Knowledge Hub


Surgical and conservative management of ectopic pregnancies

Ectopic pregnancy is a rare condition (occurs in 1% of all pregnancies ) in which the pregnancy instead of growing inside the uterus ( womb ) – grows inside the fallopian tubes. This can be potentially life threatening as if it ruptures – it can lead to massive bleeding inside the abdomen. Timely management of ectopic pregnancy can avert a disaster. The management usually involves surgical removal of the abnormal pregnancy and in some cases conservative management using injections.

Management of threatened abortions

Very often cases of threatened abortions ( where the mouth of the uterus has opened during pregnancy prematurely) can be managed managed surgically by putting a cervical stitch.


Some common gynaecological procedures are:

D & C – Dilatation and Curettage

A surgical procedure which involves scraping of the endometrial lining of the uterus. The procedure is usually done in cases of Abnormal & excessive Uterine Bleeding and in infertility patients. The scraped material may sent to the laboratory for further evaluation.


A surgical procedure which involves removal of the uterus either with or without the ovaries (oophorectomy). The uterus can either be removed vaginally, abdominally or through minimal invasive (laparoscopic route). The route of hysterectomy needs to be individualized in every case.


Myomectomy is the surgical procedure of removal of fibroids from the uterus. Fibroids of the uterus are a known cause of lower abdominal pain, excessive menstrual bleeding, painful menses (dysmenorrhoea) and in some cases infertility. Myomectomy operations in selected cases help resolve symptoms while at the same time preserve a womans fertility.

Management of endometriosis, chocolate cysts of the ovary & adhesiolysis

Endometriosis is a disease involving young women which usually presents with painful menses, excessive pain during intercourse and infertility. Early diagnosis and management of the disease can prevent the onset of irreversible infertility & provide tremendous symptomatic relief to the patient.

Surgery for Gynaecological Malignancies

Surgical management of gynaecological Malignancies (endometrial cancer, cervical cancer or ovarian cancer) is a complex and challenging process that requires expert surgical intervention. A timely surgery by the right doctor can be a life-saving procedure. Niramaya Hospital’s team of oncosurgeons and gynaecologists have vast experience in these complicated procedures.


A surgical procedure which involves removal of endometrial polyps followed by D & C. It reduces symptoms like spotting / bleeding in between periods and irregular periods.

Electrocauterization of cervical erosions

A common outpatient procedure to treat cervical erosions that if left untreated may lead to malignant change.


How laparoscopy is performed

Laparoscopy is performed under general anaesthetic, so you'll be unconscious during the procedure and have no memory of it. You can often go home on the same day.


Depending on the type of laparoscopic procedure being performed, you'll usually be asked not to eat or drink anything for 6-12 hours beforehand. If you're taking blood-thinning medication (anticoagulants), such as aspirin or warfarin, you may be asked to stop taking it a few days beforehand. This is to prevent excessive bleeding during the operation. If you smoke, you may be advised to stop during the lead-up to the operation. This is because smoking can delay healing after surgery and increase the risk of complications such as infection.

Most people can leave hospital either on the day of the procedure or the following day. Before the procedure, you'll need to arrange for someone to drive you home because you'll be advised not to drive for at least 24 hours afterwards.

The Procedure

During laparoscopy, the surgeon makes a small cut (incision) of around 1-1.5cm (0.4-0.6 inches), usually near your belly button. The total number of incisions may vary depending on the type of procedure being carried out.

A tube is inserted through the incision, and carbon dioxide gas is pumped through the tube to inflate your tummy (abdomen). Inflating your abdomen allows the surgeon to see your organs more clearly and gives them more room to work. A laparoscope is then inserted through this tube. The laparoscope relays images to a television monitor in the operating theatre, giving the surgeon a clear view of the whole area.

If the laparoscopy is used to carry out a surgical treatment, such as removing your appendix, further incisions will be made in your abdomen. Small, surgical instruments can be inserted through these incisions, and the surgeon can guide them to the right place using the view from the laparoscope. Once in place, the instruments can be used to carry out the required treatment.

After the procedure, the carbon dioxide is let out of your abdomen, the incisions are closed using stitches or clips and a dressing is applied.

When laparoscopy is used to diagnose a condition, the procedure usually takes 30-60 minutes. It will take longer if the surgeon is treating a condition, depending on the type of surgery being carried out.


