Department of

Surgical Procedures

Gastric and Oesophageal Surgery

All major gastric and oesophageal surgeries are undertaken. Laparoscopic gastric and oesophageal surgeries are offered to patients where appropriate. The following conditions are treated on a regular basis

1.Achalasia Cardia : The initial work up is done with esophageal manometry and barium swallow. Patient who have failed medical therapy or Endoscopic management are treated in our department with Laparoscopic Heller’s Myotomy with Posterior fundoplication. This needs hospitalisation for 5-6 days , oral diet is started on 2nd/3rd Postoperative period and patient is discharged to review after 1 month with Barium swallow. This Surgery gives excellent results for dysphagia due to Achalasia and patients can avoid the risk of open surgery with its attendant morbidity.

2.Gastroesophageal Reflux disease : Patient who have failed medical therapy or Endoscopic management are treated in our department with Laparoscopic Nissen’s fundoplication. ( anti-reflux surgery )

3.Benign Esophageal Stricture / corrosive acid injury : Depending on the severity of injury patients are initially resuscitated in ICU with care of respiratory and cicrculatory system. They assessed with early Endoscopy (within 1-2days) and BMFT at 3-4th week. Patients with mild to moderate injury are managed with initial Endoscopic serial dilatation. Cases who fail with medical management or have a tight and long stricture undergo surgery (Esophageal replacement with Retrosternal Colon interposition (Right colon pull up) or Gastric pull up.) Patients with benign antral strictures undergo Antrectomy and Gastro-jejunostomy.

4.Esophageal Cancer : Transhiatal oesophagectomies are also performed regularly for malignancies located at GE Junction. Thoracoscopic esophageal mobilisation and the THE with cervical esophago-gastric anastomosis is routinely performed for lesions of lower and mid esophagus. Inoperable patients are palliated by expandable metallic stents or endoscopic feeding gastrostomies. The management of these patients is generally undertaken in consultation with an oncologist to plan the adjuvant treatment that may be needed.

5.Gastroduodenal Ulcer Disease : Department offers the options of laparoscopic as well as open acid reduction procedures (Laparoscopic B/L Truncal Vagotomy + Gastrojejeunostomy). Emergency surgery is conducted for peptic ulcer perforation or massive bleed from Peptic ulcer after failure of medical / Endoscopic management.

6.Gastric Cancer : Palliative and curative resections for gastric and gastro-esophageal junction cancers are performed frequently, along with Total gastrectomy with extended lymph node dissections.(Radical D2 Gastrectomy).

7.Bariatric Surgery : Laparoscopic sleeve gastrectomy is routinely performed for morbid obesity in consultation with Endocrinologist, Nutritionist and Plastic surgeon as a team approach.

Small Intestine and Colorectal Surgery

The GI Surgery department provides integrated oncology care. The treatment of patients with rectal cancer is planned in consultation with an oncologist to include pre-operative chemotherapy and radiotherapy in patients with locally advanced cancer. This approach significantly reduces the risk of recurrence of the cancer. The department carries out a variety of procedures and treats conditions including:

2.Polyposis Syndrome : Patients with FAP and other types of polyposis syndrome are evaluated fully for coexisting pathology and are offered sphincter-preserving procedures like stapler Ileal Pouch Anal Canal Anastomosis.

3.Inflammatory Bowel Diseases (IBD) : Inflammatory bowel disease like ulcerative colitis and Crohn's Disease are initially managed conservatively in consultation with Medical Gastroenterology department. Advanced procedures like Ileal Pouch Anal Canal Anastomosis are done regularly. Staged procedures for complicated IBD and fistulas are performed along with services from stoma care people.

4.Abdominal Tuberculosis: The advanced facilities available in the hospital permit non invasive or minimally invasive confirmation of this often obscure pathology by Diagnostic laparoscopy with peritoneal / omental biopsy.

5.Rectal Prolapse : Rectal prolapse is being treated routinely by Laparoscopic and open Mesh Rectopexy, thus allowing early return to activity for the patients.

