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Gastro Intestinal Surgery

The Department of Gastrointestinal Surgery has a highly committed and focused team for care of Gastro-Intestinal diseases and is well equipped to perform all major GI surgeries like liver resections, pancreatic resections and all advanced GI Laparoscopic surgeries. The team includes well trained and experienced consultants, registrars and trainees. The department has state-of-the-art equipments like Harmonic Scalpel, Ligasure vessel sealing system, Intra-operative ultrasound, CUSA, Siemens SIREMOBIL compact L C-Arm fluoroscopy machine, High Definition 3-Chip laparoscopic systems of Karl-Storz & Stryker, 3 D Laparoscopy of Aesculap, RITA RF ablation machine and facilities for Intra-operative Endoscopy. The Department of Gastrointestinal Surgery is a tertiary referral centre attracting patients from all over India and abroad. This unit is a specialized Centre for all advanced GI Laparoscopic procedures. This dedicated team of expert GI surgeons have been pioneers in their field and have many achievements to their credit. VIZ: Highest number of Laparoscopic Colorectal Surgeries in Kerala, maximum number of laparoscopic liver surgery in the state, first Single Incision Laparoscopic Colectomy for colorectal cancer, first Single Incision Laparoscopic Surgery (SILS) Cholecystectomy in Kerala, first Lap. splenectomy for patients with portal hypertension and second laparoscopic Whipple’s resection for pancreatic tumour in Kerala. The Department of Gastrointestinal Surgery has various divisions to cater requirements of different categories of the patients.

Hepatopancreatobiliary Unit (HPB)


This unit takes care of those patients with complex liver, pancreas and biliary diseases. Predominant work is done for liver tumours and pancreatic tumours. It requires good preoperative planning, meticulous surgery and intensive postoperative care for good results following liver and pancreatic surgeries.

Liver Transplantation


Highly trained and committed team of transplant surgeons in co-ordinatioon with the hepatologists and gastroenterologists are performing Both live donor liver transplantions (LDLT) and Deceased Donor Liver Transplantations (DDLT). Facilities including dedicated transplant ICUs, trained transplantation nurses, hepatology services and interventioinal radiology services are available round the clock to facilitate this demanding procedure.

Advanced GI Laparoscopy Thoracoscopy Unit:


This specialized centre for all GI laparoscopic procedures has a track record of maximum number of laparoscopic colonic & rectal resections for benign lesions and colorectal cancers. Other major luminal and solid organ surgeries including esophagectomies, gastrectomies, pancreatic surgeries, liver resections and repair of various hernias are done using laparoscopy technique.

Bariatric Surgery Unit


Bariatric surgery unit works on comprehensive care of morbidly obese patients. These patients are taken care of by dedicated Nutritionist for dietary counseling, Endocrinologist, Physiotherapist, and Bariatric surgeons. All bariatric surgical procedures including Laparoscopic sleeve resection, Mini Gastric Bypass, and gastric banding are done in the unit.

Gastro Intestinal Surgery Training facilities.


The department is one among the few accredited centers in the state of Kerala for DNB (Diplomate in National Board) superspeciality training in Gastrointestinal surgery by the National Board, Govt of India. This unit attracts surgeons from all over country and abroad for Laparoscopic Training in Colorectal Surgery for the PACE program of Covidien and by the Ethicon Endosurgery.

Surgical Procedures routinely performed


Hepatobiliary surgery (Laparoscopic or open)


  • Right and left hepatectomies
  • Parenchyma –conserving liver resections
  • Surgery for Kalatskin tumours
  • Hydatid cyst surgeries
  • Laparoscopic or open Radiofrequency ablation (RFA) of liver tumors.
  • Laparoscopic cholecystectomy
  • Laparoscopic and open CBD explorations
  • Radical cholecystectomy for carcinoma gall bladder
  • Open and Lap Surgeries for choledochal cyst
  • Biliary stricture surgeries

Pancreatic surgery (laparoscopic or open)


  • Whipples pancreaticoduodenectomy for carcinoma pancreas and periampullary carcinoma
  • Lateral Pancreatojejunostomy, Head-Coring with LPJ for chronic pancreatitis
  • Distal pancreatectomy
  • Median pancreatectomy
  • Total pancreatectomy
  • Pancreatic necrosectomy for infected pancreatic necrosis
  • Surgery for pseudocysts

VATS (Video Assisted Thoracoscopic Surgery)


  • Thoraco-laparoscopic minimally invasive esophagectomy
  • Thoraco-laparoscopic minimally invasive Esophagogastrectomy
  • Surgeries for benign conditions like esophageal diverticulum and leomyomas

Bariatric surgery


  • Sleeve Gastric resection
  • Mini Gastric bypass
  • Gastric Banding

Luminal surgery


  • Laparoscopic Surgery for Achalasia Cardia
  • Laparoscopic fundoplication for Hiatus Hernia or GERD
  • Radical Gastrectomy
  • Laparoscopic or open Small Bowel resections/Strictureplasty
  • Laparoscopic appendectomy
  • Laparoscopic Colonic resections, Anterior Resections, APER etc.
  • Pelvic exenteration Surgery
  • Lap. Restorative proctocolectomy with Ileal Pouch Anal Anastomosis (IPAA)
  • Hartmann’s procedures and laparoscopic Hartmann’s reversal
  • Colostomy and ileostomy
  • Laparoscopic surgeries for rectal prolapse

