gemthrissur@geminstitute.in
Paravattani, Thrissur, Kerala-680 005, India
Open Hours
24x7
• Rare esophageal motility disorder where LES fails to relax and peristalsis stops, trapping food.
• Progressive; esophagus dilates over time, mimicking GERD but from undigested food.
• Dysphagia (solids/liquids feel stuck), regurgitation, chest pain, weight loss.
• Night cough, heartburn, aspiration pneumonia risk; worsens gradually.
• Nerve damage in esophagus (autoimmune, viral suspected); not hereditary.
• Types: I (classic), II (pressurization), III (spastic, severe pain).
• Manometry (gold standard: high IRP), barium swallow ("bird's beak"), endoscopy.
• Rules out cancer/mimics; timed barium emptying assesses severity.
• Botox (endoscopic, short-term months), pneumatic dilation (60-80% success).
• Heller myotomy (laparoscopic division of Lower Esophageal Sphincter + fundoplication)
• POEM (endoscopic division of Lower Esophageal Sphincter).
• Occasionally meds (nitrates) limited use; choose per age/health.
• Quick recovery, Considered as Gold standard in treatment of Achalasia Cardia. Take care of Dysphagia as well as post procedure reflux issue
• Esophagitis, cancer risk, malnutrition, pneumonia.
• 90% relief with myotomy/POEM; lifelong follow-up needed. Not fatal with treatment.
Appendicitis is inflammation of the appendix, a small finger like pouch attached to the large intestine at right lower abdomen, often requiring prompt surgical removal to prevent complications.
Blockage by stool, foreign objects, or infection leads to swelling and potential rupture. It commonly affects people aged 10-30 but can occur at any age.
Pain starts near the belly button, then shifts to the lower right abdomen, worsening over hours. Other signs include nausea, vomiting, fever, loss of appetite, and tenderness on touch.
Doctors use blood tests, ultrasound for diagnosis. Sometimes CT scans, or MRI are required to confirm inflammation and rule out other issues.
Appendectomy (surgical removal), often laparoscopic, is standard; antibiotics treat infection pre- or post-surgery. Non-surgical antibiotics may work for mild cases without rupture.
Rupture can cause abscess or peritonitis; early surgery reduces risks. Recovery takes 1-2 weeks with laparoscopic approach, focusing on light diet and wound care.
The other organs in abdomen can be visualized to rule out any other issues. The Hospital stay is shorter and recovery is faster and return to work is early
Common bile duct (CBD) stones, or choledocholithiasis, occur when gallstones migrate into the bile duct, potentially blocking bile flow and causing serious complications.
Most are secondary, migrating from the gallbladder due to cholelithiasis(Gall Bladder Stones); Occasionally primary stones form directly in the duct from infection, bile stasis, or risk factors like periampullary diverticulum. Common risks include obesity, rapid weight loss, female gender, age over 40, and prior biliary issues.
Sudden upper right abdominal pain radiating to the back, jaundice (yellow skin/eyes), dark urine, pale stools, nausea, vomiting, and fever/chills signal cholangitis. Pain often follows fatty meals and may mimic other conditions like pancreatitis.
Ultrasound detects stones or dilation; MRCP or EUS provides detailed imaging; blood tests check liver enzymes, bilirubin, and infection markers.
ERCP(Special type of Endoscopy) removes stones via sphincterotomy and extraction; laparoscopic cholecystectomy follows if gallbladder stones exist. The Gall bladder removal is done in same sitting or as a separate procedure. Some patients requires surgery for removal of CBD stones. Laparoscopic CBD stone removal is beneficial because under one anesthesia both the issues of CBD stones and gall bladder stones can be addressed. The Hospital stay is shortened and recovery is faster. Antibiotics treat infection; recurrence prevention involves ursodeoxycholic acid in select patients.
• Minimally invasive surgery for Gastro Esophageal Reflux Disease (GERD) using small incisions and a laparoscope
• Wraps stomach fundus around esophagus to strengthen anti-reflux valve.
