Fortis Hospital, Shalimar Bagh, New Delhi

Pre-Operative Hygiene Pre operative hygiene is an important factor for the success of a surgery or procedure. The Health care staff will ensure prevention of infections. You as a patient or an attendant to the patient must take care of the following:

1. Commence by thoroughly wetting your face and body
2. Use octinidine shampoo for the head and face. (NOT chlorhexidine 4%)
3. Using a sponge to apply antiseptic solution, and working downwards, wash your armpits/axilla and belly button thoroughly. Keep on the wash solution for at least 5 minutes
4. Wash very well around the genital and anal region. It is especially important for a man to wash well around the penis and under the scrotum. Equal care and attention is needed for the skin folds of the vulvain women.
5. Working downwards cover the groin and buttocks and identified surgical site. It is important that the entire body surface is washed, but these areas identified, require special attention.
6. After washing all these important areas, carefully and thoroughly rinse your body well with water.
7. Finally, Wipe your body and using a freshly laundered dry towel, dry yourself thoroughly. Clean clothes should then be worn.

Will I need to visit the hospital again after my laparoscopy? 

Depending on the findings of the laparoscopy,you may need to attend the hospital at a later date. This will be discussed with you and the doctor prior to discharge and any necessary arrangements will be made.

What happens when I go home?
When you go home you may experience some period like pain. You should not experience severe pain or have a temperature. It is not uncommon to experience pain in the legs and shoulders. This is nothing to worry about and is caused by any air left in your abdomen dispersing.

What is a Hysteroscopy?

 Hysteroscopy is a technique which allows a doctor to look directly into the womb. A thin telescope called a hysteroscope is passed very gently through the cervix (the neck of the womb) into the womb itself. By attaching the hysteroscope to a TV camera and either looking at the screen or looking down the telescope, a full clear view of the inside of the womb is seen. At this stage, any disease can be seen and a biopsy (a sample of tissue) taken if necessary. This may well have been done already at an earlier stage during a previous visit to Gynaecological Out- patients. While viewing inside of the womb, small polyps or indeed lost intrauterine contraceptive devices can be retrieved.

What should you expect? 

The preparation: When you come to the department the doctor will explain the procedure to you and ask you to sign a consent form. At that stage, if there are any questions that you would like to ask about the procedures please do so. You need to inform either the doctor or the nurse present if you have any allergies or have had bad reactions to drugs or other tests in the past. They would also like to know about any previous surgery or operations you have had performed. You will be asked to take off all your clothes below the waist and wear a hospital gown. During the procedure you will be made to feel as comfortable as possible on an examination couch. A nurse will be at your side throughout. She will ask you to rest your legs on two knee supports which are placed on either side near the end of the couch. Very gently, an instrument called a speculum, used when taking cervical smear, is placed within the vagina to enable the doctor to see the neck of the womb. A warm antiseptic solution is used to clean the surface of the cervix. The hysteroscope is gently placed close to the outer opening of the cervix and at this stage a slight cramping feeling may be felt within the lower part of the tummy, not unlike period pain. The hysteroscope is passed through the cervix into the womb and if desired you can watch the progress on the nearby television screen. Any

Will I need hormone replacement Therapy (HRT) 

No, if you have not had your ovaries removed but most likely if you have had your ovaries removed. Please discuss this with your doctor while in hospital. 

Will the ovaries continue to produce eggs? 

Yes. If you have not had your ovaries remove. If you have had surgery involving removal of your fallopian tubes you ovaries will still produce eggs that will then eventually be re-absorbed by body. 

Will I require any medication when I go home? 

On discharge from hospital you may need to take some medication. This will be prescribed and obtained for you from the hospital pharmacy, along obtained for you from the hospital pharmacy, along with any medication that you normally take that you are running out of. The pharmacy normally provides one week supply. If you need any further medication at home you should contact your doctor. A copy of the prescription will be given to you along with your tablets on discharge.

Will I need to visit the hospital again after major abdominal surgery? 

