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Laparoscopic & GI Surgery

We do routinely basic and advanced Laparoscopic procedures with best outcome. The Department of General and Minimal Access Surgery provide modern and state of the art surgical treatment options for patients. The General and Minimal Access Surgery service is manned 24/7 by an experienced and dedicated team of consultants. The department is committed to providing ethical and evidence based surgical options to our patients. A large number of major and minor operations are performed in the department every day.  To catch up with latest advancement, a full endoscopy set (Storz) with camera and video facilities has been added and is being used for surgery, urology, gynecology and orthopedic department.

The team possesses extremely competent skill sets across all forms of surgical treatment conventional and advance laparoscopic for patients requiring abdominal operations. This allows them to treat their patients with conventional and advanced laparoscopy treatment depending upon the case requirement.

We are routinely doing Weight Loss or Bariatric Surgery:

  • LAGB (Laparoscopic adjustable gastric banding)
  • Laparoscopic Sleeve Gastrectomy
  • Laparoscopic Gastric By-Pass
  • Laparoscopic Minigastric Bypass
  • Revision Laparoscopic Bariatric Surgery

We perform GI & Cancer Procedure, such as gastro cancers of Esophagus, Stomach, Colon, Rectum, Liver, Pancreas, Gall Bladder and Spleen get the benefit of the most suitable and safe treatment option.

  • Cholecystectomy for Gall Stone
  • Appendicectomy
  • Hernias
  • MIPH (minimally invasive procedure for PILES) OR Also Called Stapler Haemorrhoidectomy
  • Common Bile duct Stones (Laparoscopic & endoscopic)
  • Laparoscopy for Achalasia Cardia
  • Laparoscopy for Hiatus Hernia
  • Laparoscopy for Pseudopancreatic Cysts
  • Laparoscopy in various Liver Cysts
  • Laparoscopic for Splenectomy
  • Laparoscopic for Rectal Prolapse
  • STARR ( Stapled Trans-Anal Rectal Resection)
  • Whipple Procedure (Pancreatic Cancer)
  • Liver Resections

Lap. Cholecystectomy for Gall Stone

Lap. cholecystectomy for gall stone is a surgical procedure used to remove the gall bladder. It is used as a usual treatment for gallstones and for some other gall bladder conditions. The removal of gall bladder was performed by the old invasive procedure of surgery known as the open cholecystectomy. But, nowadays, the enhancement of laparoscopy has made it possible to perform the surgery through the laparoscope camera, which results in smaller incisions. This procedure is termed as laparoscopic cholecystectomy for gall stone.

Need for Lap. Cholecystectomy

Lap. Cholecystectomy surgical procedure is the best method to treat gall stones which cause symptoms. It is also the most common way to save the patient from the pain that gall stones bring. It is only avoided in case there is some major complication, which needs preventing the surgery.

Laproscopic Cholecystectomy Procedure

The lap. cholecystectomy procedure involves the removal of gall bladder and gall stones through small incisions in the abdomen. The abdomen of the patient is inflated by the use of air or carbon dioxide in order to give the surgeons a clear view. The surgeon then inserts a lighted scope attached to a laparoscope (video camera) into an incision made near the belly button of the patient. This laproscope camera is connected to a video monitor which allows the surgeons to get a clear view of the abdominal area. It helps the surgeons to make small necessary incisions on the required sites and remove the gall bladder with the help of specialized surgical instruments which are inserted through these incisions.

Some cholecystectomy procedures can also involve the use of a special x-ray procedure termed as intraoperative cholangiography in order to make the surgeons view the anatomy of the bile ducts before they remove the gall bladder of the patient.

The patients undergoing lap. cholecystectomy for gall stone are given general anesthesia. The effect of this anesthesia usually lasts for not more than 2 hours.

Lap. Appendicectomy

Appendicectomy is the surgical procedure of removing the vermiform appendix. It is also known as appendectomy or appendisectomy. It is mostly used in cases when the patient is suffering from acute appendicitis. Lap. appendicectomy is used when the diagnosis is doubtful or in cases when the patients wants to hide the scars which the surgical procedure brings. The recovery period after a lap. appendicectomy surgical procedure is quick but the procedure turns out to be more expensive. This surgical procedure needs extreme resources when compared to the open surgical methods. Also it takes more time while operating the patient this way and the inflation process of the abdomen using gas, which is also known as pneumoperitoneum can get risky for some of the patients.

