Colorectal Surgery Overview

Colorectal surgery is a branch of surgery that focuses on the treatment of conditions affecting the colon, rectum, and anus. These conditions can range from benign, such as haemorrhoids, to more serious conditions such as colorectal cancer. Colorectal surgeons use a variety of surgical techniques to treat these conditions and improve the health and quality of life of their patients.

The history of colorectal surgery can be traced back to the ancient Egyptians, who used a variety of surgical techniques to treat conditions affecting the rectum and anus. However, it was not until the 19th century that the field of colorectal surgery began to take shape. With the advent of anaesthesia and antiseptic techniques, surgeons were able to perform more complex procedures with greater safety and success.

In the 20th century, the field of colorectal surgery continued to evolve, with the introduction of new technologies and surgical techniques. One of the most important advancements was the development of laparoscopic surgery, which allowed surgeons to perform many procedures through small incisions using a laparoscope. This minimally invasive approach has reduced the risk of infection and scarring and has allowed patients to recover more quickly after surgery.

Today, colorectal surgery continues to evolve, with the introduction of new technologies and surgical techniques. Some of the most common procedures performed by colorectal surgeons include:

  • Colectomy: the removal of all or part of the colon
  • Rectal resection: the removal of all or part of the rectum
  • Haemorrhoidectomy: the removal of haemorrhoids
  • Anal fistula surgery: the repair of an abnormal connection between the anus and the skin
  • Colostomy: the creation of an opening in the abdominal wall to allow for the diversion of waste from the colon

To be successful, colorectal surgery requires a team approach, with the surgeon working closely with other medical professionals, including nurses, anaesthesiologists, and gastroenterologists. The goal of colorectal surgery is to provide patients with the highest quality of care, and to improve their health and quality of life.

Overall, colorectal surgery plays an important role in the treatment of conditions affecting the colon, rectum, and anus. With the continued evolution of surgical techniques and technologies, colorectal surgeons will continue to provide their patients with the highest quality of care and the best possible outcomes.

References:

  1. Holzheimer RG, Dawkins HJS. A brief history of colorectal surgery. Colorectal Disease. 2006;8(1):1-5.
  2. Brown SR. Minimally invasive surgery in colorectal surgery. Current Opinion in Gastroenterology. 2009;25(2):130-136.
  3. Poulose BK, Thukral C, Remzi FH. Evolution of surgical treatment for colorectal disease. World Journal of Gastrointestinal Surgery. 2010;2(2):34-41.

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8 Sneaky Signs You’re Walking Around With Poor Gut Health

The health of your gut microbiome impacts your overall health in more ways than you realize.

In recent years, gut health has become a hot topic in the wellness space. And considering how the state of your gut microbiome (i.e. the community of microorganisms living in your gut) connects to almost every part of the body—digestion is a key player for everything from mental health to immune function—it makes sense that folks are looking for everyday ways to optimize their gut health.

However, for that same reason, poor gut health can cause a wide range of symptoms, some of which don’t even involve the gut. It can be tricky to tell whether your gut health is thriving or floundering, or whether the random health complaints you’re having are related to the state of your gut. To make things even more confusing, these other mental and physical signs may not crop up at the same time as some of the more obvious digestive symptoms, making it difficult to link the two.

So, what are some mental and bodily clues that your gut health needs some TLC? Read on for some surprising signs and symptoms of sub-par gut health, according to the experts.

 5 Surprising Signs You’re Chewing Your Food Wrong

signs-gut-health-out-of-wack-GettyImages-1283664717
CAROL YEPES/GETTY IMAGES

01of 08

You’re more irritable than usual.

Many of us know what it’s like to experience a churning stomach due to stress and anxiety. But according to Aditya Sreenivasan, M.D., gastroenterologist at New York’s Lenox Hill Hospital, it can work in the opposite direction too. Specifically, the gut can send signals to the brain when it’s in distress, he says. It does this using neurons, or nerve cells, that are in charge of sending signals throughout the body. In fact, there are more neurons in your GI tract than your brain (who knew?), so gut issues can certainly cause mood issues such as irritability and anxiety, Dr. Sreenivasan says.

02of 08

You’re inexplicably exhausted.

If you can’t stop yawning or find you’re too fatigued to function normally day to day—even after getting the recommended amount of sleep night after night—an off-balance gut might be to blame. According to Dr. Sreenivasan, this can be partly related to the aforementioned mood issues, which can seriously mess with your shut-eye. What’s more, if your gut isn’t properly absorbing enough of the right nutrients, it can lead to malabsorption and negatively affect your energy levels, he says. You may also be experiencing some fatigue-related brain fog, mental heaviness, memory mishaps, and the like, which also often link back to gut imbalances. That said, it’s important to note that many unhealthy lifestyle habits can disrupt good sleep—so it’s worth fine-tuning your sleep hygiene (or checking in with your doctor) before chalking it up to the gut at first glance.

