Dr Nitin Jha Best Laparoscopic and Bariatric Surgeon

17/03/2016

Success Rates for Gastric Bypass Surgery. Weight loss surgery is considered successful when 50% of excess weight is lost and the loss sustained up to five years. For example, a patient who is 100 pounds overweight should lose at least 50 pounds; a patient who is 200 pounds overweight should lose at least 100 pounds.

23/02/2016

Services

Surgery of the Gall bladder, Bile duct and Liver
Laparoscopic/Open Cholecystectomy for Gall bladder stones
Common bile duct surgery for Common Bile Duct stones
Choledochal cyst excision for Choledochal cysts
Hydatid cyst of liver

Hernia Surgery
Open and Laparoscopic Inguinal Hernia
Incisional Hernia/Umbilical Hernia mesh repair
Hiatus hernia surgery (Open and Laparoscopic fundoplication)
Achalasia cardia Surgery(\(\(\(Open and Laparoscopic Cardiomyotomy)


Pancreatic Surgery
Lateral pancreaticojejunostomy for Chronic pancreatitis
Head coring surgery for Chronic pancreatitis
Cystogastrostomy/Cystojejonostomy for pseudocysts


Gastrointestinal tract Surgery
Hemicolectomy/sigmoid colectomy for colon cancer/tuberculosis
Anterior resection/abdominoperineal resection for re**al cancer (selected cases)
Gastrojejunostomy for gastric outlet obstruction due to cancer
Small intestinal resection for tumor/strictures/polyps etc
Surgery for haemorrhoids (piles)/fissure/fistula/abscess and appendix


Robotic Surgery

04/01/2016

Laparoscope in SILS

For basic laparoscopic procedures for example cholecystectomy, a standard 5-mm, 30-degree laparoscope provides sufficient visualization of the surgical field. However, for other procedures, the length and visibility supplied by the standard laparoscope may pose some limitations. Because there is only one incision, typically in the umbilicus, the distance in the umbilicus to the surgical field might be longer than with the conventional laparoscopic technique. For instance, gastric band placement or Nissen fundoplication requires close proximity towards the hiatus and may require a longer scope for adequate visualization. In these cases, an extended, rigid scope might be an option. For additional complex cases requiring two working hands, an adaptable tip laparoscope pays to. EndoEye laparoscope of Olympus Surgical & Industrial America Inc, allows panoramic view from the surgical field with minimal movements through the operator. Others purchased 45-degree laparoscopes for improved visualization. By manipulating just the tip of the laparoscope with the shaft off line, the viewing angle needed can be obtained while allowing the working ports a higher level of freedom.

Instead of using the traditional laparoscope, some purchased the flexible endoscope, as with some NOTES procedures, to do SILS cholecystectomy. Instead of puncturing with the stomach or even the va**na, the endoscope is placed transabdominally for visualization. Some have inserted a double-channel endoscope directly with the fascia, while others have used a 15-mm trocar for insertion of the endoscope. Another trocar is positioned for insufflation, smoke evacuation, and retraction. Unlike SINGLE INCISION LAPAROSCOPIC SURGERY, where the surgeon is applying a using a laparoscope, the main working instrument is the double-channel endoscope. Once the endoscope is positioned, the procedure is performed much like NOTES with slightly less technical difficulty because of distance. Current limitations of the technique, similar to those encountered using NOTES, are that most surgeons don’t have the required skills and the available endoscopic instruments are not created for surgical dissection.

Retraction

One of the initial cases of single-incision laparoscopic cholecystectomy described using two transumbilical trocars with two transabdominal stay sutures for retraction of the gallbladder. Sutures can allow retraction, lowering the quantity of ports needed. A suture that enters and exits the abdomen in separate areas and passes with an organ having a locked stitch or clips can allow for “puppeteering” or retraction in different directions. Since that time, the use of intrabdominal suture to the anterior abdominal wall with or without endoloop and use of the penrose like a sling are also described. Using percutaneous sutures for retraction begs the question of more punctures and incisions. At what point is it no longer a single-incision procedure? Another technique for retraction involving a magnetic system might be adaptable from the use within NOTES procedures.

