Dr. R.K. Mishra Director and Chief Surgeon of Laparoscopy Hospital have removed a 20-kg retroperitoneal tumour occupying entire abdominal cavity.

Mr. Chandeshwar Prasad Rai is a police inspector in Jharkhand. Surprisingly he never suffered any pain. He visited a doctor only after friends commented that his abdomen was getting unusually big and he was loosing weight. He was having protruded abdomen and ultimately he could not walk also due to heavy weight of tumor. Initially he visited many doctors and was treated for tuberculosis. Later one of the renowned surgeon of Jharkhand has examined his and referred him to All India Institute of Medical Sciences.

Retroperitoneal Tumor

Surgeon of All India Institute of Medical Sciences has done all the necessary investigation and Biopsy was performed two times to confirm type of tumour. Even after that dilemma was there. Ultimately the called the patient on 20th May to decide for surgery. Meanwhile patient came to Dr. R.K. Mishra in his Laparoscopy Hospital, New Delhi. Dr. Mishra has performed surgery without delay and life of the patient was saved.
Mr. was admitted in the hospital on 26th April and, same day surgery was performed. It was a two-and-a-half-hour complicated surgery; the mass was successfully removed by a team of Dr. R.K. Mishra, Dr. Sanjay Sharma and Dr. Anil Arora.

“It was a complicated surgery considering his age and the fact that his haemoglobin count was low,” said Dr Mishra. “Also, the tumour was retroperitoneal and surrounding aorta and both the kidney.

‘It pushed everything aside and was pressing the aorta and kidney, creating vascular and respiratory problems,’ surgeon Dr. Mishra stated. ‘The operation was complicated by the size of the tumour and during this the patient received four packages of blood transfusion.’
Tumours of that size are almost always benign, but can kill by severing circulation or increasing pressure on sensitive parts of the body.

Retroperitoneal Tumor

“It was removed from the Retroperitoneum after separating the Kidney, Spleen, Large intestine, Aorta and Vena Cava. We also repaired the bowel and other surrounding structure,” said Dr. Mishra. “We will send the tumour to the histopathology to find out if it was cancerous.”

Honorable Dr. Akhilesh Prasad Singh, Union Minister, Government of India as chief guest and Prof. Dr. P.R. Trivedi as Guest of Honour of certification ceremony of 100th batch of Laparoscopy Hospital on 13th of September 2008

Speech of Honourable Minister on the occasion of celebration of 100 th batch of Laparoscopic Training Programme of Laparoscopy Hospital on 13 th Evening at India Habitat Centre, Casurina Hall.

“I am very happy to see the Galaxy of super specialist surgeons and gynaecologists who came here from different part of India and abroad - Dr.A.P.Singh.

Laparoscopic surgery is one of the fastest growing areas in surgery today. Combining advanced technology with patient care has allowed surgeons to do more advanced surgery with less trauma to patient. Patients are experiencing less pain, shorter hospital stays, and faster recovery times than were ever imaginable 20 years ago - Dr.A.P.Singh.

Laparoscopy was previously considered as surgery of rich people but in my opinion laparoscopic surgery should be available for every citizen of India specially the poor who earn their money by hard physical work and they need more rapid recovery then rich and affluent section of society - Dr.A.P.Singh.

I am happy to know from Dr. R. K. Mishra that today Laparoscopy Hospital is celebrating the convocation of their 100 th batch of laparoscopic training course. Within last 8 year 2500 surgeons and gynaecologists has been trained in art and science of laparoscopic surgery by laparoscopy hospital. Among these 2500 surgeons 1150 surgeon are from overseas country - Dr.A.P.Singh.

Prof. Dr. R.K. Mishra Presenting the Momento to Honorable Minister of Govt. of India. Dr. A.P. Singh

It is a hard fact that only rich and middle class people can afford Laparoscopic surgery. I am very happy to know that for the poor and needy, Laparoscopy Hospital provides once a month laparoscopic surgery completely free of cost. For these patients medicines are also dispensed absolutely free of charge. There is no charge attached to any service at our hospital for these categories of patients. T his free service is provided to economically disadvantaged people irrespective of race , colour, language, class , creed, religion or region. Laparoscopy Hospital is providing these services in collaboration with World Association of Laparoscopic Surgeons - Dr.A.P.Singh.

