Compilations of Gi Surgery explain by Dr. Dhaval Mangukiya Detail of Evolution,Plan,INTRA OP,Message,Re exploration, Incisional Hernia, https://drdhavalmangukiya.com/ http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat https://gastrosurgerysurat.blogspot.com/

1. •Dr. Dhaval Mangukiya
(Surgical Gastroenterologist)
•Complications in GI Surgery

2. Evolution

4. When do we need a G I
Surgeon
• Spectrum Of G.I. Surgery is from
Entry
to
exit
• Every thing which come into the
way.

5. Spectrum
• Right from Benign to malignancy
• Pertaining to GI tract including
• liver / pancreas / spleen / retro
peritoneum.

6. What eye sees is
That
Mind knows………….

8. • GI Surgery is not a GENERAL
SURGERY Or Just LAPAROSCOPIC
SURGERY
• Its totally different approach
• Going to the root of disease
• Thorough evaluation and treatment

9. Daily routine ….

10. Critical care !!!

11. DILAYSIS
MONITORING
VENTILATER
DVT Rx
NUTRITION
INFECTION

13. Complications
• Enterocutaneous fistula
• Post operative obstruction/sepsis
• Nutritional
• Bile duct injury
• Rexploration
• Incisional hernia

14. Enterocutaneous fistula
• Stoma
• Anastomotic leak
• Drain leak

16. Post op obstruction
• Ileus
• Adhesions
• Sepsis/peritonitis
• Collection

19. Peritonitis

20. Obstruction

21. Bile duct Injury
• Post lap chole
• Incidence – 0.3%
• Factors influencing
– Emergency surgery
– Co-morbidities
– Abnormal anatomy
– Technical
– Expertise

23. CASE
• 42 Yrs female with
h/o lap cholecystectomy in 2006 
encountered BDI intra op, was
detected and RYHJ was done
• Was asymptomatic for 4 yrs
• Started developing recurrent
jaundice episodes – reason??

24. • USG: Mild to moderate B/L IHBRD
With non visualization of lower
CBD
• Rest of the abdomen was normal

25. Next ?
HJ stricture

26. Plan
• Patient needs revision surgery
• RE DO hepatico jejunostomy

27. INTRA OP

28. • Surgery: Re do Roux en Y hepatico
jejunostomy
• Pt was discharged home on POD
5 Without any undue complications

29. Message
• Revision surgery are always difficult but
possible
• Reconstruction of biliary tree should be done
with experts
• Emergency reconstruction caries a high risk of
re-stricture
• Every patient of jaundice should be properly
investigated

30. Re exploration
• Indication
– Mechanical obstruction
– Leak
– Collection
– Burst abdomen
• Increases morbidity
• Increases cost
• Increases stress

31. Re exploration

32. Incisional hernia
• Factors
– Age
– Poor nutritional status
– Emergency surgery
– Amount of peritonitis
– Timely intervention
– Post op ventilation
– Multiple surgery

33. Incisional hernia

35. CASE
• 38 yrs male with recurrent pain (type B)
in LHC & back, with decrease appetite
and wt loss
• Operated for Pustow’s procedure 20 yrs
ago (pancreatico jejunostomy)
• On evaluation found to have dilated PD
And stones both in head and tail of
pancreas with chronic pancreatitis

36. • What is chronic pancreatitis
• Exocrine insufficiency?
• Endocrine insufficiency?
• Will surgery revert the changes?

37. What is indication of sx
• Pain
• Pain
• Pain
• Complications of disease – ca,
bleeding, pseudocyst

38. • Surgery : Revision of Pustow’s
procedure to LPJ (lateral
pancreatico jejunostomy) with
Head coring
• Patient was discharged on POD 6.
• Gained 6 kg in 2 months and back
to work pain free.

39. PUSTOW’S
LPJ WITH HEAD CORING

40. Message
• Pustow’s is now out dated
• LPJ with head coring is std Rx.
• Pain receptors are maximum in
head

41. Thank You
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• www.suratgisurgery.com
• Surat Surgical Gastroenterology
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