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BEST UMBILICAL HERNIA SURGERY IN MUMBAI – THE ESTHETIC CLINIC

Umbilical hernia surgery

According to Ministry of Health and Family Welfare, Government of India about 8.5% of people in India suffer from umbilical hernia and they are advised surgery as a permanent treatment for hernia. Umbilical hernia can affect men, women, and children of all age groups. Umbilical hernia is one of the most common forms of abdominal wall hernia.

Umbilical hernia appears as a bulge on the abdomen near the naval area and it becomes prominent when you are coughing or straining. Feeling pain is normal for hernia patients. It develops when a small part of the intestine and  tissue bulges out of the opening in the abdominal wall in the shape of the sac. The common factors causing development of umbilical hernia include

·         Weak muscles because of old age

·         Obesity and being overweight as it increases pressure on abdominal muscles

·         Multiple pregnancies

·         Large abdominal tumours

·         Family history

·         Chronic straining

·         Ascites

·         Previous abdominal surgery

Umbilical hernia in children is often not painful and is recognized by the bulge in or near the belly button. It becomes noticeable when the child is crying, straining, or coughing.  In adults the symptoms include nausea, severe pain, bulge in the abdominal area, vomiting.

Umbilical hernia can be reducible i.e., that can be pushed back or reduced in size when the person is lying down. It is irreducible or incarcerated when it cannot be pushed back. This type of hernia needs immediate attention because it runs high risk of strangulation i.e., it can block the blood supply to intestine. In such cases the pain becomes unbearable.  

Treatment options for Umbilical hernia

Hernia repair surgery is the only option for successful treatment of hernia. Your surgeon’s expertise and experience are very important in selecting the right approach. Umbilical hernia surgery can be done either as an open or laparoscopic approach.

Post hernia repair surgery, the patient can go home the next day. The patient can resume normal life after 2-3 days of the surgery. Include  high fiber foods such as beans, whole grains, apricots, dates, sweet corn, pears, apples, broccoli etc in the regular diet. Drink 8-10 glasses of water everyday. Wait for three- four weeks before starting exercises and physical activity.

 By best bariatric surgeon

Dr Aparna Govil Bhasker

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BEST PILES TREATMENT IN MUMBAI – THE ESTHETIC CLINIC

Piles Treatment

Piles or hemorrhoids are a common problem. They are caused because of lumps of swollen veins in  the anal area.

Types of piles

External hemorrhoids: These originate from are skin around the anus. They cause irritation, pain, swelling and bleeding.

Internal piles: these originate from the rectum and cannot be seen or felt and are not uncomfortable but they can cause painless bleeding during bowel movements. They can become prolapsed and cause more pain.

Symptoms and causes of piles

The common symptoms of hemorrhoids are

·         Bright red blood in stool

·         Itching in peri-anal region

·         Feeling the need to empty the bowls even when you have just been to the toilet

·         Slimy mucus discharge from the anus area

·         Pain and discomfort around the anus

·         Lumps in the anal area

Increased pressure in the lower rectum area causes the veins to stretch and swell and it can be because of any of the following reasons:

·         Straining when passing the stools

·         Sitting for too long in the toilet

·         Chronic constipation

·         Being overweight

·         Pregnancy

·         Low fibre diet

·         Heavy weight lifting

·         Anal intercourse

·         Ageing

·         Genetics

Treatment for Piles

Piles are easily manageable and treatable. Before you start any home remedies or opt for over the counter treatments, consult the doctor and have an examination done. The symptoms can be because other diseases also. If diagnosed with hemorrhoids, then depending on your age, the severity of piles and health conditions any one or a combination of the following treatments might be used:

·         For mild cases of piles various OTC treatments such as creams, ointments, suppositories, and pads etc. are prescribed.

·         Stool softeners to make the bowel movements painless and easy.

·         External hemorrhoids thrombectomy is done under local anaesthesia to remove the hemorrhoids.

·         Stapled hemorrhoidopexy is done to push the hemorrhoid back in the rectal tissues to relive the patient of the pain and discomfort of the external piles.

·         Doppler-guided hemorrhoid artery ligation is done with the help of an ultrasound device which cuts off the blood supply to the pile and the hemorrhoid is stitched back in the anal tissues.

·         Rubber band ligation is a minimally invasive piles treatment in which a band is placed around the piles to cut off the circulation. The hemorrhoid dries and falls off in a week.

·         In sclerotherapy a chemical solution is injected in the piles growth which causes them to shrink. This is also a less invasive procedure for piles treatment.

·         Coagulation using laser or infrared rays shrinks the piles and makes then shrivel.

·         Excisional hemorrhoidectomy is an invasive procedure in which the surgeon will use surgical tools to cut out the hemorrhoid.

Along with the medical treatments for piles there are some home remedies that can help along with treatment:

·         Drink lots of water, fluids, and fibre rich food products to make the stools soft and reduce the pain and discomfort.

·         Keep your bottom clean and dry and use damp soft toilet paper to wipe your bottom.

