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Category Archives: IVH Expert Articles

22% of Indian adults suffer from constipation : Survey

By Vinod Kumar

New Delhi. A recent survey suggest that 22% of the adult Indian population is suffering from the condition, with 13% complaining of severe constipation. 6% of the Indian population suffer from constipation associated with certain comorbidities.

This Survey highlights the predicament of these ‘silent sufferers’, the cause of chronic constipation and problems associated with it. This survey was conducted by healthcare company Abbott in in association with IPSOS, a global market research firm that surveyed 4,133 respondents across 8 cities – Mumbai, Delhi, Kolkata, Hyderabad, Chennai, Patna, Ahmedabad and Lucknow to understand the seriousness of the issue.

Indian Cricketer, Virender Sehwag said about this survey, “Being an athlete, I know gastrointestinal issues can be the root cause for many other health issues including mental health. If we suffer from gastrointestinal issues, it becomes difficult to focus and perform well on field and in life. Having a healthy gut is key as it allows the body to build a stronger immune system.”Infact, the survey results state that after common cold and cough, constipation is one of the most common self-claimed problems for Indians.”

Kolkata tops the charts with 28% respondents suffering from constipation. The survey highlights that one-fourth of Kolkata sufferers do not indulge in any physical activity and believe in self-medication rather than consulting a doctor. Chennai, which is next in line to Kolkata, has a 34% population claiming to experience extreme pain while passing stools. Delhi, which has 23% respondents suffering from constipation shows the highest number of people consuming outside food along with high intake of junk food. Patna, Ahmedabad, Mumbai, Lucknow and Hyderabad reported lower number of constipation sufferers compared to other three cities in the survey.

Dr Kushal Mital, Coloproctologist, Medicare Hospital, Mumbai, says “The study succeeds in highlighting the issue existing around constipation. One of the key aspects being how people neglect the problem and delay seeking medical help. In fact, constipation can be completely avoided by leading a healthy life style, eating right, embracing physical exercises, having ample of water (1litre / every 20 kg weight) to keep body hydrated. However, anyone can face the issue but it should be managed or treated early to avoid complications later on.”

Dr Ramesh Roop Rai, Professor & Director, Department of Gastroenterology, NIMS Medical College and University, Jaipur, says “The problem of constipation is rising in India, especially in urban population. It is basically due to faulty diet and lifestyle habits. Less water and fibre intake, sedentary lifestyle are very much attributed to constipation thereby affecting quality of life. Moreover, many lifestyle disorders like diabetes, hypertension are also associated with symptoms of constipation. Every physician must be aware of the same and proactively enquire about symptoms of constipation and treat it accordingly.”

Dr. Rashmi Hegde said, “In the healthcare ecosystem, every player has a role to play to improve healthcare – be it the patient or the treatment providers. As highlighted in the study, a large number of sufferers are present across India and almost half of them are not visiting a doctor for treatment.

Key Findings of this survey are :

  1. The eight-city survey highlights higher percentage of constipation sufferers in metros (23%) as opposed to non-metros (19%). Kolkata has the highest number of sufferers at 28%, followed by Chennai at 26%.
  2. Various metabolic disorders are likely to cause constipation. For example, Diabetics are 2.2 times more prone to constipation vis-à-vis nondiabetics while patients with Hypothyroidism are 2.4 times likely to develop constipation vs patients without hypothyroidism. Moreover, people with Anorectal disorders have more than 2.7 times the likelihood of associated constipation. Constipation tends to be more severe when associated with some of these comorbidities.
  3. Pregnancy was found to be a common cause of constipation in women, with every 1 in 4 pregnant females (25%) suffering from constipation. It has been observed that constipation is most common in the second trimester. The survey also highlights the fact that 18% pregnant women developed anorectal disorders, thus making it imperative for medical practitioners to identify the condition in its early stage and begin treatment.
  4. Practices like irregular eating habits, consumption of junk food and less water intake have been identified as key factors causing constipation. 21% sufferers do not indulge in any physical activity, making sedentary lifestyle an important factor associated with constipation.
  5. The survey also brought to light the fact that though 88% of the sufferers are concerned about the condition, very few are willing to discuss it with their immediate family or friends due to the “social taboo”. According to the survey findings, 49% of the respondents have been shy about seeking medical help to solve their problem. In fact, on an average, respondents admit to waiting for an average of four months before deciding on consulting a doctor.
  6. A glaring 33% of the sufferers have never treated constipation, while 48% have resorted to home remedies to treat the condition.


