Dr Pradeep Jain Fortis Hospital - Current Applications of Lap in GI Surgery

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Dr Pradeep Jain Fortis Hospital - Current Applications of Lap in GI Surgery. Dr. Pradeep Jain Fortis Hospital has over 20 years of experience in the Laparoscopic GI and GI Oncology Surgery.

Dr Pradeep Jain Fortis Hospital - Current Applications of Lap in GI Surgery. Dr. Pradeep Jain Fortis Hospital has over 20 years of experience in the Laparoscopic GI and GI Oncology Surgery.

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  • 1. Current Applications of Laparoscopy in advanced GI Surgery Dr Pradeep jain M.Ch Director, Laparoscopic GI & GI Oncology and Bariatric surgery Fortis Hospital, Shalimar bagh, New Delhi
  • 2.  1901 George Kelling first laparoscopic procedure in animals  1910 Hans Christian Jacobaeus reported first laparoscopic procedures in humans  1965 Berci introduces rode lens system  1982 video laparoscope introduced  1983 Semm performed first laparoscopic appendicectomy  1985 Muhe performed first laparoscopic cholecystectomy ( though Mouret is often credited for first lap chole )  1992 NIH consensus conference lap chole as preferred alternative to open chole  Decade of 90s almost every GI surgery done laparoscopically  1st decade of 2000s safety and efficacy of GI cancers established  2005 Rao and Reddy first transgastric appendicectomy ( NOTES)  2007 First NOTES in USA ( trans vaginal cholecystectomy ) History line of Laparoscopy
  • 3. Introduction General questions in the mind of a clinician before sending the patient to a Laparoscopic Gastrointestinal Surgeon  Which is superior, open or laparoscopic approach?  Is the laparoscopic approach safe?  Is the laparoscopic approach feasible?  Are the outcomes of laparoscopic approach acceptable?
  • 4. YES  Laparoscopic approach is safe and feasible in the field of GI surgery  Laparoscopic method is largely accepted by medical fraternity as well as by aware general public
  • 5. Laparoscopic Vs Open approach On the basis of various randomized controlled trial laparoscopic approach is well accepted compared to open approach because it is—  Less invasive  Associated with less pain and postoperative disability  Require less analgesic requirement  Early return of GI function  Quicker improvement  Better preserved pulmonary function  Shorter hospital stay Gagner M et al. Surg Clin North Am, 2004April; 84(2):451-62
  • 6. Current application of laparoscopy in GI Surgery Laparoscopy used in the diseases of –  Esophagus  Stomach  Hepato-biliary-pancreatic  Small bowel  Colo-rectal
  • 7. Role of laparoscopy in GI Surgery  Diagnosis  Staging  Palliation  Curative resections  Postoperative problems- Adhesive obstruction -Incisional hernias - Leaks
  • 8. Laparoscopic esophageal Surgery  Esophagectomy  Heller’s cardiomyotomy  Fundoplications  Paraesophageal hernia repair
  • 9. Laparoscopic esophageal Surgery Minimal invasive esophagectomy –  safe as complication rate is comparable to open approach  Lymphnodes yield is comparable to open approach  Less requirement for Blood Tx, analgesics, post op ventilation, ICU stay.
  • 10. Thoraco laparoscopic esophagectomy For Ca Esophagus
  • 11. Laparoscopic Gastric Surgery  Bariatric surgery  Various types of gastrectomies for malignancy  Perforated ulcers  Gastrostomy  Gastric outlet obstruction
  • 12. Laparoscopic Gastric Surgery Laparoscopic approach for bariatric surgery- GOLD STANDARD Types of bariatric surgery done by laparoscopy-  Gastric bypass  Sleeve gastrectomy  Adjustable gastric band  BPD-DS
  • 13. GASTRIC BYPASS FOR MORBID OBESITY
  • 14. Laparoscopic Gastric Surgery For gastric malignancy - LAP vs OPEN approach  No difference in tumor staging  No difference in resection margins  No difference in LN retrieval  No difference in survival between groups Weber KJ et al. Surg Endosc, 2003;17(6):968-71
  • 15. LAP RADICAL GASTRECTOMY FOR CA STOMACH
  • 16. Laparoscopic Colo-rectal Surgery  Resection of malignant tumors  Ulcerative colitis  FAP  Colonic diverticula
  • 17. Laparoscopic Colo-rectal Surgery Laparoscopic resection of colonic malignancies  Overall and Disease free survival rate same  No difference in carcinoma recurrences  Early recovery of Bowel functions and shorter stay Advance age, obesity, Bulky tumors or prior abdominal surgery – not absolute contraindication for LAP
  • 18. LAP RADICAL RT HEMICOLECTOMY FOR CA CAECUM
  • 19. LAP TOTAL PROCTOCOLECTOMY WITH “J POUCH” FOR POLYPOSIS COLI
  • 20. Laparoscopic Hepato-biliary Surgery  Hepatic resections  Hydatid cyst  Fenestration and drainage of benign liver cysts  CBD exploration  CBD excision for choledochal cyst  Roux-en-Y hepaticojejunostomy
  • 21. LAP. LIVER RESECTION FOR HCC
  • 22. Laparoscopic Pancreatic Surgery  Distal pancreatectomy  Pancreatico duodenectomy  Cystogastrostomy/cystojejunostomy  Pancreatic necrosectomy  Lateral pancreatojejunostomy  Enucleation of insulinoma
  • 23. LAP PANCREATIC NECROSECTOMY FOR INFECTED PANCREATIC NECROSIS
  • 24. LAP DISTAL PANCREATECTOMY FOR SOLID PAPILLARY TUMOR PANCREAS
  • 25. LAP CYSTOJEJUNOSTOMY FOR PANCREATIC PSEUDOCYST
  • 26. Summary Almost all Gastrointestinal surgery including Bariatric, Cancer and HepatoPancreatobiliary surgery are feasible and safe by Laparoscopy in a well structured GI Surgery Department
  • 27. Thank You