Hernia

Hernia is the protrusion of the whole or part of a viscous from its normal position through an opening in the walls of its containing cavity.

Causes of hernia

Hernia can be either congenital or acquired. Increased intra-abdominal pressure or collagen derangement may also increase the risk of developing hernia.

Types of hernia

Hernia can be classified either by their clinical features or their sites. Clinical features include reducible, irreducible, strangulated and incarcerated / obstructed hernia. Sites include inguinal, femoral, umbilical and paraumbilical, incisional, epigastric, obturator, etc.

Symptoms

If you have any of the following symptoms, you may be experiencing hernia:

˙    A lump over the abdominal wall (eg. Groin)

˙    The lump may increase in size progressively

˙    Occasional pain

˙    Disappear when lying flat

˙    Lump size increases if patient is in standing position or coughing

Complications of hernia

When the hernia becomes strangulated, the blood supply to the content of hernia is impaired. The content becomes ischemia and then gangrenous, resulting in peritonitis.

Emergent operation is then required for this life threatening condition. You may experience severe pain over the lump, which could not be reduced. The overlying skin becomes redden and the pain will become severer and then spread out to the entire abdomen

Hernia treatment

Surgical repair is the only effective treatment for hernia. Conservative treatment is the exception rather the rule. Open hernia repair with mesh and laparoscopic hernia repair are two commonly used surgical treatment.

Open and laparoscopic surgeries are both common for hernia repair, decisions are made according to patients’ condition. Open surgery is more preferred for patients with recurrent hernia.

Reference: psclinic.com.hk/

The information aims to provide educational purpose only. Anyone reading it should consult

Surgery Specialist before considering treatment and should not rely on the information

above.

Hemorrhoid treatment (2)

Traditional surgery – Hemorrhoidectomy 

 Principles
- Decrease the blood flow to anorectal ring
- Remove redundant hemorrhoidal tissue


 Indications
- Grade II, III and IV hemorrhoids
- Failure of non-operative treatment of 2nd degree pile
- Thrombosed hemorrhoid 
- Interoexternal pile when the external pile is well defined


 Types
- Excision of hemorrhoids without (open hemorrhoidectomy) or with (closed hemorrhoidectomy) suturing 
- Using different energies for excision
 Diathermy
 Harmonic scalpel
 Bipolar scissors









Reference: psclinic.com.hk/

The information aims to provide educational purpose only. Anyone reading it should consult 
Surgery Specialist before considering treatment and should not rely on the information

above.

Hemorrhoid treatment (1)

Dietary and lifestyle modifications
 Goal: to minimize straining at stool  minimizing constipation
 Diet
- Increase fluid intake
- Stool softeners
 Lifestyle modifications
- Regular defecatory habits


Medications
 Local and oral medications
 Arrests bleeding
 Relieves pain, irritation, and inflammation
 Guard against infection


Outpatient hemorrhoid treatment
 Rubber band ligation, endoscopic ligation
 Ultroid system
 Sclerotherapy
 Infrared coagulation
 Bicap electrocoagulation
 Cryotherapy
 Laser treatment


Banding / Ligation of hemorrhoids
 For Grade 2 and 3 internal hemorrhoids
 Principle: Banding  ischemic necrosis  slough off within few days
 Successful respond rate: 60-70% cured with a single treatment session

http://youtu.be/K7HKrBwuKSw (Video demonstration)




Reference: psclinic.com.hk/

The information aims to provide educational purpose only. Anyone reading it should consult

Surgery Specialist before considering treatment and should not rely on the information above.

OGD---The lumen of the upper digestive tract-

Oesophagogastroduodenoscopy (OGD)

 

 

 

 

OGD is the method for examination of the lumen of the upper digestive tract. OGD means the use of a flexible endoscope to examine the oesophagus (Oesopha-), stomach (Gastro-) and duodenum (Duodeno-).

