admin – Drashishvashistha https://drashishvashistha.com Best Bariatric Sugreon in Delhi Mon, 14 Apr 2025 06:46:20 +0000 en-US hourly 1 https://wordpress.org/?v=6.7.3 https://drashishvashistha.com/wp-content/uploads/2021/04/cropped-imageedit_4_7918705576-1-min-32x32.png admin – Drashishvashistha https://drashishvashistha.com 32 32 CAN HERNIA AND GALLBLADDER STONE SURGERY BE DONE SIMULTANEOUSLY? https://drashishvashistha.com/post/can-hernia-and-gallbladder-stone-surgery-be-done-simultaneously-2/ Mon, 14 Apr 2025 06:46:14 +0000 https://drashishvashistha.com/?p=4318 HIATAL HERNIA IN YOUNG ADULT https://drashishvashistha.com/post/hiatal-hernia-in-young-adult/ Sat, 05 Apr 2025 14:52:58 +0000 https://drashishvashistha.com/?p=4288
DR ASHISH VASHISTHA, THE BEST HERNIA SURGEON IN DELHI

Dr. Ashish Vashistha is the Best Hernia Surgeon in Delhi, a Senior Robotic laparoscopic Surgeon, Director & HOD Department of Surgery and Robotics Max Super Specialty Hospital Saket, Delhi. Share information on Hiatal Hernia.

HIATAL HERNIA IN YOUNG ADULT
I am a young 22-year-old boy preparing for GMAT. 
For the past 3 months, I have been experiencing heartburn, and food regurgitation in my mouth, and just can’t eat anything.
I went to a physician and he did an endoscopy and found HIATAL HERNIA. 
I was put on antacids and asked to eat bland food and decrease my stress levels. 
My symptoms are increased and I am not able to concentrate on my upcoming exams. 
I came to meet DR ASHISH VASHISTHA, SENIOR DIRECTOR AND HOD DEPT OF SURGERY & ROBOTICS MAX HOSPITAL SAKET.  
He explained to me in detail about Hiatal Hernia and its treatment. 
 
What is hiatal hernia ?
Hiatal hernia is a condition in which the top of our stomach pushes up through an opening in our diaphragm into our chest. 
The diaphragm is a muscle that separates the abdominal cavity from the chest. 
A hernia is a condition in which a tissue/organ pushes through a weakness in the muscle that holds it.
Hiatal hernia can be present by birth and over the years it increases due to stress and strains on the body. 

There are two types of hiatal hernias. 
 1. Sliding types are common and account for 95%. 
     In this type part of the esophagus that connects with the stomach slides up from widened hiatus and it slides up and down.
 2. Paraoesophageal type which is less common and in this stomach pushes up through the hiatal alongside of esophagus this is called a rolling hiatal hernia.
 
Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains the symptoms of Hiatal Hernia:-
What are the symptoms of hiatal hernia? 
Most symptoms are related to chronic acid reflux GERD.
These include -: 
  1. Heartburn
  2. Chest pain which looks like angina
  3. The feeling of fullness or bloating
  4. Burping and regurgitation of food and gas going back into to mouth
  5. Sore throat due to irritation from acid 
Uncommon symptoms:- 
  1. Nausea
  2. Shortness of breath
  3. Constant pain in the abdomen 
Why do we get hiatal hernia?
Maybe we are born with a weak spot in muscles that separate body compartments and factors that increase abdominal pressure in symptoms of hiatal hernia.
 
Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains About Factors:-
The following factors contribute to the development of hiatal hernias.
  1. Chronic cough
  2. Straining while panning motion [constipation]
  3. BMI of more than 27
  4. Pregnancy
  5. Childbirth
  6. Intense weight training
 
Is hiatal hernia a serious problem?
Complications include:-
  1. Esophagitis
  2. Esophageal structure
  3. Barret’s esophagus
  4. Gastritis
 
Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains How to Diagnose Hiatal Hernia:-
How can hiatal hernias be diagnosed?
  • Complete evaluation and history-taking
  • Chest X-ray
  • Upper endoscopy
  • Esophageal manometry 

Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains About Management and Treatment:- 

Management and treatment:- 
Question – Is it possible to heal a hiatal hernia?
Answer –
Hiatal hernias don’t go away themselves
They usually get worse with time treatment depending on symptoms.
For milder symptoms, medicine can help.
 
SURGERY IS THE FINAL TREATMENT FOR HIATAL HERNIA WITH INTENSE SYMPTOMS.
WE USE ROBOTIC / LAPAROSCOPIC TECHNIQUES TO REPOSITION OF STOMACH AND TIGHTEN THE OPENING IN THE DIAPHRAM POTENTIALLY INCLUDING A FUNDOPLICATION TO ADDRESS REFLUX.
 
]]> HERNIA AFTER C-SECTION https://drashishvashistha.com/post/hernia-after-c-section/ Mon, 31 Mar 2025 11:04:24 +0000 https://drashishvashistha.com/?p=4258
DR ASHISH VASHISTHA, THE BEST HERNIA SURGEON IN DELHI

Dr. Ashish Vashistha is the Best Hernia Surgeon in Delhi, a Senior Robotic laparoscopic Surgeon, Director & HOD Department of Surgery and Robotics Max Super Specialty Hospital Saket, Delhi. Share information on HERNIA AFTER C-SECTION: -

HERNIA AFTER C-SECTION: -

  1. What are the symptoms?
  2. What are the treatment options?
  3. How fast do we expect recovery?

 
A hernia is a bulge or a lump seen when the inside part of our body protrudes through a weak muscle wall that contains it inside.
Hernia can occur in different parts of the body. 
When we perform surgery like open appendicectomy, open gall bladder surgery, or cesarean section to bring a baby out of the mother’s womb, we have to make incisions on the body. 
 A few months or years later a bulge /lump is seen developing on that site and this is an incisional type of hernia.
C- Sectional known cesarean delivery, involves an incision in the lower belly, and a bulge on it is called an incisional hernia.
 Though C-Section hernias are not common we do see them in our surgical practice.
 
Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains About Risk factors for developing  -c- section hernia:-
 Risk factors for developing  -c- section hernia include – 
  • Women who are obese, impose more pressure on C-section sites.
  • Immune suppression
  • Diabetes
  • Large incision site
  • Weak abdominal tissue
  • Some infection at the site of the incision
 
Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains About Symptoms:-
 Symptoms:-
  • A bulge appears on a C-section scar and its size can vary from grape size to tennis ball size.
  • When we stand, it increases in size.
  • Coughing |constipation also increases the size of the bulge.
  • If the hernia is large and becomes painful and red in color, it can be strangulated this is difficult condition, but it requires immediate medical attention.
 
Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains About Treatment:-
Treatment :-
Surgery is the only option.
There are no medications available to mend the hernia. 
Some people use abdominal binders at the hernia site. This does not help to correct hernia. 
You can post pose hernia surgery for some time for your personal reasons but should identify correct time to consult  aRobotic /laparoscopic hernia repairsurgeon.
 
Dr. Ashish Vashistha, BEST HERNIA SURGEON IN DELHI, recommends Robotic/ laparoscopic hernia repair with MESH.
Surgical mesh is inserted to reinforce the weak area and hold it in place.
 
Recovery: –
Most patients have quick recovery after laparoscopic/ robotic incisional hernia repair surgery. 
Patients can walk around in the home with in 24-48 hours.
You can start a liquid diet within 24 hour 
You are required to have a high-fiber diet to avoid constipation.  
We should follow the instructions of our doctor regarding medication.
Patients can return to work in 7-10 days’ time and resume light exercise in 2 weeks’ time. 
Weight lifting is recommended after 2 months.
]]> ADVANTAGES OF ROBOTIC TECHNOLOGY IN BARIATRIC METABOLIC SURGERY CASES. https://drashishvashistha.com/post/advantages-of-robotic-technology-in-bariatric-metabolic-surgery-cases/ Tue, 18 Mar 2025 08:01:32 +0000 https://drashishvashistha.com/?p=4233

DR ASHISH VASHISTHA, THE BEST BARIATRIC SURGEON IN DELHI

 Dr. Ashish Vashistha is the Best Bariatric Surgeon in Delhi, a Senior Robotic laparoscopic Surgeon, Director & HOD Department of Surgery and Robotics Max Super Specialty Hospital Saket Delhi. Share information on the ADVANTAGES OF ROBOTIC TECHNOLOGY IN BARIATRIC METABOLIC SURGERY CASES.

ADVANTAGES OF ROBOTIC TECHNOLOGY IN BARIATRIC METABOLIC SURGERY CASES.


Total Robotic metabolic & bariatric surgery may result in shorter operator time, reduced length of stay, and lower complications in comparison to laparoscopic approaches.

 

1.     What is robotic bariatric surgery?

 

Robotic bariatric surgery is a surgical procedure executed to reduce the weight of morbidly obese patients with or without co-morbidities.

 

2.     What is metabolic /diabetes surgery?

 

Metabolic surgery, also known as bariatric surgery, is a surgical procedure that modifies the digestive system to promote weight loss and improve metabolic health, particularly for individuals with obesity and related conditions like type 2 diabetes. 

 

Metabolic syndrome is a cluster of metabolic disorders that tend to occur together. It is caused by obesity, physical inactivity, increasing age, and genetics.

 

3)What are the benefits of metabolic surgery?

 

  • Significant weight loss – we can expect about 60% of excess weight to shed after metabolic bariatric surgery.
  • Improvement in blood sugar control.
  • There are changes in gut hormones as well as weight reduction. Both of them together lead to significant improvement of type 2 diabetes and sometimes remission of diabetes is also possible.
  • Improvement in other obesity-related complications is also seen like improvement in high blood pressure,  high lipid levels, non-alcoholic fatty liver disease, sleep apnea, PCOD, and respiratory problems.
  • Improvement in quality of life

 

When we see sustained weight loss with health parameters coming with range,

we generally feel better and quality of life becomes better.

 

 

Dr Ashish Vashistha, BEST BARIATRIC SURGEON IN DELHI  tells us about Robotic-assisted bariatric metabolic surgery procedures –

 

Robotic-assisted bariatric metabolic surgery procedures: –

 

Bariatric surgery procedures include gastric bypass (roux -and gastric bypass or RYGB) and sleeve gastrectomy also known as gastric sleeve.

 

Both their surgeries have an advantage if done with robotic technology.

 

The surgeon sits on the console near the operating room

 

Through the console surgeon controls a camera and tiny instruments, which are used to perform surgery through a few tiny incisions about the size of a fingertip.

 

The robotic system delivers 3D high-definition views, so surgeons get crystal clear views with surgical areas magnified 10 times what the human eye sees.

 

It translates every movement like real-time bending and rotating instruments that are more like human hands with a greater range of motion. There is less tremor and more precision.

 

Robotic technology is ideal for patients with high BMI

 

For patients with a high BMI or pre-existing health conditions like diabetes, sleep apnea, or heart disease, Robotic surgery offers a safer and more effective option. Because of the increased precision and flexibility of the robotic system, the surgeon has greater control in complex cases, especially in patients who otherwise are considered high risk.

 

In many cases, Robotic surgery can make the difference between whether a patient qualifies for surgery or not, offering hope to those who may have previously been told they were not eligible for bariatric surgery procedure.

 

Dr Ashish Vashistha, BEST BARIATRIC SURGEON IN DELHI  tells us about the Advantages of robotic technology to patients.