After laparoscopy, you may feel groggy and disorientated as you recover from the effects of the anaesthetic. Some people feel sick or vomit. These are common side effects of the anaesthetic and should pass quickly. You'll be monitored by a nurse for a few hours until you're fully awake and able to eat, drink and pass urine. Before you leave hospital, you'll be told how to keep your wounds clean and when to return for a follow-up appointment or have your stitches / staples removed (although dissolvable stitches are often used). For a few days after the procedure, you're likely to feel some pain and discomfort where the incisions were made, and you may also have a sore throat if a breathing tube was used. You'll be given painkilling medication to help ease the pain.

Some of the gas used to inflate your abdomen can remain inside your abdomen after the procedure, which can cause:

  • bloating
  • cramps
  • shoulder pain, as the gas can irritate your diaphragm (the muscle you use to breathe), which in turn can irritate nerve endings in your shoulder

These symptoms are nothing to worry about and should pass after a day or so, once your body has absorbed the remaining gas.

Recovery times

The time it takes to recover from laparoscopy is different for everybody. It depends on factors such as the reason the procedure was carried out (whether it was used to diagnose or treat a condition), your general health and if any complications develop. An early resumption of normal activities is advisable and also desirable. Recovery times vary from 3 days for minor procedures to 12 weeks for complicated oncological procedures. Exercise and swimming should be avoided for the first two weeks following surgery. However, walking is permitted within a few hours post-operatively.

When to seek medical advice

It's usually recommended that someone stays with you for the first 24 hours after surgery. This is in case you experience any symptoms that suggest a problem, such as:

  • a high temperature of 38C (100.4F) or above
  • chills
  • severe or continuous vomiting
  • increasing abdominal pain
  • redness, pain, swelling, bleeding or discharge around your wounds
  • abnormal vaginal discharge or vaginal bleeding
  • pain and swelling in one of your legs
  • a burning or stinging sensation when urinating


Ideal Body Weight and Obesity

The ideal body weight is defined as a weight that is believed to be maximally healthful for a person. We commonly use the Body Mass Index (BMI) to find out how near or far a person is from his ideal body weight. The BMI is a ratio of the person's weight to the square of his height. However, while a large number of people are overweight, only a few are so obese that the excess load they are carrying becomes a threat to their very lives. They will invariably develop high BP, diabetes, hyperlipidemia, sleep apnoea and arthritis and will have a much higher risk of cancer. A large number of obese persons suffer from malnourishment, as the modern day diet is energy dense (too many calories) but nutrient poor (not enough vitamins and minerals).


BMI = weight in kg / (ht in cm)(ht in cm)

When is Bariatric Surgery recommended?

Bariatric Surgery is for only for those persons who have attempted and failed at sustained weight loss, and in whom the health risk of continuing to be obese is far greater than the risk of the procedure. In the Indian scenario, only those with BMI of 37.5 kg/m2 without current health problems or 32.5 kg/m2 if there are additional obesity-related medical problems like diabetes, serious sleep apnea or hypertension are suitable candidates for a bariatric procedure. Recent research, however, has shown support for bariatric surgery when patients who are otherwise healthy have a BMI of at least 35 and when patients with additional medical issues have a BMI of at least 30.

It is now well accepted that diabetes mellitus is cured in 70 to 90% and high blood pressure in about 50 to 70% of people who undergo Bariatric Surgeries. The procedure is also being researched for normal weight diabetic patients whose sugars are uncontrolled with medications, with encouraging results.

Is Bariatric Surgery a shortcut for those who want to lose weight quickly?

Bariatric Surgery enables rapid and comfortable return to normal activities within a few days. It is also very effective as up to 65-70% of the excess weight is lost within a few months. However, Bariatric Surgery is not a substitute for a healthy lifestyle with adequate exercise and a healthy and nutritious diet. It is well documented that persons who go back to their earlier poor lifestyle following bariatric procedures will eventually end up regaining the lost weight. Therefore, even after the procedure, a good diet-exercise routine is mandatory to sustain the benefits of the procedure and stay healthy on a long term basis.

What are the types of Bariatric Surgery?

While there are a variety of bariatric surgery options to choose from, some surgeries lose favor over time and others become more popular as technology changes and as studies are done measuring the long term success rates. The three surgery options below are more commonly performed today due to their effectiveness and overall patient outcome.

