you are feeling hungry but you eat less, so it cannot last for life long and once you start eating, whole weight comes back.
The following table compares the three modalities.

Colon Cancer

Overview:
Colon cancer, also known as colorectal cancer, begins in the large intestine (colon) or rectum. It often starts as small, benign clumps of cells called polyps that can become cancerous over time.

Common Symptoms:

Blood in stool
Persistent abdominal discomfort (cramps, gas, pain)
Unexplained weight loss
Changes in bowel habits (diarrhea or constipation)

Risk Factors:

Age (50+ years)
Family history of colorectal cancer
Inflammatory bowel diseases (e.g., ulcerative colitis)
Diet high in red or processed meats
Sedentary lifestyle, smoking, or alcohol use

Treatment Options:

Surgery
Chemotherapy
Radiation therapy
Targeted therapy or immunotherapy (for advanced stages)

Early Detection Saves Lives:
Regular screening such as colonoscopy can detect precancerous polyps early and reduce the risk of colon cancer.

Ulcerative Colitis

Overview:
Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that causes inflammation and ulcers in the inner lining of the colon and rectum. It can lead to debilitating symptoms and long-term complications.

Common Symptoms:

Persistent diarrhea, often with blood or pus
Abdominal pain and cramping
Urgency to defecate
Fatigue and weight loss
Rectal bleeding

Causes & Risk Factors:

Exact cause unknown (believed to be immune-related)
Genetic predisposition
Environmental triggers
Typically begins before age 30

Treatment Goals:

Reduce inflammation
Control symptoms
Achieve and maintain remission
Prevent complications

Treatment Options:

Anti-inflammatory drugs (e.g., aminosalicylates)
Immunosuppressants
Biologics
Surgery (colectomy in severe cases)

Ongoing Care:
Regular follow-ups and lifestyle modifications, including stress management and dietary adjustments, are essential for long-term management.

Rectum acts a reservoir to store fecal matter before the act of evacuation. However, in few middle aged people, as the person passes motion, part of intestine comes out from anal opening. It either goes back on its own or may require manual repositioning. The condition in which rectum comes out is called as Rectal Prolapse

Usually middle aged females are affected. But old aged ladies are also frequently affected by this condition of rectal prolapse

Different types of rectal prolapse

Full thickness – Whole thickness of rectal wall comes out of the anal canal. It is the most common type of rectal prolapse
Mucosal – Only the inner lining of rectum comes out of the anal opening
Internal – Here nothing comes out of the opening but their is folding of rectum occurs on itself

Risk factors

Chronic Constipation
Chronic Cough
Diarrhea occasionally
Systemic Conditions like Multiple sclerosis, trauma to back
Pregnancy

Diagnosis

A good history and physical examination is usually sufficient for the diagnosis of rectal prolapse. Additional tests required to confirm the diagnosis are barium defecography which will actually confirm the diagnosis of rectal prolapse. Other tests which are required before deciding on type of treatment are sigmoidoscopy, +/- anal manometry and rectal ultrasound.

Treatment

Before starting any treatment for rectal prolapse, we need to find out the cause of rectal prolapse. We need to treat constipation or chronic diarrhea.

Various surgical procedures are there to address the issue of rectal prolapse. Now a days key hole surgery (Laparoscopy) has come to provide surgery with minimum trauma to the patients. With excellent vision, patients can be operated for this condition with minimal side effects. Patients are usually discharged the next day. They can resume their normal life style within a week.

Hydatid disease is a common parasitic disease that affects our liver and lungs.It is caused by tapeworms. It may occasionally affect our brain also. It is usually caused by coming in contact with animals who suffer from hydatid disease or through ingestion of parasitic eggs contaminating the food, water or soil. They are actually carriers but have the potential to infect human beings. Liver is the most commonly affected organ followed by lungs. If left untreated, they can grow to enormous size and may rupture. The treatment of the disease is usually by the medicines but may require surgery at some instances. Hence the treatment has to be individualized.

Symptoms of hydatid disease

Usually patients are asymptomatic for hydatid disease until it increases in enormous sizes and cause clinical symptoms. Non specific symptoms include weight loss and anorexia.

