Dysphagia or difficulty in swallowing is another common complaint often seen in gastroenetrological practice. It can be very mild and transient but it can be severe and persistent. Odynophagia is painful swallowing.

Transient dysphagia is often seen in throat disorders like tonsillitis and pharyngitis but these conditions may also have odynophagia, fever, redness of throat , hoarseness at times and fairly easy to diagnose and treat and a ENT consult is necessary.

Commonest cause of dysphagia is reflux esophagitis. This is a condition associated with heartburn where contents of the stomach and acid regurgitates back into the food pipe due to a faulty valve between the food pipe and stomach. This is usually transient and settles down with postural treatment and drugs.

Another group of disorders of the food pipe called the motility disorders can also cause dysphagia, some of them of a severe variety called the achalsia of the cardia. These are diagnosed by the esopgaeal manometry and respond well to medication .Some of them like achalsia may require surgery.

The most dreaded condition causing dyasphagia is cancer of the food pipe, fairly frequent in India especially among smokers and this will require advanced tests, surgery and maybe chemotherapy or radiotherapy .

So dysphagia is yet another important digestive symptom which should not be ignored and will require a specialist consultation and endoscopy if persistent.

Dr.Patta Radhakrishna
Surgical Gastroenterologist

Paasage of a few drops per rectum is a very common symptom. people do not get alarmed seeing blood in the toilet pan as much as they do when they see blood in the wash basin. But the problem is not that simple.

Majority of the times a few drops of blood in the toilet is not a grave thing to worry about. But this symptom shouldnt be ignored either.

The commonest cause of bleeding per rectum is piles(haemorrhoids) or fissure in ano. The difference between these two is quite obvious. If there is pain while passing motion it is quite often a fissure causing the trouble. Piles do not generally pain. A small skin tag which is felt at the anus is generally mistaken for piles . This tag is called the sentinel pile seen in pts with fissure in ano.
Rare causes of bleeding per rectum may be ulcerative colitis, non-specific colitis and rarely cancer of the rectum.
Most of the piles and fissures do not require any active treatment. If the problem is very persistent and troublesome surgery becomes necessary which is a fairly simple one. One should avoid getting theirs anal problems by quacks and self styled medical men.

Cancer of rectum should always be ruled out in every patient with bleeding per rectum and hence this symptom should not be ignored and allopathy is the ideal choice of treament

Vomiting of blood called as haemetemsis in medical jargon is different from Haemoptysis - coughing out blood. Quite often patients cannot differentiate between the two and undergo un-necessary investgations. Rarely bleeding gums may confuse the issue.

Haemetemesis is a serious complaint. Although 90 out of 100 patients with haemetemsis may settle down without any active treatment, all patients with haemetemesis need to see a doctor and get investigated.

A bleeding ulcer in the stomach is the commonest cause of upper GI bleeding. Ulcer disease or ulcers caused by swallowing pain killers maybe the cause. When bleeding is due to liver disease it can grave.

Rarely bleeding can be so massive requiring hospitalisation, blood transfusions, endoscopy and treatment. Very rarely life-saving emergency operation may be required to stop the bleeding.

So vomiting of blood is an ominous symptom and should never be ignored and is mandatory to see a gastroenterologist at the earliest.

Hernia is an abnormal protrusion of intra-abdominal contents through the abdominal wall due to thinning or weakening of a particular region. Herniae in the groin are very common. These groin herniae can occur in any person without a reason but chronic cough, constipation, prostatic enlargement or lifting of heavy weights can pre-dispose to this condition.
Hernia can cause pain and sometime intestines can get caught in them necessitating emergency surgery.
These can be seen in infants and children too. All herniae will require surgical treatment whic is usually done by laparoscopic method with minimal pain.
Ventral hernia or incisional hernia is a hernia arising from a defect at a previously operated area which also will require laproscopic repair using a synthetic wire net.
Umbilical hernia is in the region of umbilicus which at times can cause trouble.
In summary all herniae require surgical treatment before they cause complications.

