Often female patients come with belly button pain or pain around belly button. There are many causes. Commonest cause is muscle stretching. In India its generally common in females because of multiple pregnancies, obesity, poor muscle tone & lifting heavy weight. The navel gets so stretched that it starts to tear and the contents which are suppose to be inside start protruding out. The belly button everts & protrudes out This is called herniation. Often due to obesity this protrusion is not recognized and the patients continues to experience pain and not realize the swelling in the belly button. Gradually these small defects grow to bigger defects. Most of these muscle defects in and around the navel can be repaired laparoscopically. Its a short procedure. The defect if very small can simply be closed by few stitches A synthetic material (mesh) is often used to reinforce the repair. This minimizes the chance of recurrence. So please report to your doctor if you experience a belly button or navel pain. One easy was to check if you are developing a hernia is by placing your tip of finger on your belly and coughing in standing position. If there is an expansile impulse or feeling that something is protruding out, there are chances that you may be developing an umbilical hernia. Report to your doctor. If diagnosed early, it can be repaired very easily. To prevent such umbilical (paraumbilical) hernia avoid lifting very heavy weights, do regular exercises especially after delivery and avoid obesity.

What is a PEG?
PEG stands for percutaneous endoscopic gastrostomy, a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach. PEG allows nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and esophagus. This brochure will give you a basic understanding of the procedure – how it's performed, how it can help, and what side effects you might experience.
How is the PEG performed?
Dr. B C Shah will use a lighted flexible tube called an endoscope to guide the creation of a small opening through the skin of the upper abdomen and directly into the stomach. This procedure allows him to place and secure a feeding tube into the stomach. Patients generally receive an intravenous sedative and local anesthesia, and an antibiotic is given by vein prior to the procedure. Patients can usually go home the day of the procedure or the next day.
Who can benefit from a PEG?
Patients who have difficulty swallowing, problems with their appetite or an inability to take adequate nutrition through the mouth can benefit from this procedure.
How should I care for the PEG tube?
A dressing will be placed on the PEG site following the procedure. This dressing is usually removed after one or two days. After that you should clean the site once a day with diluted soap and water and keep the site dry between cleansings. No special dressing or covering is needed.
How are feedings given? Can I still eat and drink?
Specialized liquid nutrition, as well as fluids, are given through the PEG tube. If the PEG tube is placed because of swallowing difficulty (e.g., after a stroke), there will still be restrictions on oral intake. Although a few PEG patients may continue to eat or drink after the procedure, this is a very important issue to discuss with your physician.
Are there complications from PEG placement?
Complications can occur with the PEG placement. Possible complications include pain at the PEG site, leakage of stomach contents around the tube site, and dislodgment or malfunction of the tube. Possible complications include infection of the PEG site, aspiration (inhalation of gastric contents into the lungs), bleeding and perforation (an unwanted hole in the bowel wall). Dr. B C Shah can describe for you symptoms that could indicate a possible complication.
How long do these tubes last? How are they removed?
PEG tubes can last for months or years. However, because they can break down or become clogged over extended periods of time, they might need to be replaced. Dr. B C Shah can easily remove or replace a tube without sedatives or anesthesia, although Dr. B C Shah might opt to use sedation and endoscopy in some cases. Dr. B C Shah will remove the tube using firm traction and will either insert a new tube or let the opening close if no replacement is needed. PEG sites close quickly once the tube is removed, so accidental dislodgment requires immediate attention.

WHAT IS A HYDROCELE, A SPERMATOCELE, AND AN EPIDIDYMAL CYST?
A hydrocele is an abnormal fluid collection between the outer tissue layers of the testicle. These tissue layers naturally secrete fluid and when this fluid is not reabsorbed, as it usually would be, a fluid collection or hydrocele forms. The cause of most hydroceles is unknown, although some may be related to trauma, infection, or past surgery.
A spermatocele is a cyst-like sac that is usually attached to the epididymis, the tube that sits behind the testicle and stores sperm. The sac of a spermatocele is filled with sperm. The exact cause of a spermatocele is unknown but it is thought that injury and obstruction may play a part in their formation.
An epididymal cyst is much the same as a spermatocele. However, the sac attached to the epididymis is a true cyst and is filled with cystic fluid and not sperm.
WHAT IS A HYDROCELECTOMY, SPERMATOCELECTOMY AND AN EPIDIDYMAL CYSTECTOMY?
A hydrocelectomy is an operation to treat a hydrocele. An incision is made in the scrotum and the testicle containing the hydrocele is lifted out. The sac is then removed and the remaining tissue edges are stitched back. The tissue edges then heal onto themselves and the surrounding vessels naturally reabsorb any fluid produced.
A spermatocelectomy is an operation to remove a spermatocele from the epididymis of a testicle. An incision is made in the scrotum and the testicle with its attached spermatocele is lifted out. The spermatocele is then removed from the epididymis and any bleeding areas are sealed off.