When liver is involved, usual symptoms are pain abdomen, nausea or vomiting

When lung is involved, symptoms involve chest pain, cough and difficulty in breathing.

Diagnosis

Investigation of choice for abdominal hydatid disease is ultrasonography. To confirm the diagnosis Contrast CT scan of the abdomen is done.

Medical management

The treatment of choice for widespread hydatid disease is tablet albendazole. Dose and duration depends on the extent of disease and weight of the patient. There are other medical options mebendazole.

Surgery is required for limited disease. There are different surgical techniques of hydatid disease. They range from complete removal of the cyst (cystopericystectomy/ organ resection) to simple drainage.

We have an extensive experience in performing the surgeries for hydatid cyst of liver and lungs. With the use of minimal access surgery we routinely perform surgeries for liver as well as lungs with excellent outcomes and minimal scar. Usually patients are discharged within two to three days. Long term recurrences are minimal if tackled at an early stage.

Liver cancer

Liver is one of the most important and largest internal organ of the body which sits in right upper part of the abdomen below the chest. It is essential for life. Several types of cancers can form in the liver. Most common type of cancer which affects liver is hepatocellular cancer. Other types of liver cancers which are less prevalent are intrahepatic cholangiocarcinoma, fibro lamellar hepatocellular carcinoma. Other non cancerous liver lesions are focal nodular hyperplasia, hepatic adenoma, liver cysts, hemangiomas. Many a times liver becomes seat of cancer cells which spread from other body parts and get deposited in liver. These are secondary tumors of liver and are known as metastatic tumors.

Signs and symptoms

Fatigue

Weight loss

Pain right side of the abdomen

Jaundice

Abdominal fullness

Bleeding from mouth

Risk Factors

Alcohol

Liver infections (Hepatitis) Hep B, Hep C

Diabetes (Most common cause of liver damage leading to liver cancer now a days in India)

Certain liver diseases (Hemochromatosis or Wilson’s disease)

Diagnosis

Usually an ultrasound abdomen is done for patients presenting with above symptoms and have a clinical suspicion. A patient is then advised to undergo triple phase CT scan or MRI abdomen to further characterize the lesions. Blood tests help in further diagnosing the lesion like Alfa feto protein. Adjunct tests required are Upper Gastro endoscopy, bone scan, Contrast CT Chest, complete blood count, liver function tests. Fibroscan may further be used to confirm whether liver is damaged or not (cirrhotic).

Treatment options

Usually patients of liver cancer have associated liver damage also. So the ideal and best treatment for such patients is Liver transplant. It takes care of both the conditions i.e. Damaged liver and cancer. However, only a small fraction of patients are suitable for liver transplant. Moreover, it requires liver donation by a family member and it incurs huge expenditure.

Other treatment options available for liver cancers are surgical resection of the tumor, ablation of tumor using radio frequency machine or microwave, chemo embolization of tumor.

Less effective modalities are oral chemotherapeutic agents like targeted therapies (tyrosine kinease inhibitors) and rarely radiation. Various immunotherapeutic agents are also being used which ac as check points towards tumor formation. Stereotactic external beam radiotherapy (SBRT) gives high dose of intense radiation to the tumors to burn them.

Prevention of liver cancer

Most important way of preventing liver cancer is avoid alcohol intake. Avoidance of liver infections life hepatitis B and hepatitis C can prevent liver damage and occurence of cancer. Never use open contaminated needles, always use condom and avoid unprotected sexual intercourse.

Immunization is another way of preventing hepatitis B infection. All should get immunized for hepatitis B vaccination.

If you are suffering from end stage liver disease, frequent and regular follow up with your doctor can help in identifying the tumors at early stage.

Gall bladder stones (Cholelithiasis)

Gall bladder is a pear shaped organ lying just below the liver. Gall stone is a major problem of North India. Main function of gall bladder is to store bile and concentrate it. When the contractility of the gall bladder is affected, then stone formation occurs. In North India, it has become an epidemic. Incidence of Gall bladder stones in one study was as high as 4% in North India.

