Senthil Gnanasekaran

Jawaharlal Institute of Post Graduate Medical Education and Research

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Raja Kalayarasan

Jawaharlal Institute of Post Graduate Medical Education and Research

Biju Pottakkat

Jawaharlal Institute of Post Graduate Medical Education and Research

Sandip Chandrasekar

Jawaharlal Institute of Post Graduate Medical Education and Research

Ram Prakash Gurram

Jawaharlal Institute of Post Graduate Medical Education and Research

S L Harilal

Jawaharlal Institute of Post Graduate Medical Education and Research

Ankit Shukla

Helen DeVos Children's Hospital

Gopalakrishnan Gunasekaran

Jawaharlal Institute of Post Graduate Medical Education and Research

Bheemanathi Hanuman Srinivas

Jawaharlal Institute of Post Graduate Medical Education and Research

Shahana Gupta

All India Institute of Medical Sciences

Karan Midha

Jawaharlal Institute of Post Graduate Medical Education and Research

Cooperative Institutions

Jawaharlal Institute of Post Graduate Medical Education and Research

Creative Commons

All India Institute of Medical Sciences

Gastroenterology Medical Center and Hospital

All India Institute of Medical Sciences Bhopal

Pondicherry Institute of Medical Sciences

Maulana Azad Medical College

Medical College and Hospital, Kolkata

Institute of Medical Sciences

All India Institute of Medical Sciences Raipur

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Invasive Adenoarcinoma Arising in Mucinous Cystic Neoplasm Communicating to Main Pancreatic Duct with Concurrent Pseudocyst: A Report of Very Rare Case

Research Square (Research Square) (2022)

Dinesh Kumar Biju Pottakkat Senthil Gnanasekaran Raja Kalayarasan

Abstract Purpose: MCN communicating with pancreatic duct and co-existence of pancreatic pseudocyst with MCN are rare conditions. Malignant transformation in MCN is not uncommon but combination of these rare presentations is very rare and has not been reported previously. Methods - A Case report of malignant transformation of MCN, which was communicating to MPD with concurrent pseudocyst of pancreas. Results- Two communicating large cysts in relation of tail of pancreas and lesser sac were diagnosed in a 45-year-old woman who had symptoms of early satiety and postprandial fullness of abdomen with history of recurrent acute pancreatitis.On cross sectional imaging there were two cysts:one multiloculated cyst with internal enhancing septations and solid component, which was communicating to main pancreatic duct and other uniloculated cyst without solid component or sepatations.Preoperative diagnosis of an IPMN with co-existing pseudocyst was made. En-bloc resection of both cysts, distal pancreas-spleen, proximal stomach and left hemidiaphragm with lymphadenectomy was done owing to high risk of malignancy. Final diagnosis on histopathological examination was moderately differentiated grade 2, MCN with invasive adenocarcinoma with coexisting pseudocyst of pancreas. Conclusion: We are reporting the 1 st case of invasive adenocarcinoma arising in MCN, which was communicating to main pancreatic duct with chronic pancreatitis and co-existing pseudocyst of pancreas.This case provides unique opportunity to study spectrum of cystic lesions of pancreas in single case.

Pancreatic pseudocyst

10.21203/rs.3.rs-2329526/v1

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Advanced training in laparoscopic gastrointestinal surgical procedures using Genelyn®-embalmed human cadavers

Journal of Minimal Access Surgery (2021)