New Age Solutions for Cataract Provide Better Vision

Dr Mahipal Sachdev

Posing as a major healthcare challenge, India is a home of over 80 Lakh blind people in the country. The definition of blindness, which was changed earlier in 2016 by the Indian Government, identifies a blind person as someone who has less than 3/60 vision in better eye is understood to be blind.

One of the major factors causing loss of vision world over is cataract, which accounts to approximately 62% of blindness in India. Although government efforts are aiming towards restoring sight, a major focus on spreading awareness on quality of vision post-surgery is much needed.

I have been treating more than 200 cataract patients every month. In a world governed by screens and social media, we are glued to our digital devices day in and out. Thus impeccable intermediate vision has become a priority for younger and older generations alike. Fortunately today, cataract is easily treatable and advanced ophthalmology solutions such as extended range of vision lenses are available to enable patients lead highly active lifestyles with good quality of life even post cataract surgery.

With the growing desires of leading an independent, active life, vision loss due to cataract at any age comes as a big impediment to hopes of people. The eye ailment is not preventable but is treatable through intraocular lenses (IOLs), which are used to replace the natural eye lenses. However, with modern advancement in IOLs, patients have more than one alternative.

Post-surgery quality of vision is an important aspect that determines the quality of life. With monofocal IOLs, spectacles become a necessity. Even with progressive glasses, eyes take time to adjust while shifting from near to distance vision. This aberration is little but not completely corrected with multifocal lenses. However, the new extended range-of-vision lenses give impeccable clarity and contrast of vision, and reduce dependency on spectacles. The night vision through these lenses is uninterrupted with reduced incidence of halos or glares, quite common in the more popular multifocal lenses. The new lens also caters to distant, near and intermediate vision with seamless transition.

Although usually considered as an age related disease but cataract is not restricted to older population now.  Factors like diabetes, long-term use of steroid medicines, prolonged exposure to indoor pollution and even ultraviolet rays can lead to cataract at young and old age.

Today, cataract surgery is considerably a straightforward day care procedure, with vision being restored to patients within hours of surgery. The surgery today is possible to be done with just eye drop anesthesia, with no eye pad or stitches. Patients return home and can resume daily activities the same day. Post-surgery, careful post-operative care ensures a safe and speedy recovery.

Is wellknown opthamologist and chairman of Centre for Sight, New Delhi.

Be cautious, Sleep Deprivation Leads to Erectile Dysfunction!

By Dr. Sandeep Patil

Some people tend to cut down on sleep to make sure other responsibilities, work and familial, are met. The urge to ‘get the job done’ somehow proves to be stressful on the body. Getting the right amount of sleep can do wonders for your health; it plays an important role in reducing stress and also lifts the mood. Lack of sleep is known to have adverse effects on the Brain, Heart, weight and life in general. However, specifically in males, sleep deprivation has been said to cause Erectile Dysfunction.

Getting quality sleep is significant in maintaining Testosterone levels, which is vital in maintaining a man’s erection and sex life. It is proven, that most Testosterone is produced while sleeping; highest levels are produced during REM (deep stages of sleep) sleep. When a man is sleep-deprived, his Testosterone levels drop to as much as 70%. Thus, decrease in total sleep or disrupted sleep can impact sexual function. Studies show that sleep deprivation and Sleep Apnea(interrupted breathing while asleep) cause Erectile Dysfunction in more than 60% of men.

Sleep deprivation is often associated with mood disorders, exhaustion and poor stamina. These factors have an impact on the sexual performance and thus stall sexual functioning and energy. Ejaculation shortfall is also experienced in such situations. Males who are deprived of sleep also tend to be aggressive and intolerable which in turn affects an intimate relationship. Lack of sleep also speeds up the ageing process which obstructs sexual activities.

If one experiences sleep deprivation, seeking medical help or discussing the matter with your partner and your doctor can switch things around. Men who have been treated for such cases have shown improvement in sleep patterns which have progressively enhanced sexual functions. Most men require at least 7-8 hours of sleep for testosterone to be produced; to maintain adequate sexual function it is important to get good quality sleep.

Is a Chief Intensivist and Physician, Fortis Hospital, Kalyan.

