re-do- roux-en-y billroth 2 gastrojajunostomy for benigh gastric outletobstruction in old G-J STOMY

GROSSLY DILATED STOMACH UP TO PELVIS DUE TO GASTRIC OUTLET OBSTRUCTION,AND OLD G.J STOMY STENOSIS

old g.j. site near prepyloric area from which the stenosed loop of jajunum was seperated.

Billroth 2-gastrectomy closed partialy to allow revision g.j. by roux- en- y- loop

stomach specimen

all anastomosis completed.

a 35 yr old male presented with severe abdominal pain presented in emergency.he had h/o some abdominal surgery 15 years back,no papers available. o.g.d. scopy revealed complete pyloric stenosis with severe gastric dilatation .no g.j stomy was appreciable.on ct scan , stomach showed severe gastric dilatation and block. on exploration , old stenosed gj stomy was found in prepyloric region with ? mass, loop separated an on table frozen section  done which was negative for malignancy.so revision billroth2 gastrectomy with roux-en-y g.j.stomy was done. uneventfully post op,on 7 the day pt was discharged home absolutely fine , taking orallyfood .done by ME,DR DHAVAL PATEL, DR VYAS, DR RANPARIA,emergency frozen section done by DR PRANAV DESAI.

huge left lobe liver cyst-laparoscopic fenestration and omentopexy

left lobe nonprasitic hepatic cyst

about 2.5 to 3 liters of amber clour fluid aspirated.

hepatic cyst wall falgurated with bowa vessel sealer

fenestration completed, wall sent for biopsy,lavage given

omentopexy done

a 55 yr male having c/o lump in abdomen with heaviness in abdoman since 6 months,unable to take food, persistent vomiting.the huge intraabdominal mass covering all quadrants of abdomen turned to be diagnosed as huge left lobe nonparacytic hepatic cyst on sonography and CT SCAN. no other cyst in pancreas or kidney.his LFT and other blood reports were normal, with low hb. hydatid antigen test was not done.alfa fetoprotein was boarderline raised,laparoscopic aspiration was done, about 2.5 litre of amber colour fluid drained which was not bile-stained. pus-flakes we removed, liver cyst wall was falgurated with BOWA VESSEL SEALER DEVICE( recommended because there are chances of bile leak from the cyst wall).thorough wash was given , omentopexy done , 32 no. abdo drain kept in cavity .done with four port technique. biposy confirmed the diagnosis of benign hepatic cyst. done by ME, dr bhavin bhuva, dr chetan morawala at naveli hospital. post-op phase was uneventful, pt was discharged on 4rth postopday .now after about 10 months ,pt is fine and without recurrence.

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 .                                                 .