Detail different surgical procedures in the field of GI surgery…

GI HPB and Colorectal and Upper GI surgery including Oncosurgery ie cancer surgery  can be done by open ie conventional or laparoscopic or robotic .

Each has its own pros and cons

Open surgeries are time tested methods but takes longer recovery times and time to discharge whereas the more modern laparoscopy and robotic has advantage of faster recovery but longer duration of operating times and also much more expensive. 

So frankly which surgery to be done by which method is still debatable as some has definite proven benefits whereas some are still experimental.  Eg Laparoscopy for Gallbladder Stone done by laparoscopic cholecystectomy is definitely with proven benefits and so is some hernia and appendix etc whereas although many of us would vouch of laparoscopy of Colorectal and even stomach oesophagus and Hepatobiliary pancreatic surgeries,  some may choose to disagree. 

Basically it depends to a lot extent on skill and experience and results of surgeon which varies and also on need to extract specimen and hence size of specimen and need for tactile sensations eg some surgeries may need to feel tumor or disease where conventional surgeries would be better option. 

Similary some surgeries would be too critical to do by non conventional methods due to sheer complexity of procedure and need to handle leash of blood vessels which may not always be feasible option to handle laparoscopic or robotic  . So by and large most surgeries even today are done by conventional cut open methods but maybe with time , such cases would decrease.

Surgical Technique for Whipples

Whipples is one of the most challenging surgery done for pancreatic Duodenal lower bile duct or periampullary tumors mostly cancers .

It’s a very complex procedure of removing the Gallbladder bile duct Pancreas Head neck uncinate along with part of stomach upper jejunum and whole of Duodenum along with Lymphatic drainage basin followed by an equally complex reconstruction by Pancreatojejunostomy followed by hepaticojejunostomy followed by gastojejunostomy with or without feeding tube insertion by Freka or Feeding Jejunostomy. 

Personally we don’t put anymore FJ tube after having done 627 cases so far with success in 624 of them . We would rather give a Freka to start early feeds and take them out faster .

Problems of such surgery are that it takes 8 to 14 hrs ( we do in 3 to 4 hrs ) , needs blood transfusion ( we do bloodless so hardly need blood ) and needs prolonged Ventilator and or ICU stay ( again we don’t send most patients to ICU , almost never needs organ support) and also have high chances of complications ( we have very less , almost negligible ) and also death due to leak sepsis bleed organ failure etc .

Our results have been extremely satisfying over 25 years or more but that doesn’t rule out chances of complications or death after such a major surgery . Some cancers maybe inoperable due to metastasis found on table or due to invasions of blood vessels . Some vessels like portao vein , hepatic arterial trifurcation maybe cut out and reconstructed whereas some maybe unsuitable for whipples in which cases Triple bypass surgeries are done without resection of tumor.  These are like palliative procedures.

Surgical Techniques for Laparoscopic Colorectal surgery

Laparoscopic colorectal surgeries are done for Benign or cancerous conditions of diseases affecting colon or rectum. 

Typically they are divided into right hemicolectomy,  left hemicolectomy,  right and left extended hemicolectomy,  subtotal colectomy,  total colectomy with permanent stoma bag or restorative panproctocolectomy where ileal pouch is done to allow patient to pass stool from natural anal orifice and rectal cancer surgeries like low Anterior resection,  ultralow Anterior resection and abdominoperineal resection and extra elevator abdominoperineal resection

Surgery typically needs 5 or more holes to allow fine instruments to go inside abdomen and dissect along the feeding blood vessels to not only have the feeding vessels tied off but also for adequate nodal clearance ( most important step for staging and longterm prognostication ie outcome for cancer surgeries) and then Preserve all organs that needs to be preserved after freeing them from attachments to segment of Colon to be resected or rectum to be resected . After specimen is resected which is typically extending from one blood vessel territory to another as per extent of surgery or 5 to 10 cm on either side depending on tumor size location etc ,reconstruction is done be anastomosis ie joining of cut ends as end to end to side to side with or without stoma bag for temporary passing of stool in Bag to all anastomosis ie joining to heal .

Like all procedures these surgeries can also have leaks etc complications and even deaths . Some very large tumors may need open surgeries and can also in some cases be done by robotic .

Laparoscopic Gallbladder surgery for Stone and other diseases is a Gold Standard practice now

It encompasses doing 3 to 4 small holes through which ports are placed to introduce long instruments which are used to Dissect the Calots Trainagle ( commonly and wrongly called which ideally should be called Cholecystohepatic triangle ) where lies the Cystic Duct and artery which are clipped and divided in between clips thereby freeing Gallbladder from its attachments to Bile Duct and Blood Supply hanging it from Liver alone along Cystic plate ( a fibroareolar tissue) . Gallbladder is then sharp dissected from Liver usually by electrocautery and delivered out by stretching one the 10mm ports ( umbilical ie naval or epigastric ie upper left side of abdomen ) and mandatorily sent for HPE Ie Histopathology biopsy test .

The holes are closed by absorbable ie dissolving Stitches on inside as well skin level .

Usually takes variable 5 to 50 mins in not so difficult to 15 to 120 mins in difficult cases .

Some may need open surgery

Again all above ie timing and open or not to a lot extent depends on expertise of surgeon and availability of infrastructure and experience rather than just the disease pathology . Even though a regular surgery , still can have its set of complications which are best avoided eg bile duct injuries etc…