Have a sore throat? Blame the weather

By Dr Rajesh Gokani

The last two months of the past year brought along cold winds and the city experienced the chills, a sign that winter was here. Although the festive season has ended and the New Year has begun, the city has also experienced a shift in temperature conditions, mostly a fluctuating weather timetable.

Due to the impact of change in weather conditions ranging from 21°C to 34°C, especially in the night and early mornings, a lot of Mumbaikar’s  have been experiencing seasonal flu’s. Out of which majority have visited their Physician complaining about a sore throat. While about 15-20% of Mumbaikar’s across age groups have been affected with this problem, it is more commonly seen amongst school going children and infants. The most common allergies identified are Allergy Rhinitis (running nose, fever, sneezing and watering of eyes) as well as Viral Pharyngitis (pain while swallowing, cold and cough).

You should consider the following steps to treat your sore throat and to avoid any further infections:

  • Morning walks are avoidable: It is recommended that morning walks be avoided due to the dust and dew in the morning air, especially around5am. One can go for a walk post 6:30/7am
  • Avoid antibiotics: There is no need for antibiotics unless the temperature is high or if a person experiences breathlessness and high grade fever. In this regard, it is best to visit your doctor for guided treatment, do not self-medicate
  • Follow the dosage: Make sure you follow the course of medication, as prescribed. Avoid neglecting your course once your problems ceases. It is important to complete the entire course
  • Ditch the junk: One must avoid junk, fried food and cold drinks
  • Home intervention: There are no such home remedies, but one can have Tulsi or Ginger tea, salt water gargling and sips of hot water frequently during the day could also help
  • Eat right: Immunity is generally low at this point of time, make sure you consume a nutritious diet. To boost immunity, drinking water with a tinge of honey will help fight the mucous accumulated in the lungs. One must have small frequent meals which are healthy and avoid outside food

Is a General Physician, SL Raheja Hospital- A Fortis Associate Hospital.

Do Not Self-Medicate!

Dr Rahul Pandit

With the winter approaching, self-medication becomes a major concern for doctors. Often it is the friendly chemist, friend or patient themselves who suggest self-medicating based on the common symptoms. Needless to say it is completely inappropriate to take medications without a proper medical consultation.

For one, most of the winter illness are mild illness, caused by viruses and are self-limiting. The treatment required would often be just symptomatic care, but often antibiotics are dispensed for the same and this promotes the development of resistant organism. Secondly, what looks like a mild illness would be actually a serious problem, requiring appropriate diagnosis, tests and treatment. If precious time is wasted in self-medicating, the consequences are dire, often leading to hospital and intensive care admission or in some cases, threat to life.

The more common symptoms like cough and cold, may actually be symptoms of Pneumonia, if not treated appropriately, the consequences are serious. It is important that the patients understand, that chemists are not allowed to dispense medications like antibiotics, pain relief medications, anxiolytics etc. without a doctor’s prescription. The reason being that Chemists may have an understanding of the drug and its actions, but lack the clinical skills, lack understanding of effects of a particular drug on physiological variables and certainly are not able to correlate with different system and drug interactions. The paucity of this knowledge may be deleterious to patient, causing harm than good.

Chemists mostly tend to dispense paracetamol with an antihistamine combination, followed by Non-steroidalanti-inflammatory drugs and antibiotics. Sometimes, these are not required as they are unaware of the person’s clinical history and findings. Most of the time the most concerning self-medication is for fever; fever could be a symptom for a lot of other factors. Self-medication hampers the possibility of being treated for the right reasons. Doctors do not advise taking an Aspirin as home intervention before reaching a hospital for treatment in regards to cough, cold, fever or headaches. Taking a mild paracetamol prior to doctor consultation or a remedial steam inhalation is preferable.

Is a Director- Intensive Care, Fortis Hospital, Mulund.

‘Expectations of today’s Population V/s. Cost to Deliver It’

Dr Arun Bal,

Indian Healthcare sector is at crossroads. In recent past, there have been incidents of various types with wide publicity in print and visual media, as well as social media, creating doubts about efficacy, honesty and rationality of private as well as public health sector. There is a strong need for dispassionate analysis of the situation to arrive at an optimal solution.