03of 08

Your head hurts.

When gut issues interrupt your body’s ability to properly absorb nutrients, it can lead to pesky headaches, according to Dr. Sreenivasan. This may be related to the gut-brain connection and inflammation, according to The Journal of Headache and Pain. “Migraines are a little more complicated, but there’s an association between migraines and abdominal pain,” Dr. Sreenivasan explains further. The connection, called abdominal migraines, happens when you have migraines and abdominal pain at the same time (or sometimes, periodic abdominal pain in the absence of headaches). Additionally, hormonal imbalances that can trigger headaches and migraines may cause gut issues as well, he adds.

04of 08

You’re constipated or bloated.

From microbial imbalances to general digestive dysfunction, poor gut health can cause constipation and bloating, says Johanna Salazar, M.S., RDN, registered dietitian nutritionist and founder of Healing Nutrition. But how do you know whether this type of digestive woe is due to more chronic dysfunction within your gut, or simply a one-time blip due to something you ate? 

“If you’re feeling bloated or constipated, take a look at what you ate and drank for the past 48 hours,” Salazar recommends. The too-full feeling could certainly be caused by something you ate or not drinking enough water. However, if the constipation and bloating continue for more than seven days, Salazar recommends reaching out to your doctor to get some answers.

 The Many Pros of Probiotics and How They Affect Your Health

05of 08

You have bad breath.

Another surprising sign of poor gut health is bad breath. Here’s why it happens: If you’re not passing stool properly—like in the case of chronic or frequent constipation—it can cause a buildup of toxins in the body. This can result in bad breath, a top gut health clue that shouldn’t be ignored, Salazar says. With that in mind, if your breath smells off even with regular toothbrushing and oral care, it might be time to put down the mints and focus on your gut instead.

06of 08

You’re irregular (for you).

“Regular” bowel movements are different for everyone, however, overall, “regular” can include anything from three bowel movements per day to one bowel movement every three days, according to Dr. Sreenivasan. Thus, if your frequency changes and causes symptoms or interfere with your daily life, consider it a more pressing sign that your gut health needs some help. For example, “a change in bowel habits, [like] suddenly going from daily bowel movements to three times per day or once every three days, is worth noting,” says Dr. Sreenivasan.

07of 08

You have new food sensitivities.

Gut issues can also trigger food sensitivities, Salazar says. One common example is a “leaky gut,” which refers to the permeability of the cells lining your intestine. BTW: The gut lining is supposed to be semi-permeable, as this allows nutrients and water from the food you eat to enter the bloodstream, according to Harvard Health Publishing. Sometimes, however, the gaps between cells become too large or loose, resulting in increased permeability. When this happens, large food particles and/or bacteria may enter the bloodstream, resulting in inflammation, Salazar explains. This may contribute to food sensitivities, which can manifest as G.I. symptoms like bloating, gas, diarrhea, constipation, and nausea, as well as non-G.I. signs such as headaches, brain fog, and skin rashes, Salazar adds.

08of 08

Your skin is acting up.

There are many possible triggers for skin inflammation symptoms, including allergies and stress—but an off-kilter gut might be at a play too. This is due to the link between the immune system and gut microbiome, which is essential for maintaining healthy skin, according to the journal Microorganisms. Essentially, if the gut microbiome is imbalanced, it can alter the body’s immune response, resulting in skin issues such as acne and dandruff. In a more general sense, “eating a lot of processed and salty foods can lead to puffiness and inflammation throughout your body, including the skin,” Dr. Sreenivasan says.

How to Start Improving Your Gut Health

Before trying to diagnose yourself and blame non-gut-related symptoms on your gut health, consider other symptoms you may be experiencing too, Salazar says. For example, look for clues like frequent gas or the shape of your stool. “A good stool should be ‘S’ shaped and easy to pass,” says Salazar. If these symptoms are present and you think your G.I. tract needs a hand, try adding more gut-friendly habits to your daily routine.

  • Eat more fiber from plants. A great place to start is what you’re eating and drinking. One important strategy for keeping your gut healthy is consuming plenty of fiber, which is a vital nutrient for regular and comfortable digestion and present in most plant-based foods. Examples of high-fiber foods include vegetables, fruits, legumes, and whole grains.
  • Eat less processed, high-sugar, and greasy/fried food. While you’re at it, start to limit ultra-processed foods that are typically low in fiber (in fact, the healthy fiber is often stripped from the ingredients used during processing). Excessively greasy and fatty foods can also lead to inflammation and upset stomach, so it may be worth cutting back on these foods for the sake of your gut. Finally, starting to consume fewer added sugars, since sugar actually helps feed the “bad” strains of gut bacteria, causing it to thrive and outnumber the healthy and helpful gut bacteria we do need.
  • Adopt some general healthy lifestyle habits. Other natural ways to support gut health include drinking plenty of fluids, staying active, and getting at least seven hours of sleep per night. Practicing stress relief is also crucial, as the gut and mind are constantly communicating via the gut-brain axis mentioned earlier. Physical activity can lend a hand in this area, and don’t forget about meditation, yoga, and spending time in nature to relax the body and mind, Salazar says.

