Peshant House Hospital

1.Our hospital has got all the facilities to treat the paediatric patients from day 0 to 12 years. 2.WE have got affiliated neonatal intensive care unit and paediatric critical care unit, taking care of all the neonatal and paediatric patient. 3.We have got round the clock availability of paediatrician to take care of new born babies and all the emergencies. 4.We take care of all out patients, treat all neonatal and paediatric minor illness. 5.We give all the vaccines on daily basis with strict maintenance of cold chain. 6.We got child friendly nursing staff, who are expert in taking care of paediatric patients. 7.We take care of chronic paediatric diseases like paediatric asthma, epilepsy, nephritic syndrome etc.

1.Our hospital has all comfort and care for females who are now going to enter new phase of their lives. 2.We provide all antenatal care and suggestion including diet, exercise and medication during pregnancy. 3.We have experienced gynaecologist along with  her well trained and well behaved paramedical staff to take care. 4.Our staff regarding obstetric and gynaec patients are strictly only female. 5.We have separate labour room and post labour ward, ultrasonography, Foetal Doppler, post operative care unit for obstetric patients. 6.We have all facilities for gynaec diseases like ovarian cyst, uterine fibroid, adenomyotic uterus, uterine cancers, ovarian cancers,....etc. 7.We are doing routine laparoscopic surgeries like total laparoscopic hysterectomy, laparoscopic myomectomy..etc.. 8.For all gynec cancer diseases, well experienced oncho surgeon is associated with our hospital... 9.We are also providing care and guidance to girls with diseases like prementual syndrome, menorrhagia, irregular menses etc.

1. We are providing state of art facilities in field of proctology diseases like piles, fissure, fistula.... 2. Our aim is....If we are using all modern techniques and advance technology for treatment of other areas like...Heart, kidney...why not for anorectal disease? 3. We are having videoectoscope for first time in Gujarat. 4. We have all advance surgery in field of benign proctology... 5. Piles : Tran anal circular anopexy - painless surgery for grade 3 and grade 4 piles 6. Fissure: Lateral anal sphincterolysis – Minimum invasive surgery for fissure – no fear for post operative incontinence – day care procedure for fissure. 7. Fistula: LIFT surgery for long and complicated fistula - smooth and fast recovery – minimum post operative pain – early return to work – no dressing 8 .Radio frequency: We are using radio surgery (also known as lazer) by which all dissection done - This energy source causes minimum post operative pain. 9. Videoectoscope: First time in Gujarat available in our hospital – visualise anorectal problems on screen so patient also can have complete information about their diseases. 10. In addition to above, our hospital has many more advance techniques for treatment and diagnosis of anorectal diseases like....piles, fissure, fistula under one roof by well experienced surgeon.

1. Today, when everybody is living in jet arena, where duration is decreased...whether it is about journey or about treatment. 2. Routine surgeries with long incisions take long post operative recovery time. It will keep you or your beloved away from professional life which means financial and other loss. 3. Laparoscopy surgery is answer to all above confusion and loss – We have advanced laparoscopic abdominal surgery unit in our hospital. 4. It includes stryker three chip H.D. camera, 36 inch medical monitor, high flow co2 insufflators with warmer, made in Germany hand instruments for laparoscopic surgery. 5. We have J&J ensealer tissue dissection energy source for advance laparoscopy. 6. With all above advance technology we are performing laparoscopy like appendicetomy, cholycystectomy, inguinal hernia repair, ventral hernia repair, adhenolysis and many more....

What is shincterolysis?

In this procedure with help of instrument known as anotome, spastic muscle fibres of internal sphincter are broken at 3 o clock position with thumb pressure. Thus pain less, scar less procedure done for fissure in ano.

Why it is useful in chronic fissure?

In chronic fissure due constant trauma to fissure bad and spam internal sphincter muscles develops spasticity. Because of increased spasm, resting  tone of canal is increased. Due to this vascularity decrease in fissure bed and this further cause non healing of fissure ulcer. So by this procedure resting tone is decreased and vascularity is increased. This will further help healing of fissure ulcer.

How it is superior then other procedure?

Other procedures for chronic fissure are....