·         Soak in a warm bath using Epsom salts. You can also use a sitz bath for 20 minutes after each bowel treatment.

·         Cold compress helps reduce the swelling of external piles.

·         Stay active by exercising and yoga to prevent constipation and ease the pressure on veins.

·         Don’t spend too much time on the toilet or force pass the stools repeatedly.

·         Don’t hold in your bowel movements.

 By best bariatric surgeon

 Dr Aparna Govil Bhasker

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BEST INGUINAL HERNIA REPAIR SURGERY IN MUMBAI – THE ESTHETIC CLINIC

Inguinal Hernia Repair Surgery

Hernias are bothersome and painful and they lead to complications if not treated in time. Hernia repair surgeries are one of the most common types of surgeries but they need the expertise of hernia surgeon to make sure that there are minimal chances of recurrence.

Inguinal hernia is a type of hernia that occurs in the groin area. The intestine bulges out of the weak abdominal wall in to the inguinal i.e., the groin area causing discomfort and pain. If left untreated it can lead to complications. Inguinal hernia needs surgical intervention and cannot be treated with non-surgical methods. There is no exercise or diet that control hernia and when left unaddressed they only grow with time. The surgical process for inguinal hernia repair takes about an hour or more.

What causes Inguinal Hernia?

The inguinal canal has different functions in men and women. In men it is the passageway that allows the testicles to pass through from the spermatic cord to the scrotum at the time of birth and in women it allows the passage way of ligament that holds the uterus together. The inguinal canal usually closes after birth when the passageway’s work is complete but if it does not then it causes a congenital hernia. One can have congenital hernia or it can be an acquired hernia.

How do you know if you have Inguinal Hernia?

The common symptoms of inguinal hernia include

·         Bulge in the skin under the groin

·         Pain and discomfort in activities like moving heavy objects, lifting weights, coughing, urination, bowel moments, standing or sitting for long time.

·         The pain becomes worse as the evening nears

·         Tenderness in the area

·         A swollen scrotum

·         Burning sensation in the groin and a feeling a weakness and heaviness

·         Darkening of the skin sac that is bulging out

Risk factors for developing a hernia are:

·         Obesity

·         Chronic cough

·         Pregnancy

·         Old age

·         Heavy work

·         Previous surgery

In some patients the hernia bulge comes and goes and is manageable. But when hernia becomes permanent stuck out and the pain is continuous and severe then the surgeon should be contacted immediately.

Surgical approaches for Inguinal Hernia Repair are of three types:

·         Open approach: In this, the incision is made in the groin and lower abdomen and the surgeon gets full access to the muscle defect. He can then repair the hole and put the organs back in place. The surgeon might also use a mesh to cover the hole and then close the tissue layers.

·         Laparoscopic approach: This is done with the help of a laparoscope which is inserted through a small tube in the tiny incisions made on abdomen. The surgeon repairs the hernia using special instruments and also might use the surgical mesh to cover the defect.

·         Robotic approach: This is the same as laparoscopic approach but the surgeon uses more advanced systems assisted by robots to complete the procedure.

It is a simple surgery and the recovery takes about 10 to 14 days. You can go home the same day or next day after the surgery. Talk to your surgeon about the various options available to you for inguinal hernia repair.

 By best bariatric surgeon

Dr Aparna Govil Bhasker

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BEST INCISIONAL HERNIA SURGERY In MUMBAI - THE ESTHETIC CLINIC

Incisional Hernia Surgery

Incisional hernias constitute about 15-20 percent cases of abdominal hernia cases. A study shows that out of all abdominal surgeries performed about a third might face the problem of incisional hernia at some point of their life. Also known as ventral hernia, it occurs in the the abdomen at the prior incision site. The size of the incisional hernia can range from small to a gigantic bulge.

What causes incisional hernia

The abdominal wall is strong and it is responsible for maintaining the abdominal cavity and its contents. However, when an incision is made the abdominal wall becomes weak and its integrity is disrupted and it can become structurally weakened. This causes the abdomen content especially the intestines and omentum to herniate through the weakened cavity. The main reasons for incisional hernial are

·         Heavy and premature physical activity immediately after the surgery

·         Getting pregnant too soon after surgery

·         Gaining weight too quickly

·         Increased abdominal pressure in regular daily activity before the incision is fully healed

·         Emergency surgery or surgeries that need large incisions.

In most patients, an incisional hernia can occur anytime between three to six months after the operation. However, they do not heal on their own, and need surgical intervention by expert surgeons to correct the issue.

Symptoms of Incisional Hernia

There are some simple indications of Incisional hernia that should have you consulting with your health care provider

·         Noticeable bulge around the incision site. It may become more pronounced when you cough or strain. This bulge is more common along the vertical incision

·         Burning feeling or ache around the bulge

·         Nausea and/or vomiting

·         Increased heart rate and fever

·         Pain around the incision site

·         Constipation.

 Your surgeon will then use further diagnostic techniques and take into account your medical history and do a physical examination to confirm the initial diagnosis. Hernia symptoms should not be ignored as it can lead to complications such as strangulation or obstruction and even incarceration of other organs.