It must be noted that the attacks on doctors are not a recent phenomenon but increased frequency is a worrying factor. If one takes healthcare industry as 100%, doctors form only 25% component of this sector; rest is formed by various stakeholders over which neither doctors have control nor do they have any say in their functioning. There is also disparity of regulation. For example there is medical council, CPA, and many other laws for doctors but for other stakeholders there are no specific laws except central laws like Drugs and Cosmetics Act etc.  This dichotomy of regulation creates an unhealthy situation for overall healthcare delivery. Basic purpose of any healthcare model is to offer patient optimal treatment, taking into account patients medical problems and his/her expectations about the treatment. There is at present wide gap in the achievement of these two goals, this is the root cause of the problem.

Reasons for this widening gap needs to be understood. The disease profile of the country has changed over the past 20years. Now lifestyle diseases form almost 50% of the disease profile as against 20% two decades ago. Management of diseases like Diabetes, Hypertension, Cancer etc. require strong preventive strategies which includes patient education, regular screening, very early detection, very active participation of community etc. Once these diseases become clinically apparent then the management and treatment of complication becomes costly. The prevention involves very robust patient and social participation. At present, almost 80% healthcare is provided by private sector. This sector has traditionally given more importance to aid higher input of technology and stress on clinical treatment. One hardly finds any private sector hospital having community data about lifestyle diseases in its area of operation. This coupled with very low insurance coverage (approximately 11%), the load of lifestyle disease complication, is borne unequally by public and private sector. The cost of these complicated treatment is usually high, for which 90% patients have to pay out of their pockets; this is inherently untenable proposition. This creates discord between healthcare providers and patients/community leading to various unpleasant incidents.

It is necessary for private healthcare sector to think about different models of costing for providing treatment. The current model of A LA CARTE treatment is inefficient, leaving doctors as well as patient dissatisfied. It must be emphasized that private sector, in market dominated economy, cannot provide free treatment and some method of payment will be always necessary.This will require out-of-box ideas, and formal management training models may not work. This will involve joint participation of community in their area of operation and medical profession. There is also an urgent need for impartial transparent grievance redress cell in each hospital.

The gap between patient’s expectations about his treatment, including cost of treatment, and actual treatment model which includes various factors like drugs, technology, surgeries etc. is widening and needs to be bridged to avoid unpleasant incidents. It needs to be stressed that a patient who is ill and enters a hospital is not in frame of mind to be fully satisfied. Healthcare sector should strive to reduce patient’s dissatisfaction. This dissatisfaction goes on snowballing at every step during his treatment and stay in most of the hospitals, and efficient resolution of this dissatisfaction is very vital for health of the patient and that of the hospital.

Is a Consultant, Diabetic Foot Surgeon, SL Raheja Hospital.

Adulterated Milk and its impact on Fertility In Indians

                                                                                                  Health News

 Vinod Kumar

New Delhi: Milk is known for its numerous health benefits in people of all age groups ranging from children to old people. But lately the problem of adulteration of food products has multiplied to alarming extents thus posing serious health issues. Milk and dairy products are no exception. Cattle are fed with many steroids and hormonal injections to boost the delivery of milk production.

“Oxytocin is one such injection that not only affects the cattle but indirectly the humans in the form of dairy products we consume. The injected oxytocin reaches the human body through consumption of milk or any other dairy product causing several side effects on all. This is one of the reasons for early onset of puberty among girls, development of breast in male and lack of testosterone production due to hormonal imbalance. Milk adulterated with oxytocin should be avoided by pregnant women as it may lead to abortion and babies may be born with deformities. It increases the risk of haemorrhage in mothers after birth and can also inhibit breastfeeding” Says Dr

​. Arvind Vaid, IVF Expert, Indira IVF Hospital, New Delhi.

It is a general thought among us that milk is a rich source of calcium, but we tend to overlook the other components. Hormones like prolactin, lutenizing hormone(LH), estrogens, progesterone, oxytocin, growth hormone, thyroid stimulating hormone are present in the milk which may cause hormonal imbalance leading to infertility in humans as well.

“Among females, PCOS and endometriosis has become more common which may be attributed to drinking milk containing excess estrogen. Over 70% of the estrogen levels in the humans are from animal derived dairy products. Such hormones are known to be endocrine disruptors and play havoc with the hormonal balance causing anovulation.” 

It can adversely affect the production of cervical mucus, which in limited quantity helps the sperm reach the fallopian tube and protects the vaginal lining from acidic environment. If the cervical mucus turns hostile it can act like a barrier in the fallopian tube preventing women from conceiving. 

