Publications
Transduodenal ampullectomy for tumors of ampulla
Tumors at the ampulla require Whipple’s procedure or pancreaticoduodenenctomy surgery. But for patients who have a localised, node negative tumor such as an adenoma or neuroendocrine neoplasm, transduodenal resection of the ampulla offers a good curative surgical option. In this review, Dr. Gunjan Desai and team have highlighted their experience with this surgery, selection of patients, and a schematic on the operative technique. This is definitely a treatment option for these ampullary tumors.
Amyand's hernia surgery
Presence of an appendix in an inguinal hernia sac, whether inflamed or not, is a rare occurrence seen in <1% of all inguinal hernias. We have described our experience of 3 cases in this review, along with the relevant literature that would help students diagnose and manage this rare entity. The different surgical options based on the extent of inflammation of appendix are also discussed along with an answer to the question of whether to use the mesh.
Surgery for Appendicular perforation in dengue fever
Dengue fever is associated with many abdominal emergencies, including appendicitis, cholecystitis, and pancreatitis. Appendicular perforation is an emergency, the management of which in presence of severe Dengue fever and resultant thrombocytopenia, becomes very complex. We have here a review of 3 cases of appendicular perforation in dengue fever, successfully managed surgically. It would be a good guide to students so as not to miss such catastrophes in the patients with dengue infection.
Management of Autoimmune pancreatitis
Autoimmune pancreatitis is an uncommon cause of chronic pancreatitis. It has two types. While type 1 is usually seen in India, type 2 is rarely seen. We report here an interesting case of type 2 autoimmune pancreatitis, where the patient underwent surgical management, along with a short review of the relevant literature.
REVIEW: Bacteriobilia in liver, biliary and pancreatic surgery
Bacterial colonization of the biliary tree can lead to fulminant systemic sepsis. In this comprehensive review on bacteriobilia, we outline the causes, mechanisms, and consequences of this common but often-missed entity. We have also described the ways to prevent this fulminant infective complication in patients with pancreaticobiliary dieases.
Management of Biliary injury and related complications
Bile duct injury is a catastrophic complication that requires utmost patience and meticulous planning for successful outcomes. The case we describe here not only had a complex biliary injury, but also had to undergo multiple admissions and interventions for unforeseen complications apart from (but arising from) the biliary injury. This case is a study in itself on everything that can go wrong in a case of biliary injury and how to save the patient using a multimodality management.
Patient profile of Breast cancer in New Delhi, India
Breast cancer is the commonest cancer in Indian females, and long term survivals are still <60% despite advances in treatment. It has been postulated that the tumors in Indian subcontinent are more aggressive than those seen in the western population. This large study highlights the epidemiological profile of females with breast cancer at a single centre in New Delhi, and evaluates the applicability of the Gail risk-prediction model commonly used in the western population.
Surgery for Brunner gland adenoma in duodenum
Brunner’s glands are mucin-secreting glands present in duodenum. Hyperplasia of these glands is rare, and benign adenomas are rarer still. These can present with symptoms similar to more aggressive duodenal tumors. We present here an interesting case of what was thought to be a duodenal gastrointestinal stromal tumor with intussusception, and underwent surgical management. The histopatholgy showed Brunner’s gland adenoma. It is important that students have this differential diagnosis in mind when dealing with similar lesions in duodenum.
REVIEW: Chronic pancreatitis and pancreatic cancer
Chronic pancreatitis is a debilitating condition with multiple causes and a chronic course. Pancreatic cancer can develop in chronic pancreatitis with or without presence of an inflammatory mass in the head of pancreas. This review article outlines the pathophysiology of development of pancreatic cancer in chronic pancreatitis, its specific presentation, diagnostic protocols, and management. The common issues related to diagnosis of cancer in the setting of chronic pancreatitis are all discussed at length and the evidence reviewed to provide a state-of the art literature on this topic.
Role of CRP and procalcitonin in infective complications after a whipple surgery
Whipple’s pancreaticoduodenectomy is a major surgical procedure most commonly employed to treat periampullary and pancreatic head cancers and neuroendocrine neoplasms amongst other rare indications. Post-operative infective complications, including anastomotic leaks, are responsible for major morbidity after this procedure. This large study evaluates the role of C-reactive protein and procalcitonin, markers of inflammation and infection respectively, in predicting the infective complications after Whipple’s procedure.
REVIEW: Gastroduodenal artery
Gastroduodenal artery is commonly a branch of common hepatic artery. Due to its unique location, it is encountered in a large number of surgeries on and around liver, bile ducts, duodenum, and pancreas. This comprehensive review of this artery covers all aspects, including its embryology, surgical anatomy, variations, and their clinical applications.
Management of a patient with groove pancreatitis
Groove pancreatitis is a seldom-diagnosed and often-misdiagnosed disease that poses unique challenges due to its unusual presentation. This case report highlights this unusual presentation and the steps to arrive at the diagnosis of groove pancreatitis, along with its management protocols.
Surgery for Incisional hernia causing bladder outlet obstruction
Incisional hernia is one of the most commonly encountered diagnosis in general surgical practice. While large incisional hernias frequently contain multiple intraperitoneal viscera as contents of the sac, protrusion of extraperitoneal structures such as urinary bladder is relatively rare. This is a report of a rare presentation of urinary bladder diverticulum forming content of the hernia sac and causing bladder outlet obstruction.
