GI Surgery: Dr Deepak Govil & Dr Vivek Tandon - An experienced team of GI Surgeons

This is a case of cholangio carcinoma i.e cancer of the lower end of the bile duct. The image shows an MRCP(MR cholangiopancreatography) with blockage of the lower end of the bile duct. The pancreatic duct is also dilated. The patient was operated and a whipple’s operation was done where we removed the tumour along with part of the stomach, head of pancreas, lower end bile duct and re anastomosed the remaining structures. The patient is doing well.

Lot of surgeons doing open colorectal oncology surgery but only < 10 % doing laparoscopic colorectal surgery Most of these laparoscopic colorectal procedures require an incision 5-6cm Extracorporeal resection, anastomosis, purse string for anvil and Retrieval of specimen Most of the surgeons are doing basic laparoscopic procedures and would like to venture into laparoscopic colorectal surgery but have basic inhibitions: equipment, learning curve Bleeding Suturing Apprehension of conversion HALS( Hand assisted laparoscopic surgery) is a hybrid operation which allows the surgeon to introduce the non-dominant hand into the abdominal cavity through a special hand port while maintaining the pneumoperitoneum Main advantages of HALS are Adequate maneuverability Tissue retraction blunt dissection control of vascular pedicle Improved tactile feed back, Specimen removal easier Results of patient recovery are similar t...

We feel the incidence of diverticular disease is gradually increasing in our country. We have recently seen a number of cases with different presentations. cases with jejunal diverticuli with upper GI bleed. One was detected on push enteroscopy, one suspected on MR enteroclysis and one detected at laparotomy. The last patient had a rare blood group(O negative) and bled continuously, suspected to have colonic diverticulae. He was operated early because of rare blood group and we were able to resect the segment responsible and patient improved. Apart from this we recently saw many patients with sigmoid colonic diverticulae presenting with perforated diverticulae and diverticulitis and colo-vesical fistulae.

Meetings i am likely to attend are 1. ACRSICON 2010 at Jaipur 24th - 26th Sept'2010 2. IASG 2010 at Hyderabad 7th to 9th Oct'2010 3. ASICON 2010 at Delhi in Dec'2010

This is an interesting patient who presented with recurrent episodes of pancreatitis. He came to us with gastric outlet and biliary obstruction. Whipples' procedure was done. He recovered and is doing well now. We looked at the literature. This is not very common. Patient with annular pancreas presenting at 26 years with symptoms of pancreatitis. Whole procedure and the outcome was interesting

A case of obscure lower gastrointestinal bleed- detected to have jejunal diverticulae. Was detected on MR enteroclysis. Planned and did resection of involved segment. Pt did well and was discharged on 7the Post op day