• Laparoscopic: 4-6 small incisions, 1-3 hours, faster recovery (2-3 weeks), less pain.
• Open: Large incision, longer recovery, higher infection risk.
• GERD unresponsive to meds/lifestyle changes.
• Hiatal hernia, often repaired simultaneously.
• High patient satisfaction, over 90% pleased long-term.
• Varies by severity, patient factors, surgeon experience.
• General: Bleeding, infection, clots (rare).
• Specific: Dysphagia (temporary, up to 6 weeks), gas-bloat, wrap dislocation (3-4%).
• Discharge next day or in 2 days; soreness few weeks.
• Full eating 6-8 weeks; bloating resolves 2-3 months.
• Nissen: 360° wrap, good reflux control but mild dysphagia risk.
• Toupet: 270° partial wrap, lower dysphagia. Better for patients with motility issues.
• Symptom control >90%; reduced cancer risk.
Gastroesophageal reflux disease caused by a weakened lower esophageal sphincter allowing stomach acid to reflux.
Chronic symptoms occurring two or more times per week, unlike occasional heartburn; affects approximately 20% of adults.
Heartburn with chest burning after meals or when lying down, and regurgitation with acid sensation in the throat.
Dysphagia, cough, hoarseness; nighttime symptoms may worsen sleep.
Lower esophageal sphincter dysfunction, hiatal hernia, obesity, and smoking.
Triggers include fatty or spicy foods, caffeine, alcohol, and medications such as NSAIDs.
Clinical history, endoscopy to detect esophagitis or Barrett’s esophagus, pH monitoring, and manometry.
Barium swallow is used to evaluate structural abnormalities.
Esophagitis, strictures, Barrett’s esophagus (precancerous), and adenocarcinoma.
Respiratory complications and dental erosion.
Elevate the head of the bed by 6–8 inches, eat small meals at least three hours before bedtime, and achieve weight loss.
Avoid dietary triggers, stop smoking, and wear loose clothing.
Proton pump inhibitors such as daily therapy for eight weeks, antacids, and prokinetics if required.
Surgical management with fundoplication has approximately 90% success for refractory cases.
Symptoms that persist despite lifestyle modifications or presence of alarm signs such as weight loss or bleeding.
Family history of cancer or lack of relief with over-the-counter medications.
GERD occurs when the lower esophageal sphincter (LES) weakens or relaxes abnormally, allowing stomach contents to reflux into the esophagus.
Unlike occasional acid reflux, GERD involves symptoms at least twice weekly for several weeks and may lead to esophageal damage.
It affects about 20% of adults globally, with higher prevalence in Western populations due to dietary habits and obesity.
Heartburn presenting as a burning sensation in the chest, often after meals or when lying down, radiating toward the throat.
Regurgitation with sour or bitter-tasting acid backing up into the mouth or throat.
Dysphagia characterized by difficulty or pain during swallowing due to esophageal inflammation or narrowing.
Extraesophageal symptoms include chronic cough, hoarseness, laryngitis, or worsening asthma due to airway irritation.
Less common symptoms include chest pain mimicking cardiac disease, nausea, bloating, or a lump-in-the-throat sensation.
Nighttime symptoms worsen when lying flat, causing sleep disruption and possible enamel erosion.
Primary cause is LES dysfunction where the muscle fails to close properly after swallowing.
Hiatal hernia occurs when part of the stomach protrudes through the diaphragm, weakening LES support.
Lifestyle factors include obesity, which increases abdominal pressure, and smoking, which relaxes the LES.
Dietary triggers include fatty or spicy foods, chocolate, caffeine, alcohol, citrus, tomatoes, and large meals.
Medications such as aspirin, NSAIDs, calcium channel blockers, and antidepressants may worsen reflux.
Other risks include pregnancy, delayed gastric emptying, and connective tissue disorders such as scleroderma.
Clinical history based on symptom frequency, triggers, and response to antacids.
Upper endoscopy to evaluate esophagitis, Barrett’s esophagus, or strictures.