Intrapancreatic accessory spleen
Solitary lesions in tail of pancreas can have a large number of differential diagnoses, from inflammatory to infective to neoplastic. This article covers the numerous pitfalls faced while diagnosing the rarest of these lesions. It also covers a review of the available literature, so that students can better diagnose these diverse pathologies.
Outcomes of Laparoscopic surgery for diverticulitis India
Diverticulitis is a disease predominantly affecting the elderly population, and has various presentations, from mild disease to severe life-threatening disease. Management of diverticulitis includes surgical and non-surgical modalities. This prospective study of patients with diverticulitis highlights the role of laparoscopy in this complex disease, and discusses the outcomes of using this minimally invasive technique for this purpose.
Meta-analysis of the role of laparoscopic lavage for diverticulitis
Diverticulitis is increasingly being diagnosed in South East Asia, owing to various socioeconomic and epidemiological factors. This meta-analysis includes a large number of studies that cover the role of laparoscopic lavage in management of diverticulitis, and highlights the need for optimum patient selection to improve outcomes in diverticulitis. This article is a high-quality evidence with an in-depth analysis of various aspects of diverticulitis and its management by laparoscopic lavage.
Surgery for solid hepatic mesenchymal hamartoma (Liver tumor)
Liver, as the largest solid organ in the body, is a common site for a wide variety of tumors, both benign and malignant. Mesenchymal Hamartomas are rare liver tumors of non-hepatocyte origin, with presentation and findings similar to hepatocellular tumors. This article outlines the diagnostic protocols and management in 2 cases of this rare tumor, in addition to the relevant literature.
Mixed Neuroendocrine-Nonneuroendocrine Neoplasms (MiNEN) – largest single centre series from India
Mixed Neuroendocrine-Nonneuroendocrine Neoplasms are rare tumors that have properties of both neuroendocrine tumors and adenocarcinomas. This article is probably the largest single centre study on these incredibly rare tumors, where we have described the etiopathogenesis, diagnostic algorithms, and management protocols at our centre.
Laparoscopic surgery for post-cholecystectomy Mirrizzi syndrome
While gallstones are a common diagnosis encountered by a clinician, Mirizzi syndrome is a dreaded and uncommon sequel of gallstones. This interesting case depicts the laparoscopic management of Mirizzi syndrome in a gall bladder remnant after the patient had undergone cholecystectomy years prior to this presentation. To the best of our knowledge, this has not been described in mainstream literature.
Pott’s spine leading to Pelvic abscess
India has one of the highest number of patients suffering from tuberculosis, and development of Pott’s spine due to tuberculosis is commonly seen in surgical clinics. Pott’s spine has a varied presentation, from vertebral collapse to sensorimotor symptoms. Development of a pelvic abscess is a previously unreported presentation of Pott’s spine, and this article highlights this unusual presentation in this case report, in addition to its management and a review of the literature.
Primary neuroendocrine cancer of breast
Breast cancer is the commonest cancer in Indian females. However, rarer tumors of the breast, such as a primary neuroendocrine carcinoma, are not abundantly found in literature. This is series of 4 cases of primary neuroendocrine carcinoma of breast seen and managed at a single centre in New Delhi that outlines the diagnosis and management of these rare tumors.
Surgery for Small bowel obstruction due to endometrioses
Surgeons rarely encounter endometriosis as a primary presenting pathology causing intestinal obstruction. This interesting case is important for students to keep in mind this uncommon cause of ileal stricture and resultant small bowel obstruction. The management protocol outlined in the case report is important so as to not under- or over- treat this unusual presentation of a common pathology.
Spleen preserving distal pancreatectomy surgery for solid pseudopapillary neoplasm of pancreas
Large tumors of the distal body and tail of pancreas frequently involve the Splenic vessels, making splenectomy a routine part of surgical management of these patients. Tumors like solid pseudopapillary neoplasms (SPEN) of pancreas are rare exceptions to this rule. This interesting case report of spleen preservation in a case of a large SPEN is an important guide to students to consider the primary diagnosis when planning surgical management of such large pancreatic tail lesions.
Surgery for Infected pancreatic necrosis
Infected pancreatic necrosis is a dreaded but frequently seen sequel of acute pancreatitis. As the world is moving towards minimally invasive management of this aggressive and life-threatening pathology, video-assisted retroperitoneal drainage (VARD) is an excellent modality of management that combines minimally invasive techniques with principles of aggressive surgical debridement. This review article highlights the case selection, operative technique, and overall outcomes of patients undergoing this procedure that requires adequate clinical experience as well as surgical expertise for successful fulfilment.
Surgery for persistent pancreatic fistula - fistulojejunostomy
Pancreatic necrosis, and its management by necrosectomy, both can result in development of a pancreatic fistula. Persistent external pancreatic fistula is a complex entity that needs extensive planning and immaculate execution for successful outcomes. Fistulojejunostomy is a surgical option that has given equivalent results to conventional surgical procedures with minimal complications. This series of 6 cases of persistent external pancreatic fistula managed with fistulojejunostomy is an important study in highlighting the operative technique and outcomes of this complex procedure.
Whipple with vascular reconstruction
Whipple’s procedure is a highly complicated surgery that requires high levels of surgical expertise. Vascular reconstruction adds to the technical complexity of the procedure, and can result in disastrous complications if performed suboptimally or in inexperienced hands. This interesting case highlights the importance of case selection, the complex operative technique, and a review of the outcomes of this complicated procedure.