 

Advantages of robotic technology to patients:-

 

·         Minimally invasive

·    Robotic surgery involves small incisions leading to less trauma to reduce body pain and quicker recovery.

·         Faster recovery -shorter stay at hospitals and faster returns to their work

·         Small incision gives no Visible scars.

·        Lower risk of complications- Robotic technology offers more precision and control and minimizes the risk of complications like infections and leaks.

·         Betters post-operative outcomes.

·         Patients undergoing robotic bariatric surgeries typically report a higher state of satisfaction.

 

Dr Ashish Vashistha, BEST BARIATRIC SURGEON IN DELHI  tells us about the Advantages of robotic technology to operating surgeons.

 

Advantages of robotic technology to operating surgeons-

  • Enhance precision and control.
  • Improved ergonomics – the robotic system allows surgeons to operate from a console reducing fatigue and improving surgical experience.

 

Helps surgeons to operate till the age of 75.

 

  • Better visualization –

·         The 3D, high-definition view provided by the robotic system enhances the surgeon‘s ability to see the surgical site.

·         Robotic arms have a high degree of dexterity allowing surgeons the ability to operate in tight spaces where otherwise difficult to reach . robotic wrists and instruments provide a broader range of motion than laparoscopic equipment.

]]> Let’s address Obesity. (Informational) https://drashishvashistha.com/post/lets-address-obesity/ Thu, 13 Mar 2025 09:25:16 +0000 https://drashishvashistha.com/?p=4180

Dr. Ashish Vashistha, a Senior Robotic laparoscopic Surgeon, Director & HOD Department of Surgery and Robotics Max Super Specialty Hospital Saket Delhi. Share information on Addressing Obesity Surgery !

Let’s address Obesity ?

Obesity is characterized by excessive fat build up to the point that our health and well being are at risk.

It is a chronic disease and have detrimental effects on health.  

How do you diagnose obesity ?

1.BMI (Body mass index )

It is a screening tool to have a general look at obesity. It takes into account of person’s height and weight and  classify obesity.

It is calculated as person’s weight in kilogram divided by square of their height in meters ( kg / m2)

Different people of the same BMI may have different body shapes depending on distribution of body fat and skeletal muscle

A high BMI is a strong parameter for occurrence of Non communicable diseases like diabetes, hypertension , high lipid and many malignancies .

Although the BMI typically correlates closely with percentage body fat in a curvilinear fashion, some important caveats apply to its interpretation. In athletes  (muscular) persons, BMIs that usually indicate overweight or mild obesity may be spurious, whereas in some persons with lean sarcopenic eg, elderly individuals and persons of Asian descent, particularly from South
Asia, a typically normal BMI may conceal underlying excess adiposity characterized by an increased percentage of fat mass and reduced muscle mass.

In view of these limitations, some authorities advocate a definition of obesity based on percentage of body fat. For men, a percentage of body fat greater than 25% defines obesity, with 21-25% being borderline. For women, over 33% defines obesity, with 31-33% being borderline.

Classification of obesity

Among several classifications and definitions for degrees of obesity, the following is widely used:

  • Overweight – BMI greater than or equal to 25 to 29.9 kg/m2
  • Obesity class I – BMI 30 to 34.9 kg/m2
  • Obesity class II – BMI 35 to 39.9 kg/m2
  • Obesity class III – BMI greater than or equal to 40 kg/m2 (also termed severe, extreme, or massive obesity)

Under this classification, the cutoff points differ for Asian and South Asian populations like Indians , with overweight being classified as 23-24.9 kg/m2, and obesity as 25 kg/m2 or greater.

In children, a BMI above the 85th percentile (for age-matched and sex-matched control subjects) is commonly used to define overweight, and a BMI above the 95th percentile is commonly used to define obesity.

 

WHO classification of BMI for the Asian

population .

Underweight

<18.5 kg/m2

Normal Weight

18.5–22.9 kg/m2

Overweight

>23 kg/m2

Obese

>25kg/m2

2.Waist circumference

Waist circumference is simple to measure and it avoids any consideration of the hip as they convict of bone and skeletal muscle along with fat –

The technique for measuring WC is with measuring tape  halfway between the lower rib  and iliac crest

it is a measure of central /abdominal obesity when is more than 90 cm in men and more than 80 cm  in women ,they are associated with metabolic problems.

Fat distribution is important to identify

 Android obesity, in which adiposity is predominantly abdominal (including visceral and, to a lesser extent, subcutaneous), is strongly correlated with worsened metabolic and clinical consequences of obesity.

3.Hip circumference (HC)

It is measured at widest circumference over greater trochanters.

4.Waist – Hip ratio (WHR)

 WHR is obtained by dividing the WC by HC using same units of measurements for both.
WHR is straight forward indicator of central obesity.

The WHO classifies abdominal obesity in men if WHR >0.9 and women >0.85

The ratio greater than 1.0 in either sex indicates increased risk of metabolic complications.

Classification of -Waist-Hip ratio.

Health Risk

Women

Men

Low

0.80 or lower

0.95 or lower

Moderate

0.81–0.85

0.96–1.0

High

0.86 or high

1.0 or high

 5. Neck circumference (  NC)

NC >35.5cm in men

NC >32cm in women 

is harmful

6. Body fat percentage

Bioelectrical impedance analysis (BIA)is very accurate in diagnosing body fat.

It is more accurate then BMI .

Body impedance analyst is (BIA) is relatively simple quick and noninvasive  method to assess body composition .

BIA allows the calculation of fat free mass and body fat percentage.

Body fat percentage of more than 25% men and more than 30% in women are considered obese by Endocrine society of India

A person’s body fat percentage can be indirectly estimated by using the Deurenberg equation, as follows:

body fat percentage = 1.2(BMI) + 0.23(age) – 10.8(sex) – 5.4

with age being in years and sex being designated as 1 for males and 0 for females. This equation has a standard error of 4% and accounts for approximately 80% of the variation in body fat.