The risk of suffering from incisional hernia increases if you are a chain smoker, have a BMI of more than 25 and/or suffering from diabetes mellitus or connective tissue disorders or use steroids.

Treatment for incisional hernia

There are two types of surgeries used for incisional hernia management

·         Open hernia repair

·         Laparoscopic hernia repair which also includes robotic hernia repair

Through the surgery, the surgeon will aim to push the protruding tissue in the right place and remove the scar tissue. The surgeon will repair the defect and place a surgical mesh in the opening to fortify the joint and prevent a recurrence.

The choice of surgery by the top surgeons is influenced by many factors such as general health, age, anatomy, the size and location of hernia, physical activity, and desired level of future activities.

There are some steps that you can incorporate in your daily life to prevent incisional hernia  such as

·         Following the post-surgery recovery instructions carefully so as to let the incision site heal fully

·         Avoid heavy lifting or any other activity that might put a strain on the stiches and the incisions.

·         Make sure that you keep a close watch on your weight and it does not increase because excess fat around the abdomen will increase the pressure on the weak area.

If you are worried about any existing medical conditions then consult with your doctor.

 By best bariatric surgeon

Dr Aparna Govil Bhasker

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BEST HIATUS HERNIA SURGERY In MUMBAI - THE ESTHETIC CLINIC

Hiatus hernia surgery

Hiatus hernia is a type of hernia in which the upper part of the stomach pushes its way up through the diaphragm and hinders the normal functioning of the esophagus. The symptoms of hiatus hernia are often accompanied with gastro-oesophageal reflux disease (GORD) and therefore you must consult your doctor immediately for correct treatment.

Small and mild hiatus hernia typically do not cause any discomfort or problems and many people do not even notice it until the doctor discovers it during examinations. However very large hiatal hernias can cause complications such as severe heart burn, pain, nausea, vomiting and digestive issues.  

Patients who show no symptoms of hernia do not need any treatment expect some lifestyle management of the condition but on the other hand symptomatic hernias require surgery. Also, Patients with para oesophageal hiatus hernia should get a hernia surgery for correction as this type of hernia runs a high risk of twisting and strangulation.

Considerations

Hiatus hernia surgery is recommended  for patients  who

·         Have severe GORD akin symptoms

·         Have not benefitted from medical and lifestyle management of the hernia

·         Suffer from symptoms such as volume reflux, and regurgitation

·         Have a hernia which twists

·         Are physical and mentally fit for the hernia surgery

Hiatus hernia surgery

The surgery aims to pull the stomach back to its place and reduce the gap or opening in the diaphragm. The surgery to get relief from Hiatal hernia is usually done in one of the three ways

·         Laparoscopic Nissen fundoplication: which is done with the help of a camera and special surgical tools. The camera and the tools are inserted in the abdomen using very small incisions so that there is minimal scarring.  This type of surgery has less risk of infection and has quicker recovery time.

·         Open surgery is offered to patients who have had previous upper abdomen surgeries or are suffering from recurrent hernias. In this type of hernia operation, the lining of the hernia is removed and the stomach placement and diaphragm hole is repaired using stiches or sutures and the incision is closed. The surgeon might insert a tube in the stomach which can be removed after 2-4 weeks.

·         Endoluminal fundoplication is the least invasive hiatus hernia surgery. The surgery is done using an endoscope and there are no incisions made. The process uses a small camera that is pushed down using an esophagus and small clips are placed to prevent the stomach acid from flowing back up i.e., the point where the stomach meets the esophagus.

It is important that the patients take regular medication and follows the diet and exercise schedule post hiatus hernia surgery for an early recovery. Straining, retching, or vomiting should be strictly avoided as it can cause a recurrent hernia.

Hiatus hernia surgery is safe and has a good success rate.

By best bariatric surgeon

Dr Aparna Govil Bhasker

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BEST HERNIA SURGERY TREATMENT In MUMBAI – THE ESTHETIC CLINIC

Hernia Surgery

Hernia repair/ hernioplasty/ or herniorrhaphy are surgical procedures performed to correct different types of hernia. Hernia occurs when because of a weakened area in the abdominal wall the inner organs start to push or protrude through the muscle or tissue. In many people hernia can be asymptomatic and they can live through their lives without feeling any pain but in some it can get bigger and cause pain and other complications. Hernia can only be repaired through surgery and therefore only your surgeon can advise the correct therapy to address hernia.

Most common causes of hernia are chronic cough, constipation, being overweight, repeated hard physical work, pregnancy, frequent weight lifting especially when not done in the correct form, and frequent sneezing.

Different types of hernia are listed below:

·         Inguinal hernia that occurs near the inner groin (near or at the opening of the inguinal canal)

·         Epigastric hernia affects the upper abdomen

·         Incisional hernia occurs because of a previous surgery

·         Femoral hernia affects the groin region

·         Umbilical hernia occurs in children who are under 6 months old and affects the abdominal wall near the naval. It is also commonly seen in adults

·         In hiatal hernia part of the abdomen protrudes through the diaphragm causing pain.