If your digestive woes persist in the midst of gut-healthy habits, chat with your primary care doctor. Depending on your symptoms, they might refer you to a gastroenterologist, who can order stool or blood tests to determine what’s going on. Your doctor might also have you consult a registered dietitian for personalized nutrition guidance, if needed.

Source Credit: https://www.realsimple.com/signs-of-poor-gut-health-6951072

What Is a Gastroenterologist? What to Expect on a Visit

Are you about to see a gastroenterologist for the first time? You’re in good hands. Because they specialize in digestive diseases, gastroenterologists treat lots of people who have symptoms just like yours.

What Is a Gastroenterologist?

Gastroenterologists are internists (doctors trained in internal medicine).

They complete up to 6 more years of specialized training after medical school. These doctors study the digestive system and any diseases that affect your esophagusstomachgallbladderpancreasliverintestinescolon, and rectum, like these:

Your first appointment with your gastroenterologist will probably take 30-60 minutes. They’ll ask you about your symptoms, medical history, and any treatments you’ve tried. Other visits could be shorter.

Where Do Gastroenterologists Work?

Gastroenterologists may see patients in a hospital or an outpatient clinic. They aren’t surgeons, but they do tests, like a colonoscopy or endoscopy, at both of these places.

Your primary care doctor or family doctor may send you to a gastroenterologist. And you might need a referral from that doctor for insurance to cover the cost of your visit.

What Questions Will My Gastroenterologist Ask?

First, your nurse will check your blood pressure and heart rate, and ask you questions about your health. Tell them what medicines you take or if you have any allergies.

Your gastroenterologist should ask you more detailed questions like these:

  • What are your symptoms?
  • Where is your pain?
  • How long does your pain usually last?
  • Does your pain move around or change?
  • When did your symptoms start?
  • Do your symptoms get worse or better at certain times?
  • Does anything seem to trigger your symptoms?
  • Has anyone in your family had digestive diseases or other health problems?
  • Have you had any other illnesses or surgery before?

Some questions may not seem to have anything to do with your digestive problem. But symptoms in other parts of your body can help the gastroenterologist make the right diagnosis.

You might want to make a list of your symptoms before you see the gastroenterologist. Bring it with you so you don’t forget anything.

Questions to Ask Your Gastroenterologist

You should ask questions, too. Here are a few you can try:

  • Will I need any more tests?
  • What are the usual treatments for my condition?
  • Will I need a colonoscopy or endoscopy?
  • What do I do if I have a symptom flare-up before I see you again?
  • What are the signs of a serious complication?
  • Are there any medications that could make my problem worse?
  • Will I need to change my diet?

Your Physical Exam

The gastroenterologist will look at you to try to find the cause of your symptoms. You’ll lie on the exam table and relax. Your doctor will press down on the skin around your belly. They’ll listen for odd bowel sounds and feel for any masses or tenderness. They may ask you to take deep breaths or cough during your exam.

They might also put a finger into your rectum to feel for any bulges or masses, and to check the muscle tone.

What Are the Next Steps?

The gastroenterologist may send you for X-rays, a CT scan, or blood and stool tests. They may give you a stool test. Among other things, a stool culture can check how well your body absorbs and uses fat. They may also test your motility (how food moves through your digestive system).

The doctor might also suggest procedures to diagnose your problem. They’ll schedule these tests for later and tell you how to prepare:

Barium swallow or enema: Barium is a liquid that highlights areas inside your body on a scan. The doctor may give you barium to drink to check your esophagus, stomach, or upper small intestine. Or you may need one to check your colon or rectum. An X-ray will show the doctor your organs as they move.

Endoscopy: This long, thin tube with a tiny camera on the end goes through your mouth so the doctor can look at your upper digestive tract or take a biopsy (tissue sample). You may get an endoscopy if you have persistent heartburn, belly pain, vomiting, or other problems that don’t go away.

Colonoscopy: The doctor puts a thin scope with a camera on the end into your bottom. It goes into your colon, rectum, or large intestine to look for polyps or bleeding, get rid of any polyps, or take a biopsy. Your doctor may order a colonoscopy to check for problems such as inflammatory bowel disease, or problems that may cause changes in how often and how you poop, belly pain, or blood in your stool.

Enteroscopy: You may have this procedure if an endoscopy or a colonoscopy fails to find anything. You swallow a tiny video capsule that transmits pictures of the insides of your digestive tract. An enteroscopy may reveal causes of bleeding and ulcers (sores) caused by Crohn’s disease, among other things.