Sleeve Gastrectomy: The stomach is divided along its vertical access and stapled, reducing its volume by up to 85 percent. This is the most commonly done procedure and is safe and effective in reducing upto 65-70% of the excess weight. It is contraindicated in the presence of gastroesophageal reflux disease.

Laparoscopic Adjustable Gastric Banding: The stomach is wrapped with a saline-filled silicone band in order to decrease its volume, and the surgeon can adjust the degree of restriction after surgery by changing the amount of saline in the band. Once a very popular procedure, its use has reduced over a period of time due to relatively low success rates and complications related to the band.

Gastric Bypass: A gastric bypass dramatically reduces the size of the stomach. It also relocates the stomach's connection to the small intestine so that the duodenum and jejunum are "bypassed," a change that reduces calorie absorption. This is considered the most reliable procedure for weight loss and is especially useful in diabetics as normalization of sugars is seen in upto 90% of patients.


Regardless of the specific procedure, all types of bariatric surgery have been effective in achieving weight loss, with the majority of that loss occurring within two years of surgery. The chiefly restrictive procedures, like Vertical Sleeve Gastrectomy and Gastric Banding, tend to result in losses that are less dramatic than those obtained with combined procedures, but even those purely restrictive procedures result in losses of about 65 percent of excess weight. Weight loss is only one of the surgery's potential benefits. Almost all diabetic patients experience a significant improvement of the disease, with many obtaining a complete resolution. In more than 85 percent of patients, sleep apnea is resolved by surgery. Life expectancy increases by some 89 percent, the risk of developing heart disease is cut in half, and the risk of premature death is reduced by up to 40 percent.

Weight loss is only one of the surgery's potential benefits. Almost all diabetic patients experience a significant improvement of the disease, with many obtaining a complete resolution. In more than 85 percent of patients, sleep apnea is resolved by surgery. Life expectancy increases by some 89 percent, the risk of developing heart disease is cut in half, and the risk of premature death is reduced by up to 40 percent.

Bariatric surgery is a major procedure, done on an inpatient basis and requiring a hospital stay of up to three to four days. Most of those risks are identical to those inherent in any major surgery, including infection and incisional hernia, but the medical consensus is that the benefits of bariatric surgery outweigh its risks. The risk of death is 0.1 percent and the risk of major complications is approximately four percent.


Upper GI Endoscopy

What is upper gastrointestinal (GI) endoscopy?

Upper GI endoscopy is a procedure in which a doctor uses an endoscope—a long, flexible tube with a camera—to see the lining of your upper GI tract. A gastroenterologist, surgeon, or other trained health care provider performs the procedure, most often while you receive light sedation. Your doctor may also call the procedure an EGD or esophagogastroduodenoscopy.

Why do doctors use upper GI endoscopy?

Upper GI endoscopy can help find the cause of unexplained symptoms, such as

  • persistent heartburn
  • bleeding
  • nausea and vomiting
  • pain
  • problems swallowing
  • unexplained weight loss

Upper GI endoscopy can also find the cause of abnormal lab tests, such as

  • anemia
  • nutritional deficiencies

Upper GI endoscopy can identify many different diseases

During upper GI endoscopy, a doctor may also obtain biopsies by passing an instrument through the endoscope to obtain a small piece of tissue for further testing if needed.

  • anemia
  • gastroesophageal reflux disease
  • ulcers
  • cancer
  • inflammation, or swelling
  • precancerous abnormalities
  • celiac disease

Doctors also use upper GI endoscopy to

  • treat conditions such as bleeding ulcers
  • dilate strictures with a small balloon passed through the endoscope
  • remove objects, including food, that may be stuck in the upper GI tract

How do I prepare for an upper GI endoscopy?

Talk with your doctor

You should talk with your doctor about medical conditions you have and all prescribed and over-the-counter medicines, vitamins, and supplements you take, including

  • aspirin or medicines that contain aspirin
  • arthritis medicines
  • nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen
  • blood thinners
  • blood pressure medicines
  • diabetes medicines

Upper gastrointestinal Endoscopy can be safely done under local anaesthesia or under sedation if needed. If sedation has been given, you can't drive for 24 hours after the procedure, as the sedatives used during the procedure need time to wear off.

The doctor needs to examine the lining of your upper GI tract during the procedure. If food or drink is in your upper GI tract when you have the procedure, the doctor will not be able to see this lining clearly. To make sure your upper GI tract is clear, it is advisable not to eat, drink, smoke, or chew gum 6 to 8 hours before the procedure.