 

Important Parameters to look at-

 Indian cut-offs for Indicators

PARAMETER

INDIAN CUT-OFF MALE

INDIAN CUT-OFF FEMALE

Waist Circumference (WC

>90 cm

>80cm

Waist-Hip Ratio (WHR)

>0.9

>0.85

Wrist circumference

16.5 cm

15.7 cm

Neck circumference (NC)

35.25 cm

34.25 cm

Body Fat Percentage

>25%

>30%

Body Mass Index

>23 kg/m2 – Overweight,
>25 kg/m2 – Obesity

 Imaging

-CT scan

-MRI

Can identify visceral fat and subcutaneous fat .

Visceral fat is responsible for metabolic abnormalities

 

7. Dual – energy -x-ray absorptiometry (DEXA)

DEXA scanning uses low-level X-rays that pass through different types of tissues at different rates providing estimates of fat mass, fat-free mass, and bone density. This method is widely used to measure bone density and can also accurately measure fat mass. A limitation of most DEXA scanners is the capacity to image extremely obese persons. However, half-body scans have been shown to provide an accurate body compositional analysis. DEXA is relatively simple to perform, less expensive, and more accessible than MRI or CT Scan.

 

8.   Lab tests- like

– Liver function test

– Fasting glucose and glycosylated hemoglobin

– Thyroid  function tests

– Lipid profile  

 

Obesity can have many co-morbidities-

1) Respiratory – increased risk of bronchial asthma, COPD

2) Cardio vascular – High blood pressure, coronary artery disease, cardiomyopathy etc.

3) Psychological -social stigmatization and depression

4) Metabolic -type 2 Diabetes  and dyslipidemia

5) Gastrointestinal – Gall bladder stone, fatty liver, reflux esophagitis .

 6) Reproductive problems in women -early puberty,   infertility ,PCO ,anovulation

7) Reproductive problems in men- hypogonadism

8) Pelvic problems -stress in continence

9) Obstetrics – Pregnancy related hypertension, Gestational diabetes, macrosomia and difficult labor .

     10) Malignancies – Endometrial carcinoma  , liver , colon , breast carcinomas  etc

Management of Obesity

Complete evaluation on all aspects of  obesity is must.

1. History taking- 

– Duration of obesity

– Is obesity bothering the patient

– Family history of obesity

– Is he/ she worrisome person

– What is the sleep pattern

– Detailed dietaryhistory

– Medical history like – any metabolic disease like diabetes, high blood pressure,PCOS , high lipid , knee pain etc

– Social history – smoking,  alcohol, drug abuse

– Any other compulsion disorders like binge eating , binge drinking etc

 

2. Measurement of height , weight and calculating BMI

3. Abdominal circumference is measured

4. Hip circumference is measured

5. W/H ratio calculated

6. Neck circumference noted

7. Look for signs of insulin resistance like , acne , acanthosis nigricans , increased hair growth on face abdomen etc

8. After assessment, talk with patient and identify his / her goal of weight loss.

9. Life style modification is first step.

10. A well-balanced diet with sufficient protein, nutrients is formulated with the help of nutritionist

11.  A well-structured exercise regime is formed consisting of aerobics, strength training and yoga

12. Anti-obesity drugs are started if BMI is more than 30 or BMI more than 27 with co morbidities like type 2 diabetes / high blood pressure  and patient is unable to shed weight only on diet and exercise.

Anti obesity medications When combined with lifestyle and behaviour changes, including healthy eating and increased physical activity, can  help some people lose weight and maintain weight loss. On average, after 1 year, adults who take anti obesity medications as part of a lifestyle program lose 3% to 12% more of their starting body weight than people in a lifestyle program who do not take medication.

Orlistat

– Orlistat is a gastro – intestinal and pancreatic lipase by that indices weight loss by inhibiting dietary fat absorption.

– Orlistat should be taken  up to 1 hour after taking fatty meal  .

– It brings weight loss up to 5-7 percent and does not depend or systemic absorption.

– Full dose of 120 mg 3 times a day can give server GI events like flatulence, oily stool ,diarrhea and stool incontinence .

– -it is advisable to reduce fat content in meals to decrease side effects of orlistat.

Glucagon like peptide -1 agonist –

GLP -1agonists have shown to promote weight loss in patient with or without

Diabetes – 

GLP-1 is an appetite regulator .

– Semaglutideis indicated for chronic weight management along with life style changes like diet and exercise In patient with BMI >27 with obesity related co morbidities like type 2 diabetes , high blood pressure , high cholesterol etc

– This medicine is also good for risk reduction with regard to major adversecardo- vascular events in obese people

– This is available in 3 , 7 and 14 mg tablets , it promotes insulin secretion and delay gastric emptying .

These medications should not be taken by own self. Always see a doctor , get yourself evaluated and let doctor decide which medication is right for you.

13. Metabolic / Bariatric Surgery is gold standard for sustained weight loss and correction of metabolic side effects of obesity like type 2 diabetes , high blood pressure , high cholesterol , PCOS etc .

According to recent guidelines, particularly from the Obesity and Metabolic Surgery Society of India (OSSI), bariatric surgery in India is recommended for individuals with a BMI exceeding 35 kg/m2, regardless of the presence or severity of co-morbidities; additionally, individuals with a BMI between 30-34.9 kg/m2 and metabolic disease should also be considered for surgery, with a special consideration for the Asian population where a BMI above 27.5 kg/m2 may indicate the need for bariatric surgery due to the lower BMI threshold for obesity in Asian populations. 