I wish all the surgeons and gynaecologist who are present here a great success in their professional life. Much work is being done by many organizations, particularly in private-public partnerships, to ensure that lives are saved and health improved worldwide and I request all the doctors present in this gathering also to serve the poor and needy with their advanced surgical skill - Dr.A.P.Singh.

“Skilled Surgeon Safer Surgery “

Two-port laparoscopic cholecystectomy has been reported to be safe and feasible. At laparoscopy hospital New Delhi we have performed 200 cases of laparoscopic cholecystectomy within 5 years. Fist two port laparoscopic cholecystectomy was performed by Dr. R.K. Mishra in November 2002 at Laparoscopy Hospital, New Delhi. Laparoscopic two port cholecystectomy offers additional advantages over four port cholecystectomy or not remains controversial. During five year time we compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Two-port laparoscopic cholecystectomy resulted in less port-site pain and similar clinical outcomes as four port cholecystectomy. Two port laparoscopic cholecystectomy also offer fewer surgical scars compared to four-port laparoscopic cholecystectomy. Thus, it can be recommended as a routine procedure in elective laparoscopic cholecystectomy.

We have sent this trial to get published in World Journal of Laparoscopic Surgery. We report a prospective randomized controlled trial that compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy. In many previous study of the world Laparoctor were used perform two port cholecysctectomy and retraction of gallbladder was done by the long grasping forceps through the operating telescope, whereas dissection was accomplished through the 5-mm subxyphoid port. Additional 5-mm sub costal ports was used when it was found necessary.

The cystic duct and cystic artery were clipped by a 5-mm multiple clip applicator in previous studies. In our study we have used specially designed Mishra knot to perform two port cholecystectomy. The detail of this technique of performing two port can be seen at http://www.laparoscopyhospital.com/two_port_cholecystectomy.htm . Most of our patients reported high satisfaction for the surgery of two port laparoscopic cholecystectomy and the surgical scars was very much satisfactory. Compared to four port cholecystectomy there was a higher observed satisfaction score for the two-port laparoscopic cholecystectomy group, although this did not reach statistical significance? In the era of laparoscopic surgery, less postoperative pain and early recovery are major goals in order to achieve better patient care and cost-effectiveness. Several studies demonstrated that less postoperative pain was associated with reduction in either size or number of ports.

To conclude, we demonstrated in this study that two-port laparoscopic cholecystectomy is safe and has similar clinical outcomes compared to the conventional four-port laparoscopic cholecystectomy in selective cases. Since two-port laparoscopic cholecystectomy has less surgical scars, it can be recommended as a routine technique.

Laparoscopic management of early ovarian cancer is safe and effective and survival outcome is acceptable. At Laparoscopy Hospital, New Delhi Laparoscopic management of malignant ovarian tumour was performed for a Nigerian patient on 30th of August 2008. This giant ovarian tumors can be safely removed laparoscopically only by experienced laparoscopic surgeons.  According to Prof. Dr. R.K. Mishra, Director, Laparoscopy Hospital, the laparoscopic removal of giant ovarian tumors in  patient’s is preferable to removal by laparotomy. Surgical procedures for these malignant tumors of the ovary can be performed by open surgery (laparotomy) or keyhole surgery (laparoscopy) techniques. Historically, open surgery has been used, but new keyhole surgery seems attractive in that it appears to require a shorter hospital stay and there is a quicker return to normal activities for women.

