laparoscopic myomectomy for multiple fibroids with infertility

done by me and dr reshma yagnik.

low anterior resection for ca. rectosigmoid junction using circular staplers

rectal mobilization

intraluminal view of adenocarcinoma of rectosigmoid jn

stapler and anvil fixed with sutures before locking

complete donut after firing

55yr old male operated for adeno ca at rectosigmoid junction by using circular staplers.

laparoscopic nissen fundoplication

a 31 yr old female having c/o persistent reflux and vomiting since last 3 years, initially improved with ppi therapy but gradually required higher doses. upper gi endoscopy revealed gross reflux with grade 3 reflux esophagitis ,grossly open g.e junction throughout the procedure , allowing complete  retroflexion up to mid esophagus.after 3 three years of failed conservative trial , wt loss and intractable gerd and vomiting, pt was planned for laproscopic nissen fundoplication. three stiches at crura, two for fundoplication and one for crura hitch taken with ethibond 2.0. after 25 days of surgery, pt has improved drametically. done by me, dr rahul naik and dr chetan morawala at naveli hospital.

mirizzi's syndrome with impected 2.7 cm size commen hepatic duct stone

 a 42 yr female with diabetes mellitus with hypertension presented with pain in rt upper abdomen with fever with jaundice. c/o itching with white stool.on ct scan complete mirizzi's syndrome with impected stone in common hepatic duct was detected, cbd was normal in size with dilated ihbr.on open exploration, gb empyma with 40 cc of pus drained, subtotal cholecystectomy was done .impected stone in c.h.d was found with difficulty as it had migrated deep posteromedially to infundibulum of gb. no cystic duct or cystic artery found.stone retrived and feeding tube cannulation done in c.h.d proximately as well as distally, 12 no t- tube was placed in c.h.d and a 32 no abdodrain in sub hepatic region. after 6 days post op , pt is fine, orally. pre op total bilirubin was 4.7, with raised sgpt and alk phosphatase . today total bilirubin is 1.1, t tube is draining 100 cc bile per day with no bile in abdomen drain. done by me, dr rahul naik and dr sameer desai.T-tube graphy from a slightly displaced t-tube suggestive of normal cholangiogram, no residual stone. t-tube and drain were removed on 12th and 15th post op day respectively. pt is absolutely fine and discharged on normal l.f.t .                                                 .

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poly trauma: distal pancreatectomy, splenectomy with lt renal vascular injury with transverse mesocolon tear with # lt humerus

alleged h/o road traffic accident with # lt humerus got severe hypotension and abdominal distension, referred to institute. ct scan suggestive of  class 3 pancreatic injury distal pancreas with transverse mesocolon tear with splenic vascular tear and 2.5 lit heamoperitoneum,non filling of left renal system on ct-uro. on exploration complete avulsion of pancreatic tail from body identified and removed with splenectomy. left kidney found viable and assessed by urologist,left as it was.trasverse mesocolon tear repaired. post operatively pt went into acute pulmonary edema and malignant hypertension due to renal injury and activation of renin-angiotensin system.pt had anuria and septicemia.so he was on daily dialysis for about 25 days,with about 25-50 cc pancreatic fistula.pt was on ventilator for about 1.5 month .now he is absolutely fine fully orally and discharged from hospital.doctor"s team including me, dr dhaval pate, dr kaushik shah, dr mitul chavda and dr ronak vyas , dr harshad joshi  were happy to see the result.

grade 3 pancreatic injury with splenic hilar tear with renal injury

20 yr old male with h/o road traffic accident, with fracture humerus. ctscan abdo s/o grade 3pancreatic