·         Congenital diaphragmatic hernia affects the chest cavity and the abdominal organs push through the chest cavity.

Who needs a hernia surgery ?

The most common symptom of hernia is a bulge in the abdomen, upper thigh, belly button and groin area. Your surgeon might recommend a hernia surgery if

·         Hernia can be repaired in a planned and elective manner when it is not causing much trouble.

·         When incarceration occurs i.e., the tissue (intestine) becomes ensnared in the abdominal wall.

·         The hernia is giving unbearable pain which cannot be managed with other methods

·         The blood supply cuts off from the strangulated organs.

·         You get relief from hernia when lying on the bed and you can push the hernia down but only temporarily.

Type of hernia surgery

Hernia surgery is performed by general and paediatric surgeons who specialise in the such therapies. It is a fairy common and routine procedure with low levels of complications and risks. The most common methods of performing hernia surgery include

·         Open surgery or open hernia repair or herniorrhaphy: A clear incision is made  around the abdomen area and the hernia is pushed back and muscle wall repaired using stiches or a surgical mesh.

·         Laparoscopic or non-invasive hernia repair: this type of hernia surgery is done using a laparoscope which is a device with a small camera at one end. The surgeon can see the insides of the abdomen using the camera. The procedure requires minimal invasion and does not require long healing times.

·         Robotic hernia repair: this is an also a type of laparoscopic surgery but the difference is that the surgeon does not actually perform the operation but instead oversees through a robotic console. This type of surgery lets the surgeon get a better and more holistic 3 D video of the internal organs and hence more precision.

  By best bariatric surgeon

Dr Aparna Govil Bhasker

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BEST GASTRIC SLEEVE SURGERY In MUMBAI – THE ESTHETIC CLINIC

Gastric Sleeve Surgery

Gastric sleeve surgery is a type of bariatric surgery/weight loss surgery. It is a type of bariatric surgery that involves removal of the outer two-thirds of the stomach so that the person feels full even after eating a small amount of food. Unlike a bypass surgery, sleeve gastrectomy does not interfere with the normal digestive procedure. Like other bariatric surgery procedures, sleeve gastrectomy ( also known as vertical sleeve, gastric sleeve, or tube gastrectomy) is now covered by insurance. Obesity and Metabolic Surgery Society of India (OSSI) has defined obesity as a disease and not a lifestyle disorder.

What is gastric sleeve surgery?

It is a surgical procedure in which outer two-third of the stomach is divided surgically and removed. This leads to formation of a long and narrow tube of the stomach. Post gastric sleeve surgery, appetite is reduced, as is the capacity to eat. Eventually it leads to increased insulin sensitivity which in turn leads to healthier and fitter life.

How does vertical sleeve gastrectomy help?

The benefits are not limited to just losing weight; it reduces the risk of many life threatening diseases and conditions such as

·         Type 2 diabetes

·         Heart disease and high blood pressure

·         Stroke

·         Cancer

·         Infertility

·         Obstructive sleep apnea

Indications for Gastric Sleeve

1.       Bariatric/metabolic surgery should be considered a treatment option for acceptable Indian patients with a BMI ≥ 35 kg/m2, with/without presence of any obesity related co-morbidity.

2.       Bariatric/metabolic surgery should be considered a treatment option for acceptable Indian patients with a BMI ≥ 30 kg/m2, in presence of two or more obesity related comorbidities.

3.       Bariatric/metabolic surgery should be considered as a non-primary treatment option for acceptable Indian patients with a BMI ≥ 27.5 kg/m2, with uncontrolled type 2 diabetes despite optimum medical management.

4.       Any bariatric/metabolic surgery for an Indian patient with BMI < 27.5 kg/m2 should be strictly performed under experimental study protocol with prior ethics committee approval and informed consent from the patient.

5.       Bariatric/metabolic surgery should be considered as a treatment option for acceptable Indian patients with central obesity with a waist circumference ≥ 80 cm in females and ≥ 90 cm in males along with type two diabetes and other obesity related co-morbidities.

6.       Bariatric/metabolic surgery may be advised as a treatment option for acceptable Indian patients who qualify for the above BMI criteria if they are ≥ 18 years of age. It may be advised as a treatment option to patients younger than 18 years of age under special circumstances with approval of a multi-disciplinary team constituting a paediatrician, endocrinologist, dietician, psychologist and the bariatric team including a bariatric surgeon. Attainment of puberty and completion of skeletal maturity must be taken into account for this patient population when considering the option of surgery.

7.       Bariatric/metabolic surgery should be advised as a treatment option for acceptable Indian patients who qualify for the above BMI criteria for patients up to 65 years of age. Bariatric/metabolic surgery may also be recommended for patients ≥ 65 years of age if they are medically fit, and the benefits of surgery outweigh the risks.

8.       All patients who are advised bariatric/metabolic surgery as a treatment option should be motivated to enter a long-term weight management program and should be committed to life-long follow up.