The patient Mrs. Benedette I. Nwoye-Okorie With her husband  came from Nigeria to laparoscopy Hospital, New Delhi to get operated for this disease. She was having raised CA 125 marker and deranged hormonal essay. The CT findings were also towards the malignant change. One of the big proglem in dealing with the big tumour size is extraction of the tissue which is extremely difficult. The good quality commercially available endo-bag is required to extract the tumour without the risk of metastasis. The use of morcellator is also not possible in these cases because of risk of metastasis in other part of body. For extraction of the tumour of this patient Lap disc was used. This a hand port used to prevent metastasis

The practice of laparoscopic surgery for ovarian tumour is associated with benefits and harms. The minimal access surgical management of ovarian tumours is similar to that of open surgery. The procedures include resection of the tumour (enucleation), removal of an ovary or ovaries (oophorectomy), or surgical excision of the fallopian tube and ovary (salpingo-oophorectomy). The procedure can be done by open surgery (laparotomy) or keyhole surgery (laparoscopy) technique. The benefits of laparoscopic surgery include shorter hospital stay, earlier return to normal activity, and reduced postoperative pain. However, conventional laparoscopic surgery techniques required the infusion of gas carbon dioxide in the peritoneum to distend the abdomen and displace the bowel upward to create the room for surgical manipulation. Serious complications such as abnormally high levels of carbon dioxide in the circulating blood (hypercarbia) and perforation of internal organs have also been reported. These serious complications may be harmful to the patients especially if she is terminally ill.

New Delhi, India (PRnine - August 4, 2008) - This was a unique case of Mrs. Narender Kaur age about 29 years, resident of Tilak Nagar New Delhi. She was suffering from secondary infertility because of the huge fibroid inside her uterus. The huge intramural fibroid was 25cms big and 2.8 Kg in weight. It was successfully removed laparoscopically at Laparoscopy Hospital, New Delhi. There was hardly any space in abdomen to operate the same through Laparoscopy and most of the institution has refused the case of Mrs. Narender Kaur. Her husband Sardar Kultar Singh was helpless. He contacted Prof. Dr. R.K. Mishra and requested him to perform surgery. The main challenge is surgery was the bad adhesion, small built of the patient and lack of working space inside the abdominal cavity.

Dr.R.K.Mishra accepted this complicated case as a challenge and her operation was performed at Laparoscopy hospital, New Delhi on 3rd August 2008. Surgery continues for 3 hour and it was a very successful surgery. All the family members of this young women were waiting outside the operation theatre just thinking that may be surgeon will remove the uterus if something goes wrong, but surgery was a big success and without opening the abdomen and without disturbing the anatomy of uterus this fibroid was successfully removed. It requires unique skill, lot of Intracorporeal suturing skill snd experience to perform this kind of surgery. The patient is resident of L2/47 New Mahavir Nagar, Tilak Nagar, New Delhi 110018. Still today patient does not believe that this miracle was done she is cured now. News reporters from all over Delhi are coming to Laparoscopy Hospital, New Delhi to see the patient and to see her morcellated uterus that how it was removed without harming the uterus.

This was a unique case where a fibroid was 25cms big. Usually fibroids are detected 4-6 cms in size and easily removed by laparoscopy. When it is 25 cms big & intramural there is hardly any space in abdomen to operate through laparoscopy. It requires unique skill, lot of experience and expertise, instruments and equipments, setup and complete team effort. Patient ‘s husband Sardar kultarr singh had searched on internet & communicated with many Laparoscopic surgeons all over world and found Laparoscopy hospital as only institute suitable for her patient.

The tumour was removed in multiple strips with help of a unique instrument known as morcellator from a 12 millimeter cut only. The weight of tumour was 2.6 kgs. Laparoscopy Hospital is new Delhi, India based Advanced Laparoscopic Training & Treatment Institute for Excellence for most of the Gynecological Endoscopic Surgeries. Prof. Dr. R.K. Mishra is world renowned master laparoscopic surgeon. He has experience of most of the advanced Laparoscopic Surgeries with world class infrastructure at laparoscopy hospital, New Delhi, he perform many difficult & complicated laparoscopic surgeries.

Prof. Dr. R.K. Mishra is a well renowned surgeon who has made gesticulation in the field of Laparoscopic Surgery with his exceptional and unique laparoscopic skills, innovative & cost effective procedures and research. Prof. Mishra has trained more than 2500 surgeons and gynaecologists in his home country India , as well as from more than 100 countries.