S. S. S. N. Rajasekhar Dinesh Kumar Raveendranath Veeramani Raja Kalayarasan Senthil Gnanasekaran

Human cadaver is ideal for learning and acquiring new surgical skills. While cadavers preserved using Thiel's embalming method are commonly used for training in laparoscopic surgery, it is a cumbersome technique. We report our experience of using Genelyn®-embalmed cadavers for training in advanced laparoscopic gastrointestinal procedures.A cross-sectional satisfaction survey corresponding to level 1 of the Kirkpatrick model for training evaluation was performed among 19 participants of advanced laparoscopy surgical skills training workshop, in December 2019, using Genelyn®-embalmed cadavers. Visual, haptic and tactile characteristics of the organs and tissues were assessed along with overall satisfaction of the workshop using Likert scale.Five Genelyn®-embalmed cadavers were used for the workshop. All the 19 participants perceived that the cadavers were odourless and allowed adequate insufflation for laparoscopic procedures. Most of the participants(n=16, 84%) agreed that the appearance and tactile fidelity of the solid organs, luminal structures and tissues in Genelyn®-embalmed cadavers were similar to that of a live patient. There was a strong agreement among participants that the workshop will help improve the laparoscopic skills(median Likert score-4).The participants of the surgical skill training workshop felt that the Genelyn®-embalmed cadavers were ideal for use in practicing advanced laparoscopic procedures.

10.4103/jmas.jmas_152_20

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Frey’s plus versus Frey’s procedure for chronic pancreatitis: Analysis of postoperative outcomes and quality of life

Annals of Hepato-Biliary-Pancreatic Surgery (2020)

Gopalakrishnan Gunasekaran Raja Kalayarasan Senthil Gnanasekaran Biju Pottakkat

Additional surgical procedures are often required in patients with chronic pancreatitis (CP) related complications. The present study aims to analyze the type of additional procedures required in patients who underwent Frey's procedure (Frey's plus) and to compare the short-term outcomes and quality of life with patients who underwent only Frey's procedure.Retrospective analysis of a prospectively maintained database of patients who underwent surgery for CP between January 2012 and February 2018 and completed at least one year of follow-up. Patients who underwent non-Frey's surgical procedures were excluded. Clinical parameters, postoperative pain relief (using Izbicki pain score) and functioning scale score (EORTC QLQ C30) of patients who underwent Frey's plus procedure and only Frey's procedure were compared.Of the 146 patients who underwent surgery for CP during the study period, 100 patients (Frey's procedure-68, Frey's plus procedure-32) were included in this study. Roux-en-Y hepaticojejunostomy was the commonly performed additional procedure (n=12). The demographic and clinical parameters were comparable, except for more patients with jaundice (28.1% vs. 2.9%, p=0.01) and prolonged operative time (374.6 mins vs. 326.3 mins, p=0.01) in Frey's plus group. However, there was no significant difference in mean intraoperative blood loss, postoperative morbidity or duration of hospital stay. At median (range) follow up of 34 (12-86) months, there was no significant difference in the pain control and quality of life between two groups.Frey's plus procedure for chronic pancreatitis can be safely performed wherever indicated without adversely affecting the postoperative outcome or quality of life.

10.14701/ahbps.2020.24.4.496

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Laparoscopic hepatopancreatoduodenectomy for locally advanced gall bladder cancer

Journal of Minimal Access Surgery (2021)

Mathews James Raja Kalayarasan Senthil Gnanasekaran Biju Pottakkat

Hepatopancreatoduodenectomy (HPD) can offer a survival advantage in selected patients with locally advanced gall bladder cancer (GBC). While the safety and feasibility of minimally invasive radical cholecystectomy have been recently documented, laparoscopic HPD for GBC has not been previously reported. A 73-year-old male with GBC infiltrating the bile duct underwent laparoscopic HPD to achieve R0 resection. The patient had an uneventful post-operative course except for delayed gastric emptying that improved with conservative management. The feasibility of laparoscopic HPD for locally advanced GBC reported in the present case needs to be documented in a large case series.