Most of the people are either intolerant to lactose (sugar found in milk) or allergic to casein (protein in milk) which often goes unnoticed. The most common symptom starts off with fatigue, irritable bowel syndrome, and repeated exposure to such allergies sets off a whole body immune response that halts down the fertility by causing improper ovulation, missing periods, degrading the egg quality and recurrent miscarriage.  

“Certain amount of estrogen in male is required especially in the elderly age, but normally excess of estrogen in the male body leads to disruption of re-absorption of the luminal fluids in the epididymis leading to infertility. Consumption of more than the limit estrogen through diet leads to significant reduction in the epididymal weight causing decreased sperm motility and concentration”

added Dr. Ishita Lunkad, Pune Based Gynaecologist.

Moreover it is also noted that 70% of the Indian population get packed milk (especially in plastics). Plastic contains BPA (endocrine disruptor), which is directly linked to cause fertility issues in both male and female. It is one of the reasons in female that causes high levels of FSH, low levels of AMH, problems in implantation, PCOS and depleted ovarian reserve.

Thus it is important to understand how adulterated milk can cause serious health issues in both males and females. Boiling milk can help eliminate traces of oxytocin. Thus a little vigilance can help save us from a number of health and fertility issues.


Dr. Shashank Rai Gupta

Macular edema occurs when the retina’s ability to absorb fluid is overwhelmed by the fluid leaking into it. If more rain falls on the lawn than it can handle, you get puddles of water. In the retina, blisters of fluid form and swell the retina—this is macular edema. Factors likely to cause macular edema include conditions that:

  • Cause more fluid to leak from blood vessels (diabetes and high blood pressure)
  • Increase inflammation in the eye (surgery, inflammatory diseases)
  • Are associated with the growth of abnormal blood vessels (wet age-related macular degeneration)


Macular edema refers to an abnormal blister of fluid in the layers of the macula.The swollen retina distorts images—making it more difficult to see clearly. The more widespread, thicker, and severe the swelling becomes, the more likely one will notice visual symptoms of blur, distortion, and difficulty reading.

If untreated, chronic macular edema can lead to irreversible damage of the macula and permanent vision loss. Macular edema is typically caused by increased leakage from damaged retinal blood vessels or growth of abnormal blood vessels in the deep retina. New vessels (neovascularization or NV) do not have normal “tight junctions” and almost always result in abnormal leakage of fluid (serum from the bloodstream) into the retina.


Macular edema is not a disease, but is the result of one.

Macular edema can be caused by many factors including

  • Metabolic conditions (diabetes)
  • Blood vessel diseases (vein occlusion/blockage)
  • Aging (macular degeneration)
  • Hereditary diseases (retinitis pigmentosa)
  • Traction on the macula (macular hole, macular pucker, and vitreomacular traction)
  • Inflammatory conditions (
  • Toxicity
  • conditions (eye tumors)
  • Trauma
  • Surgical causes (following eye surgery)
  • Unknown causes

Diagnostic testing

Fluorescein angiography and optical coherence tomography (OCT; Figure ) are 2 common tests to evaluate macular edema. Based on the appearance of fluid on these tests, macular edema may be widespread, localized, or be made up of many small blisters surrounding the center of the macula—a common form called cystoid macular edema.

Treatment and prognosis

The most effective treatment strategies for macular edema address the underlying cause (diabetes, blood vessel occlusion, neovascularization, inflammation, etc), as well as an excess of fluid leaking from abnormal blood vessels in and around the macula.

Eye drops,medication, laser, and surgery can be effective in many diseases, but the mainstay of treatment is intravitreal injections (IVI). If macular edema is localized then Focal laser can be done.

The IVI is an day care procedure performed under topical anesthesia in which medication is placed inside the eye by a very small needle. The injection genrally causes little to no pain. IVI should be performed by a trained retina specialist with meticulous monitoring of treatment efficacy and detection of rare but potentially serious complications. IVI is now considered one of the most commonly performed medical procedures.

 Is Founder Chairman of Delhi Eye Care. He is specialist in Vitreo-Retina, Uveitis & Diabetic Eye Care. He is visiting consultant at Sunetra Eye & Laser Centre, Ghaziabad, Narang Eye Institute, Model Town, New Delhi, Dr. Aggarwal’s Clinic, New Delhi and Apollo Spectra, Karol Bagh.