Vertical sleeve surgery requires a life time of dedication to stick to a healthy diet and exercise

You need the best team of doctors and surgeons, dieticians, and exercise trainers to work with you after a gastric sleeve surgery. The dietician will give a documented guide on how much to eat after the sleeve surgery, and the trainer will help you get more active and make a workout program that you can easily stick to.

Modern gastric sleeve surgery is done using a laparoscopy which makes it a minimally invasive procedure with quick recovery times and fewer complications. You will back to regular life within 7 to 10 days of the surgery.

Things to keep in mind post gastric sleeve surgery:

·         Eat at a slow place. If you eat too much and too fast you might get a choking sensation or feel like vomiting.

·         Nausea is common for a few weeks after surgery

·         You need to maintain a healthy diet and make sure that you intake a balance of vitamins and minerals like iron, vitamin, B12, folate, vitamin D, protein etc.

·         You will continue to lose weight for months after the vertical sleeve surgery before it stabilizes to a normal weight.

 By best bariatric surgeon

Dr Aparna Govil Bhasker

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BEST HERNIIA CLINICS In MUMBAI – THE ESTHETIC CLINIC

Hernia Clinics

A hernia is a condition when the part of an organ or tissue squeezes or pushes its way through a weak spot in the muscle or tissue. Hernias cannot be treated medically and a surgery is usually required for repair. Hernias can lead to complications pain, irreducibility, obstruction or strangulation. Choosing the right surgical option ensures the positive outcome and greatly reduces the risk of complications and hernia recurrence. Therefore, it is important that you only select the Best hernia clinic and an expert surgeon.

Here is short guide to help you make the right selection

·         Do they offer comprehensive, patient centred care?

A clinic which has specialists that meet your specific need including various specialist that can work together to repair your hernia. Depending on the type of hernia you have you might need a general surgeon, a gastrointestinal specialist, colorectal specialist and even a Plastic surgeon. A full range of subspecialists translates into exceptional care.

·         Do they offer various surgical options for hernia?

Look for a clinic that offers various surgical options such as open, laparoscopic, and robotic approaches. If the clinic and your surgeon have an in-depth knowledge of the technology of treatment and the causes of hernia then only you will get the best treatment.

·         Surgical expertise:

This is the most important thing. Research about the surgeon that you are consulting for hernia repair and management. Here is what to ask for

o    How many years of experience does the surgeon have in hernia repair (both primary and recurrent)?  An expert surgeon also excels in abdominal wall reconstruction and wound healing to make sure there are no complications.

o    Does the surgeon have requisite qualifications for treating and diagnosing all types of hernia?

o    Has the doctor/surgeon published clinical research regarding hernia surgery and repair? You can easily find the details online. Contribution to medical literature shows a doctor’s interest in his field and its advancement.

o    What do the other patients say? You can read various reviews of the clinics and the doctor online or through various references.

·         Rankings and referrals:  The hernia clinic or hospital which gets maximum referrals for simple and complex hernia cases each year will definitely rank higher. Also, the greater the number of referrals i.e., high volume experience means better outcomes for patients. Therefore, try having your surgery at a high-volume facility. You can find this out by asking at the hospital directly.

·         Does the clinic honour your insurance? Not all hernia clinics might be in the network of your insurance provider. Therefore, you may ask the insurance company if the clinic is in-network.

·         Is the clinic located at a convenient location and has connects with other facilities? Select a hernia clinic that is closely located to your house.

  By best bariatric surgeon

 Dr Aparna Govil Bhasker

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BEST GASTRIC BYPASS SURGERY In MUMBAI – THE ESTHETIC CLINIC

Gastric Bypass Surgery

Gastric bypass surgery is a type of bariatric surgery. One of the commonest types of gastric bypass surgeries is the Roux-en-Y gastric bypass procedure. It is one of the most common types of bariatric surgery being performed all across the world today. Up until a few years ago, weight loss surgeries were considered a life style choice but today obesity is recognized by Obesity and Metabolic Surgery Society of India (OSSI) as a disease and therefore gastric bypass surgery is now covered by insurance.

Roux-en-y gastric bypass procedure is a minimally invasive surgical procedure that helps the patient to lose weight successfully. However, the important thing to always keep in mind is that after a gastric bypass, patient still needs exercise and a good diet to maintain the results in the long term.

How is a gastric bypass surgery done?

In a gastric bypass surgery, a small pouch of the stomach is created. Small intestine is divided and brought up in a Y shaped fashion to join with the gastric pouch. This procedure reduces the amount of food intake and it bypasses a part of the small intestine which in turn reduces the amount of nutrients and calories absorbed in the body. Other mechanisms for weight loss after gastric bypass surgery include- reduction in hunger, hormonal changes, increased insulin sensitivity, changes in bile acids and gut flora.

Gastric bypass surgery is usually performed laparoscopically. The total time taken is about 1 to 2 hours. The recovery time is about two weeks. It is technically a reversible procedure.

Why is gastric bypass surgery done?

A bariatric surgery is recommended for people with clinically severe obesity.