An epididymal cystectomy is an operation to remove the cyst from the epididymis. The operation is performed in exactly the same way as a spermatocelectomy.
After all three types of surgery, once the operation is complete, the wounds are stitched closed with dissolving stitches that dissolve slowing in the weeks following surgery. No wound drains are usually required.
Hydrocelectomy, spermatocelectomy and epididymal cystectomy are usually not performed unless the hydrocele, spermatocele or epididymal cyst are causing pain or social embarrassment. All three operations are usually simple day stay procedures and complications are rare. Haematoma (blood clot collection), wound infection, abscess, and recurrence, are all very uncommon complications and success rates for surgery usually approach 100%.
YOUR CONSENT
We need your permission for your operation to go ahead. Before you sign the consent form it is important that you understand the risks and effects of the operation and anaesthetic. These will be discussed with you by Dr. B C Shah and the nurse, should you have any questions, Dr.B C Shah would be happy to answer these.
If you would like any testicle tissue returned to you for personal reasons, please discuss this with your family and inform Dr. B C Shah before your operation.
ABOUT YOUR ANAESTHETIC
You will NOT be allowed to eat or drink anything for at least six hours before your surgery. This includes chewing gum and sweets.
Before your operation you will be able to discuss the type of anaesthetic with your anaesthetist, who will see you prior to your operation.
There are two main types of anaesthetic used for this surgery; • General Anaesthetic: You will be asleep throughout the operation and remember nothing of it.
Regional Anaesthetic e.g. Spinal, Epidural or Caudal: A needle is placed into your back and a solution is injected that will numb your body from the waist down. You will be awake but you maybe sleepy and you will not feel the operation.
Feel free to discuss these options and your questions with the anaesthetist.
You must not drive any vehicle or operate any machinery for 24 hours after having an anaesthetic. You will have to arrange for someone to drive you home if you go home within 24 hours of your surgery.
YOUR OPERATION
On admission you will be informed of your approximate time of surgery and prepared for theatre by your nurse.
Any shave of the surgical site is done in theatre once you are asleep.
You may be given some tablets before theatre. These are charted by your anaesthetist and may include tablets for tension, nausea and pain prevention.
You will be escorted to theatre where you will be transferred to the theatre table. Anaesthetic staff will then insert a drip in your arm and will attach various monitoring devices.
Once you have been completely prepared and given your anaesthetic, surgery will begin. The operation usually takes about 30 minutes to perform.
When the operation is completed you will go to the recovery room for a short while where you will be cared for until you are ready to be transferred to the ward.
AFTER SURGERY
Dr. B C Shah will check your blood pressure, pulse and your wound routinely.
You may still have the drip in your arm so you get enough fluid until you are drinking. You can usually eat and drink when you return to the ward.
You may have a scrotal support in place, which is a special pair of underpants that support the scrotum. These underpants help prevent bleeding and keep you comfortable.
Once you have recovered from your anaesthetic you will be able to be up and about, but you must take things very quietly in order to avoid causing any bleeding or bruising at the operation site.
Our aim is to keep you as comfortable as possible, so please tell Dr. B C shah if you have any pain or discomfort so you can be given the appropriate care. At all times, your nurse is there to help you, please ring your bell if you need assistance and your nurse is not nearby.
GOING HOME
Once you are up and about, eating and drinking and you have passed urine you will be able to return home. This may be later on your operation day or the following morning.
Before leaving the ward you will be given a discharge information letter which contains helpful information for when you get home.
Dr. B C Shah will give specific instructions about caring for your wound. You can shower daily to wash your wound but avoid soap and powders directly on the wound until it has healed. The area should be kept clean and dry and you will be given some dressings to take home that are to be placed over the wound to collect any slight ooze.
You will be given appointment to return to see Dr.B C Shah. The appointment is usually about 6 weeks after your operation.
ONCE HOME
If you were a daystay patient, it is important to take things quietly for the rest of the day as the anaesthetic can still have some effects on your body.
You should wear your scrotal support or your own supportive underpants for as long as you need for comfort after your surgery.
Your wound should heal within about 3 to 5 days. During this time your wound may ooze very slightly. However, if your wound continues to ooze or you have any signs of an infection such as a red, hot, swollen, or painful wound please contact Dr. B C Shah as soon as possible.
You should avoid any heavy lifting, straining or strenuous activity for 2 to 3 weeks after your surgery. This includes things such as any digging and strenuous sports as these activities can cause the stitches below the skin to pull apart.
Before discharge Dr. B C Shah will inform you about taking mild pain relievers, should you have any pain or discomfort after you return home.
This is routinely a straightforward operation, after which most patients have a speedy recovery and experience little pain.
While you are in hospital we will do everything we can to make your stay as comfortable as possible. The nursing and medical staff are always available to help with whatever needs you have. If you are worried about anything before or after your surgery, or if you have any further questions or would like more information, please do not hesitate to ask Dr. B C Shah who will be more than happy to help.