Prof. Mishra is a prolific author who has published his research findings in journal articles, abstracts, textbooks, book chapters, and in editorials. Prof. Mishra is editor in chief of World Journal of Laparoscopic Surgery, an international peer reviewed publication of minimal access surgery.

Fibroid is the one of the common problems in female. Previously it was removed by a “Laparotomy” operation (cutting open the abdomen). Now, fibroids can be removed very easily and safely by laparoscopic surgery by the experienced surgeon like Dr. Mishra.

Complications of Laparoscopic Gastric Bypass RNY

Gastric bypass surgery is good for reducing weight, weight loss is more predictable and usually maintained more after gastric bypass surgery. Average excess weight loss is usually higher than with purely restrictive procedures like gastric banding.
One year after gastric bypass surgery, weight loss can average 60% to 70% of excess body weight. After 10 to 14 years, some patients have maintained 40-50% of excess body weight loss.
90% of certain associated health conditions like back pain, sleep apnea, high blood pressure, diabetes and depression improves or resolved after gastric bypass or any weight reducing surgery. It also helps in leg swelling, high cholesterol, urinary incontinence etc.
Complications of Laparoscopic Gastric Bypass RNY

A. Bleeding : sometime large amount of blood is lost, and patient may require blood transfusion. The incidence of blood transfusion are less than 4 percent. Rarely delayed bleeding may require re-surgery.
B. Anesthetic complications: Risk undergoing general anesthesia has a risk of having respiratory complications. Obese patients have extra stress on the chest cavity and lungs. This means a greater risk of pulmonary problems and pneumonia developing after surgery. Stopping smoking four weeks before surgery, sitting up in the bed in the evening after surgery and performing breathing exercises will help in decreasing the risk.
C. Venous thrombosis: Blood clots in the calf muscle of leg occur more often in obese. Smoking and hormonal contraceptive pills increase the risk. The clot rarely can migrate to lungs causing Pulmonary Embolism. Heparin therapy and compression stockings should be used in all patients with laparoscopic surgery. The best way to reduce this risk is to exercise the leg calf muscles to maintain blood flow. Walking and early mobilization is the best therapy to prevent blood clots, but even moving the feet and ankles up and down while lying in bed helps.
D. Failure of anastomosis:  leak in the stomach can occur in few patients of gastric bypass surgeries. Leakage of gastric content can cause peritonitis. This may necessitate an emergency surgery to repairor drain the leak.
E. Intestinal obstructions may develop in few patients after surgery. Most common causes are adhesions and internal herniation. It may require a repeat laparoscopy or sometimes even open surgery to release the band of the obstruction.
F. Infections in the incision occur in few patients after laparoscopic gastric bypass surgery. This requires drainage and regular dressings so that they heal from inside out. Occasionally, in a serious infection, a second surgery may be required.
G. Death. About 1 in 200 to 1 in 300 people who had gastric bypass surgery die from the procedure. With laparoscopic gastric bypass, the average mortality is significantly less. Weight experts and bariatric surgeons consider the known risks and health dangers of severe obesity to be greater than those resulting from weight loss surgery
H. Dumping syndrome. When stomach contents are literally “dumped” more rapidly into the small intestine. Dumping syndrome is usually triggered by too much sugar or large amounts of food, dumping syndrome doesn’t pose a serious health risk, but its symptoms aren’t fun: nausea, weakness, sweating, faintness, and diarrhea. Some patients can prevent dumping syndrome by avoiding taking sweets after surgery.
I. Bowel problems. After gastric bypass surgery, there may be a period of intestinal adaptation. During this time bowel movements can be frequent with diarrhea. This bowel complaint, frequently accompanied by bloating, gas and foul smelling stools, may reduce with time.
In the first three to six months, the patient may experience one or more of the following changes as the body reacts to rapid weight loss:

