Dr. Navin Goyal

General Surgery

The Department of General Surgery provides surgical interventions that focus on the endocrine system, gastrointestinal tract, liver, colon, and other major parts of the human body. Some of the common procedures include appendix, gallbladder removals, colonoscopies, thyroidectomies, hernia and bariatric surgeries. The Department also offers proper management to the patients suffering from diseases involving skin, soft-tissue, breast, hernia, and trauma. The department of General Surgery at Magnus provides its patients with the services employing cutting-edge surgical care. The department also specializes in Laparoscopic (also known as key-hole surgery or minimally invasive surgery), which helps in providing patients with a variety of treatments in the fields of gynecology, gastroenterology and urology. Using such advanced techniques helps in the speedy recovery of the patients with minimal amount of tissue damage, minimal blood loss, reduced risk of developing infection and hence, minimal pain and discomfort. The general surgery team has its expertise in providing complete patient safety and satisfaction by using all the latest diagnosing and surgical techniques.

Hernia Surgery

The department of general surgery or Gastroenterology deals with the hernia surgeries and its management. Hernia is a condition where a person's contents of the body cavity protrude out from where they were contained normally. Hernia can be further categorized into the following types:

Inguinal Hernia
Ventral hernias
Hiatal hernias
Incisional hernias
Umbilical hernia
Femoral hernia
Spigelian hernia
Epigastric hernia
Obturator hernia
Diaphragmatic hernia

The team of surgeons specializes in treating all types of hernia with utmost precision and quality care. The department also offers diagnostic services by physical examination or CT (CAT) scan for accurate assessment of the type of hernia. Magnus provides all the latest and advanced techniques to perform hernia surgeries. This surgery can either be performed as a Open Surgical Repair and or as a Laparoscopic Surgery. The skilled approach of the team advises the best treatment options for the patients according to their condition. The team ensures a proper post-operative quality care to the patient by keeping the patient under continuous monitoring until complete recovery. The department also makes sure about delivering the medications to the patient on time and providing every possible support required for a speedy recovery.

Laparoscopic Surgery

The Laparoscopic Surgery Department is well equipped with all the advanced technology and excellent infrastructure, and is supported by a skilled team of surgeons, trained technical staff and nurses. The department specializes in performing a variety of major surgeries involving breast, uterus, skin, soft tissues, abdomen and hernia. Laparoscopic surgery is also known as minimally invasive surgery or a key-hole surgery. Laparoscopic surgeries are widely performed in the fields like gastroenterology, gynecology and urology. Patients receive accurate diagnosis and assessment, latest treatment techniques along with medications, clinical post-operative care and regular follow-ups specially until complete recovery. The benefits of laparoscopic technique over traditional open surgery include shorter length of hospital stay and speedy recovery time, lesser pain, minimal tissue trauma and bleeding after the operation, and reduced scarring. The team of surgeons are experts in performing variety of laparoscopic surgeries with great precision, and offering quality services and utmost care.

Hemorrhoidal is plexus is normal anatomical part of anal anatomical part of anal canal. There are 3 hemorrhoid plexus in the right anterior right posterior, left lateral. They are useful for anal canal physiology especially on the time of defecation. They have two useful function. First for protection of anal canal mucosa second for anal continence. At rest by complete closure of anal canal.

The complains are, bleeding, nodule, soilage, itching, pain, pruritis, and symptomatic prolaps. Relaxation of fibro are connective tissues that fixed hemorrhoid to the anal canal make descending of hemorrhoid and results tortucity of hemorrhoidal plexus.

There are three types of Hemorrhoids:

Internal:

2) External:

3) Mixed Internal Hemorrhoid:

Internal hemorrhoid: Internal hemorrhoids are divided to 4 degree.

First degree bulge into the anal canal prolaps beyond the dentate line on straining

Second degree pro-laps through the anus and reduces pontaneous

Third degree prolaps through the anal canal and require manually reduction

Fourth: degree bleed, prolapse but cannot reduce and are at risk of strangulation.

There are many treatments for hemorrhoids

Bandligation
Electrocoagulation,
Stapled hemorrhoidpexy
Infrared Laser
Photocoagulation
Sclerothereapy,
Doppler guided artery ligation

There are many types of laser, like gas laser chemical ,laser-metal vapor, solid, scotch semiconductor, and etc. there are two types of medical laser system contact and non contact. Contact systems work by sending laser light through a fiber or sapphire crystal tip. The tip absorbs the radiant energy and becomes hot. Direct contact between tissue and the heated tip cause conduction of heat energy from the tip to tissue, resulting the vaporization of the target cells. Diode laser is the direct contact laser. We are searching for a new technique for treatment of hemorrhoids that satisfy the patient. As there is limited research in the using of diode laser for treatment of hemorrhoid we aim to use diode laser in our patients and evaluate side effect and recurrence for one year.

Diode 30 W laser with 1480 nm wave length was used for this procedure. Then make a pinhole by spot laser at anal verge near the hemorrhoid base then push diode laser fiber from it into hemorrhoid submucosaly, then start shooting laser. Before laser shooting we must wear anti laser glasses. each shoot has 15 watt energy 3 sec duration. for small hemorrhoids (one centimeter diameter) one shoot and for large hemorrhoids several shoots is needed. we see that the hemorrhoid shrink and is to be small. There after we with- draw the fiber from it. Then can repeat this arrange work for each hemorrhoid in another sites, so with this method all hemorrhoids treated in one stage. Patients discharged after 12-24 hrs. in the hospital stay need to analgesia was zero or very low.

Follow up are generally done 7 and 14 day of surgery. All method for treatment of hemorrhoid has advantages, disadvantages, limitations. And complications. But there is evidence that laser has less complication. In the study by Giamundo et al., they concluded the hemorrhoid laser procedure was more effective than rubber band ligation in reducing complication and improving quality of life following treatment. In their study, follow-up duration was < 1yr Follow-up duration was the main limitation in our study and Gia mundoet al study There is evidence that using Indocyanine

green (ICG) increase efficacy of diode laser, during 1 year of follow-up, no recurrence was seen.. All method for treatment of hemorrhoid has advantages, disadvantages, limitations. and complications. But there is evidence that laser has less complication.

Because of some complication like, hemor- rhage, recurrence, stricture especially in sur- gery, the diode laser is a good method for treatment of hemorrhoid because of less com- plication, low discomfort and pain after opera- tion, simple, less time of operation, low hospi- tal stay. We prefer laser diode in all patient with hemorrhoid especially patients with co- aguloapaty and disability, but may be expen- sive. With diode laser all hemorrhoid piles operated in one stage, but in surgery if hemor- rhoids are extended the operation is done in two stages because of stricture formation after one year. Diode laser has no limitation in op- eration in all ages and all stages of hemor- rhoids