OGD is indicated for diagnosis, biopsy and delivery of targeted therapies. It may be used for patients suffering from peptic ulcer disease or bleeding, suspected oesophageal and gastric cancer, symptoms of indigestion, acid reflux and difficulty in swallowing.



Procedures

 
1. Prior to the examination, local anesthetics will be sprayed to the throat of patients. Dur the procedure, patients are fully conscious.

2. A flexible endoscope with a diameter of 0.9-1.2cm will then be introduced by the endoscopist through patients’ mouth into the esophagus, stomach and the duodenum.

3. Blood pressure and heart rate will be closely monitored during the procedure.

4. The entire procedure will last for about 10 to 20 minutes.





Reference: psclinic.com.hk/ 

The information aims to provide educational purpose only. Anyone reading it should consult
Surgery Specialist before considering treatment and should not rely on the information
above.


 

大腸癌最常見的徵狀- 大腸癌症狀

 

• 排便習慣出現持續改變 (包括腹瀉和便秘，若直腸出血或糞便有血更應特別留意)
• 持續腹痛
• 腹部有腫塊
• 在排使便後，感到糞便仍未排清
• 糞便持續有血 (呈鮮紅色或深棕色)，而原因不明
• 出現貧血或體重下降但原因不明
• 無故感到極度疲勞
• 嘔吐 + 便秘 + 腹漲 = 腸梗塞

誰人最有機會患上大腸癌 ?

• 所有五十歲或以上人士
• 自己曾經患有大腸瘜肉或有炎症性腸病的病歷
• 家人曾被證實患上大腸癌(尤其45歲前患病親屬)
• 家人曾有患大腸瘜肉的病歷

與生活習慣相關的風險因素

• 超重或肥胖
• 缺乏體能活動
• 飲食中包含大量紅肉及加工肉類
• 飲用酒精
• 飲食中的纖維含量不足
• 吸煙

參考資料: psclinic.com.hk/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向外科醫生查詢，而不應單倚賴以上提供的資料。

Hemorrhoid

Introduction
Hemorrhoid is a very common disease, which affects more than 80% of adults. In the past, hemorrhoid was considered as varicose vein. Recently, it is defined as a vascular cushion resulted from downward displacement of anal cushion, which are blood-filled spaces supported by a matrix of fibrous tissue and smooth muscle located in lower rectum. It is resulted from chronic straining, leading to local congestion due to various reasons such as chronic constipation, diarrhea, prolonged attempts when defecation, prolonged sitting and standing, lack of fibers in diet, etc. Local congestion will cause anal cushions to lose their attachment to the underlying rectal wall, leading to prolapse of internal hemorrhoidal tissue through the anal canal. As these hemorrhoids engorge, vasculature increases and the overlying mucosa become more friable. As a result, rectal bleeding occurs.
Hemorrhoid is classified as internal, external or internoexternal in relation to dentate line at lower rectum. Internal hemorrhoids are located above the dentate line, external hemorrhoids are located below the dentate line, while interno-external hemorrhoids are extended from above to below the dentate line

Clinical features
Hemorrhoids in many patients are found to be asymptomatic, and therefore no treatment is needed.
For symptomatic hemorrhoids, symptoms include:

1. Rectal bleeding – fresh bleeding is found after defecation that stain toilet paper and is separated from stool. Anemia will be results if prolonged bleeding occurs.
2. Prolapse – According to severity, prolapse is divided into different grading:
   
   
   • Grade 1 – bleeding without prolapse
   • Grade 2 – prolapse with spontaneous reduction
   • Grade 3 – prolapse with manual reduction
   • Grade 4 – incarcerated, irreducible prolapse


3. Perianal irritation (itchiness) and discharge (mucus)
4. Pain due to thrombosis of external hemorrhoid

Hemorrhoids in pregnancy
Hemorrhoids can also be found usually in the third trimester during pregnancy. It can be due to hormonal changes, obstruction of venous return by the gravid uterus and chronic straining secondary to constipation. Majority of symptoms can be resolved after delivery. These can be treated with conservative measures and intervention is rarely being indicated.