6.Complicated Perianal Conditions : the evaluation and management of complex perianal fistulae is aided greatly by Conventional Fistulogram and MR fistulograms. Single stage Fistulectomy is routinely performed on day care basis and Two stage Fistulectomy with Seton placement done for complex High fistula. Stapler hemorrhoidectomy is offered to patients at their choice, avoiding the painful and prolonged convalescence after piles surgery.

7.Adult Hirscsprung’s disease : Is treated with Martin’s modification of Duhamel procedure and stapler colo-anal anastomosis.

8.Anal Sphincter Reconstruction and Augmentation : Reconstruction of anal sphincter with muscle transfer procedures are done for patients with incontinence due to traumatic injuries to the sphincter in consultation with Plastic surgeon.

Hepato Pancreato Biliary Services

1.Liver surgery : Major liver resections are undertaken routinely for primary cancers of the liver and the biliary tree. Laparoscopic Marsupialisation is commonly performed for hydatid cyst and large cysts of Polycystic liver disease.

2.Pancreas : The unit has carried out more than 50 major pancreatic resections with results being comparable with the best centres in the world. Surgical treatment is offered to patients with pancreatic cancers (Whipple’s pancreaticoduodenectomy/ Distal pancreatectomy + Spleenectomy), chronic pancreatitis (Roux En Y lateral pancreaticojejunostomy with head coring) and complications of pancreatitis (Laparoscopic and open cystogastrostomy for pseudocyst of pancreas) including psedoaneurysm.

3.Disorders of the biliary system : The treatment of gallstone disease and CBD stones is done in coordination with the Medical Gastroenterology Department so as to allow planning of combined and sequential treatment procedures that would help in reducing the hospital stay. Surgical management of complicated benign biliary disorders is done by Roux en Y hepatico-jejunostomy.

4.Bile duct and gall bladder cancer : Palliative and curative resections for biliary cancer and palliative drainage procedures are performed. Combined liver and bile duct resection for advanced Gall bladder and Bile duct cancers are being performed regularly with excellent results. Patients who have inoperable diseases are offered various palliative measures like stenting or bypass procedures.

Laparoscopic Surgeries

The unit operates with two fully equipped laparoscopic suites (with Advanced 1588 series HD Laparoscopy unit with Indocyanine Green Fluroscence and infrared technology from Stryker ), which are also equipped with advanced equipment like Harmonic Scalpel, Argon laser, Mechanical and Laser Lithotripsy, endoscopic stapling devices and endoscopic suturing devices. The unit is routinely conducting:

Lap cholecystectomy & appendicectomy.

Lap common bile duct exploration for stone disease with Flexible choledochoscopy (Only one of its kind in the state)

Thoracoscopic Esophagectomy for Esophageal cancer (Only one of its kind in the state)

Laparoscopic hernia repair

Diagnostic laparoscopy for the evaluation of obscure abdominal symptoms, pain or ascites

Lap assisted colorectal resections for cancer

Lap liver surgeries for cystic diseases of the liver

Lap Heller’s myotomy for Achalasia Cardia

Lap Nissen’s Fundoplication for Gastroesophageal reflux Disease

Lap splenectomy

Lap cysto-gastrostomy

Lap bariatric surgery

Gastro Intestinal Oncology

The department works in close association with the Department of Medical Oncology. Management of cancers is handled on the basis of protocols already in place. Adjuvant treatment for colorectal cancers, cancers of the stomach and pancreas, cholangiocarcinoma, etc. are taken up after detailed discussions between the surgeon and the oncologist. This interaction helps in the optimisation of the treatment for each patient.

Stoma Care Centre

Patients who need permanent or temporary diversion of the faecal stream are given advice regarding the types of stoma care materials and are trained about the proper use and care of the appliances. The unit is manned by trained enterostomal therapists. They take care to ensure smooth and painless transition to life with a stoma.

Trauma and Emergency Services

The GI Surgery unit functions as a tertiary referral center for hepatobiliary and pancreatic trauma from all over Odisha. Complicated postoperative GI and biliary fistulas are also admitted through the emergency services. The GI bleed team composing of the critical care specialist, the medical gastroenterologist, interventional radiologist and the GI surgeon manage the patient with a well coordinated approach. 6 beded intensive care unit (ICU) with ventilators, cardiac monitors, blood gas and electrolyte management facility. All patient records are computerized.