How do doctors perform an upper GI endoscopy?

A doctor performs an upper GI endoscopy in a hospital or an outpatient center. An intravenous (IV) needle will be placed in your arm to provide a sedative. Sedatives help you stay relaxed and comfortable during the procedure. In some cases, the procedure can be performed without sedation. You will be given a liquid anesthetic to gargle or spray anesthetic on the back of your throat. The anesthetic numbs your throat and calms the gag reflex. The health care staff will monitor your vital signs and keep you as comfortable as possible.

You’ll be asked to lie on your side on an exam table. The doctor will carefully feed the endoscope down your esophagus and into your stomach and duodenum. A small camera mounted on the endoscope will send a video image to a monitor, allowing close examination of the lining of your upper GI tract. The endoscope pumps air into your stomach and duodenum, making them easier to see.

During the upper GI endoscopy, the doctor may
  • perform a biopsy of tissue in your upper GI tract. You won’t feel the biopsy.
  • stop any bleeding.
  • perform other specialized procedures, such as dilating strictures.

The procedure most often takes between 15 and 30 minutes. The endoscope does not interfere with your breathing, and many people fall asleep during the procedure.

What should I expect from an upper GI endoscopy?

  • to stay at the hospital or outpatient center for 1 to 2 hours after the procedure so the sedative can wear off
  • bloating or nausea for a short time after the procedure
  • a sore throat for 1 to 2 days to go back to your normal diet once your swallowing has returned to normal
  • to rest at home for the remainder of the day if you have received sedation.

Following the procedure, you—or a friend or family member who is with you if you’re still groggy—will receive instructions on how to care for yourself following the procedure. You should follow all instructions.

Some results from an upper GI endoscopy are available right away after the procedure. After the sedative has worn off, the doctor will share these results with you or, if you choose, with your friend or family member. A pathologist will examine the biopsy tissue to help confirm a diagnosis. Biopsy results take a few days or longer to come back, usually about a week.

What are the risks of an upper GI endoscopy?

Upper gastrointestinal endoscopy is a very safe procedure, with low risk. However, complications may rarely be seen, such as:

  • bleeding from the site where the doctor took the biopsy or removed a polyp
  • perforation in the lining of the upper GI tract
  • an abnormal reaction to the sedative, including respiratory or cardiac problems

Bleeding and perforation are more common in endoscopies used for treatment rather than testing. Bleeding caused by the procedure often stops without treatment. Research has shown that serious complications occur in one out of every 1,000 upper GI endoscopies.1 A doctor may need to perform surgery to treat some complications. A doctor can treat an abnormal reaction to a sedative with medicines or IV fluids during or after the procedure.

Lower Gastrointestinal Endoscopy (Colonoscopy)

Colonoscopy is a test that allows your doctor to look at the inner lining of your large intestine (rectum and colon). He or she uses a thin, flexible tube called a colonoscope to look at the colon. The colonoscope is a thin, flexible tube that ranges from 48 in. (125 cm) to 72 in. (183 cm) long. A small video camera is attached to the colonoscope so that your doctor can take pictures or video of the large intestine (colon). The colonoscope can be used to look at the whole colon and the lower part of the small intestine. A test called sigmoidoscopy shows only the rectum and the lower part of the colon.

A colonoscopy can help a doctor find the cause of unexplained symptoms, such as

  • changes in your bowel activity
  • pain in your abdomen
  • bleeding from your anus
  • unexplained weight loss

Doctors also use colonoscopy as a screening tool for colon polyps and cancer . Screening is testing for diseases when you have no symptoms. Screening may find diseases at an early stage, when a doctor has a better chance of curing the disease.

Bowel Preparation

A health care professional orders a bowel prep so that little to no stool is present in your intestine. A complete bowel prep lets you pass stool that is clear. Stool inside your colon can prevent your doctor from clearly seeing the lining of your intestine.

You may need to follow a clear liquid diet usually for 12 hours but occasionally up to 3 days before the procedure and avoid drinks that contain dyes. The instructions will provide specific direction about when to start and stop the clear liquid diet. In most cases, you may drink or eat the following:

  • clear soup or broth
  • clear strained fruit juice, such as apple or white grape
  • water
  • plain coffee or tea, without cream or milk
  • sports drinks in flavors such as lemon, lime, or orange
  • gelatin in flavors such as lemon, lime, or orange

Your doctor will tell you before the procedure when you should have nothing by mouth.