Ambulatory pH monitoring measures esophageal acid exposure over 24–48 hours.
Esophageal manometry assesses LES pressure and esophageal motility.
Barium swallow X-ray identifies structural abnormalities such as hiatal hernia or narrowing.
No single test definitively diagnoses GERD; endoscopy is recommended if alarm symptoms are present.
Esophagitis with inflammation and erosions due to repeated acid exposure.
Esophageal strictures causing progressive swallowing difficulty.
Barrett’s esophagus with precancerous changes occurring in 10–15% of chronic cases.
Esophageal adenocarcinoma, a rare but increasing risk in Barrett’s patients.
Respiratory complications including aspiration pneumonia or asthma exacerbation.
Dental erosion and chronic sinusitis from repeated acid exposure.
Elevate the head of the bed by 6–8 inches using blocks rather than pillows.
Consume smaller, frequent meals and avoid eating within three hours of bedtime.
Weight loss of 5–10% can significantly improve symptoms in obese patients.
Avoid dietary triggers such as alcohol, caffeine, chocolate, peppermint, and fatty foods.
Smoking cessation improves LES function within weeks.
Avoid tight clothing around the waist to reduce abdominal pressure.
Chewing gum after meals increases saliva production to help neutralize acid.
Proton pump inhibitors used daily for eight weeks to heal esophageal damage, with maintenance therapy for chronic GERD.
Vonoprazan provides rapid and potent acid suppression.
Prokinetic agents enhance gastric motility but are less commonly used.
Baclofen reduces transient LES relaxations and may be used off-label in refractory cases.
Sucralfate coats the esophagus and provides protection in mild esophagitis.
Fundoplication procedures such as Nissen or Toupet reinforce the LES and are usually performed laparoscopically with approximately 90% success in refractory GERD.
The LINX device uses magnetic beads around the LES to preserve swallowing but is not commonly used.
Transoral incisionless fundoplication is a less invasive endoscopic option and is not commonly performed.
Surgery is indicated for failed medical therapy, younger patients, or large hiatal hernias.
Potential risks include dysphagia, gas bloat syndrome, and symptom recurrence over time.
Pregnancy-related GERD is common in the third trimester and managed with lifestyle changes and antacids; PPIs are considered safe if required.
Children may present with vomiting or poor weight gain and are evaluated with pH monitoring.
Elderly patients have a higher risk of complications and may require screening for Barrett’s esophagus.
Post-bariatric surgery patients may experience worsened reflux and require close monitoring.
Symptoms occurring more than twice weekly despite lifestyle modifications.
Alarm signs including unintentional weight loss, severe dysphagia, vomiting blood, black stools, or anemia.
Persistent cough, hoarseness, or new-onset asthma symptoms.
No relief from over-the-counter medications after two weeks.
Family history of esophageal cancer.
Maintain a healthy weight through regular physical activity and balanced nutrition.
Adopt a high-fiber, low-fat diet.
Manage stress through relaxation techniques such as yoga or meditation.
Attend routine dental checkups to monitor for enamel erosion.
Annual surveillance is recommended if Barrett’s esophagus is diagnosed.
For further information, please contact GEM Hospital and Research Centre, Thrissur, Kerala.
Common types include:
• Inguinal hernia (groin area)
• Umbilical hernia (belly button area)
• Incisional hernia (through a surgical scar)
• Epigastric hernia (upper abdomen area)
Hernias can be caused by a combination of factors, including:
• In children it is formed from birth and will be noticed later
• In adults it is secondary to weakened muscles due to age, injury, or genetics
• Increased pressure within the body (e.g., from heavy lifting, coughing, or straining)
• Certain medical conditions (e.g., obesity, constipation)
While some hernias can't be prevented, maintaining a healthy weight, avoiding heavy lifting, and managing chronic conditions like constipation can reduce the risk.
Laparoscopic appendicectomy is a minimally invasive surgical procedure used to remove an inflamed or infected appendix (appendicitis) using small incisions, a camera (laparoscope), and specialized instruments. This approach enables less tissue trauma and faster recovery compared to open surgery.