Medications

Your gastroenterologist may suggest over-the-counter antacids, or prescribe medications to treat your heartburngasconstipation, or other symptoms. They often prescribe proton pump inhibitors, H2 blockers, or metoclopramide, which helps with motility.

Lifestyle Changes

Your gastroenterologist may tell you to do these things to manage your symptoms:

  • Cut back on caffeine.
  • Don’t eat foods that trigger symptoms.
  • Eat more fiber.
  • Exercise regularly.
  • Find ways to manage your stress.
  • Poop when you have the urge.

What You Can Do to Help

Follow your gastroenterologist’s lifestyle tips to feel better, and get regular colon screenings to spot early signs of cancer.

Let the doctor know if you have blood in your stool, changes to your bowel movements, fatigue, or weight loss you can’t explain.

Source Credit: https://www.webmd.com/ibs/gastrologist-vs-gastroenterologist-whats-the-difference

WHY WOULDN’T I QUALIFY FOR BARIATRIC SURGERY?

When patients finally arrive in our office ready to commit to the life change that is bariatric surgery, they are often eager to go and want to have surgery as soon as possible. Years of dieting, exercising, weight loss programs and more are so exasperating that surgery feels like a breath of fresh air and excitement. So, when the news comes back that there may be a hiccup in their qualification for bariatric surgery, it can be downright depressing. But why might a patient not qualify for bariatric surgery?

BMI: First and most obviously, they simply may not have a BMI that is high enough. A BMI of 35 or more with one or more obesity related conditions or BMI of 40 or greater regardless of obesity related conditions is required to have surgery. This is a fixed rule ensuring the patient truly does need bariatric surgery and cannot benefit from other interventions.

Health Concerns: Surgery puts significant strain on the body. Both the surgical intervention and anaesthesia come with risks, and patients in poor general health increase those risks dramatically. That is why we perform several pre-operative tests to ensure this risk is as low as possible.

Smoking: Smoking is a recipe for complications during and after surgery. Patients must be able to quit smoking at least six weeks before the procedure.

Payment arrangements: Not all insurance plans cover bariatric surgery. Further, getting a pre-authorization for surgery is not always successful. While some patients may be denied coverage due to a clerical error or a technicality which can be overturned, other patients may not be deemed candidates for bariatric surgery by their insurance company and therefore not have coverage. Some insurance plans specifically exclude bariatric surgery, but of course, there are always financing, and cash pay options as well.

Other Reasons: There are also some intangible reasons why a patient may not be suitable for bariatric surgery the greatest of which is simply not being ready psychologically and emotionally. This is something that our surgeons take very seriously and will discuss with every patient in detail. Some patients will also need to have a psychological evaluation that is less about mental health and more about emotional suitability for the trials and changes that will undoubtedly occur after surgery.

Of course, while being denied the opportunity to undergo bariatric surgery is difficult to hear, it is done for good reason. The most important focus is on the safety and effectiveness of the procedure. Without that, bariatric surgery becomes less effective and safe. With that being said, we will always work with you to understand what it takes to have surgery. We will have a frank and honest discussion with you about your suitability and whether bariatric surgery makes sense or if non-surgical weight loss may be a better option for you.

To find out if you are a candidate for bariatric surgery, please send an email to dutfun@gmail.com with the heading CONSULTATION WITH DR IVOR FUNNEL.

Source Credit: https://sampadocs.com/2021/01/04/why-wouldnt-i-qualify-for-bariatric-surgery/

Common Vascular Procedures and Treatments

Angioplasty, Atherectomy and Stenting

Arteries, blood vessels that carry oxygen-rich blood to all the parts of the body, are normally flexible and smooth on the inner side, but deposits of cholesterol, calcium, and fibrous tissue (plaque) can build up on the inner walls of the arteries, making them hard, stiff, and narrow.

Arteriovenous Fistula Creation for Dialysis Access

Haemodialysis is a procedure performed to manage patients suffering from kidney failure. A dialysis machine takes over the function of the diseased kidneys by filtering the blood of wastes. During dialysis, you will be attached to a machine called a dialyser through a thin tube.

Carotid Endarterectomy

Carotid endarterectomy is a surgical procedure performed to remove plaque (deposits of fat) from the carotid arteries of the neck; the main blood vessels that supply blood to the brain.

Carotid Stenting

Carotid artery stenting is a minimally invasive procedure to open or clear the blocked carotid artery. It is performed along with carotid angiography, which uses X-ray images to check for the blocked carotid arteries.

Chronic/Non-healing Wound Management

Chronic non-healing wounds are the wounds that do not heal even after a few months or years, secondary to an underlying disease which may interfere with the normal healing process. Chronic wounds can be painful and can adversely affect the quality of life of the patient. Chronic wounds may lead to life threatening complications.

Dialysis Access

Dialysis is an artificial method of purifying the blood in individuals with kidney failure. It helps in removing the impurities and waste products from the blood. Dialysis access is a method of gaining access into the bloodstream through blood vessels for dialysis.