Lap. Appendicectomy Procedure

The lap appendicectomy surgery takes place in a fixed procedure, which starts with the process of exposing the appendix. The trocars are inserted after the creation of a pneumo-peritoneum. Specialized instruments are inserted via these trocars then. The surgeons take hold of the appendix with the help of a 5mm claw type grasper which is also inserted using a trocar and the appendix is held towards the abdominal wall.

The next step is to create the mesenteric window under the appendix’s base with the help of a dolphin nose grasper. This 1cm window has to be created as close to the base of the appendix as possible.

Then, begins the process of transecting the meso appendix and the appendix by inserting a special instrument, which is known as multifire endogia 30tm. The appendix is closed at its base and fired. It is important to wait for a few minutes so as to stop an bleeding site on the staple line.

The appendix now has to be retrieved. The surgeons hold it with a grasper and placed in a bag, which is then closed and taken out from the intra abdominal cavity through the endocatch instrument.

Lap. Hernias

Lap hernias surgery is used to treat a patient suffering from inguinal hernias that cause pain or other symptoms. It is also used for treating incarcerated or strangulated hernias.

It is recommended not to operate children having inguinal hernias with the lap hernias surgical method. Also it is suggested not to use this method for people who cannot tolerate general anesthesia or the ones who have bleeding disorders like hemophilia or idiopathic thrombocytopenic purpura. Patients of lung diseases can also not be treated this way since the carbon dioxide gas used to inflate the abdomen can create more breathing problems for them.

The patient is given general anesthesia before operating through lap hernias surgical method. This technique costs out to be more expensive since it takes a bit longer time in the operation and the cost of the laparoscopic technology adds on to it. But it is indeed an effective way to treat hernias and quick recovery.

Advantages of Lap Hernias Surgery

The patients experience less pain when compared to the open surgical procedures of treating hernias. Also the recovery time is quick and the patient suffers from fewer scars due to smaller incisions. The patients are able to return back to work in a few days after the surgery. The lap hernias surgical procedure is easier than the open surgery. Also the laparoscopic hernias method sounds better due to cosmetic reasons.

Hernias on both sides can be repaired at the same time using the lap hernias surgery. There will not be a need of another large incision through this technique. The surgeon gets the freedom to examine both groin areas and all sites of hernias thoroughly. Also the mesh can be applied to all weak areas, which will help in preventing the reoccurrence of hernias in the same spot or its development in a different place.

MIPH (Minimally Invasive Procedure for PILES) or Stapler Haemorrhoidectomy

Minimally Invasive Procedure for PILES (MIPH) or stapler haemorrhoidectomy is a surgical procedure used for the treatment of haemorrhoids, especially for treating third degree haemorrhoids. It involves the removal of the abnormally enlarged haemorrhoidal tissue followed by the repositioning of the left hemorrhoidal tissue back to its normal anatomic position.

The minimally invasive procedure for piles is faster than the traditional surgical method. It brings lesser pain to the patient. This procedure saves the patient from the post operative pain by avoiding the need of any wounds in the sensitive perianal area during the operation.

Procedure for Stapler Haemorrhoidectomy or MIPH

A hollow tube is inserted into the anal canal. A suture (long thread) is woven circumferentially within the anal canal through this tube just above the internal haemorrhoids and its ends are brought out of the anus through the same tube. These ends of the suture are pulled once the stapler gets in through the first hollow tube. This results in getting the expanded hemorrhoidal supporting tissue in the jaws of the stapler. The hemorrhoidal cushions can then be pulled back to their normal position within the anal canal. Firing the stapler then cuts off the circumferential ring of expanded hemorrhoidal tissue, which was held in the jaws of the stapler. Also the upper and lower edges of the cut tissue get stapled together at the same time when the stapler is fired.

Common Bile Duct Stones (Laparoscopic & Endoscopic)

Common bile duct stones (CBDS) is common to happen to up to 14.7% of patients who have gone through cholecystectomy. The patients who suffer through common bile duct stones can observe symptoms like biliary colic, jaundice, cholangitis, pancreatitis or asymptomatic. There can be different techniques to treat CBDS. The selection of the treatment techniques varies according to the condition of the patient. It may vary according to the number of stones and the size of stones present.

The commonly used methods to manage CBDS include endoscopic retrograde cholangiopancreatography (ERCP), endoscopic biliary sphincterotomy, laparoscopic CBD exploration and laparotomy with CBD exploration.

Most of the bile duct stones are diagnosed by endoscopic or transabdominal ultrasound, magnetic resonance cholangiography or computed tomography. After diagnosis the common bile duct stones undergo laparoscopic or endoscopic removal.