• Less postoperative pain
• Smaller scars and better cosmetic results
• Lower risk of wound infection
• Faster recovery and return to normal activities
• Shorter hospital stay
The surgeon makes three or four small incisions in the abdomen. A laparoscope is inserted to visualize the surgical area. The appendix is carefully separated, ligated (tied off), and removed through one of the small incisions. The wounds are then closed with sutures or surgical glue.
A typical laparoscopic appendicectomy takes about 30–60 minutes, but may vary depending on the complexity of the case and findings during surgery.
A typical laparoscopic appendicectomy takes about 30–60 minutes, but may vary depending on the complexity of the case and findings during surgery.
Most patients are able to go home within 24–48 hours of surgery and return to normal activities within one to two weeks. Complete healing may take a bit longer if there are complications or if the appendix had ruptured.
Mild to moderate pain is expected and usually managed with pain medications. Surgeons provide a set schedule on these medicines to minimize pain.
• No lifting more than medium weights for six weeks
• No strenuous activities (e.g., heavy exercise, sports) for six weeks
• Walking is encouraged, but driving should be avoided until your follow-up visit and until you are off prescription pain medicines
Most patients can resume their normal diet in a gradual manner starting with fluids; then small, frequent meals which helps in transition. Staying hydrated by drinking lot of water and oral fluids is very important.
Contact your doctor if you notice:
• Fever above 101°F (38.3°C)
• Increasing pain, redness, swelling, or drainage at the incision sites
• Abdominal pain , abdominal distension
• Nausea, vomiting, chills, excessive sweating, diarrhea, constipation, or trouble urinating
• Wound opening or persistent discomfort
• Gently wash incisions and keep them clean and dry
• Avoid tub baths, hot tubs, or swimming until wounds are fully healed
• Wear loose clothing to prevent skin irritation
All surgery carries risks such as infection, bleeding, and damage to nearby organs. Laparoscopic surgery, however, has a lower risk of wound complications and generally a quicker recovery than open surgery
The incisions made for laparoscopic surgery are small (usually less than 1cm each), and the resulting scars are minimal and often barely noticeable over time.
A follow-up clinic visit is usually scheduled about two weeks after surgery, unless otherwise directed by your doctors These FAQs are designed to address common patient and public concerns surrounding laparoscopic appendicectomy. Each patient’s recovery and experience may vary, so always follow your surgeon’s individual recommendations and seek medical attention for any unusual symptoms or concerns.
• Preparation: You’ll be asked not to eat or drink for several hours before the operation.
• Anesthesia: The procedure is done under general anesthesia, meaning you’ll be asleep and pain-free throughout.
• Positioning: You will lie on your back on the operating table.
• Incisions : The surgeon will make three or four small incisions in your abdomen.
• Laparoscope and Instruments: : : A laparoscope (a thin tube with a camera and light) is inserted through one incision, and other specialized instruments are inserted through the other incisions.
• Appendix Removal:
o The surgeon uses the camera to locate the appendix and guides the instruments to carefully free it from the surrounding tissues.
o Blood vessels supplying the appendix are tied off or sealed and divided.
o The appendix is ligated at the base and is removed through one of the incisions in a specimen bag.
• Inspection and Closure: : The surgical area may be washed with saline to reduce infection risk, instruments are removed, and incisions closed with stitches or surgical glue.
• Recovery Room: You’ll wake up in the recovery room as the anesthesia wears off. You may feel mild to moderate pain that is managed with medication.
• Duration: The surgery typically takes 30–60 minutes but may be longer depending on individual factor.
• Hospital Stay: : Most patients can go home within 24–48 hours and return to normal activities in one to two weeks, depending on their recovery.
• Risks: As with any surgery, risks include infection, bleeding, or rare injury to nearby organs. Occasionally, if there are complications, the procedure may need to be converted to open surgery
You should discuss any individual factors or questions with your surgical team, as details may vary based on your health and the findings during surgery.
