Surgical Speciality

Dr. Manish K Gupta, Senior Consultant working in Department of Laparoscopic, Laser & General Surgery at Sir Ganga Ram Hospital, Delhi. He is having a vast experience of 20 years and more than 15000 Advance Laparoscopic Surgical procedures especially of biliary tract, upper & lower GI and complex hernias. Laparoscopy is a well-established technique to look inside the abdomen on a monitor. A laparoscope (camera) & thin instruments are passed into the abdomen through 0.5 - 1 cm incisions (cuts) in the skin. Surgeon looks the inside magnified picture on a TV monitor & operates. Incisions (cuts) are closed with single stitches. Smaller cuts leads to less blood loss, less pain, decrease hospitalization & early return to work. Gall bladder removal & hernia repair can be easily done as Day Care Surgeries (same day discharge).  

Dr. Manish K Gupta has undergone extensive training in Robotic Surgery at Roswell Park Cancer Institute, Buffalo, New York, USA. Robotic assisted surgery overcomes the limitations of minimally invasive surgery. Articulation of robotic instrument tips provides seven dimensional movements like human wrist & 3-D vision. Robotic surgery leads to precision with smaller incisions, reduced blood loss & transfusion, less pain, quick healing & less hospitalization. The role of robotic surgery is specially indicated in benign and malignant diseases of hepato-biliary, upper gastro intestinal & lower gastro intestinal tract.

Dr. Manish Gupta has innovated a “555 Manish Technique” for inguinal hernia repair. He has indigenously made “Manish Retractor” which enables to complete the surgery by only 5 mm cuts. He presented this technique in various international hernia conferences held at Boston USA, Vienna Austria, Hamburg Germany, Dubai UAE and national forums and have successfully completed more than 400 hernia repairs with best results. This technique makes the surgery safe as the first 5 mm trocar placement in the body is under complete vision and not blind. It avoids use of Hasson trocar which leaves a 2.5 – 3 cm cut below the naval and leaves a big scar after surgery in usual laparoscopic repair. It’s first time in the world that inguinal hernia repair (TEP) can be completed by such small incisions. 5 mm small cuts lead to less pain, fast recovery and almost invisible scars after recovery. 

Divarication recti or Diastasis recti is a common problem especially after childbirth in females where the tummy bulges out even when you are not fat. Males are no exception for this carrying large bellies. The two rectus muscles (6 pack muscle) gets apart from midline and don't support intestine and intra-abdominal organs. It is a cause of hernia formation too. It leads to poor body image, backache, constipation and urinary problems. It can be corrected laparoscopically by SCOLA technique,  making three keyhole size cuts and placing a mesh to reinforce the weak muscles. Now enjoy a flat tummy without loosing a single kilogram of body weight, requiring hospitalization of 2-3 days only

Gall bladder is a pear-shaped organ attached to the liver. Its main function is to store bile (golden yellow digestive liquid) produced by the liver and releases the bile in to the small intestine where it helps in the digestion of fat. When the concentration of bile components like cholesterol or bile pigments increases, they precipitate to form solid stones. There is nothing one can do or avoid in the diet to prevent the gallstones from forming.  Particularly after eating fatty food patients develop heartburn, heaviness or severe abdominal pain in the right upper side of abdomen. Sometimes complications such as jaundice, infection of the gallbladder (cholecystitis) or pancreas (pancreatitis) can occur. Some stones cause no symptoms & so called "silent" gallstones, but they can cause complications.  Gallstones are usually diagnosed by a relatively simple test called ultrasonography. Surgical removal of the gallbladder (cholecystectomy) is the best treatment. Laparoscopic cholecystectomy is carried out through 4 small punctures each of which is 0.5 - 1 cm in length. As the incisions are small, the pain after the operation is minimal and recovery is much faster. Clear liquids allowed within 6 - 8 hours & soft diet after 1 day. Most patients go home within 24 hours after surgery. Soon after returning home the patients are allowed all activities they feel comfortable with & able to return to work within 5 days. After operation, function of storage of bile is taken over by the bile ducts and there is no impairment of the digestive process. What's something exciting your business offers? Say it here.

FAQs

I'm aware of my gallbladder stones. I don't have much problem due to gallbladder stones, just gas and heaviness and occasional problem after heavy meals. What to do?

One should avoid having heavy, oily meals. Some patients can even have silent stones, but they can lead to complications like jaundice, pancreatitis, cholecystitis etc. It's better to go for removal of gallbladder and avoid such complications.

What are the precautions required after gall bladder surgery?

No specific precautions as such, patients can take normal home cooked food, can move around and climb stairs on the very same day of surgery. One can take normal bath daily over waterproof dressings. No need for strict bed rest. Can resume work and driving after 5 to 7 days.