Different bowel preps may contain different combinations of laxatives, pills that you swallow or powders that you dissolve in water and other clear liquids, and enemas. Some people will need to drink a large amount, often 2 liters, of liquid laxative over a scheduled amount of time—most often the night before the procedure. You may find this part of the bowel prep difficult; however, completing the prep is very important. Your doctor will not be able to see your colon clearly if the prep is incomplete.

Call a health care professional if you have side effects that prevent you from finishing the prep.

How do doctors perform a colonoscopy?

A trained specialist performs a colonoscopy in a hospital or an outpatient center. A health care professional will place an intravenous (IV) needle in a vein in your arm to give you sedatives, anesthesia, or pain medicine so you can relax during the procedure. The health care staff will monitor your vital signs and keep you as comfortable as possible.

For the procedure, you’ll be asked to lie on a table while the doctor inserts a colonoscope into your anus and slowly guides it through your rectum and into your colon. The scope pumps air into your large intestine to give the doctor a better view. The camera sends a video image of the intestinal lining to a monitor, allowing the doctor to examine your intestinal tissues. The doctor may move you several times on the table to adjust the scope for better viewing. Once the scope has reached the opening to your small intestine, the doctor slowly withdraws it and examines the lining of your large intestine again.

During the procedure, the doctor may remove polyps and send them to a lab for testing. Colon polyps are common in adults and are harmless in most cases. However, most colon cancer begins as a polyp, so removing polyps early is an effective way to prevent cancer.

The doctor may also perform a biopsy. You won’t feel the biopsy.

Colonoscopy typically takes 30 to 60 minutes.

After a colonoscopy, you can expect the following:

  • You’ll stay at the hospital or outpatient center for 1 to 2 hours after the procedure.
  • You may have abdominal cramping or bloating during the first hour after the procedure.
  • The sedatives or anesthesia takes time to wear off completely.
  • You should expect a full recovery by the next day, and you should be able to go back to your normal diet.
  • After the procedure, you—or a friend or family member—will receive instructions on how to care for yourself after the procedure. You should follow all instructions.
  • A friend or family member will need to drive you home after the procedure.
  • If the doctor removed polyps or performed a biopsy, you may have light bleeding from your anus. This bleeding is normal.
  • Some results from a colonoscopy are available right after the procedure. After the sedatives or anesthesia has worn off, the doctor will share results with you or, if you choose, with your friend or family member.
  • A pathologist will examine the biopsy tissue. Biopsy results take a few days or longer to come back.

What are the risks of colonoscopy?

Colonoscopy is a safe procedure with low risk. However, complications can occur in 2 out of every 1000 patients. The risk is greater if a treatment has been carried out than for a diagnostic procedure. The risks of colonoscopy include

  • bleeding
  • perforation of the colon
  • abnormal reaction to the sedative, including respiratory or cardiac problems
  • abdominal pain
  • death, although this risk is rare

Bleeding and perforation are the most common complications from colonoscopy. Most cases of bleeding occur in patients who have polyps removed. The doctor can treat bleeding that occurs during the colonoscopy right away. However, you may have delayed bleeding up to 2 weeks after the procedure. The doctor diagnoses and treats delayed bleeding with a repeat colonoscopy. The doctor may need to treat perforation with surgery.

|| Knee & Shoulder Surgery ||

Knee Replacement Surgery

In knee arthrits, joint surfaces get worn out,causing pain and deformity. Knee replacement surgery restores function and comfort with a high degree of success, giving huge benefits to the long term quality of life for arthritis patients.

Arthroscopic Knee Surgery (Keyhole surgery)

Minimally invasive surgery through telescope can repair ligaments, meniscus, cartilage, etc., which are damaged in sports injuries, arthritis, or accidents.

Anterior Cruciate Ligament (ACL) is commonly torn in knee injuries, and it it reconstructed by arthroscopic surgery.

Arthroscopic Shoulder Surgery

Tears of the glenoid labrum (called Bankart's lesion), cause repeated dislocations instability in the shoulder.

Similar tears in the rorator cuff tendons surrounding the shoulder cause persistent pain and poor function.

All these structures in the shoulder are repaired by arthroscopic surgery.

Shoulder Replacement Surgery

In cases of rheumatoid arthritis, avascular necrosis, or badly shattered fractures of the shoulder ball, offer good pain relief and function.