During a laparoscopic appendectomy, you will be completely unconscious due to general anesthesia, so you will not experience any sensations, pain, or discomfort during the actual procedure itself. The anesthesia ensures you remain unaware and pain-free while the surgery is performed
• No Awareness or Sensation: : Since general anesthesia is used, patients do not feel any cutting, pressure, or movement during surgery.
• No Memory of the Procedure: You will not remember the events that occur during the operation
However, once the procedure is completed and the anesthesia wears off:
• Mild to Moderate Pain: As you wake up, you may experience some mild to moderate pain or discomfort around the incision sites in your abdomen, which is common and expected. This pain is usually manageable with medications and typically improves quickly in the hours and days after surgery.
• Abdominal Fullness : Some people report a feeling of bloating or mild fullness in the abdomen after the procedure, which will be settled soon.
• Throat Soreness: : Occasionally, you may have a mild sore throat from the breathing tube placed during general anesthesia.
In summary, you will not feel anything during the laparoscopic appendectomy procedure itself, but mild to moderate pain and abdominal discomfort are common in the recovery period immediately afterward. If you have special concerns about anesthesia or pain control, discuss them with your surgical and anesthesia team before the procedure.
GEM Hospital offers both routine and advanced laparoscopic surgeries also known as minimally invasive or keyhole surgery, Laparoscopic surgery offers a range of significant benefits compared to traditional open surgical methods. At Gem Hospital, Thrissur, we are committed to providing our patients with the latest advancements in surgical care, and advanced laparoscopic procedures with lot of benefits are a prime example of this commitment.
• Smaller Incisions and Minimal Scarring
• Faster Recovery and Shorter Hospital Stay
• Less Pain and Discomfort
• Lower Risk of Infection and Complications
• Enhanced Surgical Precision
• Less Blood Loss
• Better Cosmetic Results
In summary, advanced laparoscopic surgery at Gem Hospital provides patients with a safer, less painful, and more efficient surgical option compared to traditional open surgery, ensuring quicker recovery, fewer complications, and excellent surgical outcomes. If you have questions about whether laparoscopic surgery is right for you, our expert surgical team is here to help.
Yes, GEM Hospital Thrissur offers advanced laparoscopic surgery for obesity, commonly known as bariatric surgery. As a leading centre in the field of gastroenterology and minimally invasive surgery, GEM Hospital is recognized for its expertise in treating obesity through state-of-the-art laparoscopic procedures.
Laparoscopic bariatric surgery is a minimally invasive technique that uses small incisions and specialized instruments, resulting in less pain, reduced risk of complications, minimal scarring, and a faster recovery compared to traditional open surgery. At GEM Hospital, patients have access to a comprehensive range of bariatric procedures, including:
• Laparoscopic Sleeve Gastrectomy
• Laparoscopic Gastric Bypass (Roux-en-Y and Mini-Gastric Bypass)
• Intra gastric Balloon Placement (a non-surgical method for weight loss)
These procedures aim to assist individuals facing severe obesity in achieving meaningful and long-lasting weight loss. Bariatric surgery not only reduces the size of the stomach or alters the digestive tract but also brings about positive changes in hormones that regulate hunger and satiety. This can lead to marked improvements in obesity-related health conditions, such as type 2 diabetes, high blood pressure, sleep apnoea, and joint problems.
GEM Hospital’s multidisciplinary team includes experienced bariatric surgeons, Gastroenterologists,anaesthetists, nutritionists, psychologists ensuring that each patient receives personalized care before, during, and after surgery. The hospital is committed to patient safety and long-term success, providing thorough preoperative assessments, advanced surgical techniques, and dedicated postoperative support.
If you or a loved one is considering weight loss surgery, GEM Hospital Thrissur offers expert consultation and guidance to determine the most suitable treatment option based on individual health needs and goals. Many patients with mild to moderate obesity can be managed with Life style modifications and medical management. They focus on minimally invasive laparoscopic Bariatric surgery ensuring a safer, more comfortable experience and optimal outcomes for patients with severe obesity seeking a healthier future.