There are two types of gall bladder stones

Cholesterol stones – These are most common types of stones found in gall bladder. They are formed from cholesterol found in the blood.

Pigment stones – They are formed from the breakdown of red blood cells

Why are gall stones formed?

There are many reasons for gall bladder stones to form.

Gall bladder fails to contract leading to concentration of bile inside the gall bladder.

Excess concentration of cholesterol in the bile.

Pregnancy

Blood disorders like sickle cell anemia

Sudden weight loss

Post bariatric surgery

Risk factors for development of gall bladder stones?

Certain strata of population are at high risk of developing gall bladder stones

Female sex

Obesity

Age more than 40 years

Diabetes

Blood disorders like sickle cell anemia

North Indian females are at high risk of gall stones

Drugs like OCPs

Symptoms of gall bladder stone disease

Main symptom of gall bladder stone disease are –

Pain in upper abdomen. Pain typically has a waxing and waning course. It may radiate to back, lower chest, and even shoulder.

Jaundice – it may occur due to slippage of stones in side the bile duct.

Fever – if gall bladder gets inflammed due to stone blockage, patient may develop fever. Rarely, gall bladder gets perforated (giveway in the wall of gall bladder) leading to development of fever

Nausea and vomiting

Gall bladder cancer

Gall bladder is located in right upper site of our abdomen. Its main role is in digestion of food. It acts as store house of juice secreted from liver (bile). Whenever the food enters our body, gall bladder contracts and delivers bile in the intestine which aids in digestion.

However, it can get affected by cancer cells in few people. This condition is known as gall bladder cancer. Unfortunately, people of north India are living in an endemic zone and are highly susceptible of having gall bladder cancer.

Signs and symptoms

Most patients are asymptomatic and often present in last stage

Pain in upper abdomen is the most common symptom

Late presentations include jaundice, abdominal fullness (ascites)

Lack of appetite

Weight loss

Risk factors

Living in North India is itself a risk factor as it is considered to be an endemic zone

Women of above 40 years

If a family member has suffered from GBC

? Gall stones – It is difficult to say that gall bladder stones cause GBC. Gall stone is very common and compared to their incidence, incidence of GBC is very low. So whether GBC is caused by gall stones is difficult to say. But if we have a family history, then we have to be very careful.

Diagnosis

A simple ultrasound of the abdomen is sufficient in 90% of the population to diagnose GBC. Whenever even a suspicion is raised, it needs to be taken seriously and need to contact a gastro surgeon.

Once a suspicion is raised, patient needs to undergo CECT scan of the abdomen and whole body PET scan.

Treatment options

Various treatment options are surgical resection, chemotherapy and radiotherapy. Early detection is a must for good outcomes of this disease.

A patient having gall bladder polyp should immediately contact the doctor for further management as it may be pre cancerous in few. It needs management by expert hands.

Surgical Gastroenterology

Esophagus

Achalasia cardia

Esophagus is also known as the food pipe of the digestive system. Its main role is to transfer food from mouth to stomach. It plays an important role in the process of digestion also. Many patients suffer from disease called as achalasia cardia. The main problem in achalasia cardia is that lower portion of esophagus (Lower esophageal sphincter) fails to relax and give passage to food from esophagus to stomach. As a result food gets stuck in lower portion of chest. It is a neurological defect and their is no mechanical cause.

Signs and symptoms

Food especially liquids getting stuck up and difficulty in swallowing them. Solids however may be digested with ease
Pain behind lower chest bone and heartburn
Vomiting of previously taken undigested food
Weight loss

Risk factors

Middle aged males
History of other autoimmune disorders

Diagnosis

Achalasia cardia is diagnosed by simple procedures like barium swallow. In this, patient is given dye from mouth and x rays are taken. Characteristic picture is bird beak appearance. Other investigations which are required are endoscopy, esophageal manometry studies.

In endoscopy, a camera mounted on endoscope is introduced from mouth. It looks after the inner lining of esophagus. If their is any blockage at lower end of esophagus, it identifies it and can also rule out any mechanical cause of obstruction.