How much hospital stay is required for gall bladder surgery?

Usually in uncomplicated cases laparoscopic gall bladder surgery is a daycare procedure and patients can be discharged on the very same day or within 24 hours.

Any lifetime precautions after gall bladder surgery?

Not as such. One can eat normally and can lead an absolutely normal life.

Can women of child bearing age go for gall bladder surgery?

There is absolutely no problem in getting pregnant after gall bladder surgery.

Kids with gall bladder stone, what to do?

Absolutely no problem in getting the gall bladder removed. Children can grow and lead an absolutely normal life.

I've a stone in CBD and gallbladder as well, what to do?

CBD stone should be taken out prior to gall bladder surgery.

Hernia is a defect in muscle layer of abdominal wall. It can occur commonly at umbilicus, inguinal (groin) and over scars of previous abdominal surgery. Initially hernia swelling is small and reduces on lying or pushing it manually. Defect size & swelling keeps on increasing with time. Complications like irreducibility, intestinal obstruction & strangulation of intestine need emergency operation. Hernia should be operated on a priority basis as soon as it has got diagnosed. One should not wait for complications to develop.  Abdominal wall repair (AWR), Robotic, Laparoscopic or Open hernia repairs are different techniques which are needed in different case scenarios depending on the complexity of hernia. 

FAQs

My hernia isn't causing any problem, should I go for surgery?

One should not wait for the complications to occur in hernia. One should not wait for hernia to become big. The dictum is to operate hernia as soon as possible once it's diagnosed. The recovery is always better if hernia is repaired when the defect is smaller.

I've a hernia, could it be repaired laparoscopically?

After seeing and evaluating the various aspects, surgeon will decide the nature of surgery. Laparoscopic surgery is always a better choice over open surgery if possible.

What is "555 Manish Technique" for groin hernia repair?

Dr Manish K Gupta has innovated a technique for inguinal hernia repair by smallest possible 5mm holes only. He presented this technique in international hernia conferences held at Boston, Vienna, Hamburg and Dubai & did more than 500 cases. In place of 2.5 to 3cm cut below the belly button, this technique leaves only a 5mm cut below the belly button. He also devised a technique to put mesh inside through 5mm hole. Smaller wound means less pain, almost invisible scar and early recovery to work.

I've groin/inguinal hernia. Is laparoscopic repair possible?

Groin or inguinal hernia can be easily repaired with Laparoscopic surgery. Dr Manish K Gupta has innovated a "555 Manish technique" for inguinal hernia repair by smallest possible three 5mm holes, 1st Time in the World. Almost invisible scars and less pain are the advantage of the technique. It's a daycare surgery and patients can go home on the very same day of surgery.

I've an abdominal wall hernia (Umbilical/incisional), which surgery is best, laparoscopic or open?

It depends on many factors like site, size, severity and co-morbidities of the patients. Laparoscopic surgery leads to better recovery and less chances of complications over open surgery, but in some cases open surgery is required. 

Hiatus hernia is the protrusion of stomach in to the chest through the opening of food pipe, in the diaphragm (structure separating chest from abdomen). Patients usually complaints of heartburn, sour burps and regurgitation of sour fluid in the mouth after meals especially at night. The diagnosis can easily be made by Barium swallow (X-Ray study), endoscopy & 24 hour pH monitoring. It can be managed by medicines but in severe cases requires Laparoscopic surgery (Laparoscopic fundoplication). It needs 3-4 days of hospitalization.

Breast lumps can occur at any age. The lumps are usually benign in adolescent & younger age group. Sometimes this is a part of normal changes in the female breast. As the age advances, the chance of breast cancer increases. Sometimes patient can have breast pain & nipple discharge along with disfigurement due to large size of lump. Unmarried females, lack of breast feeding, family history and obese females are more prone for breast cancer. The diagnosis can be easily made by examination, Ultrasonography, Mammography, FNAC and biopsy. Mammography is good test for diagnosing cancer in very early stages even when the cancer lumps are not obvious or manually palpable. Diagnosing breast cancer in early stages helps in better management, good prognosis and longevity of life.

