Department of Gastrointestinal Surgery

OVER VIEW

The Department of Gastrointestinal Surgery is a tertiary referral centre attracting patients from all over the region. This highly specialised unit is committed to focussed care on Gastro-Intestinal diseases and is well equipped to perform all major GI surgeries like liver resections, pancreatic resections and all advanced GI Laparoscopic surgeries. The main objective of the department is to serve as an apex institution providing state-of-the art medical facilities though highly sophisticated equipment and highly skilled personnel and to serve as a training institution on the subject.

The department has state-of-the-art equipments like Harmonic Scalpel, vessel sealing system, Intra-operative ultrasound, High Definition 3-Chip laparoscopic systems of Karl-Storz, Stryker and has facilities like Intra-operative Endoscopy. Department has excellent backing of well equipped ICU, Medical Gastro and Cardiac Deptt Services Carried out.

Gastric and Oesophageal Surgery

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

1. Gastric Cancer – Palliative and curative resections for gastric and gastro-esophageal junction cancers are performed frequently, along with gastrectomy with extended lymph node dissections.

2. Achalasia Cardia – The initial work up is done in the esophageal motility lab in the Medical Gastroenterology department, then the GI Surgery department sees patients who need surgery. Laparoscopic myotomy is performed so that patients can avoid the risk of open surgery with its attendant morbidity.

3. Esophageal Cancer – Transthoracic and transhiatal oesophagectomies are also performed regularly. Thoracoscopic mobilisation of esophagus has been started by deptt.

4. Gastro Esophageal Reflux Disease -The treatment is begun only after extensive evaluation in the motility lab of the Medical Gastroenterology department. Optional minimally invasive anti-reflux surgery is offered to the patient.

5. Ulcer Disease – With the current advances in medical treatment, it is rare for patients to need surgical intervention. When such cases do arise, the department offers the options of laparoscopic as well as open acid reduction procedures.

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 radiotherapy. This approach significantly reduces the risk of recurrence of the cancer. The department carries out a variety of procedures and treats conditions including:

1. Colorectal Cancers – Low anterior resections and stapled pouch anastomosis are carried out routinely. All attempts are made at sphincter preservation. Laparoscopic colorectal resections are being taken up on depending on patient preference and suitability.

2. Inflammatory Bowel Diseases – Inflammatory bowel disease like ulcerative colitis and Crohn’s Disease are handled in consultation with the Medical Gastroenterology department. Advanced procedures like Ileal Pouch Anal Canal Anastomosis are done regularly. Staged procedures for complicated IBD and management of fistulas utilize the services of the integrated

3. Abdominal Tuberculosis – The advanced facilities available in the hospital permit non invasive or minimally invasive confirmation of this often obscure pathology.

4.Rectal Prolapse – Rectal prolapse is being treated routinely by Laparoscopic Rectopexy, thus allowing early return to activity  for the patients.

5. Complicated Perianal Conditions – the evaluation and management of complex perianal fistulae is aided greatly by the  excellent imaging modalities of conventional and MR fistulograms done in the Radiology department.Stapler hemorrhoidectomy is offered to patients at their choice, avoiding the painful and prolonged convalescence after piles surgery.

6. 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.

7. Stoma clinic – The department has a fully equipped stoma care centre that takes care of patients with stomas. 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.In house assistance to patients who requires it also available

Hepato Pancreato Biliary Services

1. Liver surgery – Major liver resections are undertaken routinely for primary cancers of the liver and the biliary tree.

2. Pancreas – The unit routinely carries major pancreatic resections with results being comparable with the best  centres in the world. Surgical treatment is offered to patients with pancreatic cancers as well as chronic pancreatitis.

3. Disorders of the biliary system – The treatment of gallstone disease 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 biliary reconstructive procedures.

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 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.

Gastro Intestinal Oncology

The department works in close association with the Department of Oncology. Management of cancers is handled on the basis of protocols already in place. This close association between the departments allows the patients to get integrated care for their diseases.Unlike most other centres, all phases of the treatment can be completed under one roof. 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.