Endarterectomy

Normally, the arteries have a smooth surface inside to promote unobstructed flow of blood. With advancing age, a sticky plaque made up of cholesterol, calcium or fibrous tissue starts accumulating on the inner walls of your arteries.

Endovascular Stent Graft

Arteries are the blood vessels that carry oxygen-rich blood from the heart to all parts of the body. An aneurysm is a balloon like bulging or swelling in a weak area along the wall of an artery.

Renal Transplant & Vascular Access

A renal or kidney transplant is a procedure in which a healthy kidney is transplanted into your body to treat kidney failure. The procedure involves precisely suturing the blood vessels of the donor kidney to the recipient’s blood supply.

Surgical Aneurysm Repair

An aneurysm is a balloon like enlarged and weakened area (caused due to blood pressure) on the wall of an artery. An aneurysm can cause serious complications when it increases in size and ruptures or when blood clots block the blood flow.

Surgical Bypass

Normally, the arteries have a smooth surface inside to promote unobstructed flow of blood. A sticky plaque made up of cholesterol, calcium or fibrous tissue starts building up on the inner walls of your artery, as you age.

                          Thoracic Outlet Surgery

The thoracic outlet is a small passageway leading from the base of the neck to the armpit and arm. This small area contains many blood vessels, nerves, and muscle. When this passageway becomes compressed, the condition is termed as thoracic outlet syndrome.

Thrombolytic Therapy

The normal process of blood clotting or coagulation occurs when platelets clump with other blood components to form a gel. Generally, clotting after an injury avoids excessive bleeding, but clots formed in the blood vessels of the body may block the blood flow in vital organs such as the lungs, heart or brain creating a life-threatening situation which requires emergency management.

Source Credit: https://www.sydneyvascularsurgery.com.au/common-vascular-procedures-treatments.html

Understanding Trauma and How It’s Treated

Trauma surgery is the branch of surgical medicine that deals with treating injuries caused by an impact. For example, a trauma surgeon may be called to the emergency room to evaluate a patient who is a victim of a car crash.

Surgeons performing surgery in operating room
Morsa Images / DigitalVision / Getty Images

Trauma Explained

Trauma is the injuries suffered when a person experiences a blunt force or a penetrating trauma.1You may also hear trauma referred to as “major trauma.” Many trauma patients are the victims of car crashes, stabbings, and gunshot wounds. Trauma can also be caused by falls, crush type injuries, and pedestrians being struck by a car.1

Traumatic injuries can affect internal organs, bones, the brain, and the other soft tissues of the body. No area of the body is immune to trauma, but trauma can range from minor (hitting your finger with a hammer) to major (being hit by a car traveling at a high rate of speed or falling off of a building).

Who Performs Trauma Surgery

In the case of severe trauma, such as a catastrophic car crash, the trauma surgeon may be one part of a surgical team that includes general surgeons (to repair internal abdominal injuries), vascular surgeons (to repair damage to blood vessels), orthopedic surgeons (to repair broken bones), and other surgeons as needed.2

The trauma team will include not only one or more surgeons, but also the paramedics who stabilize and transport the patient, nurses, anesthetist, respiratory therapist, radiographer, and the support of the medical laboratory scientists, including the blood bank.

For surgeons, extensive education is required in order to practice in their chosen field. As with all physicians, they first graduate from college with a bachelor’s degree and enter medical school for four years. For general surgeons, five years of surgical training as a residency is required. For surgeons who want to specialize, the same five-year residency is completed, followed by additional years of training in the area of specialization.3 Trauma surgery fellowships are usually one to two years long. Trauma surgeons often also serve a critical care fellowship. They take their boards for a certification in Surgical Critical Care.4

From the Emergency Room to Surgery

A trauma surgeon has a different set of skills and functions from an emergency room doctor.5 When you arrive in the emergency room for any complaint, the ER doctor will see you, stabilize your condition, examine you, and order tests and imaging studies. She will alert the specialists needed, which may include the trauma surgeon. The ER doctor’s function includes referring you for admission or discharging you with appropriate treatment and follow-up referrals.

If your condition requires trauma surgery, you will be handed off to the trauma surgeon, who will become your provider. She will not only perform the surgery, but you will also be followed by her and her team through recovery, rehabilitation, and discharge.5 When you need emergency surgery, you may be treated at the facility where you arrived, or you may be transported to a facility that has the specialists needed for your condition. The trauma surgeon may not be available to examine you until you arrive at her facility.

The trauma surgeon is often the person responsible for prioritizing which of your injuries will be treated first and determining the order of the diagnostic and operative procedures needed.

Source Credit: https://www.verywellhealth.com/trauma-surgery-defined-3157175

Obesity Is Linked With Cancer – Now We Finally Know Why

Cancer is caused by genetic changes

Brain Obesity Weight Loss

Cancer is caused by genetic changes that break down normal constraints on cell growth. It is known that obesity and overweight increases the risk of developing cancer, but the question until now has been why? Now, researchers at University of Bergen have demonstrated that lipids associated with obesity make cancer cells more aggressive and likely to form actual tumors.