Laparoscopic Techniques for Extracting Common Bile Duct Stones

The use of laparoscopic techniques for common bile duct exploration is a prospective option for managing common bile duct stones within the biliary tree. For this, the patient has to be given prophyaxis for deep venous thrombosis and prophylactic antibiotics. Ports are made by the surgeon to insert trochars. The laparoscopic common bile duct exploration is performed in two different approaches: transcystic and choledochotomy.

For the trancystic approach, the cystic duct is exposed for 2-3cm incision through which a cholangiogram catheter is then introduced. The common bile duct stones can then be flushed using 30cc of saline via this catheter. All small stones get flushed away this way. In some cases a 4 Fr Fogarty balloon is inserted through the cystic duct, which is then inflated and withdrawn in order to pull the stones into intra-abdominal cavity. For even more difficult stones, a retrieval basket can be inserted through the choledochoscope under direct visualization.

The common bile duct stones can also be treated by following the same steps through choledochotomy. The common bile duct is exposed for the surgeons to perform vertical ductomy. This takes place on about 5mm of the anterior surface of the duct. The techniques used for the removal of the stones is however similar to the trans-cystic approach. Choledochotomy can be done using a T-tube which is sutured in place with absorbable suture. It is carried forward by primary closure over a stent or primary closure alone.

Laparoscopic for Rectal Prolapse

A rectal prolapse refers to the occurrence of a protrusion of the rectum through the anus. This results in symptoms like a change in bowel habits, mucus drainage, rectal bleeding, anorectal pain or fecal incontinence. Laparoscopic surgery is the best way to treat the patient and repair a rectal prolapse. In the laparoscopic surgery for rectal prolapsed, the rectum is restored to its normal position in the pelvis. This prevents it to protrude from the anus. The rectum is secured by adding stitches to it along with the mesh.

This surgical procedure involves two major steps: one is the positioning of the laparoscope and the other is the repositioning process of the rectum. The patient is operated under anesthesia. The surgeon makes a 0.5 inch small incision near the belly button and inserts a laparoscope through it. The images can be viewed on the monitor screen. Once the surgeons place the laparoscope at the correct place, they make several more keyhole incisions in the abdomen of the patient. These incisions may vary according to the build of the patient, the preference of his surgeon and a few other factors. The surgeon will then pass surgical instruments through these incisions in order to operate the patient. The surgeon will locate your sigmoid colon and rectum and will then free the rectum from its surrounding structures. This freed rectum will be gently lifted into its proper position inside the pelvis. The surgeon will stitch the rectum to the nearby mesh to securely let it remain there. In some cases the surgeon might also feel the need of removing a portion of your sigmoid colon. After that the surgeon rinses out the pelvis and closes all incisions  with stitches.

Our Team

Dr Vipender Sabherwal (Director)

Consultant Laparoscopic & General Surgeon

Dr Vipender is a Gold Medalist and got his master from Edinburgh (UK). He is an International Faculty, teaching worldwide with Johnson and Johnson (J&J, Storz, Royal College of Surgeons). He is having specialization in Laparoscopy and Laser Surgeries and performed more than 7000 minimal access laparoscopic surgeries in last 15 years and has expertise in Laser Surgeries (Ultrasonic)

Qualification

  • MBBS
  • MS (Surgery) ( Gold Medalist)
  • DNB (Delhi)
  • MNAMS (Delhi)
  • MRCS (Edinburgh, UK)

Expertise:

  • Laparoscopic Cholecystectomy (Gall Stone)
  • Laparoscopic Appendicectomy (Appendix)
  • Laparoscopic Hernioplasty (Hernia)
    • Inguinal/Hernia Groin
    • Incisional Hernia
    • Ventral Hernia
  • Laparoscopic Surgery Intestines Small & Large (Perforation intestinal Obstruction)
  • Laparoscopic Rectopexy ( for Rectal Prolapse)
  • Stapler Anopexy (M.I.P.H.-for Piles)
  • Ultrasonic Haemorrhoidectomy ( through Ultrasonic Harmonica Scalpel)
  • Bariatric Surgery

Dr. Rajeev Om Prakash

Consultant General Surgeon

Dr Rajeev Om Prakash having more than 30 year of expertise in General Surgeries and associated with Jeewan Hospital for last 25 years. He is specializes in General, GI, Rectal, Breast & Neck Surgery

Qualification: 

  • M.B.B.S
  • M.S.
  • F.A.C.I.P (U.S.A) 

Expertise: 

  • General Surgery
  • GI Surgery
  • Rectal Surgery
  • Breast Surgery
  • Neck Surgery
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