]]> HOW TO ADDRESS OBESITY? https://drashishvashistha.com/post/how-to-address-obesity/ Tue, 11 Mar 2025 15:33:28 +0000 https://drashishvashistha.com/?p=4157
DR ASHISH VASHISTHA, THE BEST BARIATRIC SURGEON IN DELHI

Dr. Ashish Vashistha is the Best Bariatric Surgeon in Delhi, a Senior Robotic laparoscopic Surgeon, Director & HOD Department of Surgery and Robotics Max Super Specialty Hospital Saket Delhi. Share information on Addressing Obesity Surgery!

HOW TO ADDRESS OBESITY?

Obesity is a defined condition characterized by excessive fat build-up to the point that health and well-being are at risk.

It is a chronic disease and has detrimental effects on health.

 

DR ASHISH VASHISTHA, BEST BARIATRIC SURGEON IN DELHI Says:-

Obesity can have many co-morbidities-

1) Respiratory  – increased risk of bronchial asthma, COPD

2) Cardiovascular – High blood pressure, coronary artery disease, cardiomyopathy etc.

3) Psychological -social stigmatization and depression

4) Metabolic -type 2 Diabetes and dyslipidemia

5) Gastrointestinal (GI)-Gall bladder stone, fatty liver, reflux esophagitis.

6) Reproductive problems in women -early puberty,  infertility, PCO, Anovulation

7)Reproductive problems in men- hypogonadism

8) Pelvic problems -stress incontinence

9) Obstetrics – Pregnancy-related hypertension, Gestational diabetes, macrosomia, and difficult labor.

10) Malignancies – Endometrial carcinoma  , liver , colon , breast carcinomas, etc

 

DR ASHISH VASHISTHA, BEST BARIATRIC SURGEON IN DELHI tells about how you diagnose obesity:-

How do you diagnose obesity?

–      Lab tests- like

–      Liver function test

–      Fasting glucose and glycosylated hemoglobin

–      Thyroid  function tests

–      Lipid profile

Evaluation of the degree of fat in the body –

BMI Calculation

For Asian population-

–      Normal weight -18.5-22.9kg/m2  

–      Overweight – 23 kg/m2

–      Obese- 25 kg/m2

DR ASHISH VASHISTHA, BEST BARIATRIC SURGEON IN DELHI says about important Parameters:-

Important Parameters

Waist circumference men >90 and women >80

Waist -hip ratio        men >0.9 and women >0.85

Wrist circumference     in men more than 16.5 cm  and women more than 15.7 cm

Neek circumference    men >35.25 cm and women  >34.25 cm

Body fat percentagemen > 25.1% and women >30%

Body mass indexBMI >  23kg/m2

  1. BMI (Body mass index )

It is a screening tool that provides a general look at obesity. It takes into account of person’s height and weight and classifies obesity.

It is calculated as a person’s weight in kilogram divided by the square of their height in meters ( kg / m2)

 Different people of the same BMI may have different body shapes depending on the distribution of body fat and skeletal muscle

A high BMI is a strong parameter for the occurrence of Non-communicable diseases like diabetes, hypertension, high lipid, and many malignancies

  1. Waist circumference

 – it is a measure of central /abdominal obesity when is more than 90 cm in men and more than 80 cm in women, they are associated with metabolic problems.

Waist circumference is simple to measure and it avoids any consideration of the hip as it consists of bone and skeletal muscle along with fat- –

The technique for measuring WC is with measuring tape  halfway between the lower rib  and iliac crest

  1. Hip circumference (HC)

It is measured at the widest circumference over greater trochanters.

  1. Waist –Hip ratio (WHR)

 WHR is obtained by dividing the WC by HC using the same units of measurement for both. WHR is a straightforward indicator of central obesity.

The WHO classifies abdominal obesity in men as WHR >0.9 and in women >0.85

A ratio greater than 1.0 in either sex indicates an increased risk of metabolic complications.

  1. Neck circumference (  NC)

NC >35.5cm in men

NC >32cm in women

 is harmful

  1. Body fat percentage

Bioelectrical impedance analysis (BIA)is very accurate in diagnosing body fat.

It is more accurate than BMI.

Body impedance analysis (BIA) is a relatively simple quick and noninvasive method to assess body composition.

BIA allows the calculation of fat-free mass and body fat percentage.

Body fat percentage of more than 25% of men and more than 30% of women are considered obese by the Endocrine Society of India.

Imaging

-CT scan

-MRI

Can identify visceral fat and subcutaneous fat.

Visceral fat is responsible for metabolic abnormalities

  1. Dual-energy -x-ray absorptiometry (DEXA)

DEXA scanning uses low-level X-rays that pass through different types of tissues at different rates providing estimates of fat mass, fat-free mass, and bone density. This method is widely used to measure bone density and can also accurately measure fat mass. A limitation of most DEXA scanners is the capacity to image extremely obese persons. However, half-body scans have been shown to provide an accurate body compositional analysis. DEXA is relatively simple to perform, less expensive, and more accessible than MRI or CT Scan. Radiation exposure is much less than a CT scan. Although subcutaneous and visceral fat cannot be clearly separated by DEXA, abdominal mass determined by DEXA correlates well with visceral fat as determined by other methods such as CT Scan and MRI Scanning.

DR ASHISH VASHISTHA, BEST BARIATRIC SURGEON IN DELHI Says about the Management of Obesity:-

Management of Obesity

Complete evaluation of all aspects of obesity is a must.

  1. History taking-

–      Duration of obesity

–      Is obesity bothering the patient

–      Family history of obesity

–      Is he/ she a worrisome person

–      What is the sleep pattern

–      Detailed dietary history

–      Medical history like – any metabolic disease like diabetes, high blood pressure, PCOS , high lipid , knee pain, etc

–      Social history – smoking,  alcohol, drug abuse

–      Any other compulsion disorders like binge eating , binge drinking, etc

  1. Measurement of height, weight, and calculating BMI
  2. Abdominal circumference is measured.
  3. Hip circumference is measured.
  4. W/H ratio calculated
  5. Neck circumference noted
  6. Look for signs of insulin resistance like acne, acanthosis nigricans, increased hair growth on the face and abdomen, etc.
  7. After assessment, talk with the patient and identify his / her goal of weight loss.
  8. Lifestyle modification is the first step.
  9. A well-balanced diet with sufficient protein and nutrients is formulated with the help of a nutritionist.
  10. A well-structured exercise regime consists of aerobics, strength training, and yoga.
  11. Anti-obesity drugs are started if BMI is more than 30 or BMI more than 27 with co-morbidities like type 2 diabetes / high blood pressure and the patient is unable to shed weight only on diet and exercise.

