HEPATO PANCREATICO BILIARY SYSTEM
1. Liver cirrhosis assessment, maintenance, Liver transplantation and follow up care.
2. Interventions for cirrhosis- Plasmapheresis, CRRT in ICU for liver failure, TIPSS / drains, etc.
3. Acute liver failure/ACLF management including emergency transplantation.
4. Liver cancers - assessment, treatment plan, surgery / Interventional therapy.
5. Segmental Resection and Right/ Le Hepatectomy for Liver Tumors
6 Laparoscopic/ Open Hydatid Cyst Surgery
7. Laparoscopic Surgery for Liver Abscess
8. Surgery for Portal Hypertension like Shunt Surgery and Devascularisaon
(B) Pancreas & Spleen
1. Abdominal / Liver and pancreas trauma care - conservative, surgical, Interventional.
2. Management of acute severe pancreas/pancreatic necrosis- Interventions and surgery.
3. Assessment and surgical/interventional treatment of pancreatic cancers, bile duct cancers, and gall bladder cancers.
4. Whipple's Procedure for Periampullary & Pancreatic Carcinoma
5. Lateral Pancreacojejunostomy and Frey's Procedure for Chronic Calcific Pancreas
6. Distal Pancreacosplenectomy & Spleen Preserving Pancreatectomy for Tumors of Pancreatic Tail
7. Pancreatic Necrosectomy for Necrozing Pancreas and Walled Off Pancreatic Necrosis(WOPN)
8. Laparoscopic Splenectomy
9. Laparoscopic Cystogastrostomy & Cystojejunostomy for Pancreatic Pseudocyst
1. Living Donor Liver Transplantation(LDLT)
2. Acute liver failure management including emergency transplantation.
SMALL INTESTINAL & LARGE INTESTINAL
1. Laparoscopic & Open Small Bowel Resection
2. Surgery For Crohn's Disease, Meckel's Diverticulum, and Small Bowel Strictures
3. Laparoscopic Ileo Caecal Resecon for Obstructive Ileocaecal Crohn's Disease and Tuberculosis.
4. Laparoscopic Appendectomy for Complicated Appendices
5. Laparoscopic & Open Hemicolectomy, Le Hemicolectomy, Transverse Colectomy for Carcinoma Colon
6. Extended Le Hemicolectomy, Extended Right Hemicolectomy for Colon Cancer
7. Laparoscopic Total Colectomy with Real Pouch Anal Anastomosis for Ulcerative Colis & Polyposis Coll
8. Laparoscopic & Open Low Anterior Resection & Abdominoperineal Resection for Carcinoma Rectum
9. Sphincter Preserving Surgery of Rectum
10. Laparoscopic Mesh Repair for Rectal Prolapse
11. Rectovaginal Fistula Repair
12. Stapled Haemorrhoidectomy
13. Surgery for Anal Diseases like Fistula En Ano, Fissure En Ano, Anal Incontinence
BARIATRIC & METABOLIC SURGERY
Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or by a combination of both gastric restriction and malabsorption. Bariatric procedures also oen cause hormonal changes. Most weight-loss surgeries today are performed using minimally invasive techniques (laparoscopic surgery).
The most common bariatric surgery procedures are gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch. Each surgery has its own advantages and disadvantages.
- Jump to a Procedure
- Gastric Bypass
- Sleeve Gastrectomy
- Adjustable Gastric Band
- Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery.
There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of the small intestine will eventually mix with the food.
The gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into fewer calories consumed. Additionally, because there is less digestion of food by the smaller stomach pouch, and there is a segment of the small intestine that would normally absorb calories as well as nutrients that no longer has food going through it, there is probably to some degree less absorption of calories and nutrients.
Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.
|1. Produces significant long-term weight loss (60 to 80 percent excess weight loss)||1. Is technically a more complex operation than the AGB or LSG and potentially could result in greater complication rates|
|2. Restricts the amount of food that can be consumed||2. Can lead to long-term vitamin/mineral deficiencies particularly deficits in vitamin B12, iron, calcium, and folate|
|3. May lead to conditions that increase energy expenditure||3. Generally has a longer hospital stay than the AGB|
|4. Produces favorable changes in gut hormones that reduce appetite and enhance safety||4. Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance|
|5. Typical maintenance of >50% excess weight loss|
The Laparoscopic Sleeve Gastrectomy – oen called the sleeve – is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana.
This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food (and thus calories) that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, safety, and blood sugar control.
Short term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggests the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of the weight loss. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.
|1. Restricts the amount of food the stomach can hold||1. Is a non-reversible procedure|
|2. Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with the maintenance of >50%||2. Has the potential for long-term vitamin deficiencies|
|3. Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB)||3. Has a higher early complication rate than the AGB|
|4. Involves a relatively short hospital stay of approximately 2 days|
|5. Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve safety|
Adjustable Gastric Band
The Adjustable Gastric Band – oen called the band – involves an inflatable band that is placed around the upper portion of the stomach, creating a small stomach pouch above the band, and the rest of the stomach below the band.