• Body aches
• Feeling tired
• Dry skin
• Hair thinning
• Hair loss
• Changes in mood
• Sexual inactivity
Patients may develop gallstones after rapidly losing weight in about 25% of cases. The risk of gallstones can be reduced to 2% by taking bile salts for 6 months following surgery.
J. Hernia of incision site occurs in about 2 percent of patients after laparoscopic gastric bypass (15 percent after open weight-reduction surgery). This usually requires surgical repair, depending on the symptoms and the extent of the hernia.
K. Narrowing or “stricture” of the stoma of anastomosis between the stomach and intestine is a rare complication. When foods are not chewed properly and get stuck or have difficulty passing through the stoma, they cause scarring. When scarring occurs, it becomes more difficult for the food to pass. It is suspected when vomiting occurs most of the times after food. The stoma can be stretched by a gastro enterologist in the outpatient with a dilating tube that is passed to the stomach through the mouth (endoscopic dilatation).
L. Ulceration of the small intestine to the upper part of the stomach may occur in 5 percent of people who have gastric bypass surgery. Ulcers are more common in people who take aspirin or other medications called non-steroidal anti-inflammatory agents.
M. Malnutrition: Almost a third of patients may develop nutritional deficiencies. Because the duodenum is bypassed in this procedure, the body cannot absorb important minerals like: iron, calcium, zinc, selenium and other nutrients efficiently after gastric bypass surgery. Fortunately, these deficiencies can usually be controlled with proper diet and vitamin supplements.

N. Iron deficiency anemia. Duodenum is bypassed in this procedure, the body doesn’t absorb iron and calcium very well after surgery, which can lead to iron deficiency anemia. This is a particular concern for patients who experience chronic blood loss during menstruation or from bleeding hemorrhoids. Taking a tablet daily of multivitamin and iron will prevent or reverse this process.
O. Osteoporosis. Because the body doesn’t absorb calcium properly after surgery, there is a greater risk of developing osteoporosis. Daily supplementations of calcium will prevent osteoporosis.

P. Metabolic bone disease. Also caused by bypassing the duodenum, some patients experience bone pain, loss of height, humped back and fractures of the ribs and hip bones.

Q. Chronic anemia. A type of anemia caused by a deficiency of vitamin B12 can usually be managed with pills or injections, which will be taken life long.

Laparoscopy is an advanced surgical methodology in the field of medical science which has gained increased popularity in the past few years. The specialty of this method is to handle complicated surgeries in a simple way. As the recovery period for the patients is also short, the method has become successful all over the world. So getting treated through laparoscopy is effective and less painful. But, like in all cases the effectiveness of the surgery depends on the quality of the surgery and the surgeon’s experience. Only a surgeon who is trained by a reputed laparoscopy institution using appropriate laparoscopy tools will be able to become a successful Laparoscopic surgeon. This was one of my major concerns when I wanted to join a Laparoscopy training institute.

Like every good physician, I too wanted to do my laparoscopic course in a reputed institution but I was not sure where to join. When I was still in this confusion, I fortunately happened to meet one of my old friends. He told me about Laparoscopy Hospital and about the standard of Laparoscopy training courses offered there. Considering his reference, I joined the Laparoscopy Hospital and I am now proud that I am a student of this premier institute of Minimal Access Surgery.

All that anyone would be concerned about any institution he or she wishes to join would be its reputation, standard of courses offered, teaching methodology, experience of the faculties, well equipped operation theatres for good exposure sessions, periodic seminars, reasonable fee structure and so on. Students would want to join an institution only when they are satisfied with all the above expectations. I would say that this institution meets all the expectations of a common student who wishes to do a laparoscopic course. I really feel happy being a part of Laparoscopy Hospital as we are getting enough attention from the staff and doctors who train us in the best possible way. Students are trained and helped in mastering every new approach pertaining to laparoscopy. Each and every surgery is performed using ultra modern techniques and we get a chance to attend these operation theatre exposure sessions along with other laparoscopic expert surgeons who perform the operation.