Hernia disease is now generally known to common people just as appendicitis is known. When a bulge or swelling appears in the groin, every body knows that it is hernia. So bulge or swelling due to any other disease might be mistaken as hernia bulge. Like wise, hernia occurs only in the groin is also a misconception. It can occur any where inside the body as well as visibly out side the body. The hernias which are visible on the surface of the body mainly occur on the abdomen.
When any organ of our body or part of it leaves its original place and enters into other cavity through a defect or hole, it forms a hernia sac. This sac becomes visible on the abdomen when intestines enter in to it on coughing. This bulge seen on the abdomen is called as hernia. It is seen in nearly 1-1.5% of our people but this incidence is higher (2-3%) in the western countries and Africa. Abdominal wall hernias are given different names depending on the area where they arise. Inguinal hernia, umbilical hernia, epigastric hernia, lumbar hernia, spigelion hernia etc. are some of such hernias that are seen on the abdominal wall. Hernias can occur inside the body also that are not visible outside. Diaphragmatic hernia is an example of this.
Why hernia forms? Every body naturally wants to know as to why at all hernia forms in their body or on abdomen. What are the reasons? Weakness of the abdominal wall muscle cover at some place or spot is the main reason. Then if by any reason say like coughing or straining while passing stools or urine, intra-abdominal pressure rises and the result is the hernia formation through the weak spot. Chronic cough as seen in asthmatic patients, job of lifting heavy weights, constipation, obstruction in passing urine due to enlarged prostate are some of the important reasons that precipitates the hernia formation in the groin or at some other place on abdomen. Stretching of muscles as seen in pregnancy or ascitis can also result in hernia formation. These reasons are not seen in children; still they are affected with hernia due to pre formed hernia sac.
What are the symptoms: A soft swelling appearing in the groin that increases in size after coughing and disappears after lying down or during sleep then you can think that it is groin hernia. This groin swelling is small betel nut size in the beginning but later if kept untreated goes on increasing and enters in the scrotum also. Initially, this bulge can be pushed inside the abdomen but later it becomes impossible to push them back because intestines get adherent to the hernia sac. There is no pain in this hernia swelling. That is the main reason why people are not serious about its early treatment. In general, pain in hernia is to be understood as an alarming symptom. It occurs whenever this hernia gets obstructed and you can not push intestines back or when hernia gets strangulated, a serious condition. Blood supply to the intestines gets cut off and they start dying inside the hernia sac during the process of strangulation. Patient does not allow touching the hernia swelling because it becomes painful and tender. Some times, intestines get perforated inside the sac and peritonitis takes place. Patient starts vomiting, there is abdominal distension and general condition of the patient deteriorates fast. This is a life threatening emergency and needs to be operated immediately to save the life of the patient. Therefore, it is advised that hernia should be treated as early as possible and not to wait till it starts paining.
Examination & treatment: Examination of hernia gives an idea about the type of hernia and whether there are any complications developed in it. What type of organ e.g. intestines or omentum has entered the hernia sac is also judged. Then general examination is done to find out whether patient is having any systemic disease like bronchitis, hypertension, heart disease, enlarged prostate etc. Some blood tests, x-ray chest or ECG. is done to find out whether patient is fit to undergo surgery. If there are some serious complications developed in hernia and patient needs urgent surgery to save his life then patient can be taken for surgery without doing these tests also. Just as a torn shirt needs stitching to repair it, similarly this torn shirt of abdominal muscles also need proper stitching to repair the hernia. First of all the hernia sac is separated from other tissues and it is excised. Second part of the operation is to stitch the hernia hole to prevent hernia formation again. This is called as herniorrhaphy or hernioplasty. Therefore, do not believe if some body assures you that hernia can be cured without surgery and with medicines or some other means. Many times patients are advised to do exercises so as to strengthen the muscles and cure the hernia. It is absolutely wrong to do exercises when there is hernia because every exercise increases the intra-abdominal pressure and that tends to increase the size of hernia. Some times advice of using a hernia truss is given to avoid the surgery. This hernia truss or hernia belt is fitted on the hernia hole in an attempt to prevent it from coming outside. This is not cure to the hernia. At the most you can postpone surgery for some time by using it. But now surgeons clearly advise not to use truss in any situation because of its complications. Hernia belt slips from the hernia hole due to movements and the intestines can get obstructed easily giving rise to a dangerous situation of obstruction or strangulation.
Hernia operation is done by stitching a piece of synthetic cloth called as mesh on the hernia hole. Polypropylene, polyethylene, prolene, Dacron, Teflon is such synthetic chemical thread from which mesh is prepared. This mesh is imported and costly also. Therefore, at many places a low quality mesh is used to save on the cost. This increases the chances of hernia reappearing or getting infected. Recurrence, infection, pain, mesh migration are some of the well documented complications associated with this mesh repair because mesh is a synthetic cloth and a foreign body. Re-operation is the only remedy to treat those complications and this re-surgery is very difficult, complicated and commanding even in the hands of expert surgeons because mesh causes extensive damage to the nearby tissues and fibrosis. Techniques older than this are now discarded because they all had unacceptable rate of surgery failures.
A new technique- “Dr. Desarda repair”: A search to find out some operation technique that
does not use mesh and gives excellent results was going on through out the world. Desarda repair introduced in the market in year 2001 became immediately popular because it gives what you want and that too without use of any foreign body like mesh. This operation is done by taking a cut on the skin. It is simple and does not require any foreign body like mesh or any complicated instruments like endoscopes. A strip of a nearby muscle is separated and stitched on the weak spot to cover the hernia hole. There is no foreign body like mesh or no endoscopes are required therefore, this operation is free from all complications and risks that are associated with the mesh or laparoscopic repair. There is no tension on the stitches or muscles as seen in Bassini-Shouldice operation. Therefore, there are no complications and risks that are associated with the Bassini- Shouldice operation. Hernia hole is covered by a strong muscle. Therefore, protection starts on the operation table itself. Patient is admitted in the morning and immediately taken for surgery after preparation. Operation is done under local or spinal anaesthesia. No general anaesthesia is required. Operation is completed in 30 minutes and patient is back on his feet as soon as anaesthesia effect is gone. Patient goes to bathroom on his own within couple of hours and moves freely in the wards afterwards and goes home same day night or next day morning. Patients are allowed to drive car and go to office, bend, squat, climb up the staircase or carry luggage and travel. All foreign patients coming to Indian Hernia Institute go back to their country on third day carrying their luggage and a journey of 20-22 hours without any difficulty. The most important quality of this operation is that there is virtually no recurrence or pain. This operation is spreading rapidly around the globe and today it is being followed in many countries.

Interested patients and doctors can contact Dr. Desarda on his mobile no. 0091 (0)9373322178 or log on to his website http://desarda.webs.com or http://herniasurgery.tripod.com