Broken Heart Syndrome Can Prove Fatal

 Dr. Aseem Dhall

It’s common that we get to hear the unfortunate news of a couple who died one after the other due to grief. Or, someone who could not cope up with the tragic news of financial loss or any kind of personal loss. These deaths are very often result of a “broken heart syndrome“, also known as stress cardiomyopathy or takotsubo cardiomyopathy, a condition that’s often brought on by stressful situations. 
Most people suffering from “broken heart syndrome” have normal coronary arteries and do not show any major blockages or clots. Infact, patients who suffer cardiomyopathy, their heartmuscle becomes suddenly weakened or stunned. And, there’s a temporary disruption in the  heart‘s normal pumping function but only in one area that leads to change in shape of heart. Whereas the remaining heart functions normally or with even more forceful contractions. Perhaps the reason this condition is also called as apical ballooning syndrome.
The symptoms of a broken heart syndrome are usually treatable, but only if diagnosed on time, and it at times reverses itself in a span of few days or weeks.
Broken heart syndrome symptoms very often mimic a heart attack as such people often have sudden intense chest pain and experience shortness of breath. These symptoms begin just a few minutes to hours after exposure to the unexpected stress. 
Other symptoms may include:
* Fatigue, feeling lethargic, sleepy 
* Electrocardiogram abnormalities are very identical to those of a heart attack
* No evidence of coronary artery obstruction
* Abnormalities in the left ventricle
* Ballooning of the left ventricle
Common Causes 
Though the exact cause of a broken heart syndrome is unclear, it is believed that a surge of stress hormones, such as adrenaline, might temporarily damage the heart of some people, especially women. But how exactly these hormones might hurt the heart or whether something else is responsible too isn’t completely clear. 
However, a broken heart syndrome is often accompanied by an intense physical or emotional event. Some potential triggers of broken heart syndrome are:
* News of an unexpected death of a loved one
* A frightening medical diagnosis
* Domestic abuse
* Losing/winning a lottery
* Having to perform publicly
* Job loss
* Divorce
* Physical stressors, such as an asthma 
Broken Heart Syndrome Versus Heart Attack 
Heart attacks are generally caused by a complete or partial blockage of a heart artery due to a blood clot formation in the wall of the artery. While in a broken heart syndrome, the heartarteries are not blocked, although flow of blood in the arteries of the heart may be reduced. And there are a number of known risk factors for broken heart syndrome, which may include:
* Sex; as the condition is believed to affect women far more often than men.
* Age is another criterion. Broken heart syndrome affects mostly people who are older than 50.
* People who have a history of a neurological condition such as a head injury or a seizure disorder (epilepsy) have a greater risk of broken heart syndrome.
* Any psychiatric disorders such as anxiety or depression, etc. 
Diagnosis and Treatment 
In some cases broken heart syndrome proves to be fatal. However, most people who experience broken heart syndrome recover over a period of time and don’t have long-lasting effects. But in some cases it may lead to other complications such as :
* Pulmonary Edema 
* Low blood pressure (hypotension)
* Disruptions in the heartbeat
Heart failure
However, if the cardiologist suspects of a broken heart syndrome, he/she will prescribe tests such as ECG which helps to detect irregularities in the heart‘s rhythm and structure, a chest XRay, Cardiac MRI, Echocardiogram and coronary angiogram, etc. Echocardiogram helps to find out if the heart is enlarged or has an abnormal 
Though there’s no standard treatment for broken heart syndrome, change of 
environment often helps to divert mind of such patients.
Once it’s clear that broken heart syndrome is the cause of underlying symptoms, the doctor will prescribe heart medications. It’s mainly treated with diuretics, agents that improve heart muscle contraction, and other therapies but there’s no surgery that’s required for the treatment of this disorder. And most of all its important to keep the patient away from any physical/emotional stress that may have played a role in triggering the disorder.
Is a Director and Head, Saroj Cardiac Sciences, 
 ISIC ,Vasant Kunj.


Combining CRS and HIPEC Techniques – A Game Changer For Oncologists

Dr Kapil Kumar

A 65-year-old hypertensive lady with Carcinoma Ovary post three cycles of chemotherapy was admitted to BLK Cancer Centre. Carcinoma is a type of cancer in the epithelial cells of the abdominal cavity.  Cancer in each of the abdominal organs can spread to abdominal surfaces and the peritoneum. This kind of spread is called peritoneal carcinomatosis and traditionally, considered an incurable disease with a life expectancy of not more than few months. Despite undergoing chemotherapy, her disease was present with nearly two liters of ascites(abnormal accumulation of fluids in the abdomen) and thickened omentum and peritoneum which are the fatty lining covering stomach, large intestines and other abdominal organs containing lymph nodes.