1)...Lord's dilatation

• Four finger dilation (not more than 4 cm diameter) rather than six finger
• Disadvantage of this method is then due to uncontrolled dilatation also cause stretching of external sphincter muscle → can cause partial or complete incontinence

2)...Sphincterotomy

• Surgical cutting of internal sphincter muscle either by open method  or close method
• Disadvantage
• Sometimes causes  severe bleeding during procedure
• Post op wound infection may lead to abscess

Rectal prolapse occurs when part of the large intestine's lowest section (rectum) slips outside the muscular opening at the end of the digestive tract (anus). The prolapsed rectum can cause fecal incontinence. Surgery is usually needed to treat rectal prolapse.

causes

• Chronic constipation or chronic diarrhea chronic constipation defined as infrequent stools or severe straining is present in over 30-67% of patients and an additional 15% experience diarrhea.^2,3,4 .
• Long-term history of straining during bowel movements.
• Older age...Woman  aged 50 and older are six times as likely as men to present with rectal prolapse. The peak age of incidence is the seventh decade in women, whereas the relatively few men afflicted with the problem may develop prolapse at the age of 40 or less. .
• Weakening of the  sphincter. ...
• Prior injury to the or pelvic areas either accidental or due to previous surgery like for piles or fistula...

Damage to nerves. . Pudendal nerve damage can result from direct trauma (obstetric injury), chronic diseases such as diabetes, from neoplastic processes causing sacral nerve root damage, and from back injury or surgery...

• Other diseases, conditions, and infections.

  Rectal Prolapse Symptoms

The symptoms of a prolapsed rectum are similar to those of hemorrhoids; however, rectal prolapse originates higher in the body than hemorrhoids do. A person with a prolapsed rectum may feel tissue protruding from the anus and experience the following symptoms:

• Pain during bowel movements
• Mucus or blood discharge from the protruding tissue
• Fecal incontinence (inability to control bowel movements)
• Loss of urge to defecate (mostly with larger prolapses)
• Awareness of something protruding upon wiping

.

Difference between prolapse and hemorrhoids

A common pitfall in the diagnosis of rectal prolapse is the potential for confusion with prolapsed incarcerated internal hemorrhoids Prolapsed, incarcerated hemorrhoids produce extreme pain. and can be accompanied by fever and urinary retention.

Unless incarcerated, rectal prolapse is easily reducible and painless.

Investigation

In case of rectal prolapse it is very much of clinical diagnosis. But it shouls always necessory to look out for other patholpgy that may be cause for this

Proctoscopy/sigmoidoscopy/colonoscopy

These may reveal congestion and edema (swelling) of the distal rectal mucosa, and in 10-15% of cases there may be a solitary rectal ulcer on the anterior rectal wall. Localized inflammation or ulceration can be biopsied, and may lead to a diagnosis of SRUS or colitis cystica profunda. Rarely, a neoplasm (tumour) may form on the leading edge of the intussusceptum. In addition, patients are frequently elderly and therefore have increased incidence of colorectal cancer. Full length colonoscopy is usually carried out in adults prior to any surgical intervention These investigations may be used with contrast media (barium enema) which may show the associated mucosal abnormalities

Videodefecography

This investigation is used to diagnose internal intussusception, or demonstrate a suspected external prolapse that could not be produced during the examination. It is usually not necessary with obvious external rectal prolapse. Defecographymay demonstrate associated conditions like cystocele, vaginal vault prolapse or enterocele.

What is drawback of routine piles surgery?

When patient come to know that he/she is suffering from piles disease and need surgery, next thing come to mind is post operative status in which there is too much pain, have to avoid sitting, frequent visits to clinic for painful dressing, may suffer from inability to hold stool or air...and many more..

1. Haemorrhoidectomy...

In this conventional surgery enlarged piles are excised and leaves painful wound needs many days to heal along with other difficulties mentioned as above...

1. Stapler surgery....

In this surgery strip of mucosa removed from rectum so prolapsed piles pulled up to fit in defect created by mucosa excision. This is as such painless surgery but carried high risk of surgical complication like wound dehiscence which leads to massive blood loss and can create life threatening condition. It also carries high risk of recurrence. More over its application is banned in some countries like U.S.A...

3)... DGHL(Doppler guided surgery)

In this surgery blood vessels supplying blood to piles are identified and ligated. But this surgery has high recurrence rate because all blood vessels cannot ligated as tiny vessels escaped. More over it also not taking proper care for prolapsed.

What is newer painless piles surgery?

In this surgery two sutures line taken in rectum to fix prolapsed piles mucosa at its original place and to occlude blood supply to pile. As surgery is done in painless area so it is painless surgery and no need to cut piles so leaves no wound requiring dressing. This wound less surgery also gives advantage to continue your routine work from very next day as sitting is possible from very next day.