You may need to attend the outpatient shachalinaee for a follow-up appointment, depending on your doctor's wishes. This will be discussed prior to discharge. If an appointment is required it will be given to you on the day you go home. It is important that you attend this appointment to discuss your progress and the results of any test. If you are unable to attend your outpatient appointment it is very important that you cancel the appointment and re-arrange another date.

Retrograde Intrarenal Surgery (RIRS) is a minimally invasive procedure used to treat kidney stones and certain other kidney conditions. It involves inserting a thin, flexible tube called a ureteroscope through the urinary tract to access the kidney. A laser is then used to break the kidney stones into small fragments, which can either be removed or pass naturally through the urinary tract. 

RIRS is recommended for patients who:

• Have kidney stones that are difficult to treat with non-invasive methods.
• Have anatomical abnormalities that make other treatments difficult.
• Have failed to respond to other treatments for kidney stones.
• Are in good general health. 

Anesthesia: You will be placed under general anesthesia to ensure comfort during the procedure.

Ureteroscope Insertion: A flexible ureteroscope is inserted through the urethra, bladder, and ureter to reach the kidney

Stone Visualization and Fragmentation: Using a high-resolution camera, the surgeon locates the kidney stones. A laser is then used to break the stones into smaller pieces.

Stone Removal: The fragmented stones are either removed using specialized tools or allowed to pass naturally through urine

Stent Placement: A temporary stent may be placed in the ureter to ensure proper drainage and aid recovery. 

• Medical Evaluation: Your doctor will assess your medical history, overall health, and details about your kidney stones.
• Imaging Tests: Tests like CT scans or ultrasounds may be conducted to locate the stones accurately.
• Fasting: You may be instructed to fast for 6-8 hours before the procedure.
• Medication Review: Inform your doctor about all medications you are taking, including over-the-counter drugs and supplements.

• Hospital Stay: Most patients are discharged the same day or the next day after the procedure.
• Discomfort: You may experience mild burning or bleeding during urination for a short time.  
• Stent Management: If a stent is placed, it is usually temporary and will be removed in a follow-up appointment.
• Activity: Rest is advised for a few days, and strenuous activities should be avoided.
• Hydration: Drink plenty of fluids to help flush out any remaining stone fragments.

While RIRS is generally safe, potential risks include:

• Infection: May require antibiotic treatment.
• Bleeding: Minor bleeding during or after the procedure.
• Injury: Possible injury to the ureter or kidney.
• Incomplete Stone Removal: May necessitate additional procedures. Your doctor will discuss these risks with you and take precautions to minimize them.
• Staged procedure: In case of tight ureter, the doctor may place only the stent in first sitting. This is done, to avoid instrumental damage to the ureter. Stent helps to widen the urinary passage. Stone and stent are removed later on, usually after 2- 4 weeks.

Seek medical attention if you experience:

• Fever or chills
• Severe pain not relieved by prescribed medications
• Persistent nausea or vomiting
• Heavy bleeding during urination

• Stent Removal: If a stent was placed, a follow-up appointment will be scheduled for its removal.
• Imaging Tests: Post-procedure imaging may be conducted in some patients, to ensure all stones have been cleared.
• Lifestyle Recommendations: Your doctor may provide dietary and lifestyle advice to prevent future kidney stones.

Liver transplant involves replacement of a patient's diseased liver by a new liver which is derived either from a brain dead but heart beating donor i.e. a cadaver (Cadaveric or Deceased-Donor Liver Transplant or DDLT) or from a living donor (Living Donor Liver Transplant or LDLT). Liver from a cadaver is a complete liver, while that from the living donor is a half or hemiliver. Liver is a unique organ in the human body as it has a special capacity of regeneration.
It has been seen that even 70% of a liver can be safely removed without any untoward consequences because of the capacity of regeneration. The remaining liver rapidly grows and restores the full functional capacity required for the normal functioning of the body. Owing to this unique property, a part of the healthy liver can be safely removed from a voluntary donor and can be utilised to replace a diseased liver in a patient without causing any harm to either the donor or the patient. The remaining half of liver in the donor and recipient grows back to achieve full functional recovery within 3-4 weeks.
Fortis is amongst the very few hospitals offering Small Incision Donor Hepatectomy (SIDH) for donors. SIDH minimises the time for recovery and markedly decreases complications relating to surgical wound and scarring by providing a smaller and cosmetically acceptable scar compared to
conventional incision used at various other centres. In the quest towards further improving donor safety and its outcome, the department visions to introduce laparoscopy and robotic assisted donor hepatectomy.