Conservative Management

Gallbladder Cancer

10.4103/jmas.jmas_179_20

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Minimally Invasive Retrosternal Esophageal Bypass Using a Mid‐Colon Esophagocoloplasty for Corrosive‐Induced Esophageal Stricture

World Journal of Surgery (2020)

Ram Prakash Gurram Raja Kalayarasan Senthil Gnanasekaran Biju Pottakkat

Esophageal stricture

Cardiothoracic surgery

10.1007/s00268-020-05719-4

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Early experience with robot-assisted Frey’s procedure surgical outcome and technique: Indian perspective

Daehan nae'si'gyeong bog'gang'gyeong oe'gwa haghoeji/Journal of minimally invasive surgery (2022)

Ankit Shukla Senthil Gnanasekaran Raja Kalayarasan Biju Pottakkat

Robotic surgery for pancreatic diseases is currently on the rise, feasible, well-accepted, and safe. Frequently performed procedures in relation to pancreatic diseases include distal pancreatectomy and pancreatoduodenectomy. The literature commonly describes robotic lateral pancreaticojejunostomy; however, data on robot-assisted Frey's is scarce.We herein, describe our series and technique of robot-assisted Frey's procedure at our tertiary care center between November 2019 and March 2022, and its short-term outcomes in comparison to the open Frey's. Patients with chronic pancreatitis having intractable pain, dilated duct, and no evidence of inflammatory head mass or malignancy were included in the study for robot-assisted Frey's.In our study, out of 32 patients, nine patients underwent robot assisted Frey's procedure. The duration of surgery was significantly longer in robotic group (570 minutes vs. 360 minutes, p = 0.003). The medians of intraoperative blood loss and postoperative analgesic requirement were lower in robotic group, but the difference was not statistically significant (250 mL vs. 350 mL, p = 0.400 and 3 days vs. 4 days, p = 0.200, respectively). The median length of hospital stay was shorter in the robotic group, though not significant (6 days vs. 7 days, p = 0.540). At a median follow-up of 28 months, there was no significant difference in the postoperative complications and short-term outcomes between the two groups.Robotic surgery offers benefits of laparoscopic surgery in addition it has better visualization, magnification, dexterity, and ergonomics. Frey's procedure is possible robotically with acceptable outcomes in selected patients.

10.7602/jmis.2022.25.4.145

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Functional Outcome of Treatment after Failed Intertrochanteric Fracture Fixation

Journal of Orthopedics and Joint Surgery (2023)

Senthil Gnanasekaran Muthu K Vaiyapuri Amudha Ganesh Selvaraj Vijaya A Sivaji Rex Chandrabose

Salvage hip arthroplasty and revision osteosynthesis are the two main treatment options for failed IT fractures.Salvage hip arthroplasty includes total hip arthroplasty and hemiarthroplasty. 12,13Many technical challenges one must overcome before doing revision procedures, like poor bone stock, residual bone deformity, removable of broken implant, altered soft tissue anatomy after primary fixation, and proximal femoral deficiency.Due to these technical challenges, revision surgeries IntroductIonIntertrochanteric (IT) fracture of the hip is mostly seen in the elderly osteoporotic population.2][3] These fractures are more common in females when compared with males due to postmenopausal decrease in bone density.The ratio is 2:1-8:1, with female predominance. 4 The surgical options are either intramedullary fixation and extramedullary fixations like sliding slip screws or proximal femoral locking plating. 5Despite the controversy of using fixation devices, intramedullary fixations are the choice of implants because of their superior advantages. 6Changes in implant design and reduction methods are made to achieve stability of the fracture.8][9] Fracture pattern, preexisting chronic comorbidities, and bone density are some factors that determine the fracture union.Failed IT fractures can cause significant pain and disability and always needs surgery. 10Indications for surgery are nonunion, malunion, implant failure, refracture, dislocations, femoral head necrosis, and infection.

