Robotic Surgery

Hernia surgery – eTEP (extended view totally extra-peritoneal) technique; TAPP (trans abdominal pre-peritoneal) technique Robotic surgery is a newer most significant revolution in minimally invasive technique for hernia and bowel surgery. Like laparoscopic surgery, robotic surgery uses keyhole, and is performed in the same way (small incisions, a small camera, insufflation of the abdomen, and projecting the inside of the abdomen onto television screens). In robotic surgery, the surgeon is seated at a console in the operating room and handles the surgical instruments from the console and this allows the surgeon to work with increased accuracy, dexterity and precision in confined spaces.
While robotic surgery can be used for hernias, it can also be used to reconstruct the abdominal wall. The difference is that the patch or graft is inserted in a very safe plane, away from the bowel, between the abdominal wall and the fascia. Studies of robotic hernia repairs show evidence that there's a low risk of recurrence, complications, shorter hospitalization time and less need for narcotic analgesia.

Dr.Murugesan will be operating in the robotic suite at Campbelltown Private Hospital. He introduced robotic eTEP (extended view Totally extra peritoneal) and robotic TAPP (trans abdominal pre peritoneal) techniques in Macarthur area health service to treat complex hernia in a minimally invasive manner, providing his patients with the best possible care. He also uses the robot for bowel surgery including colonic and rectal surgery.

Incontinence workup

Anorectal physiology

Anorectal physiology testing is used to investigate patients presenting with symptoms of faecal incontinence. This is performed as an outpatient procedure and takes approximately 10-15 minutes. Generally, no bowel preparation, sedation or anaesthesia is required for this test. Tiny hollow catheters are inserted into the anal canal and pressures within the rectum and anus are measured. Usually, this is combined with assessment of the pudendal nerve and rectosphincteric reflex. Dr.Murugesan will subsequently interpret the test results to help understand the cause and severity of your problem. In some cases, an endoanal ultrasound is performed to assess the anatomical integrity of the anal sphincter muscle. Our centre is accredited by Quality Innovation Performance (QIP) for endorectal ultrasound.

Incontinence Surgery

Sacral Nerve Stimulation

Bladder and bowel control problems affect millions of Australians. If you’re one of them, you know how these conditions, like over-active bladder (OAB), faecal incontinence (involuntary loss of stool), and urinary retention can interrupt your life. You may have tried changing your diet or Kegel exercises and physical therapy or medications with unpleasant side effects and the results aren’t what you hoped. Communication between your brain and bladder is critical. That’s why conventional treatments may not produce the desired results as they do not target the miscommunication between your bowel and the brain. Bladder and Bowel Control Treatments delivered by Medtronic InterStim system called sacral neuromodulation (SNM) utilizes gentle nerve stimulation to correct bladder/bowel-brain communication pathway and restore function. This therapy is safe, TGA-approved and minimally invasive. InterStim therapy allows you to try first and is called an evaluation, like a test run and not a long-term commitment.

Trial or the test run

A lead (thin wire) is placed in your upper buttock, along the nerves that control your bladder and bowel. The lead then attaches to a smaller external device worn discreetly under your clothes. A dedicated therapy specialist will guide you throughout your trial period and afterwards. A Samsung controller is used to stop, start or adjust the therapy. During this test period, you will be able to do most of your normal activities.

Permanent or long term treatment

If the results from the test run are successful, together, we will decide about insertion of a permanent lead.

Rectal Prolapse Surgery

Rectal prolapse occurs when the normal supports of the rectum (the lower end of the colon just above the anus) become weakened and the rectum drops down outside the anus. This often happens because the anal sphincter muscle (the muscle of the anus) has become weak and there is difficulty in controlling the bowels with leakage of stool. Dr.Murugesan will take a careful history by asking you a series of questions and a complete anorectal examination. In some cases, an x-ray test called defecating proctogram may be helpful. Anorectal Physiology studies are most often arranged to assess the anal sphincters. There are different ways to surgically treat rectal prolapse, one through the abdomen called a Rectopexy and the other through the anus called the “perineal” approach.

Gastroscopy And Colonoscopy

Dr.Murugesan is a GESA (Gastroenterological Society of Australia) accredited endoscopist for gastroscopy and colonoscopy.

