Anvin Mathew

Ananthapuri Hospitals and Research Institute

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Puneet Dhar

Amrita Institute of Medical Sciences and Research Centre

Gourav Kaushal

All India Institute of Medical Sciences

Deepti Ramachandra

All India Institute of Medical Sciences Rishikesh

Mithun Nariampalli Karthyarth

All India Institute of Medical Sciences Rishikesh

Anuj Goyal

All India Institute of Medical Sciences Rishikesh

Nirjhar Raj Rakesh

All India Institute of Medical Sciences Rishikesh

Abhishek Agrawal

Trinity College Dublin

Neeraj Yadav

Sarojini Naidu Medical College

Nirjhar Raj Rakesh

Indian Council of Agricultural Research

Anuj Goyal

GLA University

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All India Institute of Medical Sciences Rishikesh

All India Institute of Medical Sciences

All India Institute of Medical Sciences Raipur

Narayana Health

Amrita Vishwa Vidyapeetham

All India Institute of Medical Sciences Bhopal

Creative Commons

Institute of Medical Sciences

Amrita Institute of Medical Sciences and Research Centre

Central University of Punjab

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Tu1675: BENIGN MASQUERADE OF A MALIGNANT LESION-WHAT THE MIND DOES NOT KNOW, THE EYES DO NOT SEE!!

Gastroenterology (2022)

Deepti Ramachandra Puneet Dhar Gourav Kaushal Nirjhar R. Rakesh Abhishek Agrawal

Need to know

10.1016/s0016-5085(22)64028-9

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1293 EARLY VERSUS DELAYED SURGERY FOLLOWING NEOADJUVANT CHEMORADIATION FOR ESOPHAGEAL CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

Gastroenterology (2023)

Mithun Nariampalli Karthyarth Anvin Mathew Deepti Ramachandra Anuj Goyal Nirjhar R. Rakesh

Chemoradiotherapy

Neoadjuvant Therapy

10.1016/s0016-5085(23)04622-x

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1207 ROBOTIC DIAPHRAGMATIC HERNIA REPAIR

Gastroenterology (2023)

Mithun Nariampalli Karthyarth Nirjhar R. Rakesh Anvin Mathew Deepti Ramachandra Anuj Goyal

10.1016/s0016-5085(23)04596-1

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Reconstructive techniques following low anterior resection for carcinoma of the rectum

Minerva Surgery (2024)

Anuj Goyal Anvin Mathew Princy Joseph Gourav Kaushal Nirjhar Raj Rakesh

INTRODUCTION: Multiple reconstructive techniques have been described for reconstruction after a low anterior resection for carcinoma rectum. Colonic J pouch (CJP), Side to end anastomosis (SEA), transverse coloplasty pouch (TCP) and Straight Colo-rectal/anal anastomosis were the most widely studied.EVIDENCE ACQUISITION: PubMed, Embase and Cochrane data base were searched for randomized, non-randomized studies and systematic reviews from inception of the databases till July 31st, 2023.EVIDENCE SYNTHESIS: Considerable heterogeneity existed among different study findings. Reservoir techniques, including CJP, SEA, and TCP, exhibited reduced stool frequency, decreased urgency, and improved continence status compared to SCA, particularly in the short term. CJP maintained this advantage into the intermediate term. Other functional outcomes were similar among the techniques. However, these functional improvements did not translate into enhanced Quality of Life (QoL). TCP was associated with an elevated risk of anastomotic leaks. Other surgical outcomes remained comparable across all four techniques. Sexual outcomes also exhibited no significant variation. Some studies suggested that the size of the side limb in CJP or SEA may not significantly impact functional outcomes, implying that neorectum capacity may not be the primary determinant of improved function. The precise physiological mechanism underlying these findings remains unknown.CONCLUSIONS: In the short and intermediate terms, reservoir techniques demonstrated superior functional outcomes, but long-term performance was comparable among all techniques. Notably, enhanced functional outcomes did not translate to improved Quality of Life. TCP, while effective, is linked to an increased risk of anastomotic complications, necessitating cautious utilization.

Pouch

10.23736/s2724-5691.23.10115-8

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Gall bladder mass-always a cancer? Think outside the box

Annals of Hepato-Biliary-Pancreatic Surgery (2023)

Deepti Ramachandra Gourav Kaushal Puneet Dhar Nirjhar Raj Rakesh Anvin Mathew

Deepti RAMACHANDRA, Gourav KAUSHAL*, Puneet DHAR, Nirjhar Raj RAKESH, Anvin MATHEW, Anuj GOYAL, Mithun NERIYAMPALLI KARTHYARTH, Neeraj YADAV. Ann Hepatobiliary Pancreat Surg 2023;27:S381. https://doi.org/10.14701/ahbps.2023S1.EP-114

10.14701/ahbps.2023s1.ep-114

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Staple Line Dehiscence in Gastric Conduit Following Esophagectomy: A Complication Conspicuously Missing a Mention It Deserves

Cureus (2022)

Anvin Mathew Gourav Kaushal Deepti Ramachandra Nirjhar Raj Rakesh Puneet Dhar

Following esophagectomy, anatomical reconstruction with a gastric tube is the most common practice. The construction of the gastric tube is done with staplers nowadays, be it a minimally invasive esophagectomy or a conventional open surgery. Even though anastomotic leak and conduit necrosis are reported widely in the literature, the number of studies on staple line dehiscence is meager in comparison. Management of conduit failure usually sacrifices conduit combined with a diverting cervical esophagostomy. We report a case of successful surgical management of a big staple line dehiscence and 'salvaging of the conduit'.