Obesity is no more a disease of western world. With the changing life style and eating habits, more and more Indians are becoming obese. Obesity is a chronic disease and symptoms develop gradually. It also affects every day routine activities. Knee ache and backache are due to additional body weight borne by the joints. Obesity, if left untreated, can lead to life threatening conditions such as Type 2 diabetes, high blood pressure, high cholesterol levels, sleep apnea, cancer, cardiac problems, menstrual irregularities and infertility in females.  “BMI” (Body mass index) will help to know the status. BMI is the ratio of body weight (in kilograms) and height (in meter). The BMI for overweight individuals ranges between 25-30 kg/m2.  The BMI for obese person ranges from 30-39 kg/m2. Morbid Obesity refers to a BMI more than 40 kg/m2  Restricting calories intake and burning them by exercise are the major components of weight reduction. However, low calories diets result in quick weight loss but the weight is often regained. Researches also indicate that exercise is better for maintaining weight loss than triggering initial weight loss. Drugs causes weight reduction by 5-10% only by suppressing the appetite. Weight gain recurs after stopping the medication. Long-term use of drugs leads to their side effects.  “Laproscopic Obesity Surgery” (Bariatric Surgery) is the answer. With the use of laparoscopy, major operations are performed through tiny incisions with specialized long instruments. Less pain and shortened hospital stay & recovery time are some of the benefits of laparoscopic surgery  Surgery combined with behavioral modification is currently the only proven method of achieving long-term weight loss and to get rid of the complications of morbid obesity. Patients having BMI of > 40 Kg/m2 or BMI of >35 Kg/m2 with associated obesity related diseases are candidates for bariatric surgery.  

Gastric banding - A soft band is placed around the stomach, shaping it like an hourglass. This reduces the amount of food you can consume at one time and makes you feel full sooner and for longer time. You therefore eat less and so lose weight.          

Sleeve Gastrectomy - The size of the stomach is reduced to a small banana size. It reduces the amount of food you eat at one meal. You therefore eat less and so lose weight.      

Gastric bypass - The size of the stomach is reduced and the digestion process altered. It reduces the amount of food you eat at one meal, absorbs less of the food you eat and you become intolerant to foods you should avoid anyway.    In first few years after the surgical procedure patients usually permanently loose 50-70% of the excess body weight. Complications of clinically severe obesity begin to resolve after weight reduction. These include control of high blood pressure, Type 2 diabetes, cholesterol levels, and relief from sleep apnea, backache and depression. In 80 % cases Diabetes was resolved completely and in remaining 20 % cases the doses of anti-diabetic drugs were curtailed down. Surgery helps in improving self-esteem, mood elevation and improved mobility.

Thyroid is a bi-lobed gland in front of neck & secrets thyroid hormone. Thyroid swelling usually presents as gradually increasing, painless swelling. It can be a diffuse swelling (Goiter) or can involve a lobe (Solitary nodule). Large thyroid swelling can cause difficulty in swallowing & in breathing. It can be benign or malignant. Thyroid Profile, Ultrasonography & FNAC (Needle test) is done to make diagnosis. 

Piles are normal anal cushions for smooth passage of stools & to make water tight seal for back passage. Constipation & prolonged straining during passing stools cause these cushions to swell and descend downwards. Initially there is painless fresh bleeding and protrusion of these piles while passing stools. If neglected, these piles enlarge & remain outside even after passing stools, causing pain & mucus discharge. Open surgery cuts these useful cushions causing bleeding & pain after surgery. Laser haemorrhidectomy or Stapler surgery fixes the piles to their normal position without any bleeding and pain in post-operative period. Patients after surgery can be discharged on the same day and resume normal activities in a day or two.

Fissure and fistula are another very common problems which can be treated.

Rectocele is one of the most common cause of chronic constipation, it's the out pouching of rectum where the stool gets stuck. Patients usually complains of constipation as if the stools gets stuck somewhere lower down in the rectum and not coming out, with sense of incomplete evacuation and manual extraction of stools along with pain in the rectum in severe cases. It can be corrected with stool softner but in severe cases STARR surgery is done to correct the out pouching so that patient start passing normal stools without obstruction. At the same time Rectal prolapse is the protrusion of either the rectal mucosa or the entire wall of the rectum outside while passing stools. In advanced cases it may appear on standing, coughing or sneezing and so greatly interfere with patient’s quality of life. Patients have to replace it manually. Partial or complete rectal prolapsed can be distinguished by clinical examination. Patients are evaluated with colonoscopy, anal manometery & defecography. Partial prolapsed can be treated by haemorrhoidectomy while complete rectal prolapse can be treated by Laparoscopic surgery (Laparoscopic Rectopexy). Patients who are not fit for surgery a Thiersch wire can be placed around the anal opening

The most common site of Pilonidal sinus is in between the hips in the midline. Usually it present with recurrent pus discharging painful opening which bothers the patient while sitting. In long standing Pilonidal sinus cases, patients can develop multiple openings in and around the midline. The treatment of Pilonidal sinus is control of infection followed by surgical removal of sinus openings and that there won't be any chances of recurrence. Excision and primary closure with or without flap are the surgical procedure of choice for better outcome.