Anti-obesity medications When combined with lifestyle and behavior changes, including healthy eating and increased physical activity, can help some people lose weight and maintain weight loss. On average, after 1 year, adults who take anti-obesity medications as part of a lifestyle program lose 3% to 12% more of their starting body weight than people in a lifestyle program who do not take medication.

DR ASHISH VASHISTHA, BEST BARIATRIC SURGEON IN DELHI Says about Orlistrat:-

Orlistat

–      Orlistat is a gastrointestinal and pancreatic lipase that induces weight loss by inhibiting dietary fat absorption.

–      Orlistat should be taken up to 1 hour after taking a fatty meal  .

–      It brings weight loss up to 10 percent and does not depend on systemic absorption.

–      Full dose of 120 mg 3 times a day can give server GI events like flatulence, oily stool , diarrhea, and stool incontinence .

–      -it is advisable to reduce fat content in meals to decrease the side effects of orlistat.

Glucagon-like peptide -1 agonist –

GLP -GLP1agonists have been shown to promote weight loss in patients with or without

Diabetes –

GLP-1 is an appetite regulator.

–      Semaglutide is indicated for chronic weight management along with lifestyle changes like diet and exercise In patients with BMI >27 with obesity-related co-morbidities like type 2 diabetes, high blood pressure, high cholesterol, etc

–      This medicine is also good for risk reduction of major adverse-cardo- vascular events in obese people

–      This is available in 3 , 7, and 14 mg tablets , it promotes insulin secretion and delays gastric emptying .

–      These medications should not be taken by oneself. Always see a doctor, get yourself evaluated, and let a doctor decide which medication is right for you.

  1. Metabolic / Bariatric Surgery is the gold standard for sustained weight loss and correction of metabolic side effects of obesity like type 2 diabetes, high blood pressure, high cholesterol, PCOS, etc. According to recent guidelines, particularly from the Obesity and Metabolic Surgery Society of India (OSSI), bariatric surgery in India is recommended for individuals with a BMI exceeding 35 kg/m2, regardless of the presence or severity of co-morbidities; additionally, individuals with a BMI between 30-34.9 kg/m2 and metabolic disease should also be considered for surgery, with special consideration for the Asian population where a BMI above 27.5 kg/m2 may indicate the need for bariatric surgery due to the lower BMI threshold for obesity in Asian populations. 
]]> AWR SURGERY https://drashishvashistha.com/post/awr-surgery/ Wed, 05 Mar 2025 11:25:47 +0000 https://drashishvashistha.com/?p=4090

DR. ASHISH VASHISTHA, THE BEST HERNIA SURGEON IN DELHI

Dr. Ashish Vashistha is the Best Hernia Surgeon in Delhi, a Senior Robotic laparoscopic Surgeon, Director & HOD Department of Surgery and Robotics Max Super Specialty Hospital Saket, Delhi. Share insights on AWR- ABDOMINAL WALL RE CONSTRUCTION SURGERY.

AWR SURGERY

Abdominal wall reconstruction (AWR) surgery is a subspecialty of general surgery that repairs or replaces a weakened abdominal wall. It is often used to treat hernias.

  

Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains How AWR surgery is performed.  

How AWR surgery is performed  

AWR surgery can be performed using laparoscopic, robotic-assisted, or open methods.

 

Who are the right patient for AWR Hernia Surgery?

Those patients who have intermittent discomfort, and inability to perform certain activities of daily living due to a large hernia. In these patients, the surgeon has the opportunity to optimize comorbidities preoperatively. The ultimate goal is the improvement of the patient’s quality of life. The means for obtaining this goal are 2-fold: the surgeon must achieve a strong, durable dynamic abdominal wall, which is usually best obtained by mesh-reinforced innervated musculofascial reapproximation. The surgeon must also strive to minimize complications such as hernia recurrence and surgical site occurrences.

 

Dr. Ashish Vashistha, BEST HERNIA SURGEON IN DELHI Explains How to take a call to decide on AWR surgery.

How to take a call to deciding on AWR surgery  

  • There should not be any co- morbidities or contamination.
  • Preferably Diabetes and respiratory conditions should be under control.
  • Try to shed weight before surgery if possible
  • Immune suppression should be minimal.

 Select the correct procedure

  • We should minimize the risk of hernia recurrence and bulge.
  • Primary musculofascial closure should be good.
  • Most closures in complex patients should be reinforced with mesh.

We should make fascial closure after adequate debridement of non-viable damaged tissue. This will help us have a dynamic abdominal wall that can resist stress and stain, helping us have lower rates of hernia recurrence. If, for any reason, primary closure cannot be achieved, then component separation should be tried.

The issue of tension on closure deserves special attention. Excessive tension can cause fascial dehiscence and hernia recurrence.

Excessive tension can Cause abdominal compartment syndrome. This can be fatal. 

 

Ensure proper mesh placement and fixation.

Ideally mesh location should insulate the viscera from the mesh. The retro-ectus / retro muscular plane (rives -stupa)  technique is very good.

Another mesh placement is the intraperitoneal under-lay position.

-Choosing the correct mesh 

While deciding about the type of mesh, the surgeon needs to weigh each patient’s risk of infection against recurrence – 

Meshare of two types –

-Synthetic

-Biologic

Synthetic meshes are more durable-

Biology meshes tend to be more resistant to infection.