Treatment options

Various treatment options depend on the severity of disease and duration of disease. In late stages, esophagus gets severely damaged in which we are left with no option but to remove the damaged esophagus. In early stages, various treatment options are Surgery, endoscopic treatment.
Till date surgery has been the treatment of choice where we open the defective lower esophageal sphincter and join an anti-reflux procedure to it. We have extensive experience in operating on patients of achalasia cardia by Heller’s Myotomy and Fundoplication. All these surgeries are performed using laparoscopy (key hole surgery). Long term results have been excellent. In very rare cases, the esophagus can become grossly dilated and tortuous. In these conditions, we might need to remove this dilated esophagus and make an new passage for food with the help of stomach.

Other treatment option which we offer is endoscopic opening of contracted LES by a process known as POEM. Here, with the help of endoscopy, the muscle fibres are cut to release the tension on sphincter. Various other options are dilating LES using balloon or injecting botox in the sphincter. However the results of these procedures are not satisfactory and very high recurrence rates.

All patients irrespective of the type of treatment require regular follow up with their doctors. Repeat assessment of the esophagus is essential for the better long term outcomes.

Esophageal cancer

Esophageal cancer

Risk factors of esophageal cancer

Smoking
Alcohol
Refulx disease
Obesity

Symptoms of esophageal cancer

Difficulty in swallowing
Cough especially on intake of liquids
Weight loss
Chest pain radiating to back
Change in voice
Noticing a lump in neck

Investigation

For staging the disease (to know the exact spread of the disease), PET scan of whole body is done. It is latest modality by which we can quite exactly know the spread of disease.

Treatment options

Main treatment options of cancer of esophagus are surgery, chemotherapy and radiation. It is a multimodality approach for the patient which actually gives best results

Hiatus hernia

Types of hiatus hernia

Sliding Hiatus hernia
Para esophageal Hiatus Hernia
Combined para esophageal and sliding hernia

What are the symptoms of hiatus hernia?

burning in the chest
regurgitation of food in the mouth
pain in the upper abdomen
Difficulty in swallowing
It may rarely be associated with severe pain in chest
Patient may have blood in vomitus

Hiatus hernia causes

Some children have large hiatus by birth.
Due to trauma, there can be damage to diaphragm leading to hiatus hernia
With age also in few people, the size of the hiatus increases
If the pressure in the belly increases, it can forcefully increase the size of hiatus leading to hernia.

Diagnosis

Treatment

Rarely, complications of hiatus hernia can occur when adjacent organs also slide in the abdominal cavity.

Stomach

Stomach cancer

Ulcer disease

GERD

Obesity treatment

Bariatric surgery

Bariatric (weight loss) Surgery

WHY BARIATRIC SURGERY?

Colon

Colon cancer

Ulcerative colitis

Rectum

Rectal cancer

Rectal prolapse

Usually middle aged females are affected. But old aged ladies are also frequently affected by this condition of rectal prolapse

Different types of rectal prolapse

Full thickness – Whole thickness of rectal wall comes out of the anal canal. It is the most common type of rectal prolapse
Mucosal – Only the inner lining of rectum comes out of the anal opening
Internal – Here nothing comes out of the opening but their is folding of rectum occurs on itself

Risk factors

Chronic Constipation
Chronic Cough
Diarrhea occasionally
Systemic Conditions like Multiple sclerosis, trauma to back
Pregnancy

Diagnosis

Treatment

Before starting any treatment for rectal prolapse, we need to find out the cause of rectal prolapse. We need to treat constipation or chronic diarrhea.

Liver

Hydatid disease

hydatid disease is a common parasitic disease that affects our liver and lungs.It is caused by tapeworms. It may occasionally affect our brain also. It is usually caused by coming in contact with animals who suffer from hydatid disease or through ingestion of parasitic eggs contaminating the food, water or soil. They are actually carriers but have the potential to infect human beings. Liver is the most commonly affected organ followed by lungs. If left untreated, they can grow to enormous size and may rupture. The treatment of the disease is usually by the medicines but may require surgery at some instances. Hence the treatment has to be individualized.