The common explanation of how this device works is that with the smaller stomach pouch, eang just a small amount of food will sasfy hunger and promote the feeling of fullness. The feeling of fullness depends upon the size of the opening between the pouch and the remainder of the stomach created by the gastric band. The size of the stomach opening can be adjusted by filling the band with sterile saline, which is injected through a port placed under the skin.
|1. Reduces the amount of food the stomach can hold||1. Slower and less early weight loss than other surgical procedures|
|2. Induces excess weight loss of approximately 40 – 50 percent||2. A greater percentage of patients failing to lose at least 50 percent of excess body weight compared to the other surgeries commonly performed|
|3. Involves no cung of the stomach or rerouting of the intestines||3. Requires a foreign device to remain in the body|
|4. Requires a shorter hospital stay, usually less than 24 hours, with some centers discharging the patient the same day as surgery||4. Can result in possible band slippage or band erosion into the stomach in a small percentage of patients|
|5. Is reversible and adjustable||5. Can have mechanical problems with the band, tube or port in a small percentage of patients|
|6. Has the lowest rate of early postoperative complications and mortality among the approved bariatric procedures||6. Can result in dilation of the esophagus if the patient overeats|
|7. Has the lowest risk for vitamin/mineral deficiencies||7. Requires strict adherence to the postoperative diet and to postoperative follow-up visits|
|8. The highest rate of re-operation|
Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Gastric Bypass
The Biliopancreatic Diversion with Duodenal Switch – abbreviated as BPD/DS – is a procedure with two components. First, a smaller, tubular stomach pouch is created by removing a portion of the stomach, very similar to the sleeve gastrectomy. Next, a large portion of the small intestine is bypassed.
The duodenum, or the first portion of the small intestine, is divided just past the outlet of the stomach. A segment of the distal (last portion) small intestine is then brought up and connected to the outlet of the newly created stomach so that when the patient eats, the food goes through a newly created tubular stomach pouch and empties directly into the last segment of the small intestine. Roughly three-fourths of the small intestine is bypassed by the food stream.
The bypassed small intestine, which carries the bile and pancreatic enzymes that are necessary for the breakdown and absorption of protein and fat, is reconnected to the last portion of the small intestine so that they can eventually mix with the food stream. Similar to the other surgeries described above, the BPD/DS initially helps to reduce the amount of food that is consumed; however, over me, this effect lessens and patients are able to eventually consume near “normal” amounts of food. Unlike the other procedures, there is a significant amount of small bowel that is bypassed by the food stream.
Additionally, the food does not mix with the bile and pancreatic enzymes until very far down the small intestine. This results in a significant decrease in the absorption of calories and nutrients (particularly protein and fat) as well as nutrients and vitamins dependent on fat for absorption (fat-soluble vitamins and nutrients). Lastly, the BPD/DS, similar to the gastric bypass and sleeve gastrectomy, affects guts hormones in a manner that impacts hunger and safety as well as blood sugar control. The BPD/DS is considered to be the most effective surgery for the treatment of diabetes among those that are described here.
|1. Results in greater weight loss than RYGB, LSG, or AGB, i.e. 60 – 70% percent excess weight loss or greater, at 5 years follow up||1. Has higher complication rates and risk for mortality than the AGB, LSG, and RYGB|
|2. Allows parents to eventually eat near “normal” meals||2. Requires a longer hospital stay than the AGB or LSG|
|3. Reduces the absorption of fat by 70 percent or more||3. Has a greater potential to cause protein deficiencies and long-term deficiencies in a number of vitamin and minerals, i.e. iron, calcium, zinc, fat-soluble vitamins such as vitamin D|
|4. Causes favorable changes in gut hormones to reduce appetite and improve safety||4. Compliance with follow-up visits and care and strict adherence to dietary and vitamin supplementation guidelines are critical to avoiding serious complications from protein and certain vitamin deficiencies|
|5. Is the most effective against diabetes compared to RYGB, LSG, and AGB|
Inflammatory Bowel Disorder
SCOPE OF SERVICES
- Diagnostic and therapeutic colonoscopy
- Screening for Colorectal Cancer
- Management of acute ulcerative colis
- Biological therapy and FMT
- Colonic stricture Dilataon/Colonic polypectomy Laparoscopic/ open bowel surgery/ pouch surgery CT/MR enterography
COLORECTAL CANCER SCREENING SAVES LIVES
BOTH MEN AND WOMEN ARE AT RISK FOR COLORECTAL CANCER.
SCREENING SAVES LIVES
Among cancers that affect both men and women, colorectal cancer is the 2nd leading cancer killer in the U.S. But it doesn’t have to be. There is strong scientific evidence that screening for colorectal cancer beginning at age 50 saves lives!
WHAT IS COLORECTAL CANCER?
Cancer is a disease in which cells in the body grow out of control. Cancer is always named for the part of the body where it starts, even if it spreads to other parts of the body later. Colorectal cancer is cancer that occurs in the colon or rectum. The colon is the large intesne or large bowel. The rectum is the passageway that connects the colon to the anus.
Colorectal cancer usually starts from precancerous polyps (abnormal growths) in the colon or rectum. A polyp is a growth that shouldn’t be there.
• Over me, some polyps can turn into cancer.
• Screening tests can find precancerous polyps, so they can be removed before they turn into cancer.
• Screening tests can also find colorectal cancer early when treatment works best.
WHAT ARE THE SYMPTOMS OF COLORECTAL CANCER?
People who have polyps or colorectal cancer don’t always have symptoms, especially at first.
Someone could have polyps or colorectal cancer and not know it. If there are symptoms, they may include:
• Blood in or on your stool (bowel movement).
• Pains, aches, or cramps in your stomach that won't go away.
• Losing weight and you don’t know why.
If you have any of these symptoms, talk to your doctor. They may be caused by something other than cancer. However, the only way to know what is causing them is to see your doctor