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.
ranshiatal 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.
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).
Laparoscopic sleeve gastrectomy is routinely performed for morbid obesity in consultation with Endocrinologist, Nutritionist and Plastic surgeon as a team approach.