1.       Bariatric/metabolic surgery should be considered a treatment option for acceptable Indian patients with a BMI ≥ 35 kg/m2, with/without presence of any obesity related co-morbidity.

2.       Bariatric/metabolic surgery should be considered a treatment option for accepta               ble Indian patients with a BMI ≥ 30 kg/m2, in presence of two or more obesity related comorbidities.

3.       Bariatric/metabolic surgery should be considered as a non-primary treatment option for acceptable Indian patients with a BMI ≥ 27.5 kg/m2, with uncontrolled type 2 diabetes despite optimum medical management.

4.       Any bariatric/metabolic surgery for an Indian patient with BMI < 27.5 kg/m2 should be strictly performed under experimental study protocol with prior ethics committee approval and informed consent from the patient.

5.       Bariatric/metabolic surgery should be considered as a treatment option for acceptable Indian patients with central obesity with a waist circumference ≥ 80 cm in females and ≥ 90 cm in males along with type two diabetes and other obesity related co-morbidities.

6.       Bariatric/metabolic surgery may be advised as a treatment option for acceptable Indian patients who qualify for the above BMI criteria if they are ≥ 18 years of age. It may be advised as a treatment option to patients younger than 18 years of age under special circumstances with approval of a multi-disciplinary team constituting a paediatrician, endocrinologist, dietician, psychologist and the bariatric team including a bariatric surgeon. Attainment of puberty and completion of skeletal maturity must be taken into account for this patient population when considering the option of surgery.

7.       Bariatric/metabolic surgery should be advised as a treatment option for acceptable Indian patients who qualify for the above BMI criteria for patients up to 65 years of age. Bariatric/metabolic surgery may also be recommended for patients ≥ 65 years of age if they are medically fit, and the benefits of surgery outweigh the risks.

8.       All patients who are advised bariatric/metabolic surgery as a treatment option should be motivated to enter a long-term weight management program and should be committed to life-long follow up.

Additionally, a Roux-en y gastric bypass surgery is the procedure of choice in obese patients with GERD and hiatus hernia.

A successful gastric bypass surgery will not only help you get fitter but also reduce the health risks caused by weight related diseases like diabetes, hypertension and heart disease. Exercising regularly, keeping the portion sizes in control, and changing your lifestyle are the main post bariatric surgery requirements.

Results of gastric bypass surgery

Post recovery of gastric bypass you can expect to have a weight loss of about 60 to 80 percent of excess body weight. The weight loss takes about 12 to 18 months post the bariatric surgery. You will continue to enjoy the improved quality of life post bypass surgery provided you follow the instructions of dietician regarding your eating habits and take the much needed vitamin and mineral supplements to suffice the body’s needs.

 By best bariatric surgeon

Dr Aparna Govil Bhasker

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BEST BARIATRIC DOCTOR In MUMBAI – THE ESTHETIC CLINIC

Bariatric Surgeon/ Weight Loss Surgeon, Doctor

Getting a weight loss surgery done is a major decision and should only be taken after weighing all the pros and cons. And the first right step in that direction is finding the best bariatric or weight loss surgeon who can meet your expectations.  

Selecting the best weight loss doctor for you will not only ensure great results and a smooth recovery but also make sure that end result is sustainable.  Here is a short guide to help you through the selection process

·         The three Rs: Referrals, recommendations, and research: This is the obvious first step. You can discuss your issues with your local GP/family physician and even talk to your friends and relatives for recommendations. Another good place to seek a recommendation is to go on social media and connect with other patients who have had weight loss surgery. You will see many reviews about clinics and doctors. Based on the referral, recommendation and your research make a list of clinics and Bariatric surgeons around the location suitable to you

·         Fix up an appointment:  When consulting for bariatric surgery be very specific and candid with the surgeon about what do you expect from the bariatric surgery. Also make sure that you check the doctor’s credentials. Is he or she experienced in bariatric surgery? Is the surgeon willing to share the patient details with you? Does he or she have the relevant accreditations from the concerned medical boards etc.?  Also don’t forget to ask about the complication rates. Keep in mind that bariatric surgery is an invasive surgery and therefore it will not hurt to double check.

·         Top and best bariatric surgeons will not be hesitant to share their credentials and testimonials with you. They will also talk to you in detail about the type of bariatric surgery that will suit your body type, days of recovery and post-surgical complications, maintenance and follow up.

·         Communication style: Did you feel comfortable with the surgeon? Is she/he comfortable explaining different medical terms like BMI, gastric bypass etc.?  Choose a surgeon who is comfortable with your questions and respects your decisions.

A good bariatric surgeon will help you to make this life changing or life saving decision easier and smooth. Therefore, select one that you are most comfortable with.

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BEST GASTRIC BALLOON SURGERY In MUMBAI — THE ESTHETCI CLINIC

Gastric balloon surgery

Gastric balloon surgery is type of endoscopic weight loss procedure aimed for weight loss in patients who have had little or no success in losing weight through diet and exercise. Obesity is now considered as a disease and Obesity and Metabolic Surgery Society of India (OSSI) has given clear guidelines for gastric balloon procedure and other bariatric surgeries.