 


Reference: psclinic.com.hk/
The information aims to provide educational purpose only. Anyone reading it should consult
Surgery Specialist before considering treatment and should not rely on the information
above.

倒甲- 嵌甲處理,倒甲手術

嵌甲(倒甲)常見於腳趾甲兩旁，以腳趾公為多數。正常的趾甲兩旁與甲溝並不連在一起而是有約一毫米的間隙。但是如果趾甲向兩旁生長而插入甲溝，會撕破附近的軟組織，繼而引起感染。倒甲會導致指甲四周的皮膚出現紅腫或嚴重至化膿感染。



倒甲成因

不正確的修甲護理(趾甲過短或把趾甲剪成圓形)、穿着不合適的鞋子：尺碼太小、尖頭鞋、高根鞋等、受傷令腳甲變形(趾甲卷曲、拇趾外翻)都有機會導致倒甲。遺傳、肥胖、多汗亦是部份原因。


倒甲治療

治療方法分為保守及手術治療兩種。不過，預防勝於治療，養成正確的修甲方法可以有效預防倒甲，避免腳甲發炎。正確的修甲方法是把指甲兩側剪平，而把兩側剪弧形是不正確的修甲方法。

保守治療
 
保守治療利用止痛藥及抗生素控制炎症，而且可以運用小工具防止趾甲嵌入(見圖示)



倒甲手術

手術治療以清除甲基質為目的，防止趾甲重生。以下是常見的倒甲手術方法:

• 手術切除 (wedge excision)
• 以藥物破壞趾甲的根部 (Phenol)
• 以鐳射激光(Laser)或高温射頻 (radiofrequency)射入甲床的根部，使其破壞不再生長，激光亦氣化了甲床組織，令腫脹情況減少。

資料來源：psclinic.com.hk
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向外科醫生查詢，而不應單倚賴以上提供的資料。

疝氣治療

疝氣 (小腸氣) 是因腹腔壁出現缺口，以致體腔內腸道從腹腔壁突出。疝氣的缺口成因可以是先天或後天形成，再加上長期咳嗽、便秘、小便困難及長期提取重物而誘發。要治療疝氣，手術是有效的治理方法。手術方式包括傳統修補手術配合人工網膜，以及腹腔鏡疝氣修補手術。


傳統修補手術配合人工網膜 

傳統開腹手術會在疝氣缺損的位置上開一個5至10公分的切口以進行修補，並放入一塊補片覆蓋疝氣缺損的位置。

 

 

 

腹腔鏡疝氣修補手術
 
進行腹腔鏡疝氣修補手術時，醫生會先在病人的肚臍下半邊緣開一個1公分的切口，用來放置已接駁攝錄機及光源之腹腔鏡。然後，醫生會透過攝錄 機投射在顯示器上的情況，清楚找出腹壁內的缺損及疝氣的位置，在疝氣缺損的位置上進行修補，並放入一塊補片覆蓋疝氣缺損的位置。補片會在病人復原期間強化 腹壁內的缺損，完全修補疝氣。
腹腔鏡疝氣修補手術是最常用的手術療程，由於此手術的入侵性較少，患者在術後會感到較少痛楚，住院及康復時間亦較短，而復發率更相對較低。

 

 

 

 

	傳統修補手術配合人工網膜	腹腔鏡疝氣修補手術
傷口大小	一個 4-5 厘米傷口	數個 0.5-1 厘米傷口
手術需時	較短	較傳統手術長約 40-60 分鐘
手術過程	簡單	複雜
住院時間	2-3 天	1-2 天
康復時間	較長	較傳統手術短
復發率	1-2%	0.1-0.5%

資料來源：psclinic.com.hk
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向外科醫生查詢，而不應單倚賴以上提供的資料。