Circumcision for Phimosis

Circumcision is the procedure for removal of the foreskin from the tip of the penis. A circumcision can be done at birth up to 4 to 6 weeks of age in clinic with a local anesthetic. If a circumcision is not done in that timeframe, it can be done later under general anesthesia. There are multiple reasons why a circumcision may not have been done at birth including prematurity, illness or the identification of an abnormality in the penis.

Circumcision can be performed under local or general anesthesia and the procedure would take hardly 30 minutes. There is minimum pain and the procedure is done as day surgery. Patients are discharged with tablet pain-killers and antibiotics for 1-2 days only. The procedure can be easily performed for children of above 2 years old as well as for adult and elderly males. The excess foreskin is removed. A couple of stitches placed to bring the edges of the skin together after removal of the excess skin. These stitches are self absorbable and do not require removal in a later date.

Circumcision helps in preventing cancer as penis can be kept clean however sexual excitement is decreased after keratinisation of mucosa of glans. Since throughout life, the foreskin keeps the glans soft and moist and protects it from trauma and injury.

Postoperative bleeding is the most common complication. It usually occurs when a scab is pulled off as the dressing is being removed. However, sutures can also be torn by erections before healing is completed. Bleeding can often be controlled with direct pressure. Rarely, electrocautery or ligature is required.Infection after circumcision is uncommon and, if encountered, may be treated with local or oral antibiotics.

The patient is discharged on the same day of surgery. They will be prescribed pain-relief, antibiotics and anti-inflammation medications. The wound would require a dressing cover for the initial 2-3 days only. As the procedure only involves removal of the foreskin and not affecting the urinary tube, passage of urine is normal after surgery. Most patients can return to work within 2 -3 days. Children recover much quicker from the procedure.The wound will heal within 7-10 days.

Choledocholithotomy

Choledocholithotomy, or common bile duct exploration, is used to remove large stones. This normally performed when the duct anatomy is complex during or after some gallbladder operations when stones are detected. Procedures involving CBD stone removal are caused by blockage from bile stones that formed in gallbladder.

Choledocholithotomy

In this procedure, the surgeon performs open abdominal surgery and extracts gallstones through an incision in the common bile duct. Routinely, a “T-tube” is temporarily left in the common bile duct after surgery and the doctor x-rays the bile duct through the tube 7 – 10 days after surgery, to determine whether any stones remain in the duct.

There are two types of Laparoscopic surgery: transcystic and choledochotom. This procedure involves the use of a keyhole camera inserted into the cystic duct via a small incision in the abdomen. A nintinol stone basket passed through the working channel of the choledochoscope as saline pressure irrigation is engaged. The stone(s) located in the bile duct is then cleared off under monitor guidance. This process requires no T-tubes or drains and can be performed as an outpatient procedure.

Women are much more likely than men to develop gallstones.

Stones stuck in the common bile duct can cause symptoms that are similar to those produced by stones that lodge in the gallbladder, but they may also cause the following symptoms:

  • Dark urine, lighter stools, or both
  • Rapid heartbeat and abrupt blood pressure drop
  • Jaundice (yellowish skin)

Fever, chills, nausea and vomiting, and severe pain in the upper right abdomen. These symptoms suggest an infection in the bile duct (called cholangitis).

The Choledocholithotomy (rmoval of CBD stones), can be cleared off easily with the supervision and treatment provided by Dr.K.N.Srikanth.

Inguinal Hernia Repair

An inguinal hernia is a state in which intra-abdominal fat or part of the small intestine, bulges through a fragile area in the lower abdominal muscles. An inguinal hernia occurs in the groin???the area between the abdomen and thigh. This type of hernia is called inguinal because fat or part of the intestine slides through a weak area at the inguinal ring, the opening to the inguinal canal. An inguinal hernia can happen any time from childhood to adulthood and is much more common in males than females. Inguinal hernias tend become larger with time.

Inguinal hernias in newborns and children result from a weakness in the abdominal wall that’s present at birth. Sometimes the hernia may be visible only when an infant is crying, coughing or straining during a bowel movement. In an older child, a hernia is likely to be clearer when the child coughs and strains during a bowel movement or stands for a long period of time.

Some of the main causes for Inguinal hernias are increased pressure within the abdomen, pre-existing weak spot in the abdominal wall, combination of increased pressure within the abdomen and a pre-existing weak spot in the abdominal wall, straining during bowel movements or urination, heavy lifting, fluid in the abdomen, pregnancy, excess weight and heavy coughing or sneezing.

Most people who have laparoscopic inguinal hernia repair are scheduled as outpatients -able to go home the same day. Inguinal hernia recovery time is about 1 to 2 weeks. Studies have found that people have less pain after laparoscopic hernia repair than after open hernia surgery.

An inguinal hernia repair is a surgery to push the bulge back into place and to strengthen the abdominal wall. The surgery is necessary as, if left untreated, the herniated tissue can get trapped and have its blood supply cut off (known as a strangulated hernia). Emergency surgery within hours is necessary to release the intended tissue and restore its blood supply so it does not die.

The wound may be closed with stitches or clips which need to be taken out 10 to 14 days after the operation. Sometimes there are stitches under the skin instead. These melt away and they don’t need to be removed. A plaster on the wound makes it more comfortable.

Since the success of the Inguinal hernia repair procedure depends on the skill of the surgeon. Dr. K.N.Srikanth, general laparoscopic surgeon, has thoroughly been performing laparoscopic treatment for the past 2 decades.