Nils Halberg

Associate professor Nils Halberg. Credit: Melanie Burford

The researchers have discovered that the changed environment surrounding the cancerous cell, from a normal weight body to an overweight or obese body, pushes the cancer cell to adapt. This allows the malignant cells to form a tumor.

“This means that even in the absence of new gene mutations, obesity increases the risk that tumors will form,” says associate professor Nils Halberg.
Obesity is the cause of approximately 500 000 new cancer cases each year – a number that is expected to grow as obesity rates continue to increase.

“To scientifically dissect how these two complicated diseases interact has been extremely interesting and rewarding. Especially as this new understanding will enable researchers to design improved treatments for obese cancer patients,” Halberg adds

Reference: “C/EBPB-dependent adaptation to palmitic acid promotes tumor formation in hormone receptor negative breast cancer” by Xiao-Zheng Liu, Anastasiia Rulina, Man Hung Choi, Line Pedersen, Johanna Lepland, Sina T. Takle, Noelly Madeleine, Stacey D’mello Peters, Cara Ellen Wogsland, Sturla Magnus Grøndal, James B. Lorens, Hani Goodarzi, Per E. Lønning, Stian Knappskog, Anders Molven and Nils Halberg, 10 January 2022, Nature Communications.
DOI: 10.1038/s41467-021-27734-2

Source Credit: https://scitechdaily.com/obesity-is-linked-with-cancer-now-we-finally-know-why/

Endocrine Surgery

Surgery performed with its focus on one or more of the endocrine organs is referred to as endocrine surgery. The endocrine organs are glands located throughout the body, which secrete hormones that are vital for maintaining homeostasis (i.e. a constant internal environment) and metabolism into the bloodstream.

These glands together make up what is known as the endocrine system, whose control and command centers are the pituitary gland and hypothalamus. Other endocrine glands are the endocrine pancreas, pineal, adrenal, thyroid, and parathyroid glands. Specialists who conduct surgery on these glands are called endocrine surgeons.

Endocrine organs

Hypothalamus and pituitary gland

Hamartomas, although rare, are non-neoplastic tumors that arise in the hypothalamus and cause devastating consequences, such as seizures, cognitive impairment, behavioural and emotional troubles, hormonal imbalances and early puberty. Surgical removal of the tumor is required, and surgeons take advantage of the physiological gap between the hemispheres of the brain to gain access to the tumor and remove it.

Another less invasive approach is the use of stereotactic radiosurgery (gamma knife), which uses light energy to destroy the tumor and surrounding damaged tissue. It is a more focused form of standard external beam radiotherapy that targets the tumor more precisely.

The pituitary gland, located at the base of the brain, is the size of a kidney bean, yet is responsible for growth and development, and the function of all endocrine glands. Tumors of the pituitary gland are mostly benign adenomas that remain within the pituitary gland and do not metastasize. However, some tumors produce excess hormone, which is responsible for the symptoms.

Others produce symptoms because of the mass effect of the tumor itself. Most pituitary gland tumors may not require treatment, but if the tumor is compressing the optic nerve, then emergency surgery is necessary. There are two main surgical approaches: an endoscopic trans-nasal trans-sphenoidal (ETNTS) method and a trans-cranial technique.

With the ETNTS approach, surgeons remove the pituitary tumor through the sphenoidal sinuses and the nose. There is no need for an external incision. Moreover, there is no effect on other parts of the brain, and just as importantly, there are no surgical scars producing a better aesthetic effect.

Large tumors, however, may be much more difficult to remove via this method. Therefore, a trans-cranial approach or craniotomy may be done. An incision is made through the upper part of the scalp and the tumor is removed.

Endocrine pancreas and neuroendocrine glands

In contrast to the exocrine pancreas, which produces enzymes for digestion, the endocrine pancreas secretes hormones, such as glucagon, insulin and gastrin. These are produced with the help of specialized cells called “islet cells” that are found scattered throughout the pancreas, which is itself located deep within the abdominal cavity.

Tumors may arise in the endocrine pancreas that warrant surgical removal. These tumors can cause local symptoms due to the mass of tumor compressing adjacent structures, or they may be responsible for clinical syndromes due to the overproduction of hormones.

Cells of neural crest embryological origin can develop into neuroendocrine tumors. These are commonly found in the lungs and gastrointestinal tract, and cause symptoms due to hormone production. Since endocrine pancreatic tumors as well as neuroendocrine gland tumors are found deep within the abdominal cavity, surgery is done under general anesthesia. It may be necessary in some cases to remove parts of the intestine and/ or pancreas.