Gastroscopy is a simple and effective way to evaluate symptoms such as upper abdominal pain, nausea, vomiting, reflux and difficulty swallowing, by inserting a small camera through the mouth to get a clear view of the oesophagus, stomach and small intestine. The procedure starts with a small amount of anaesthetic, allowing you to sleep through the procedure. Then a small camera is inserted through the mouth, displaying images on a video screen – this procedure is far more effective in detecting inflammation, ulcers or early cancer.

Colonoscopy is a test similar to gastroscopy but done through the back passage. It is done to assess symptoms of abdominal pain, per rectal bleeding, examine for colon polyps (growth within the lumen or inner lining of the large bowel, which can develop into cancer), family history of colon cancer, and to rule out colorectal cancer. This is done using a small fibre optic video instrument (colonoscope) which gives a far better view of the large intestine, achieving more accurate results. Colonoscopy is performed under a light anaesthetic which will allow them to sleep for the brief period of time it takes to complete the procedure. Once the patient is asleep, a small camera is introduced, again showing images on a video screen. Colonoscopies require specific preparation of the digestive system and information regarding your bowel preparation for colonoscopy can be found at one of our clinics.

Haemorrhoid Surgery

Mild haemorrhoidal symptoms sometimes respond to over the counter, non-prescription ointments and suppositories. Although they will not remove the haemorrhoid, they can relieve the discomfort. Relief from uncomfortable haemorrhoids may also be obtained by sitting in warm water for a few minutes (Sitz bath). When external haemorrhoids are very swollen and uncomfortable, the application of a cold compress such as ice wrapped in a towel can be helpful.

Treatment options include:

Rubber Band Ligation works well for internal haemorrhoids which prolapse with bowel movements (grade II haemorrhoids). A small band is placed around the haemorrhoid cutting off the blood supply and causing scarring which holds the haemorrhoid inside. The bands normally fall off within a few days. This procedure may cause some discomfort and may need to be repeated for full effect.

Injection sclerotherapy can be used to treat small, bleeding haemorrhoids which do not protrude. It is relatively painless and causes the haemorrhoid to shrivel up. The procedure may need to be repeated for full effect.

Haemorrhoidal artery ligation operation or HALO is a technique that involves identifying the blood vessels feeding the haemorrhoid using ultrasound and suturing them off. Further sutures are used to repair the prolapsing element of the haemorrhoids. HALO is suitable for most prolapsing haemorrhoids or those that bleed. Most cases are carried out under a short general anaesthetic. Patients can go home the same day, as the procedure is relatively painless and return to work early following the procedure.

Haemorrhoidectomy is a surgical procedure which involves cutting off the haemorrhoidal tissue. This is a very effective treatment for large haemorrhoids which prolapse and are associated with significant external tags. This operation requires a general anaesthetic and may be associated with pain for a few days afterwards.

Stapled haemorrhoidectomy is a technique that involves using a special stapling device which cuts out a ring of haemorrhoidal tissue. It is most useful in dealing with extensive prolapsing haemorrhoids. This requires a general anaesthetic and is more painful than banding.

Pilonidal Sinus Surgery

Making sure you choose the right treatment option is one of the first steps to prevent recurrence. There are different types of treatments available and some have a much better long-term success rate than the others. Dr.Murugesan offers various treatments including PiLAC (Pilonidal sinus Laser Assisted Closure), a safe, simple and minimally invasive technique for the treatment of primary and recurrent pilonidal sinus disease. It is an alternative to surgical excision. Other treatment options include cleft lift, Karyadakis procedure etc.

Bowel Surgery

Patients may need to have a section of bowel removed for treatment of various conditions such as bowel cancer, inflammatory bowel disorders or diverticular disease. This surgery may be performed using robotic, laparoscopic (keyhole) or open techniques, depending on various factors. Dr.Murugesan will discuss with you about which part of the bowel needs to be removed, technique involved and the pros and cons of its removal. Patients are usually in hospital for about a week and full recovery can take up to 6-12 weeks.

Anal Sphincter Repair

The aim of anal sphincter repair is to improve faecal incontinence that occurs when damage to an anal sphincter muscle results in a gap in the normal ring of muscle. Anal sphincter damage is most commonly related to childbirth, even though it might be many years before incontinence appears. Anorectal physiology, endorectal ultrasound and pudendal nerve testing are usually performed as a workup towards further management. Anal sphincter repair is only possible when there is a well-defined gap in the sphincter that has been confirmed by examination and specialist tests. In addition, nerve supply to the muscle must be good enough, for a sphincter repair to be successful. In a sphincter repair operation, the surgeon overlaps the damaged muscle ends to form a complete ring of muscle around the anus.