As laparoscopy is an advanced technique of performing surgery through small incisions, one needs to be very careful and experienced before he or she could handle a surgery on his/her own. The second millennium has brought with it a new era of modern surgery. The creation of video surgery is as revolutionary to this century as the development of anesthesia and sterile technique was to the last one. With ten years of solid experience behind them, surgeons can now confidently approach almost every part of the human body with cameras and video monitors. First they make a small cut in the skin and then introduce a harmless gas, such as carbon dioxide, into the body cavity to expand it and create a large working space. By this means, under high magnification diseased organs are able to be examined with minimal trauma to the patient. Instead of making a large cut into the skin and underlying muscles, surgeons are now able to make small entry ports into the area of interest and perform all the major maneuvers previously done when a large opening was present.

One can become an expert only when they are trained by expert surgeons and this is what happens at Laparoscopy Hospital. As laparoscopy is just not a study of theoretical subjects but something mainly to do with practical observation and practice, Laparoscopy Hospital excels in giving us enough training, both theoretically and practically, to perform any type of laparoscopic surgery. The extensive training we undergo is what builds confidence in us to perform any laparoscopic surgery.
The need for additional training is because laparoscopic surgeons leave the familiar territory of a three dimensional operating field to working on a two dimensional flat video display. The shift is a critical one, and requires some degree of practice moving around long laparoscopic instruments while handling delicate tissues. Despite these temporary disadvantages, with the proper training, surgeons are able to adapt to this means of operating.

In short, it is an internationally renowned Laparoscopic Hospital which treats patients and trains students with utmost care and concern. Over 2500 Students from all over the world have been trained by this institute and this is a clear proof of Laparoscopy Hospital’s reputation, standard and success.

New research has prompted calls for hernia surgery to return back to the domain of general surgeons and the use of open repair rather than laparoscopic procedures for simple hernia. Laparoscopy is considered a good option for recurrent and bilateral hernia but it is not recommended by many surgeons for unilateral small hernia

The findings come from a 26 centre, randomised controlled  trial by the Medical Research Council Laparoscopic Hernia Group, which compared laparoscopic surgery for hernia with open procedures in more than 900 patients. In line with previous studies which was conducted at many centre the group found that laparoscopic techniques caused patients less postoperative pain and allowed them to return to normal life more quickly compared to open surgery. But it also found that all instances of serious complications and hernia recurrences in the trialthree and seven events respectivelytook place in the laparoscopy group (Lancet 1999;354:183-8).

There is definit association between the level of a surgeon’s experience and the complication rate, but the trial’s leader, Professor Patrick O’Dwyer from the Western Infirmary, Glasgow, said that the results supported a move to make laparoscopic hernia surgery the domain of general surgeon not laparoscopic surgeon. “Although laparoscopic hernia repair has advantages for patients, safety concerns indicate open repair is the more appropriate option for the general surgeon.”

The other study showed that laparoscopic repair takes longer and has a more serious complication rate in respect of visceral and vascular injuries, but recovery is quicker with less persisting pain and numbness. Reduced hernia recurrence of around 30-50% was related to the use of mesh rather than the method of mesh placement.

In contrast, Professor Andrew Kingsnorth, director of the NHS-run Hernia Centre at Plymouth’s Derriford Hospital and one of the authors of the Royal College of Surgeons’ guidelines on hernia procedures, argued that, far from encouraging the development of laparoscopic hernia specialists, the findings should bury the idea as a waste of resources. “Hernia is a simple operation100000 are done a year and you don’t need to be a specialist to get good results in open surgery. We would be much better using our money in highly specialist areas such as cardiology and oncology where laparoscopy can make a difference and more benificial for patient.”

In opinion of most of the surgeon laparoscopic repair of a hernia is more expensive than open surgery because of the increased costs associated with slightly longer operating room time and the cost of laparoscopic technology like, stapler, tacker or special mesh.

Laparoscopic hernia repair is more costly; difficult to learn  for everyone with a steep learning curve, carries the risk of serious visceral and or vascular injuries. All cases of groin hernia are not suitable for laparoscopic hernia repair as it is contraindicated in strangulated hernia, sliding hernia, irreducible hernia, and patients who are elderly or have co-morbid conditions.