Future Technologies

Magnetically anchored and guidance systems (MAGS) are designed to maneuver intra-abdominal instruments by use of an external handheld magnet] The fundus from the gallbladder, for instance, could be retracted above the costal margin by coupling the interior aspect of an external magnet. The graspers are situated on the gallbladder with the help of endoscopic biopsy forceps. Magnets may become valuable, but challenges have an exponential reduction in force with thicker abdominal walls and clumping of ferrous objects within the operating room.

Robotic or remotely controlled devices are other technologies that could aid single-incision laparoscopy. The ability to insert instruments and also have the surgeon control them remotely makes it possible for examples of freedom and triangulation not otherwise possible with a single point of origin. Avoiding the requirement for handles and resulting clashing or interference of instrument motion are significant potential advantages of these systems.

09/10/2015

Dr Nitin Jha briefly explains about piles

Diagnoses of Piles

The piles which exist in pr*****ed form can be usually diagnosed by means of an external examination of areas surrounding the a**l cavity.
Proctoscpy usually serves to highlight the presence of internal piles.
By means of proctoscopy the presence of tumors or polyps and that of an inflamed prostate are also detected as the detection is valuable in determining the line of treatment.
Proctoscopy or anoscopy is usually performed with patients being subject to sedation.

Treatment for Piles

The course of treatment which follows the findings of re**al examination includes the administration of anti inflammatory drugs of non steroidal nature.
Traditional line of treatment is geared to the increased consumption of dietary fibers.
If constipation happens to be the underlying cause, insistence is given on the inclusion of green and yellow vegetables apart from being well hydrated by increasing the fluid intake.
Certain topical formula and suppositories are also available as treatment options; but long drawn usage of the same should be discouraged on account of their tendency to cause localized irritations.
Generally surgical removal of the inflamed vessels is resorted to as the last possible alternative.
Means based on cauterization and cryosurgery has also been found to be quite effective.
Ligation with the help of rubber band is also resorted to so that the blood supply to the inflamed tissues can be cut off.
Decartelization using an ultra sound Doppler has also been used so as to rectify the pr*****ed structure of piles.
Resectioning of the inflamed tissue which involves partial surgical interference is also made use of so that one can avoid the intensely painstaking procedure of total removal.

26/09/2015

Single incision laparoscopic surgery in gynecology: Evolution, current trends, and future perspectives

inimally invasive surgery has become the standard of care for different procedures in various subspecialties. Single-incision laparoscopic surgery (SILS) is a rapidly developing field that may mark the new frontier in laparoscopy. The ongoing and continuous efforts to decrease morbidity and improve cosmesis from laparoscopic surgery has led to minimization in number and size of ports required for these procedures. SILS is laparoscopic surgery performed through a single, small skin incision 15-20 mm in size, usually hidden in the umbilicus. SILS is not a new endeavor, but recent advances in conventional laparoscopic techniques and instrumentation has made SILS more feasible and safer for patients. Within a short span of time there has been an increase in the number of studies and clinical reports depicting the use of SILS in gynecology. As this novel field moves forward, a review of its evolution and current status is requisite. The objective of this article is to review the contemporary literature on SILS in gynecology and the recent advances in techniques and instrumentation used in SILS. The ongoing refinement of surgical techniques and instrumentation has resulted in increasing use of SILS across many subspecialties. Recently published studies have proven the feasibility, safety, and reproducibility of SILS in various gynecologic procedures.

26/09/2015

Laparoscopic Cholecystectomy

What is Laparoscopic Cholecystectomy?

Cholecystectomy is a surgical procedure to remove the gallbladder. The gall bladder is a pear-shaped organ that sits just below your liver on the right side of the abdomen. The gallbladder collects and stores bile which is a digestive fluid produced in the liver.
Why is it done?

Stones in the Gall Blader
Cyst in the Gall Bladder
Pancreatitis (inflammation of the Pancreas)
Cholecystitis (inflammation of gall bladder)
Carcinoma of Gall Bladder
What is done during the surgery?