 

Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains that what are the key indications for AWR Suregry. 

What are the key indications for AWR  surgery?

·       Large or complex abdominal; wall hernia

·       Recurrent hernia

·       Serve abdominal wall weakness

·       Large abdominal wall defects

·       Symptoms imparting quality of life 

]]> GALL BLADDER STONES SLIPPING IN THE CYSTIC DUCT. https://drashishvashistha.com/post/gall-bladder-stones-slipping-in-the-cystic-duct/ Sun, 02 Mar 2025 13:18:55 +0000 https://drashishvashistha.com/?p=4061
Dr. Ashish Vashistha – Best Gallbladder Surgeon in Delhi

Dr. Ashish Vashistha is the Best Gallbladder Surgeon in Delhi, a Senior Robotic laparoscopic surgeon who is HOD Department of Surgery and Robotics Max Super Specialty Hospital Saket Delhi explains about GALL BLADDER STONES WITH STONES SLIPPING IN CYSTIC DUCT.

GALL BLADDER STONES WITH STONES SLIPPING IN THE CYSTIC DUCT.

I am 29 years old girl with a BMI of 30. 
I am a banker with an average working more than 12 hours per day. 
Yesterday night we had an evening dinner meeting at the office and suddenly after dinner, I started having pain in the epigastric region and bloating in my stomach. I thought it was some gastric problem and looked for antacids to relieve pain.
The next day morning, I got up with another bout of pain, vomiting, and loose motions. Now  I decided to visit the hospital and I went to the emergency department at Max Hospital Saket, New Delhi. They evaluated my vitals and gave me some injections to relieve pain and vomiting.
To my relief, the doctor on duty informed Dr. Ashish Vashistha and the team for further evaluation to rule out gall bladder stones or appendicitis.
Ultrasound abdomen was done and they found out my Gall bladder full of stones and some stones/sludge in the cystic duct as well.
 
The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha explained to me in detail –
Gallbladder stones are crystal-like substances made up of cholesterol or sometimes of bile and calcium. Gall bladder stones can vary in size from a tiny size of 2mm to as large as the size of a golf ball. Stones can be single or multiple.
 
The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha explains that:-

Why do cholesterol stones form? 
When bile contains too much cholesterol and not enough bile salts, cholesterol stones develop. 
Sometimes bladder stones slip out of the gall bladder to a cystic duct or bile duct. 
They may pass into the stomach and if their size is large can be struct in the cystic duct/bile duct. 
The cystic duct /bile duct stones can cause agonizing pain and can be dangerous.
 
The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha explains other Factors:-
 Other factors for developing stones are- 
  • Obesity
  • When we lose weight rapidly
  • Prolonged fasting
  • On OCPs
  • Pregnancy
 
Gallstones can be silent stones with no symptoms and diagnosed only on routine ultrasound /MRI /Generally gall stones come following symptoms:-
 
  • Acute pain happening suddenly after heavy Meals
  • Pain between shoulder blades
  • Chills and fever
  • Nausea, vomiting
  • Pain radiating from the epigastric region to the back
 
When stones slip in the cystic duct and cause pain, then we have cholangitis and this is a very painful condition. If a stone slips in CBD  then the situation is more difficult. This can and can cause pancreatitis which can be fatal.
 
The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha advised MRI for me and found that my cystic duct was full of stones.
 ERCP was done to place a stent and remove stones from the bile duct.
 
Dr. Vashistha did a laparoscopic cholecystectomy. Fortunately, all stones were milked out of the cystic duct and I am doing well now.
]]> GALLBLADDER STONE DISEASE IN ELDERLY CAN BE DANGEROUS. https://drashishvashistha.com/post/i-am-a-78-year-old-male-with-gallbladder-stones-for-5-years/ Fri, 21 Feb 2025 11:56:11 +0000 https://drashishvashistha.com/?p=4011

Dr. Ashish Vashistha – Best Gallbladder Surgeon in Delhi

Dr. Ashish Vashistha is the Best Gallbladder Surgeon in Delhi, a Senior Robotic laparoscopic surgeon who is HODDepartment of Surgery and Robotics Max Super Specialty Hospital Saket Delhi, evaluated the Patient's case.

I am a 78-year-old male with Gallbladder stones for 5 years.

For the past 7 to 10 days, I have had dull ache pain in my chest and dyspepsia.

I am diabetic and hypertensive, well-controlled on medications.

I came to DR ASHISH VASHISTHA, SENIOR DIRECTOR of HOD MAX HOSPITAL SAKET FOR EVALUATION AND MANAGEMENT.

He explained to me all about it.

 

GALLBLADDER STONE DISEASE IN THE ELDERLY CAN BE DANGEROUS.

 

GERIATRIC PATIENTS TEND TO HAVE SUBTLE PRESENTATIONS OF BILIARY DISORDERS AND IF UNTREATED CAN DECOMPENSATE ACUTELY.

GALLBLADDER STONES CAN CAUSE ACUTE CHOLECYSTITIS AND ARE SOMETIMES DIFFICULT TO MANAGE.

 

With the progression of age, the biliary tract undergoes anatomic and physiologic changes. Geriatric patients tend to have a subtle presentation of biliary disorders and can decompensate acutely if untreated. They have higher rates of complications and slower recovery because of delayed healing, comorbidities, and weaker immune systems. The management of gallstones must incorporate therapeutic goals ranging from improvement of quality of life to a disease-free body.

 

The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha explains about Asymptomatic Gallbladder stones.

Asymptomatic Gallbladder stones –

Elderly people can have a symptomatic gallbladder stone diagnosed on ultrasound / MRI etc.

Looking into their medical conditions, they should be offered its management.