Electrical conduit

Esophagectomy

Suture line

10.7759/cureus.21581

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Adjuvant chemotherapy in resectable carcinoma gall bladder: A systematic review and meta-analysis

HPB (2024)

Mithun Nariampalli Karthyarth Anvin Mathew Anuj Goyal Deepti Ramchandra Neeraj Yadav

Adjuvant Chemotherapy

10.1016/j.hpb.2024.07.217

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49: RE-CONSTRUCTIVE TECHNIQUES FOLLOWING RESECTION OF MID AND LOW RECTAL CANCERS: AN UPDATED NETWORK META-ANALYSIS

Gastroenterology (2022)

Anvin Mathew Deepti Ramachandra Anuj Goyal Mithun Nariampalli Karthyarth Gourav Kaushal

Constructive

10.1016/s0016-5085(22)63808-3

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Squamous Cell Carcinoma of the Sigmoid Colon: A Path Less Traveled

Cureus (2022)

Deepti Ramachandra Gourav Kaushal Anvin Mathew Puneet Dhar Nirjhar Raj Rakesh

Squamous cell carcinoma (SCC) involving the gastrointestinal tract is exceptionally rare, except in the esophagus and the anal canal. In the hindgut, a common site of involvement is the colo-rectum, commonly seen in the fifth decade of life. The presentation is usually in the advanced stages and carries a poor prognosis. Due to the rarity of the disease, before labeling it as a primary lesion, the possibility of metastasis from a distant primary should be entertained. Consensus guidelines regarding the management of such a rare condition are lacking. Here, we present the case of an elderly gentleman with a history of surgery for urinary bladder cancer 20 years back (the nature of which is not known). The patient presented with left lower abdominal pain and altered bowel habits. His pain had persisted for approximately two months along with a recent onset of overflow incontinence but no other associated constitutional symptoms. Examination revealed pallor and a vague abdominal mass in the left iliac fossa. On further evaluation with a colonoscopy, a growth was seen in the sigmoid colon. Computed tomography of the abdomen revealed a locally invasive growth arising from the sigmoid colon along with a space-occupying lesion in the left lobe of the liver enhancing on the portal phase. Biopsy from the sigmoid and the liver lesion was reported as SCC which was confirmed by immunohistochemistry. Given the metastatic nature of the lesion, treatment options were discussed in a multidisciplinary team setting, and the decision was made to proceed with diversion colostomy and palliative chemotherapy. SCC of the colon is a rare disease and is usually diagnosed at an advanced stage. Even in operable cases, the prognosis is dismal, and various treatment modalities have been attempted. Due to the rarity of the disease and paucity of data regarding definitive management, treatment varies from one patient to another.

10.7759/cureus.22297

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The Practice of Pancreatoduodenectomy in India: A Nation-Wide Survey

Cureus (2023)

Gourav Kaushal Nirjhar Raj Rakesh Anvin Mathew Sumit Sanyal Abhishek Agrawal

Introduction The way pancreatoduodenectomy (PD) is performed can vary a lot around the world, and there is no agreed-upon standard approach. To learn more about how PD is practised in India, a survey was conducted among Indian surgeons to gather information about their current practices. Methods A survey was created and shared with surgeons in India who practice pancreatic surgery. It had 33 questions that aimed to capture information about different aspects of PD practice. These questions covered topics such as the surgeons' education and experience, how they evaluated patients before surgery, what they considered during the operation, and how they managed patients after surgery. Results A total of 129 surgeons were sent the survey, and 110 of them completed it. The results showed that 40.9% of the surgeons had less than five years of experience, and 36.4% of them performed more than 15 PDs in a year. When deciding whether to perform preoperative biliary drainage, 60% of surgeons based their decision on the level of bilirubin in the patient's blood, while the rest considered other specific indications. The majority of surgeons (72.7%) looked at the trend of albumin levels to assess the patient's nutritional status before surgery. Venous infiltration was seen as a reason for neoadjuvant therapy by 76.4% of the participants, whereas 95.5% considered upfront surgery in cases of venous abutment. When it came to the type of PD, 40% preferred classical PD, 40.9% preferred pylorus-resecting PD (PRPD), and the rest chose pylorus-preserving PD (PPPD). Pancreatojejunostomy (PJ) was the preferred method for 77.3% of surgeons, while 6.3% preferred pancreatogastrostomy (PG). About 65.5% of surgeons used octreotide selectively during the operation when the duct diameter was small. Nearly all surgeons (94.5%) preferred to secure feeding access during PD, and all of them placed intraperitoneal drains. As for postoperative care, 37.3% of surgeons attempted early oral feeding within 48 hours, while 28.2% preferred to wait at least 48 hours before initiating oral feeds. Conclusions The survey revealed significant differences in how PD is practised among surgeons in India, highlighting the heterogeneity in their approaches and preferences.

10.7759/cureus.41828

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