Laparoscopic cholecystectomy is a common surgery, and carries only a small risk of complications. Laparoscopic cholecystectomy is most commonly performed by inserting a tiny video camera and special surgical tools through four small incisions to see inside your abdomen and remove the gallbladder. Doctors call this laparoscopic cholecystectomy. In some cases, one large incision may be used to remove the gallbladder. This is called an open cholecystectomy.

15/09/2015

Best Laparoscopic Bariatric Surgery (weight loss surgery) Hostpital in Delhi.
Bariatric surgery (weight loss surgery) includes a variety of procedures performed in obese patients for reduction of weight. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy). Dr Nitin Jha is the best Laparoscopic Weight Loss Surgeon in Delhi

08/08/2015

Silc

30/07/2015

How is life after Bariatric surgery

All post bariatric surgery patients need to know that they will not be able to eat as much they used to because of their smaller stomach size. Their hunger is satisfied eating much less than before. However this should not be interpreted as becoming weak because on the contrary these people start leading a more active life as soon as they start losing weight and gaining confidence. The usual instructions for a healthy lifestyle of eating correctly (no sweets, colas, fried food) and moving more applies even after surgery.
All patients with band have to come for regular follow up to see that the band is in the right place and is not too tight or loose. One may need to adjust the band sometimes and may require removal too.
Patients who undergo gastric bypass however have to consume iron and vitamin B regularly and also need to be checked for the same periodically with some blood tests.

30/07/2015

FAQ’s

Single Incision Laparoscopic Surgery

What is Single Incision Laparoscopic Surgery?
Single Incision Laparoscopic Surgery is the latest significant technical advancement in the field of laparoscopic surgery. As the name suggests, the surgery is performed making a single cut. Usually, this cut is made at the navel or the belly-button.

Why Single Incision Laparoscopic Surgery?
Traditional Laparoscopic surgery is performed by makingmultiple incisions (ranging from 3mm to 12mm) which may result in visible scars. Single Incision Laparoscopic Surgeryhas been able to accomplish the same through a single 20 mm incision through the belly button. Thus, this advancement in laparoscopic surgery has the potential for no visible scar. As an extension, this may minimize the wound pain associated with the multiple incisions for entry used during traditional laparoscopic surgery. The main advantages include:
Minimal pain
Extremely short hospital stay
Quicker recovery
Lastly and most importantly, an almost invisible scar buried within the umbilicus

What are the benefits of this new surgery for the patient?
A single small incision is definitely preferred over multiple cuts. Pain is lesser and patients can get back to work earlier. The incision usually lies in the navel and is hardly visible after healing.

How is this surgery performed? What equipment is used in the process?
As the name suggests, the abdomen is entered through a single incision in the navel. Special ports are now available through which 2 to 3 trocars can be inserted. Also, there are special instruments that can be rotated at the end. These provide surgeons with maneuverability and optimal access to the target tissue through a single access point.

What is the cost of this surgery?
Specialised equipment required to perform surgery include special ports, rotating hand instruments. These equipments make the procedure more expensive. As more companies get involved in the instrumentation, the cost of instruments should come down.

Is it a day care surgery?
Yes. This procedure can be performed as a daycare procedure. This is possible depending on the nature of the illness for which the surgery is performed.

What kind of surgeries can be done?
It is being used for planned elective surgeries. As the surgeon’s skill level and experience increase over time, it may be used even for emergency surgeries.

Which patients can undergo surgery by this technique?
The criteria for patient selection are sim

30/07/2015

VARIOUS TYPES OF LAPAROSCOPIC SURGERY
Single incision laparoscopic cholecystectomy for gallstones
Single incision laparoscopic appendicectomy for appendicitis
Single incision laparoscopic oophorectomy (removal of ovaries)
Single incision laparoscopic ovarian cystectomy (removal of ovarian cyst)

Visit www.drnitinjha.webs.com for more information

Dr. Nitin Jha is a Surgeon with expertise in Laparoscopic Surgery. He has achieved fellowship in minimally invasive surgery and takes special interest in Bariatric Surgery. Performing Gastro-intestinal and Hepato - Biliary Surgeries are an important aspect of his work.