Open mesh repair is economical, easy to teach and learn without any steep learning curve and every surgeon learn it during. Open hernia repair does not need any specialized training and results are some in both specialist and non-specialist center without much complication. Open hernia repair does not carry any risk of serious visceral or bowel injuries. Open mesh repair is suitable for all types of groin hernias including strangulated, irreducible, sliding hernia or in elderly patients and patients with co-morbidity it can be performed even under local anaesthesia.

This week was a very interesting week at Laparoscopy Hospital as we had a lecture and workshop on bariatric surgery through laparoscopic technique. Everyone in the class was attentive to know about different method of weight reducing procedure including gastric banding, gastric bypass and sleeve gastrectomy. Laparoscopic obesity surgery is a sure result of advancement in technology in the field of medicine. This weight reducing surgery is gaining increased popularity all over the world as it is relatively less invasive, and proven way of reducing weight when compared to other procedures which promise to reduce weight in 7 days, in 30 days, overnight and what not. Laparoscopic obesity surgery can be considered a reliable way of getting rid of the extra and unnecessary fat which might become the basic cause of many diseases.
I came to know about many secrets about this procedure during PowerPoint presentation. A laparoscopic adjustable gastric banding is a restrictive bariatric surgery and designed for obese patients with a body mass index (BMI) of 40 or greater—or between 35–40 in cases of patients with certain co-morbidities that are known to improve with weight loss, such as sleep apnea, diabetes, osteoarthritis, or metabolic syndrome. The gastric band is an inflatable silicone prosthetic device that is placed around the top portion of the stomach, via laparoscopic surgery.
The next day it was our operation theatre exposure session on laparoscopic obesity surgery (Gastric Banding). For some reason I was more interested in this topic than anything else, may be because of my own overweight. The actual procedure involved in this surgery is very simple and it is obvious that there is no long term morbidity involved after this surgery. The procedure involves creating a small pouch in the upper part of the stomach referred as new stomach by use of gastric band. This procedure actually does not involve cutting off any stomach parts or fat or any stapling tasks. As in any other laparoscopic surgery, small incision is made and five ports were used in this surgery. Swedish gastric band was used by other professor. Band was introduced in the abdomen and a gastric band is applied in the stomach at the level of gastro-esophageal junction by the help of gold finger forcep. A nice retro-gastric tunnel was formed and band was pulled from behind the stomach. This small dumbbell creation forms a pouch in the stomach would restrict the patient from eating more thus reducing weight. The hormone ghrelin secretion is reduced. Ghrelin is a hormone produced mainly by P/D1 cells lining the fundus of the human stomach and epsilon cells of the pancreas that stimulates appetite. Ghrelin levels increase before meals and decrease after meals. It is considered the counterpart of the hormone leptin, produced by adipose tissue, which induces satiation when present at higher levels. Ghrelin is also produced in the hypothalamic arcuate nucleus where it stimulates the secretion of growth hormone from the anterior pituitary gland. In gastric banding procedures, the level of ghrelin is reduced in patients, thus causing satiation before it would normally occur. As consuming less food is a sure way to reduce your weight, this post surgery eating system helps in reducing weight quickly and safely unlike many other open surgical procedures. One more advantage is that the recovery time is also not more than 48 hours.  
I am sure that after I become a certified laparoscopic surgeon, I would not have any problem in convincing my patients for a laparoscopic surgery for weight loss as the risks involved are very less and the patients can be back to their work just within few days of surgery. Researches also prove that number of cases that have post surgical complications after a laparoscopic surgery are very less when compared to other open surgeries.
Laparoscopy has more than one type of procedure to treat obesity. Other obesity surgeries are gastric bypass, sleeve gastrectomy, etc. My curiousness is still high to know more about these surgeries as the operation theatre exposure sessions of other types of obesity reducing surgeries are yet to be conducted this week. I am feeling really excited being a student of Laparoscopy Hospital and I am glad that I chose this institution for my Laparoscopic training.