Fortis team brings together the best brains in the country who have worked at various centres across the globe under one unit. They also have a rich cumulative experience of working at various successful Transplant centres in India.
 

• Outcomes: Success rate in high nineties
• Donor safety
• Small Incision Donor Hepatectomy
• Affordable packages
• Experience of performing high number of liver transplants

Patients of liver cirrhosis with end stage liver failure require a liver transplant. The other condition requiring a liver transplant include acute or fulminant liver failure and liver cancer (Hepatocellular Carcinoma).

Easy fatigability and lethargy, progressive or persistent jaundice, abdominal distenion (Ascites). altered mental functions or (Hepatic encephalopathy), decreased urine output or renal failure, easy bruisability or recurrent epistaxis (coagulopathy) and/or hematemesis and passage of black colored stools signifies presence of liver failure. Patients of liver cirrhosis with any of these symptoms require evaluation by a specialist regarding requirement of a liver transplant.

Common ailments leading to end stage liver failure include viral hepatitis (Hepatitis B, Hepatitis C), regular alcohol consumption in excess, autoimmune liver cirrhosis, non-alcoholic fatty liver disease, cryptogenic liver disease (when cause is not known) and cholestatic liver diseases like primary or secondary biliary cirrhosis and primary sclerosing cholangitis. In children, congenital disorders like biliary atresia, Progressive Familial Intrahepatic Cholestatis (PFIC) and Congenital Hepatic Fibrosis can lead to end stage liver failure and requires a liver transplant.
WHAT IS ACUTE LIVER FAILURE?
Sometimes patients without any evidence of any liver disease or cirrhosis develop liver failure within a short span of time (within 2-6 weeks) and are present with signs of liver failure like deep and progressive jaundice, altered sensorium or liver coma (Hepatic Encephalopathy). This disease is medically called as acute liver failure or fulminant liver failure. Patients of this disease usually don't survive unless an urgent liver transplant is performed.

Various causes that can lead to acute liver failure include overuse of drugs (paracetamol) or toxins (herbal or ayurvedic medications), viral hepatitis (Hepatitis A, Hepatitis E and Hepatitis B), and Wilson's disease (an inborn disorder of copper metabolism). Acute or fulminant liver failure as a result of any of these conditions is an emergency and an urgent liver transplant (within hours) has to be performed.

The new liver can be obtained either from a brain dead heart beating (cadaveric) donor or from a voluntary living liver donor.

In India, cadaveric liver transplantation is less popular owing to lack of cadaveric organ donation. Awareness regarding sanctity of organ donation is still in its infancy not only in India but in the eastern part of the world making Living Donor Liver Transplant more popular in these areas.

Any person above the age of 18 years can legally donate his part of liver. Howev-er, in India as per Human Organ Act 1996, liver donation is restricted to family members (brother, sister, father, mother, son, daughter) or close relatives (uncle, aunt, cousin, brother-in-law, sister-in-law, grandparents). Medically, the liver donor should have a compatible blood group (same blood group as patient or O group), should not be more than 55 years of age and should be medically fit and psychologically sound. All voluntary liver donors are evaluated thoroughly to look for medical and surgical fitness.

The success rate of liver transplant worldwide is around 85-90%. Most of the patients lead a normal, healthy and productive life following a liver transplant.
However, the individual outcome depends on patient factors like cause of the disease, degree of liver failure, patient's general conditions, etc., and cannot be generalised.

Donors can usually be discharged within 10 days and patients within 2-3 weeks' time. Donors can resume their normal activities within
3-4 weeks and get back to their jobs within 6 weeks' time and patients would require 4-6 months to resume work post the surgery. No special precautions are needed for the donors after about 4-6 weeks and they lead a normal life thereafter. Patients of liver transplant have to receive life-long immunosuppressive medication. They have to take special care for prevention of infections. There are no specific dietary restrictions.