Symptoms of hydatid disease

Usually patients are asymptomatic for hydatid disease until it increases in enormous sizes and cause clinical symptoms. Non specific symptoms include weight loss and anorexia.

When liver is involved, usual symptoms are pain abdomen, nausea or vomiting

When lung is involved, symptoms involve chest pain, cough and difficulty in breathing.

Diagnosis

Investigation of choice for abdominal hydatid disease is ultrasonography. To confirm the diagnosis Contrast CT scan of the abdomen is done.

Medical management

Liver cancer

Signs and symptoms

Fatigue

Weight loss

Pain right side of the abdomen

Jaundice

Abdominal fullness

Bleeding from mouth

Risk Factors

Alcohol

Liver infections (Hepatitis) Hep B, Hep C

Diabetes (Most common cause of liver damage leading to liver cancer now a days in India)

Certain liver diseases (Hemochromatosis or Wilson’s disease)

Diagnosis

Treatment options

Other treatment options available for liver cancers are surgical resection of the tumor, ablation of tumor using radio frequency machine or microwave, chemo embolization of tumor.

Prevention of liver cancer

Immunization is another way of preventing hepatitis B infection. All should get immunized for hepatitis B vaccination.

If you are suffering from end stage liver disease, frequent and regular follow up with your doctor can help in identifying the tumors at early stage.

Liver cysts and tumors

Gall bladder

Gall stone disease

Gall bladder stones (Cholelithiasis)

There are two types of gall bladder stones

Cholesterol stones – These are most common types of stones found in gall bladder. They are formed from cholesterol found in the blood.
Pigment stones – They are formed from the breakdown of red blood cells

Why are gall stones formed?

There are many reasons for gall bladder stones to form.

Gall bladder fails to contract leading to concentration of bile inside the gall bladder.
Excess concentration of cholesterol in the bile.
Pregnancy
Blood disorders like sickle cell anemia
Sudden weight loss
Post bariatric surgery

Risk factors for development of gall bladder stones?

Certain strata of population are at high risk of developing gall bladder stones

Female sex
Obesity
Age more than 40 years
Diabetes
Blood disorders like sickle cell anemia
North Indian females are at high risk of gall stones
Drugs like OCPs

Symptoms of gall bladder stone disease

Main symptom of gall bladder stone disease are –

Pain in upper abdomen. Pain typically has a waxing and waning course. It may radiate to back, lower chest, and even shoulder.
Jaundice – it may occur due to slippage of stones in side the bile duct.
Fever – if gall bladder gets inflammed due to stone blockage, patient may develop fever. Rarely, gall bladder gets perforated (giveway in the wall of gall bladder) leading to development of fever
Nausea and vomiting

Gall bladder cancer

Signs and symptoms

Most patients are asymptomatic and often present in last stage
Pain in upper abdomen is the most common symptom
Late presentations include jaundice, abdominal fullness (ascites)
Lack of appetite
Weight loss

Risk factors

Living in North India is itself a risk factor as it is considered to be an endemic zone
Women of above 40 years
If a family member has suffered from GBC
? Gall stones – It is difficult to say that gall bladder stones cause GBC. Gall stone is very common and compared to their incidence, incidence of GBC is very low. So whether GBC is caused by gall stones is difficult to say. But if we have a family history, then we have to be very careful.

Diagnosis

A simple ultrasound of the abdomen is sufficient in 90% of the population to diagnose GBC. Whenever even a suspicion is raised, it needs to be taken seriously and need to contact a gastro surgeon.

Once a suspicion is raised, patient needs to undergo CECT scan of the abdomen and whole body PET scan.

Treatment options

Various treatment options are surgical resection, chemotherapy and radiotherapy. Early detection is a must for good outcomes of this disease.

A patient having gall bladder polyp should immediately contact the doctor for further management as it may be pre cancerous in few. It needs management by expert hands.

