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Honored to have received Award in the category of
"OUTSTANDING LAPAROSCOPIC GI HPB ONCOSURGEON OF THE YEAR 2022 FROM INDIA " At The INDO ARAB LEADERS SUMMIT AND AWARDS 2022 , held at Taj , Business Bay Burj Khalifa Road , DUBAI , UAE on 2nd July 2022 ,organized by WORLDWIDE ACHIEVERS partnered with Zee Business and Aj Tak and other International Media Partners , in presence of Dignitaries as was expected.
1. Shri Ramdas Athawale , Hon. Minister of State for Social Justice and Empowerment, Govt of India
2. Shri Narayan Tatu Rane - Hon. Minister MSME Govt of India
3. Sheikh Nagin Bin Mubarak Al Nahyan - Hon. Minister of State for Tolerance , Govt of UAE
4. Shri Som Prakash , Hon. Union Minister of State for Commerce and Industry , Govt of India
5. Prof. S P Singh Baghel , Hon. Minister of State for Law and Justice , Govt of India
6. Dr Bharti Pravin Pawar , Hon. Minister of State Health and Family Welfare, Govt of India
7. Sheikh Dr Bhuh of Bhuh Foundation , UAE
8. Padmashree Shri Sonu Nigam , Singer
Event also had Fashion show from GLOBAL MEDIA FASHION LEAGUE with showcase of Designer wardrobe by various designers of International Repute , by models of international repute .
The event also had live music on request by Sonu Nigam and Dance performances by various performers and Dance schools of INDO ARAB countries.
Overall , a Fantastic Extravaganza of Awards , Fashion , Music and Performances and last but not the least , a panel discussion on INDO ARAB collaborative future for the Youth.
8.5 KG abdominal cystuc mass in elderly thin frail lady who presented with massive swollen abdomen and pain and compressive symptoms due to pressure on colon and intestines and stomach so couldn't eat or pass stool properly for few months. We did laparotomy and excised the entire mass with left ovary . Absolute bloodless surgery done with no loss or transfusion. Total operation done in 17 to 20 Mins skin to skin as per Anaesthesia team. Patient fine.
8.5 KG abdominal cystuc mass in elderly thin frail lady who presented with massive swollen abdomen and pain and compressive symptoms due to pressure on colon and intestines and stomach so couldn't eat or pass stool properly for few months. We did laparotomy and excised the entire mass with left ovary . Absolute bloodless surgery done with no loss or transfusion. Total operation done in 17 to 20 Mins skin to skin as per Anaesthesia team. Patient fine.
A RARE CASE OF CYSTIC PANCREATIC CANCER WITH ACUTE PANCREATITIS WITH PANCREATIC NECROSIS --- Anterior RAMPS ( Radical Antegrade modular Pancreatosplenectomy) 70 year plus aged lady presented with severe pain abdomen 1.5 months back and admitted with suspicion of Acute pancreatitis but blood amylase lipase levels were normal ! She was diagnosed with a large solid cystic mass in pancreas body tail region. Presented to me with Ct scan and usg report suggestive of pseudocyst or walled off pancreatic necrosis . I wasnt convinced!!! Sent for Endo USG and all tumour marker and fluid studies for mucin ca199 cea amylase ca 15-3 and cell culture and study . All tumour markers in fluid and blood were high in thousands and few linear calcification with fuzzy septa in SOL ( tumour ) Now comes dilemma between cystic pancreatic cancer ( rare type) vs pancreatic necrosis. EUS suggested walled off pancreatic necrosis . So all radiological examination suggested benign necrosis . I was still dubious considering high tumour markers . Did another triphasic CT scan which suggested mixed picture of cancer along with necrosis. The Splenic artery and vein were involved by tumour and replaced by multiple collateral varices ( sinistral hypertension with thin walled multiple abnormal blood vessels all around which increased chances of severe bleed) We explored under high risks today as patient also had other problems of heart lung and diabetes . We found a mixed picture inside . It was a cystic pancreatic cancer which had also given rise to pancreatitis and hence necrosis. So it was a bad double combination . Dissecting involved blood vessels were too difficult and tricky but we could succeed . Finally after dividing pancreas with splenic vein just at level of Portal vein formation ( visible on picture behind pancreas proximal transaction staple line ) . We could complete RAMP ( Radical Antegrade modular Pancreatosplenectomy) where the entire body tail pancreas with tumour with spleen was taken out with all lymphatic and lymph nodes and fibro fatty tissue with the posterior fascia exposing the left kidney and left renal vascular structures after completion of operation . Was really difficult . We have done RAMPS before but hardly any with tumour and pancreatic necrosis combined with past pancreatitis especially with all blood vessels involved and severe collateral vessels in all planes . Total operative time was 2hr 10 mins Blood loss of 200 ml . Patient stable . PS - Whatever the report says , always trust clinical judgement and do what is right . Else both you and the patient can land up in dubious diagnosis and hence the treatment in completely different direction with severe connotations. Dont miss the bus by miles . Be maximum sure before deciding what's right in such atypical cases .
Difficult radical cholecystectomy for gallbladder cancer near neck and body junction with extensive lymph nodes along common hepatic artery and portal vein and hepatic ducts . Segment 4B and 5 of liver resected. Non anatomic. Blood loss 30ml Ot time 1 hr 10 mins skin to skin . Elderly 70 + age with comorbidity and increasing pain abdomen . Did at Ashok N H and no special instruments .
Abdominal wall repair
AWR ... abdominal wall repair for complex multiple midline hernias with domain loss ...
Abdominal wall repair
AWR ... abdominal wall repair for complex multiple midline hernias with domain loss ...
Chronic pancreatitis re operative surgery
Chronic pancreatitis re operative surgery for recurrent acute on chronic pancreatitis with pancreatic strictures and ductal stones with bile duct stenosis / stricture with biliary obstruction and jaundice .
Chronic pancreatitis re operative surgery
Chronic pancreatitis re operative surgery for recurrent acute on chronic pancreatitis with pancreatic strictures and ductal stones with bile duct stenosis / stricture with biliary obstruction and jaundice .
A 50 plus male who supposedly had Appendectomy by open conventional method 25 years back ..Presented with recurrent abdominal pain for last 6 years . Pain was typically RIF to start and then entire abdomen . Had one episode of Acute pancreatitis diagnosed and treated in past . Since then had multiple admissions and treatment at local tertiary care centers and Hyderabad and other centers of excellence . And was being treated in lines of Pancreatitis without obvious CT findings although everytime CT suggested a tubular Swelling just adjacent to Caecum and some suspected Appendicular stump problem .Was operated again locally by a senior surgeon who supposedly had operated adhesions and other findings ( details not available ) Patients pain persisted for 2 years with multiple more admissions. Finally was referred to us . We found all CT including present one showing the same finding . We did Laparoscopic exploration and found a 1.2 cm lump almost embedded into part of colon ( caecum ) and almost invisible and inseparable. We finally were able to dissect it out and did realise , it is an appendix stump with probably a tumor ( high possibility of Carcinoid ie neuroendocrine tumors , found after opening specimen later ) . Ot time was only 1 hr Blood loss almost none . Hopefully the patient will now be able to stop multiple visits and admissions after some more time for final treatment ( if at all ) . PS - Gallbladder and Appendix stump or residue may dilate over time to cause recurrent symptoms . It is not always fault of previous surgery but probably difficult situation on table during 1st surgery where a little stump is left as safeguard to major morbidity or mortality . And if any tumour develops over time , do understand, it is more likely misfortune of patient rather than ignorance of previous doctors.
A 50 plus male who supposedly had Appendectomy by open conventional method 25 years back ..Presented with recurrent abdominal pain for last 6 years . Pain was typically RIF to start and then entire abdomen . Had one episode of Acute pancreatitis diagnosed and treated in past . Since then had multiple admissions and treatment at local tertiary care centers and Hyderabad and other centers of excellence . And was being treated in lines of Pancreatitis without obvious CT findings although everytime CT suggested a tubular Swelling just adjacent to Caecum and some suspected Appendicular stump problem .Was operated again locally by a senior surgeon who supposedly had operated adhesions and other findings ( details not available ) Patients pain persisted for 2 years with multiple more admissions. Finally was referred to us . We found all CT including present one showing the same finding . We did Laparoscopic exploration and found a 1.2 cm lump almost embedded into part of colon ( caecum ) and almost invisible and inseparable. We finally were able to dissect it out and did realise , it is an appendix stump with probably a tumor ( high possibility of Carcinoid ie neuroendocrine tumors , found after opening specimen later ) . Ot time was only 1 hr Blood loss almost none . Hopefully the patient will now be able to stop multiple visits and admissions after some more time for final treatment ( if at all ) . PS - Gallbladder and Appendix stump or residue may dilate over time to cause recurrent symptoms . It is not always fault of previous surgery but probably difficult situation on table during 1st surgery where a little stump is left as safeguard to major morbidity or mortality . And if any tumour develops over time , do understand, it is more likely misfortune of patient rather than ignorance of previous doctors.
A 50 plus male who supposedly had Appendectomy by open conventional method 25 years back ..Presented with recurrent abdominal pain for last 6 years . Pain was typically RIF to start and then entire abdomen . Had one episode of Acute pancreatitis diagnosed and treated in past . Since then had multiple admissions and treatment at local tertiary care centers and Hyderabad and other centers of excellence . And was being treated in lines of Pancreatitis without obvious CT findings although everytime CT suggested a tubular Swelling just adjacent to Caecum and some suspected Appendicular stump problem .Was operated again locally by a senior surgeon who supposedly had operated adhesions and other findings ( details not available ) Patients pain persisted for 2 years with multiple more admissions. Finally was referred to us . We found all CT including present one showing the same finding . We did Laparoscopic exploration and found a 1.2 cm lump almost embedded into part of colon ( caecum ) and almost invisible and inseparable. We finally were able to dissect it out and did realise , it is an appendix stump with probably a tumor ( high possibility of Carcinoid ie neuroendocrine tumors , found after opening specimen later ) . Ot time was only 1 hr Blood loss almost none . Hopefully the patient will now be able to stop multiple visits and admissions after some more time for final treatment ( if at all ) . PS - Gallbladder and Appendix stump or residue may dilate over time to cause recurrent symptoms . It is not always fault of previous surgery but probably difficult situation on table during 1st surgery where a little stump is left as safeguard to major morbidity or mortality . And if any tumour develops over time , do understand, it is more likely misfortune of patient rather than ignorance of previous doctors.
Invited lecture on gastrointestinal and Hepatobiliary pancreatic surgery and Oncosurgery at Annual conference of Family Practitioners Association
Invited Lecture on Gastrointestinal and Hepatobiliary pancreatic surgery and Oncosurgery at Indian medical Association Kolkata .
Mass connect for gastrointestinal and Hepatobiliary pancreatic surgery and Oncosurgery at Amri Dhakuria hospital .
70 year man with 3 times ERCP stented for 18 Bilirubin jaundice due to lower CBD cholangiocarcinoma with multiple comorbidity . Had local involvement of Portal vein of less than 180° .
We did Whipples with sleeve / partial portal vein resection reconstruction by portal vein recon plus pancreatojejunostomy hepaticojejunostomy and jejunojejunostomy .
Blood loss minimal . No transfusion given. Operating time total 3hrs ( skin cut to final skin stitch) .
We do Whipples quite frequently but usually portal vein resection recons take more time .
70 year man with 3 times ERCP stented for 18 Bilirubin jaundice due to lower CBD cholangiocarcinoma with multiple comorbidity . Had local involvement of Portal vein of less than 180° .
We did Whipples with sleeve / partial portal vein resection reconstruction by portal vein recon plus pancreatojejunostomy hepaticojejunostomy and jejunojejunostomy .
Blood loss minimal . No transfusion given. Operating time total 3hrs ( skin cut to final skin stitch) .
We do Whipples quite frequently but usually portal vein resection recons take more time .
93 + year old male presented with acute pain abdomen with vomiting and constipation. Diagnosed as recurrent sigmoid volvulus ( where the redundant or excess left part colon gets dilated twists on it's on axis and causes obstruction to stool flow and gradually lacks blood supply and goes into gangrene and perforates ie ruptures and patient can even die of severe sepsis due to presence of old infected stool volumes in abdomen).
He had similar episode and open operation in past .
So re do operation in already disfigured abdomen would be more challenging especially considering age , poor health , comorbidity and already delayed presentation of the case beyond the golden period of cure .
However we operated and did a colectomy for the hugely dilated segment because untwisting wasn't possible due to not only bands but severe anastomosis stricture ie narrowing of the twist area and then we had to do stoma and distal mucus fistula ( bring both cut ends of remaining colon and rectum out on the abdomen so that stoo
24 year old female with polyposis coli presented with low rectal and right colonic proved cancers . Received CT + RT followed by Pan proctocolectomy ( after CT MRI Pet CT all suggested operable disease )
The biopsy report suggests as below
All POLYPS ARE CANCERS and IT IS NOT FAP !
There are 100s of CANCERS/ LUMINAL METS in this case
Middle aged lady underwent laparoscopic cholecystectomy ( gallbladder removal ) but unfortunately had major bile duct excision injury where common bile duct ( CBD ) and Common hepatic duct (CHD ) was cut off leading to biliary fistula and peritonitis ( spread of bile into abdomen and severe sepsis ) . She was re operated to have controlled fistula ( ie all bile draining out of abdomen by drains ie tubes ) ( any body fluid as long as it comes of body without accumulating inside abdomen cavity has higher chances of survival due to lower chances of infection ) .
She works with Senior Doctor .
Was referred to us at 4th month of Biliary fistula .
MRCP revealed TYPE 4 injury which is one the most severe grade and complex . The right and left ( 2 main ducts from each side of liver) were cut and separated and retracted little inside liver .
We finally conducted a complex Hepatobiliary bypass surgery by ROUX en Y bypass of RHD and LHD after limited hepatotomy ( dissect liver to take the ducts out ) and obliquely
Middle aged lady underwent laparoscopic cholecystectomy ( gallbladder removal ) but unfortunately had major bile duct excision injury where common bile duct ( CBD ) and Common hepatic duct (CHD ) was cut off leading to biliary fistula and peritonitis ( spread of bile into abdomen and severe sepsis ) . She was re operated to have controlled fistula ( ie all bile draining out of abdomen by drains ie tubes ) ( any body fluid as long as it comes of body without accumulating inside abdomen cavity has higher chances of survival due to lower chances of infection ) .
She works with Senior Doctor .
Was referred to us at 4th month of Biliary fistula .
MRCP revealed TYPE 4 injury which is one the most severe grade and complex . The right and left ( 2 main ducts from each side of liver) were cut and separated and retracted little inside liver .
We finally conducted a complex Hepatobiliary bypass surgery by ROUX en Y bypass of RHD and LHD after limited hepatotomy ( dissect liver to take the ducts out ) and obliquely
AMRI Dhakuria today.
Celebration for succesful stapler piles surgery as per stapler company milestone on 20000 stapler procedures .
Glad to be part of it for years
24 year female presented with polyposis coli with low rectal cancer with intestinal obstruction to a Tertiary care hospital 2 years back at Bangalore. She underwent loop Sigmoid colostomy with Chemotherapy and Radiotherapy .
She didnt accept surgery for APR ie removal of rectum and anus with permanent end colostomy ( ie stool in bag over abdomen ) at that time .
Presently she presented to us with proven cancer right colon , right colic flexure and operable low rectal cancer near anorectal junction .
Wilkies Superior mesenteric artery syndrome. Young female with weight loss and intestinal obstruction and vomiting
Lay people have idea that Appendix and Gallbladder operations are walk in a park easy . NO they can be as treacherous or even more , compared to a major critical cancer surgery . Here is 1 of many such intriguing cases we do . Nearly 80 year male with 2 abdominal operations in same region with multiple associated ailments ( comorbidities ) coming with severe pain with fever with sepsis with acute intestinal obstruction . Surgery revealed fecopurulent peritonitis ( stool and pus in abdomen ) with ruptured gangrenous appendicitis with caecal ( the part of right colon ) gangrene with perforation ( ie a hole through which faecal matter ie stool escapes freely inside abdomen causing severe deadly sepsis ) . Entire gangrenous structures removed . Buttress caecal base repair done . Patient discharged on day 6 .
Lay people have idea that Appendix and Gallbladder operations are walk in a park easy . NO they can be as treacherous or even more , compared to a major critical cancer surgery . Here is 1 of many such intriguing cases we do . Nearly 80 year male with 2 abdominal operations in same region with multiple associated ailments ( comorbidities ) coming with severe pain with fever with sepsis with acute intestinal obstruction . Surgery revealed fecopurulent peritonitis ( stool and pus in abdomen ) with ruptured gangrenous appendicitis with caecal ( the part of right colon ) gangrene with perforation ( ie a hole through which faecal matter ie stool escapes freely inside abdomen causing severe deadly sepsis ) . Entire gangrenous structures removed . Buttress caecal base repair done . Patient discharged on day 6 .
Lay people have idea that Appendix and Gallbladder operations are walk in a park easy . NO they can be as treacherous or even more , compared to a major critical cancer surgery . Here is 1 of many such intriguing cases we do . Nearly 80 year male with 2 abdominal operations in same region with multiple associated ailments ( comorbidities ) coming with severe pain with fever with sepsis with acute intestinal obstruction . Surgery revealed fecopurulent peritonitis ( stool and pus in abdomen ) with ruptured gangrenous appendicitis with caecal ( the part of right colon ) gangrene with perforation ( ie a hole through which faecal matter ie stool escapes freely inside abdomen causing severe deadly sepsis ) . Entire gangrenous structures removed . Buttress caecal base repair done . Patient discharged on day 6 .
Cirrhotic liver with acute cholecystitis ( ie acute infection of Gallbladder due to stones ) . We have done plenty so far by laparoscopy but contrary to belief that they need sub total ie partial gallbladder removal , in most our cases , we have removed entire Gallbladder without bleed or complications . The ones with severe dilated vessels in and around Gallbladders are the ones that need cautious movements and various modifications of techniques to instruments to skills to peri operative care .
Cirrhotic liver with acute cholecystitis ( ie acute infection of Gallbladder due to stones ) . We have done plenty so far by laparoscopy but contrary to belief that they need sub total ie partial gallbladder removal , in most our cases , we have removed entire Gallbladder without bleed or complications . The ones with severe dilated vessels in and around Gallbladders are the ones that need cautious movements and various modifications of techniques to instruments to skills to peri operative care .
A known and most dreadful complication of Laparoscopic Gallbladder surgery is bile duct injury . The worst of that is the transection and segment loss injuries . Even worse when bilioma ie collection of bile now spreads inside abdomen causing biliary peritonitis called Waltman Walter's syndrome where septic shock and other organ dysfunction can cause high chance of death.
A young lady suffered somewhere in the periphery and brought to us with percutaneous drains all blocked and patient in very critical shape with severe septic shock and multi organ dysfunction .
We re operated today ( we have done quite few in past as well ) by laparoscopy . There was 5.3 litres of bile approximately . All cleared drained . Abdomen washed vigorously and thoroughly with 6 litres warm Normal Saline . And widest bore drains put in HRP and Pelvis . ( purpose is to have controlled biliary fistula ie all bile leaks out of abdomen in bags and prevents further sepsis ) and later do biliary bypass reconstructive surgery .
A known and most dreadful complication of Laparoscopic Gallbladder surgery is bile duct injury . The worst of that is the transection and segment loss injuries . Even worse when bilioma ie collection of bile now spreads inside abdomen causing biliary peritonitis called Waltman Walter's syndrome where septic shock and other organ dysfunction can cause high chance of death.
A young lady suffered somewhere in the periphery and brought to us with percutaneous drains all blocked and patient in very critical shape with severe septic shock and multi organ dysfunction .
We re operated today ( we have done quite few in past as well ) by laparoscopy . There was 5.3 litres of bile approximately . All cleared drained . Abdomen washed vigorously and thoroughly with 6 litres warm Normal Saline . And widest bore drains put in HRP and Pelvis . ( purpose is to have controlled biliary fistula ie all bile leaks out of abdomen in bags and prevents further sepsis ) and later do biliary bypass reconstructive surgery .
Middle aged Male with Situs inversus of stomach with chronic pancreatitis and cholecystitis with infected walled off pancreatic necrosis causing pancreatic tail splenic hilum region abscess with severe adhesions and fibrosis esp
He did a major task of Splenectomy where the spleen was occupying almost entire abdomen .
It's size was 29cm × 16 × 12 cm ( so almost a foot long instead of normal 7 to 14cm ) and was weighing 1980 gm ( so nearly 2 KG instead of 150 gms) .
Operation was done complete in 1hr 15 mins with minimal blood loss of around 30 to 40 ml.
A complex infected pilonidal sinus . ( it is a sinus tract formed on back over sacral region and sacrum bone ie a last fused 5 vertebral bone just above tail bone coccyx. ) These sinuses are formed due to hairs mostly and has a small opening and a big cavity down below right upto bones . These are dangerously prone to recurrence . Besides cutting them out completely leaves a big gap upto bone which is difficult to close and won't heal in midline . So needs a large flap for adequate coverage and to avoid a midline scar . We have done quite mane without recurrence or complications . Not at all a small or easy surgery though it looks small sinus from outside .
70 year frail male with gallbladder stone along with neuroendocrine tumor of pancreas done laparoscopic surgery successfully and discharged in few days . Awaiting reports . Apparently carcinoid based on tests and severe fibrosis inside abdomen . Recently a famous Bollywood star was in news for a neuroendocrine tumor . These are indolent growing nerve hormone secreting cell tumor which maybe benign or malignant . But has a potential for cure . By Drsuddhasattwa Sen and team at AMRI DHAKURIA HOSPITALS , KOLKATA ..
Elderly patient with acute abdomen due to perforated gangrenous appendix with caecal base with periappendicular and Psoas abscess . In a case of ? Crohns ( inflammatory bowel disease ) disease. Look at typical fat wrapping .
Pancreatic cancer Suegery.Whipples with portal vein and Gastroduodenal artery trifurcation resection reconstruction
Billiary Stricture and Jaundice following bile duct cut injury afterlapariscopic Gallbladder surgery
MBBS (Gold medalist), MS (Gold medalist), DNB (All India Gold medalist), MNAMS (IND), MRCS (UK), FICS (USA), DNB (SGE & HPB), FMAS (AMASI), Fellow HPB & Liver Transplant (Sir Gangaram, Apollo, Del), CC Lap Solid Organ Surgery (Ethicon), CC Endohernia (Ethicon), CC Lap Colorectal (Galaxy, Pune) / Lap UGI surgery and VATS (Calicut), OB. Fellow HPB & GIS (SGPGIMS, Lucknow / GB Pant, Del).
+91 93308 06699 (Argha - Secretary)
drsss_surg@yahoo.co.in
arghamdk@gmail.com
drsen@bestgicancersurgeon.com