Gastric balloon insertion is a non-surgical and minimally invasive weight loss procedure that involves placing a specialized inflatable silicon balloon inside the stomach so that it limits the food carrying capacity and therefore makes you feel full. The balloon is made of medical grade silicon which is safe.

Endoscopic intragastric balloon insertion is a temporary procedure. Different types of balloons can be kept inside the stomach for duration varying from 4 to 12 months. After removal of the balloon the patient needs to maintain a strict diet and exercise routine to maintain weight loss and prevent weight regain.

Indications for gastric balloon insertion:

·         Your BMI is more than 27.5 i.e., class I obesity and you have tried multiple conservative methods for weight loss.

·         Medical problems such as diabetes, high blood pressure, breathing problems etc. because of obesity are becoming life threatening

·         Invasive weight loss surgery is not possible because of medical conditions

·         Special cases of PCOD and infertility where dietary measures have not worked

·         Weight loss is needed to reduce the risk of surgery complications in bariatric surgeries

Contraindications for gastric balloon procedure

·         Allergy to silicon

·         Previous bariatric surgery

·         Complications or problem in the digestive structure, GI tract, esophagus etc.

·         Alcohol, medicine, or drug abuse

·         Pregnant or women who are trying to get pregnant

·         Breastfeeding women

·         Underage children

How is the procedure done?

Gastric balloon insertion takes about 30 to 40 minutes. The balloon is placed in the stomach using an endoscopic approach. The balloon is filled wit a saline solution and then it floats freely in the stomach thereby reducing the amount of food it can hold.  The second most significant benefit of gastric balloon is that it reduces the free passage of food and water through the stomach which in turn fills the stomach faster. There are different kind of balloons as listed below:

·         Elipse ‘procedureless’ balloon

·         Orbera Gastric Balloon

·         Spatz3 Adjustable Gastric Balloon

After insertion, you can go home on the same day.  However, the treatment does not end here. Post the surgery the dietician and exercise coach will work with you to get your body to adapt to the new routine and maintain it.

Gastric balloon results in up to 10-20% of total body weight loss. Regular ongoing consultations with weight loss specialist, trainers and doctors will ensure maximum results from the gastric balloon insertion. You too can help with the recovery by

·         Eating meals slowly

·         Eating healthy

·         Scheduling your meals as suggested by the nutritionist and dietician

·         Avoiding sodas and fast foods

·         Doing regular workouts

 By best bariatric surgeon

Dr Aparna Govil Bhasker

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BEST GALL BLADDER SURGERY In MUMBAI — THE ESTHETIC CLINIC

Gall bladder surgery

The gall bladder surgery to remove gall bladder is medically termed as Cholecystectomy and it is one of the commonest albeit elective surgical procedures in India. The gall bladder is a small sac like organ that is located on the upper right portion of the abdomen. The main function of gallbladder is to store the extra bile and release it to help in the process of digestion.  

Gall bladder surgery is recommended in following conditions

·         Complications arising from gallstones such as slipping of the stone into the common bile duct, biliary pancreatitis etc.

·         Biliary colic which causes pain in abdomen.

·         Inflammation in gall bladder

Generally asymptomatic patients may not be advised immediate surgery however patients who have gall bladder stones but are not showing any symptoms (silent gallstones) can also be offered a gall bladder surgery. In case of symptomatic gall stones the common indications for surgery include:

·         Sudden, intense, and unbearable abdominal pain especially on the right side

·         Jaundice

·         Feeling sick and bloated

·         Nausea, vomiting

·         Fever

Who has a high risk of gallbladder problems?

·         Women

·         People with obesity

·         Age > 40

·         Family history of gallstones.

Options for gall bladder surgery

There are two options for gallbladder removal

·         Laparoscopic cholecystectomy or keyhole gallbladder surgery which is done by making several small incisions on the abdomen and then removing the gallbladder. This procedure has quick recovery rate and small chances of complications. This is presently the standard of care across the world.

·         Open cholecystectomy is done by making a large cut on the tummy to gain access to gallbladder.

Most cholecystectomies are done using the minimally invasive laparoscopic method but, in some cases, open surgery also might be used. Laparoscopic gallbladder removal might not be an option for you if

·         You have multiple episodes of severe gallbladder inflammation or scars.

·         You have had early surgery in your upper abdomen and have multiple adhesions.

·         You are severely obese.

·         You have bleeding problems during surgery.

·         You live in an area where there is a shorted of trained staff for laparoscopic surgery.

Both types of gall bladder surgery are done under general anaesthesia.

Recovery

The patient can go home on the next day and return to normal activities in about 10 to 14 days. Open surgery requires a longer hospital stay.  

For a proper and sustained recovery, one should follow the instructions given by surgeon and stick to a healthy and balanced diet for life.

  Article by

Dr. Aparna Bhasker

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BEST GASTRIC BAND SURGERY In MUMBAI- THE ESTHETIC CLINIC

Gastric band surgery

Obesity is a disease and while diet and exercise are the two most common advices that one hears as a ‘solution’ to obesity, it does not work for everybody. Many people struggle to lose the extra weight. In such patients, surgical intervention such as the gastric band surgery may be needed to achieve the desired results.