Mirizzi syndrome

Gall bladder polyps

Pt. Name	Room Ward/No	CR No	DOA	DOD	Consultant Name	Surgery Date	Contact No	E-mail	Comments
Sweety	1001	201271507	09/05/22	12/05/22	Dr. Nikhil Gupta	10/05/22	9811057730	—————-	I’m Satisfied Very good behavior, good Hospital, Talented Doctor.
Bishamber Dayal Gupta	HDU-5	300074991	04/5/22	05/05/22	Dr. Nikhil Gupta	04/05/22	9891233978	—————-	I would Like to thanks, Dr. Nikhil Gupta ,He saved my Life thanks so much.
Gurmeet Kaur	1154	201245186	03/05/22	7/05/22	Dr. Nikhil Gupta	3/05/22	9821174759	Haginder79 Singh@ gmail.com	There team members to save my mother life We are remember whole life of Dr. Nikhil Gupta. When I visit to hospital I’ll be meeting to the Dr. Nikhil.
Tika Ram	224-4	300127700	06/05/22	7/05/22	Dr. Nikhil	06/05/22	9811022047	————————–	Thank you so much for taking care of my father, I thanked Dr. Nikhil Gupta for helping us a lot. He Suggest us the best treatment and best facility I hope my father will better soon. The Dr is also helpful .
Lalita tomare	207-1	300127053	25/04/25	07/05/22	Dr. Nikhil Gupta	27/05/22	9871218429	————————-	Dr. Nikhil sir & their team members are really good and reliable. Their efforts and care it possible that the patient got recovered so quickly.
Sonal	2002	201270770	04/05/22	09/05/22	Dr. Nikhil Gupta	05/05/22	8076303003	—————-	I would like to thank you all their doctors and the staff of GI ONCO department from Bottom of my heath.
Mohan lal saluja	2001-3	300127765	6/5/22	12/5/22	Dr. Nikhil Gupta	7/05/22	9717710499	—————-	A very good doctors and services were also excellent & Dr. Nikhil Gupta thanks sir.
Tshivenda Kaur	1016	2012790973	11/05/22	13/05/22	Dr. Nikhil Gupta	11/05/22	9312373693	—————-	I’m Satisfied by Dr.
Akhilesh Jangid	202-1	300125810	16/05/22	24/05/22	Dr. Nikhil Gupta	17/05/22	7976500511	—————-	Dr. Nikhil Sir Thank you so much, for my excellent surgery, you save my life, Thank you again sir.
Neetu Sharma	—————-	201272279	20/05/22	22-05-22	Dr. Nikhil Gupta	20/05/22	9027497654	—————-	Dr. Nikhil Gupta is good Doctor, his nature is very polite.
Nirmala Devi	205-2	300129114	6/7/22	7/7/22	Dr. Nikhil Gupta	6/7/22	8285379596	—————-	Behavior was very polite of Dr. & treatment very well.
Krishna Jain	201-4	201-4	30/6/22	6/7/22	Dr. Nikhil Gupta	—————-	9837641995	—————-	We showed it to Dr. Nikhil Gupta and had a great experience. Thanks sir.
Sunil Kumar	1013	201281584	10/7/22	17/07/22	Dr. Nikhil Gupta	11/7/22	9896368747	—————-	It is an excellent experience to treated from Dr. Nikhil Gupta this is my 2nd time. I will highly recommend this hospital and Dr. Nikhil Gupta thanks sir
Mohit	206-3	300129134	4/07/22	15/7/22	Dr. Nikhil Gupta	7/07/22	8755332256	—————-	Everything is very fine thanks Dr. Nikhil sir
Mr. Rajni Kanta	1010	201132661	15/07/22	18/07/22	Dr. Nikhil Gupta	yes	9958487599	—————-	Satisfied with treatment, staff, Doctors. Well Maintained. Thanks all of you.
Sarle Devi	201-4	300129123	9/7/22	18/07/22	Dr. Nikhil Gupta	yes	9899926703	—————-	I’m very grateful to Dr. Nikhil Gupta I’m very impressed by his words and thoughts. He is a very good doctor. He had operated on my wife. Today my wife is very well and my whole family is very happy. Thanks sir