Elective laparoscopic cholecystectomy is an ideal procedure to be done.

 

The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha explains Acute cholecystitis.

Acute cholecystitis refers to acute inflammation of the gallbladder, which in most cases results from gallstones.

Acute calculous cholecystitis results from cystic duct obstruction and increased intraluminal pressure and congestion.

 

Symptoms –

  • Acute pain in epigastric region 
  • Nausea, vomiting
  • Distention of abdomen
  • Unable to pass gas/flatus
  • Pain radiating to the back
  • Acute pain is seen after fatty meals and early in the morning

 

On examination Murphy’s sign is positive. Sometimes in elderly patients due to neuropathy, less pain is felt and other symptoms like dizziness, weakness, ghabrahat, and a general feeling of unwell are felt.

 

The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha explains about Diagnosis.

Diagnosis –

  • Ultrasound is extremely important to look for gallbladder stones, sludge, the thickness of the gallbladder wall, gas in the lumen of the gallbladder, cystic duct, bile duct caliber, wall thickness, and any presence of stones or sludge.
  • HIDA scan can help if nothing significant is seen on the ultrasound
  • MRI abdomen can also help
  • A complete blood count will give us a clue about the association between pancreatitis and CBD stones.
  • Clinical suspicion is also very important.

 

The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha explains about complications.

 

Complications–

  • Gangrenous cholecystitis
  • Emphysematous cholecystitis
  • Gallbladder ileus
  • Cholecystoenteric fistula
  • Gallbladder perforation

 

Elderly people are prone to have complications so Gallbladder stones should be electively treated in them.

LAPAROSCOPIC CHOLECYSTECTOMY AFTER MEDICAL MANAGEMENT IS THE IDEAL TREATMENT FOR GALLSTONES IN THE ELDERLY.

IT SHOULD BE DONE IN TERTIARY HOSPITAL WITH HIGH-TECH INFRASTRUCTURE.

 

The Best Gallbladder surgeon in Delhi, Dr. Ashish Vashistha explains about CHRONIC CHOLECYSTITIS.

CHRONIC CHOLECYSTITIS –

Long-standing gallstones or prior episodes of acute cholecystitis may cause indolent gallbladder inflammation, also called chronic cholecystitis.

On histology, gallbladder wall thickening, serosal adhesions, smooth muscle hypertrophy, and pathognomonic Rokitansky-Aschoff sinuses are observed.

The chronic inflammation may cause gallbladder calcification and porcelain gallbladder, the mechanism of which is unclear.

 

 TREATMENT FOR CHRONIC CHOLECYSTITIS IS ALSO MEDICAL MANAGEMENT AND LAPAROSCOPIC CHOLECYSTECTOMY

]]> INGUINAL HERNIA https://drashishvashistha.com/post/inguinal-hernia/ Sat, 15 Feb 2025 12:20:39 +0000 https://drashishvashistha.com/?p=3965

DR. ASHISH VASHISTHA , BEST HERNIA SURGEON IN DELHI


Dr. Ashish Vashistha is the Best Hernia Surgeon in Delhi, a Senior Robotic laparoscopic Surgeon, Director & HOD Department of Surgery and Robotics Max Super Specialty Hospital Saket, Delhi, Share information on Inguinal Hernia.

DR ASHISH VASHISTHA HAS RECEIVED AN AWARD OF CENTRE OF EXCELLENCE FOR HERNIA SURGERY BY HERNIA SOCIETY OF INDIA

INGUINAL HERNIA

An inguinal hernia is a bulge/ swelling that develops in the groin region between your thigh and abdomen. 
So, We have 3 layers of skin, abdominal muscles, and thin peritoneum that protect our intestines. 
When an inguinal hernia occurs, there is a weakness of muscle at a given point and the intestines with peritoneum push out and a bulge appears under our skin. Inguinal hernias always should be operated on soon diagnosed as they keep increasing in size and sometimes get trapped inside hernia defect and their blood supply gets cut. This is called an obstructed hernia and this is an emergency that requires immediate surgery. 
Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains About the facts of Inguinal Hernia:-  
Let us understand facts about inguinal hernia.  
There are two types of hernias. 
1. Indirect inguinal hernia – This is more commonly seen in men because male testicles are inside the abdomen and they go to the scrotum through an opening in the groin area.
Sometimes this opening does not close and hernia forms.  
In women this hernia slides into the groin area due to weakness in the muscle.
 2. Direct inguinal hernias are not very common and are seen in men only.
 
Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains About Symptoms:- 
Symptoms:-
A bulge is seen in the groin area which increases in size when we stand or stain and disappears when lie down.
  1. Sudden pain in groin and scrotum area.
  2. A dull ache, pressure, or burning sensation in the groin area. 
Sometimes the bulge is large and the intestine does not go back into the abdomen and we feel severe pain.
This could be obstructed or strangulated hernia. 
Symptoms:-
  1. Server pain and redness
  2. Pain which is extreme in severity
  3. Fever with Chills
  4. Nausea  and vomiting
  5. Raised  heart rate
 
Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains About Diagnosis:-
DIAGNOSIS – 
-A physical examination with ultrasound and MRI can confirm the diagnosis Treatment.
 
Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains About Treatment:-
Treatment :-  
-Laparoscopic / Robotic assisted hernia repair surgery.  
Mesh is typically used for these repairs.  
Recovery is quick and less painful after minimal invasive techniques,
Open repair is sometimes done when surgery is done in an emergency and general anesthesia can not be given due to medical reasons.
 
Dr Ashish Vashistha, BEST HERNIA SURGEON IN DELHI  Explains About Prevention:-
PREVENTION:-
Indirect inguinal hernia are present by birth and nothing can be done.
For Direct inguinal hernia
–       Use weight lifting with precautions
–       Treat cough early
–       Avoid constipation
–       If overweight – Reduce weight
 
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