A specialized oncological team took up the task which was led by Dr Kapil Kumar, Director & HOD, Surgical Oncology. On complete and detailed investigation it was observed that the carcinoma involving the peritoneum, included metastasis (spread) of cancer of the appendix, cancer of the colon and rectum, cancer of the ovaries, and cancer of the stomach. After going through the complete history of the patient, the team came to a conclusion of performing multiple surgeries, using the innovative technique known as Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

 What is a CRS?

Because heated chemotherapy can penetrate only at a very limited distance in the tumor tissue, it is imperative to remove all visible and palpable tumor deposits before HIPEC is delivered. Surgery for removal of tumor deposits in the abdomen is known as cytoreductive surgery. Cytoreductive surgery is a complex surgical procedure, during which some organs are resected (removed). This includes various surgeries as in the case of this patient. She underwent the following: –

1. Total Abdominal Hysterectomy(TAH) – It is a surgical procedure done for the removal of uterus along with cervix. It is done in extreme cases like cancer when non-surgical treatments fail.

2. Bilateral Saplingo Oopherectomy(BSO) – This surgical procedure is done for removal of both ovaries and the fallopian tube. It is usually performed along with TAH when the cancer cells have spread completely and a more casual term is used ‘Ovariohysterectomy(TAH-BSO)

3. Lymphadenectomy – lymph node dissection is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. This patient also underwent pelvic and para aortic lymph node dissection.

4. Omentectomy – Surgery to remove part or all of the omentum, an large apron of fatty tissue containing veins, arteries, lymphatics. The omentum attaches to and nourishes the stomach and the entire colon.

5. Peritonectomy is the most common surgical procedure for peritoneal mesothelioma patients. The goal of the surgery is to remove the cancerous part of the lining of the abdominal cavity.

6. Extended Right Hemicolectomy – Open right hemicolectomy is a procedure that involves removing the cecum, the ascending colon, the hepatic flexure (where the ascending colon joins the transverse colon), the first one-third of the transverse colon, and part of the terminal ileum, along with fat and lymph nodes.

With more than 11 hours of complex surgical performance the patient was now ready for HIPEC. This type of complex surgery requires special equipments and high surgical skills. CRS is aggressive removal of all or most visible tumours in the abdomen and preventing growth of microscopic cells which are left behind. After completion of the resection of all tumor tissue, the HIPEC procedure was performed.

How is the HIPEC Procedure conducted? 

Hyperthermic Intraperitoneal Chemotherpy (HIPEC) is instilled via a machine which circulates Chemotherapy solution in the peritoneal cavity at 42 degree Celsius for 60-90 minutes. During the HIPEC procedure, a machine will continuously circulate a heated sterile solution containing a chemotherapeutic agent throughout the peritoneal cavity of the patient, for one to one and half hours and killed the remaining cancer cells. The HIPEC procedure also improves drug absorption and effect with minimal exposure to the rest of the body. In this way, the normal side effects of chemotherapy can be avoided. It is being performed in selected centres across India including BLK Cancer Centre and abroad.

She made steady post-operative progress, and was discharged after two weeks. She is now undergoing her remaining chemotherapy procedure. Her quality of life has improved and chances of her survival are very much on the cards.

Most commonly treated diseases are pseudomyxoma peritonei, mesothelioma, colon and rectal cancer, appendiceal cancer, gastric cancer, ovarian cancer, and primary peritoneal cancer.

Another 43 years old African patient was diagnosed with carcinoma ovary with incomplete staging surgery done in Kenya came to BLK. Where similar procedure was followed with three cycles of chemotherapy and CRS was done. The team drained out 19 liters of ascites. She is making steady progress now and has hope of improved survival despite stage IV Ovarian Cancer.

The HIPEC procedure, when combined with CRS, has proven to be an effective therapy that has improved survival outcomes. BLK Cancer centre has now treated many peritoneal cancer patients in the recent times with this innovative technology.

 Dr Kapil Kumar, & HOD, Surgical Oncology, BLK Cancer Centre, New Delhi