Ashrna	4006	201120941	20/07/22	22/07/22	Dr. Nikhil Gupta	21/07/22	9999080443	—————-	Excellent Knowledge, Very good Behavior & Satisfactory service Thank you.
Arun	1161-3	201282889	18/07/22	22/7/22	Dr. Nikhil Gupta	21/7/22	9868130606	—————-	Service are very good thanks sir
Shreya Mittal	1003	201254349	14/04/22	16/04/22	Dr. Nikhil Gupta	15/04/22	9999695785	—————-	Over all experience was 5 Star with Dr. Nikhil Gupta and team, I’ll remember to all.
Geeta Devi	3158	200856388	15/04/22	16/04/22	Dr. Nikhil Gupta	15/04/22	9650304442	—————-	Staff and doctors are very Cooperative and helping nature surgery was performed I’m Happy thanks sir
Anamika Tiwari	3157-5	20126442	27/03/22	31/03/22	Dr. Nikhil Gupta	29/03/22	9956263866	—————-	All of the staff was great-they were helpful Patient Thank you.
Ashok Gupta	304	300126687	25/03/22	1/04/22	Dr. Nikhil Gupta	————————–	9911960653	————————–	Dr. Nikhil Gupta was very cooperative it was easy to communicate with him as well as with his team great work very satisfied thanks you to the team and the doctors.
Pooja Mehta	3160	201228513	22/11/22	25/11/22	Dr. Nikhil Gupta	Yes	9250861706	—————-	-We are very much satisfied with the priceless doctor Nikhil and his team.
Rinku	201-5	—————-	—————-	—————-	Dr. Nikhil Gupta	—————-	—————-	—————-	Dr. Nikhil a great Surgeon and quite down to earth person.
Pratik	2006	—————-	29/10/22	02/11/22	Dr. Nikhil Gupta	—————-	9868494515	—————-	The whole team and staff were Polite and incredible.
Munni	206-1	—————-	—————-	—————-	Dr. Nikhil Gupta	—————-	8975654516	—————-	Dr. Nikhil is very superglue Heaper to me in my case. He suggest in every step. Thanks sir
Hemlata	1155-1	—————	—————	—————	Dr. Nikhil Gupta	—————-	7989459705	—————-	Service are good all staff are very polite and very supportive.
Rajwati	1017	2301224	03/1/23	03/1/23	Dr. Nikhil Gupta	Yes	9355330930	—————-	Dr. Nikhil is best doctor had meet even He made patient very comfortable, Behavior all staff is very Good Thanks Nikhil sir and his staff
Ganesh Dass Bareja	702-3	304471	07/1/23	09/1/23	Dr. Nikhil Gupta	—————-	7988243798	—————-	Doctor and staff are very good helping nature everyone Always ready to help to anyone.
Neha Yadav	3012	201269350	27/04/22	27/04/22	Dr. Nikhil Gupta	28/04/22	9311822577	—————-	Dr. Nikhil, he is ready every excellent doctor he understand his patents very well he is very kind and polite person
Ashok Kumar bhatiya	1009	200775726	03/05/22	04/05/22	Dr. Nikhil Gupta	3/5/22	9971332470	————————–	I was refered to Dr. Nikhil by Dr. Iohan Mohan. Loncotoyy depth the is humble staff and Dr. Nikhil was very good person and he saved my life thanks sir.
Priyanka	205-4	300127574	28/04/22	03/05/22	Dr. Nikhil Gupta	29/04/22	8930323334	—————-	Dr. Nikhil is very good person and he saved my son life thanks sir.
Satish Chandra Mishra	205-3	300127409	27/04/23	03/05/23	Dr. Nikhil Gupta	28/05/23	8384098640	—————-	Highly impressed were professional and educative Doctors here work and very good person Dr. Nikhil and his staff every on thanks
Babita Kaur	4002	201268502	21/04/22	22/04/23	Dr. Nikhil Gupta	21/04/22	—————–	—————–	The service is 9* Dr Nikhil is a very good surgeon. Thanks sir to save my life