Pineal gland

The pineal gland is the location of the internal biological clock in humans. It is a small gland located posteriorly within the diencephalon in the center of the brain. In the absence of light, and at night, it secretes melatonin, a hormone that plays a pivotal role in regulating circadian and seasonal rhythms.

Although extremely rare, tumors may arise in the pineal gland. These will necessitate surgery to remove the tumor, which can cause serious complications, such as visual impairment, seizures, and memory disturbances. Surgical removal is usually curative.

Adrenal glands

The adrenal glands, like other endocrine glands, are also susceptible to the formation of tumors, both benign and malignant, that can cause a wide range of symptoms. Most of these tumors can be surgically removed and are usually amenable to laparoscopy. In some patients, however, an open adrenalectomy may be required. Associated risks include infection, bleeding, and extreme changes in blood pressure. These risks are outweighed by the medical benefits of the surgery.

Thyroid and parathyroid glands

Thyroid gland removal, also referred to as thyroidectomy, may be indicated for benign and malignant thyroid lesions, as well as an overactive thyroid gland. The amount of the gland removed depends on the indication for the surgery. Partial removal is warranted in some cases, allowing the remaining parts to function normally after the operation.

In contrast, total removal means that the patient will need lifelong thyroid hormone supplementation, as is the case when other endocrine glands are completely removed. It is a safe procedure, but may have associated risks, such as bleeding, infection and inadvertent injury to the laryngeal nerve, or the parathyroid glands.

Thyroidectomies may be done by one of three approaches. In the first, which is the conventional approach, an incision is made down the center of the neck to access the gland directly. In the second approach, the gland is removed endoscopically with smaller neck incisions. The third approach is called the robotic method. Here incisions are made in the chest or armpit, circumventing the need for incisions in the center of the neck.

Parathyroid surgeries may also be required for similar indications as a thyroid surgery and the diseased parathyroid gland is surgically removed via neck incisions in a similar fashion.

Source Credit: https://www.news-medical.net/health/Endocrine-Surgery.aspx

Hernia

A hernia happens when an internal organ pushes through a weak spot in your muscle or tissue. There are several types of hernia that you can experience including, inguinal hernias, femoral hernias, umbilical hernias, and hiatal hernias. If you have a hernia, it’s important to treat it quickly.

What is a hernia?

A hernia occurs when an internal organ or other body part protrudes through the wall of muscle or tissue that normally contains it. Most hernias occur within the abdominal cavity, between the chest and the hips.

The most common forms of hernia are:

  • Inguinal hernia: In men, the inguinal canal is a passageway for the spermatic cord and blood vessels leading to the testicles. In women, the inguinal canal contains the round ligament that gives support for the womb. In an inguinal hernia, fatty tissue, or a part of the intestine pokes into the groin at the top of the inner thigh. This is the most common type of hernia and affects men more often than women.
  • Femoral hernia: Fatty tissue or part of the intestine protrudes into the groin at the top of the inner thigh. Femoral hernias are much less common than inguinal hernias and affect older women.
  • Umbilical hernia: Fatty tissue or part of the intestine pushes through the abdomen near the navel (belly button).
  • Hiatal (hiatus) hernia: Part of the stomach pushes up into the chest cavity through an opening in the diaphragm (the horizontal sheet of muscle that separates the chest from the abdomen).

Other types of hernias include:

  • Incisional hernia: Tissue protrudes through the site of an abdominal scar from a remote abdominal or pelvic operation.
  • Epigastric hernia: Fatty tissue protrudes through the abdominal area between the navel and lower part of the sternum (breastbone).
  • Spigelian hernia: The intestine pushes through the abdomen at the side of the abdominal muscle, below the navel.
  • Diaphragmatic hernia: Organs in the abdomen move into the chest through an opening in the diaphragm.

How common are hernias?

Of all hernias that occur:

  • 75 to 80% are inguinal or femoral.
  • 2% are incisional or ventral.
  • 3 to 10% are umbilical, affecting 10 to 20% of newborns; most close by themselves by 5 years of age.
  • 1 to 3% are other types.

SYMPTOMS AND CAUSES

What causes a hernia?

Inguinal and femoral hernias are due to weakened muscles that may have been present since birth or are associated with aging and repeated strains on the abdominal and groin areas. Such strain may come from physical exertion, obesity, pregnancy, frequent coughing, or straining on the toilet due to constipation.

Adults may get an umbilical hernia by straining the abdominal area, being overweight, having a long-lasting heavy cough or after giving birth.

The cause of hiatal hernias is not fully understood, but a weakening of the diaphragm with age or pressure on the abdomen could play a part.

What are the symptoms of a hernia?

A hernia in the abdomen or groin can produce a noticeable lump or bulge that can be pushed back in, or that can disappear when lying down. Laughing, crying, coughing, straining during a bowel movement, or physical activity may make the lump reappear after it has been pushed in. More symptoms of a hernia include:

  • Swelling or bulge in the groin or scrotum (the pouch that contains the testicles).
  • Increased pain at the site of the bulge.
  • Pain while lifting.
  • Increase in the bulge size over time.
  • A dull aching sensation.
  • A sense of feeling full or signs of bowel obstruction.