Intertrochanteric fracture

10.5005/jojs-10079-1112

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Atypical Presentation of Gastrointestinal Stromal Tumor as Multiple Intra-Abdominal Cysts: A Case Report

Cureus (2020)

Ram Prakash Gurram Senthil Gnanasekaran Karan Midha Biju Pottakkat Raja Kalayarasan

Gastrointestinal stromal tumors (GISTs) are the most common nonepithelial solid neoplasms involving the alimentary tract. We report a case of cystic GIST with multiple cystic metastases. A 61-year-old man presented with upper abdominal pain for two months. Further evaluation revealed a large intra-abdominal cyst in the lesser sac and another cyst over the segment VII of the liver on imaging. Multiple intra-abdominal hydatidoses were suspected based on the imaging and its endemic nature in the geographical area. However, the hydatid serology was normal. In view of hemorrhagic cyst fluid, an intraoperative frozen biopsy of the cyst wall was done, which revealed features suspicious of a mesenchymal tumor. Sleeve gastrectomy with en-bloc excision of the gastric cyst, excision of the hepatic cyst, and complete excision of multiple other intra-abdominal cysts were performed considering GIST as a possibility. Histology revealed a clear cell variant of GIST. Gastric GISTs primarily presenting as multiple intra-abdominal cysts and of clear cell histological variants had never been reported in the literature. The patient was started on imatinib, and he has shown no evidence of recurrence after 12 months of follow-up. A high index of suspicion, intraoperative frozen section, meticulous surgery, and immunohistochemistry are all crucial for the effective management of atypical cases. GIST may be considered as a part of differential diagnosis in clinical scenarios with multiple intra-abdominal cysts, especially in the equivocal setting.

Imatinib Mesylate

Stromal tumor

CD117

Abdominal mass

10.7759/cureus.7999

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Stapled Repair of Benign Acquired Tracheoesophageal Fistula: Description of Novel Technique and Assessment of Outcomes

Cureus (2020)

Ram Prakash Gurram Senthil Gnanasekaran Raja Kalayarasan Biju Pottakkat Sandip Chandrasekar

Compared to less invasive measures, surgical repair is the most effective modality for managing benign acquired tracheoesophageal fistula (TEF). Traditionally, this involves dismantling of the fistula and suture repair of tracheal and esophageal defects using a lateral or direct approach. However, the best approach remains a subject of debate. We describe a novel and simple technique for dismantling a benign acquired TEF with the use of an endo-stapler and interposition with sternocleidomastoid (SCM) muscle flap. Eleven TEF patients underwent repair using this stapled repair technique. Retrospectively, the perioperative and long-term outcomes were assessed in these patients. There were no cases of procedure-related mortality or airway-related complications. Two patients developed transient vocal cord palsy and one developed esophageal leak. At a mean follow-up of 21.4 months, no fistula recurrence, dysphagia, or tracheal stenosis was observed. Hence stapled dismantling and SCM muscle interposition is a simple and safe technique for repair of benign acquired TEF.

Tracheoesophageal Fistula

Sternocleidomastoid muscle

10.7759/cureus.9854

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Transient mesoportal shunt: An innovative technique for maintaining portal flow during pancreatoduodenectomy with portal vein resection

Annals of Hepato-Biliary-Pancreatic Surgery (2021)

M Gautham Senthil Gnanasekaran Raja Kalayarasan Biju Pottakkat

Pancreatic cancers exhibit a surgical challenge, in light of frequent vascular involvement. In absence of metastatic spread, vascular invasion is the predominant limiting factor for determining the resectability. With progression of time vascular involvement is no longer considered a surgical contraindication. However these complex procedures are fraught with technical challenges. Portal clamping required for vascular resection and reconstruction results in hepatic ischemia and visceral congestion. In order to mitigate these untoward effects, surgeons have tried diverse techniques including venous shunts. Venous shunting facilitates the resection and allows for an enhanced exposure and a safe procedure. Previously described techniques were either cumbersome or failed to maintain portal flow. We present a technique of transient mesoportal shunt, to facilitate vascular resection during pancreatoduodenectomy. This technique is both simple and maintains portal flow throughout the procedure preventing both hepatic ischemia and visceral congestion.

Transient (computer programming)

10.14701/ahbps.2021.25.1.122

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Citations (1)