Gastric band surgery

· Is minimally invasive and reversible weight loss surgery

· The band can be adjusted to reduce or increase the stomach’s intake of food.

· Gastric band surgery results in significant weight loss and improves obesity related conditions.

· It is important to follow strict diet after the surgery for lifetime.

How is Gastric band surgery done?

An adjustable silicone band is placed laparoscopically around the upper part of the stomach. The band divides the stomach into a smaller upper pouch and a bigger lower pouch. A band is connected to a tube that lets the bariatric surgeon inject saline into the band that makes the band tight or loose as per requirement. This procedure does not alter the digestive system. Entire procedure takes about 60 minutes from start to end.

How much weight will you lose?

Gastric banding surgery results in up to 45 to 50% of excess weight loss.

Who can have a gastric band surgery?

Being just a few kgs overweight does not qualify you for gastric band surgery. Bariatric surgeons follow the guidelines laid down by Obesity and Metabolic Surgery Society of India (OSSI) and the indications of gastric banding include

· The patient should be mentally stable and not have any dependency on alcohol, tobacco, and drugs.

· The BMI is 35 or more.

· When the conditions such as sleep apnea, type II diabetes, cardiovascular diseases, are directly linked to obesity and a BMI between 30 to 35.

Gastric banding gives slow and steady weight loss and the weight loss Gastric banding can also help get relief from various medical conditions such as asthma, GERD, high blood pressure, high cholesterol, diabetes etc.

By best bariatric surgeon

Dr Aparna Govil Bhasker

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BEST APPENDIX TREATMENT In MUMBAI — THE ESTHETIC CLINIC

Treatment for appendicitis

The appendix is a small vestigial organ located at the proximal part of the large intestine called cecum. Exactly function of appendix is not known but when it becomes inflamed or blocked it is very painful and can cause serious complications. This condition is called appendicitis.

Types of appendicitis

When the appendix becomes blocked because of a tumour or stool, it can cause infection, pus formation, swelling and even block the blood flow. The walls of appendix can perforate and cause it to burst and can be the reason behind sudden and severe pain in the right lower abdomen.

There are two types of appendicitis

Acute appendicitis: This happens suddenly and is very severe. This type of appendicitis commonly affects children and young adults. The pain intensifies quickly and immediate treatment is needed or else it can lead to complications.

Chronic appendicitis: This is a less common form of appendicitis and has very mild symptoms. There are episodes of pain off and on over a period of months or even years. It is difficult to diagnose but can be dangerous nonetheless and can develop into acute appendicitis.

What causes appendicitis?

Few known triggers for appendicitis include :

·         Injury to abdominal area or recent trauma

·         Blockage at the appendix opening

·         Infection and/or inflammation in digestive tract or bowels

·         Growth or tumour in appendix

What are the signs and symptoms of appendicitis?

Pain in the upper abdomen or a radiating pain in the belly button area which moves to the lower right portion of abdomen is the most common symptom of appendicitis. This pain can

·         Start suddenly and be very intense

·         Get worse when you cough or sneeze

·         Make it difficult to work or sleep

·         Increase in few hours

Other symptoms include

·         Pain and tenderness in the abdomen area

·         Swelling

·         Constipation and difficulty in passing gas

·         Diarrhoea

·         Loss of appetite

·         Fever and chills

·         Nausea and vomiting

Treatment of appendicitis

If appendicitis is not treated it can cause complications. If appendix ruptures it can cause the stools, bile, and infection to spill into the abdominal cavity and cause peritonitis, abscesses, and even sepsis.

Your doctor will be able to diagnose appendicitis by examining the symptoms and your medical history. There is no specific test for appendicitis. The doctor might run a number tests to confirm appendicitis which include blood work, ultrasound of the abdomen and/or a CT scan of the abdomen.

Treatment of appendicitis involves antibiotics and surgery for removal of the organ. Mild cases of appendicitis can generally be controlled using simple antibiotics. Surgery options for appendix treatment include:

Laparoscopic method : This is the most common method of appendix treatment. This method is least invasive and offers fewer complications.  Small incisions are made around the belly the surgeon uses laparoscope and other instruments to remove the appendix. The incisions are then closed using small sutures.

Open appendix surgery (traditional method): This method is used in cases when laparoscopic method cannot be used or the appendix has burst. The appendix is removed by making a cut in the lower right hand side of the belly. The surgeon might also have to use a small tube to drain out the pus and fluids from the abdomen area in case of burst appendix.

 Article By

Aparna Bhasker

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BEST TATTOO REMOVAL TREATMENT IN MUMBAI - THE ESTHETIC CLINIC 

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BEST SKIN WHITENING TREATMENT IN MUMBAI - THE ESTHETIC CLINIC

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BEST SKIN PIGMENTATION TREATMENT IN MUMBAI - THE ESTHETIC CLINIC