In the case of hiatal hernias there are no bulges on the outside of the body. Instead, symptoms may include heartburn, indigestion, difficulty swallowing, frequent regurgitation (bringing food back up) and chest pain.

DIAGNOSIS AND TESTS

How is a hernia diagnosed?

It is usually possible to see or feel a bulge in the area where a hernia has occurred by physical exam. As part of a male’s typical physical exam for inguinal hernias, the doctor feels the area around the testicles and groin while the patient is asked to cough. In some cases, soft-tissue imaging like a CT scan will accurately diagnose the condition.

MANAGEMENT AND TREATMENT

What kind of doctor do you see for a hernia?

When you have a hernia, treatment will start with your primary care provider. If you need surgery to repair the hernia, you’ll be referred to a general surgeon. In fact, ventral hernia repairs are one of the most common operations U.S. general surgeons perform.

If you think you have a hernia, don’t wait to seek help. A neglected hernia can grow larger and more painful — this can lead to complications and possibly emergency surgery. Early repair is more successful, less risky and offers a better recovery and outcome.

How is a hernia treated?

Hernias usually do not get better on their own, and surgery may be the only way to repair them. However, your doctor will recommend the best therapy to address your hernia and may refer you to a surgeon. If the surgeon thinks it is necessary to repair your hernia, then the surgeon will tailor the method of repair that best meets your needs.

In the case of an umbilical hernia in a child, surgery may be recommended if the hernia is large or if it has not healed by the age of 4 to 5 years old. By this age, a child can usually avoid surgical complications.

If an adult has an umbilical hernia, surgery is usually recommended because the condition will not likely improve on its own and the risk of complications is higher.

One of three types of hernia surgery can be performed:

  • Open surgery, in which a cut is made into the body at the location of the hernia. The protruding tissue is set back in place and the weakened muscle wall is stitched back together. Sometimes a type of mesh is implanted in the area to provide extra support.
  • Laparoscopic surgery involves the same type of repairs. However, instead of a cut to the outside of the abdomen or groin, tiny incisions are made to allow for the insertion of surgical tools to complete the procedure.
  • Robotic hernia repair, like laparoscopic surgery, uses a laparoscope, and is performed with small incisions. With robotic surgery, the surgeon is seated at a console in the operating room and handles the surgical instruments from the console. While robotic surgery can be used for some smaller hernias, or weak areas, it can now also be used to reconstruct the abdominal wall.

Each type of surgery has its advantages and disadvantages. The patient’s surgeon will decide the best approach.

What can happen if a hernia is not treated?

Other than umbilical hernias in babies, hernias will not disappear on their own. Over time, a hernia can grow larger and more painful or can develop complications.

Complications of an untreated inguinal or femoral hernia may include:

  • Obstruction (incarceration): Part of the intestine becomes stuck in the inguinal canal, causing nausea, vomiting, stomach pain, and a painful lump in the groin.
  • Strangulation: Part of the intestine is trapped in a way that cuts off its blood supply. In such cases, emergency surgery (within hours of occurring) is necessary to prevent tissue death.

PREVENTION

How can a hernia be prevented?

  • Maintain ideal body weight by eating a healthy diet and exercising.
  • Eat enough fruits, vegetables, and whole grains to avoid constipation.
  • Use correct form when lifting weights or heavy objects. Avoid lifting anything that is beyond your ability.
  • See a doctor when you are ill with persistent coughs or sneezing.
  • Don’t smoke, as the habit can lead to coughing that triggers a hernia.

OUTLOOK / PROGNOSIS

What can be expected following surgical treatment for a hernia?

After surgery, you will be given instructions. These include what diet to follow, how to care for the incision site, and how to take care to avoid physical strain. Hernias may recur regardless of the repair operations. This is sometimes caused by inherent tissue weakness or protracted healing. Smoking and obesity are also major risk factors for hernia recurrence.

Source Credit: https://my.clevelandclinic.org/health/diseases/15757-hernia

Durban metabolic surgery center joins ranks of the few in SA accredited to perform a specialized procedure

The Durban Metabolic Surgery Centre, run by well-known surgeons Dr Gert du Toit and Dr Ivor Funnell, has been accredited by the South African Society for Surgery, Obesity and Metabolism (SASSO) to perform the highly advanced Biliopancreatic Diversion with Duodenal Switch (BPD-DS) surgery. Performing procedures at Netcare St Augustine’s and Netcare uMhlanga hospitals, Drs Du Toit and Funnell started performing laparoscopic gastric bypass surgery – the preferred procedure for morbid obesity and associated illnesses including type 2 diabetes – in 2006. Since then the team has completed approximately 660 procedures, which have achieved some life-changing results for patients. Read more: