Department of Surgical Gastroenterology
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Gastric and Oesophageal Surgery
All major gastric and oesophageal surgeries are undertaken. Laparoscopic gastric and oesophageal surgeries are offered to patients where appropriate. The following conditions are treated on a regular basis
1.Achalasia Cardia
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.
4.Esophageal Cancer
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.
6.Gastric Cancer
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).
7.Gastroduodenal Ulcer Disease
Laparoscopic sleeve gastrectomy is routinely performed for morbid obesity in consultation with Endocrinologist, Nutritionist and Plastic surgeon as a team approach.
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 chemotherapy and radiotherapy in patients with locally advanced cancer. This approach significantly reduces the risk of recurrence of the cancer. The department carries out a variety of procedures and treats conditions including:
1.Polyposis Syndrome
Patients with FAP and other types of polyposis syndrome are evaluated fully for coexisting pathology and are offered sphincter-preserving procedures like stapler Ileal Pouch Anal Canal Anastomosis.
2.Inflammatory Bowel Diseases (IBD)
Inflammatory bowel disease like ulcerative colitis and Crohn’s Disease are initially managed conservatively in consultation with Medical Gastroenterology department. Advanced procedures like Ileal Pouch Anal Canal Anastomosis are done regularly. Staged procedures for complicated IBD and fistulas are performed along with services from stoma care people.
3.Abdominal Tuberculosis
The advanced facilities available in the hospital permit non invasive or minimally invasive confirmation of this often obscure pathology by Diagnostic laparoscopy with peritoneal / omental biopsy.
4.Rectal Prolapse
Rectal prolapse is being treated routinely by Laparoscopic and open Mesh 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 Conventional Fistulogram and MR fistulograms. Single stage Fistulectomy is routinely performed on day care basis and Two stage Fistulectomy with Seton placement done for complex High fistula. Stapler hemorrhoidectomy is offered to patients at their choice, avoiding the painful and prolonged convalescence after piles surgery.
6.Adlut Hirscsprung’s disease
Is treated with Martin’s modification of Duhamel procedure and stapler colo-anal anastomosis.
7.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 in consultation with Plastic surgeon.
Gastro Intestinal Oncology
The department works in close association with the Department of Medical Oncology. Management of cancers is handled on the basis of protocols already in place. 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.
Stoma Care Centre
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.
Trauma and Emergency Services
The GI Surgery unit functions as a tertiary referral center for hepatobiliary and pancreatic trauma from all over Odisha. Complicated postoperative GI and biliary fistulas are also admitted through the emergency services. The GI bleed team composing of the critical care specialist, the medical gastroenterologist, interventional radiologist and the GI surgeon manage the patient with a well coordinated approach. 6 beded intensive care unit (ICU) with ventilators, cardiac monitors, blood gas and electrolyte management facility. All patient records are computerized.