Perianal procedures


  • Piles operatrions including Classical haemorrhoidectomy and Stapled haemorrhoidectomy
  • Fistula surgeries including fistulotomy, seton insertion, fistula plugging
  • Perianal abscess drainage
  • Lateral internal sphincterotomy
  • Liver Transplantation


    • Deceased Donor Liver Transplantation (DDLT)
    • Live Donor Liver Transplanatation (LDLT)

    Other surgeries


    • Laparoscopic splenectomy
    • Retroperitoneal tumor resection
    • Laparoscopic Adrenal surgery
    • Abdominal cocoon surgery
    • Surgery for pseudomyxoma peritoneii
    • Laparoscopic hernia repair for ventral, inguinal, femoral, obturator and diaphragmatic hernias

Advanced GI Laparoscopy


This unit is a specialised centre for all GI laparoscopic procedures. This unit has performed maximum number of colonic & rectal resection for benign lesions and for cancer. Unit is equipped with Auscelap 3D Laparoscopy system, High Definition 3-Chip Camera system from Karl-Storz and Stryker, Harmonic scalpel, thermosuflator, Force Triad-Ligasure vessel sealing system, Intraoperative Ultrasound and Radiofrequency ablation system etc. Commonly performed laparoscopic surgeries are

  • Laparoscopic Anterior resection for carcinoma rectum
  • Laparoscopic APER for anal canal tumours
  • Laparoscopic colonic resection (Hemicolectomy, Segmental Colectomy etc) for benign and malignant lesions
  • Laparoscopic restorative proctocolectomy with IPAA for polyposis coli
  • Thoraco-Laparoscopic surgery for Esophageal cancer
  • Lap surgery for Achalasia Cardia (cardiomyotomy)
  • Laparoscopic Fundoplication Gastroesophageal Reflux Disease (GERD)
  • Laparoscopic surgery for inguinal hernia (Lap TEP & TAPP repair)
  • Laparoscopic mesh repair for Incisional & Umbilical Hernia
  • Laparoscopic cholecystectomy
  • Lap CBD exploration for CBD stone
  • Laparoscopic surgery for choledochal cyst
  • Laparoscopic Gastrectomy
  • Laparoscopic resection for liver lesions
  • Diagnostic laparoscopy
  • Laparoscopic adhesiolysis
  • Lap Appendicectomy
  • Laparoscopic Bariatric/Obesity surgery
  • Laparoscopic splenectomy
  • Laparoscopic Whipples Pancreatoduodenectomy
  • Laparoscopic pancreatectomy
  • Laparoscopic pancreatic necrosectomy

Doctors in Gastro Intestinal Surgery


Dr. Satheesh Iype


MS, DNB, MCh (SGE), FEBS (Transplant Surgery) , M Phil (Cambridge), FRCS(Eng), CCT (UK)



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Dr. Solomon Kuruvilla P John


MBBS, MS, MRCS Edinburgh, MRCS England, DM, FRCS (UK), FEBS (HPB)



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Dr. Kamalesh N.P


MS, DNB(GI Surg), FICS, FMAS, FACS
Senior Consultant Gastrointestinal,
HPB and Laparoscopic Surgeon



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Dr. Pramil Kaniyarakkal


MBBS, MS, FMAS, DNB,
Consultant Gastrointestinal, HPB & Laparoscopic Surgeon



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Dr. Shaji Ponnambathayil


MBBS, MS, FMAS, DNB (GI surgery),
Fellowship in Transplantation Surgery (UK), Senior Consultant in HPB surgery, GI surgery and Multi organ transplantation.



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Articles

  • Hilar Cholangiocarcinoma: results of parenchyma conserving hepatic resection. H Ramesh, Prakash K, A Venugopal, V Lekha, G Jacob. HPB Surgery 53;2003: 124-7
  • Brunner’s gland adenoma with circumferential duodenal involvement. Varma D, Prakash K, Augustine P, Mahadevan P, Ramesh H. Indian J Gastroenterol. 2001;20(6):243-4.
  • Primary tuberculous stricture of the oesophagus mimicking carcimona. Prakash. K Kuruvilla, V Lekha, A Venugopal, G Jacob, H Ramesh. Tropical Gastroenterology. 10.: 2001;22(3):143-144.
  • Laparoscopic cholecystectomy in acute cholecystitis: factors associated with conversion. Prakash. K, G. Jacob, V. Lekha, A. Venugopal, B. Venugopal, and H. Ramesh. Surgical endoscopy. 2002;16(1):180-183.
  • Reconstruction of portal vein using hepatic vein patch graft after combined hepatectomy and portal vein resection. Prakash K, Regimbeau JM, Belghiti J. Am J Surg 2003 Mar;185(3):230-1.
  • A high short-term survival justify extended resection for hepatocellular carcinoma with majorportal vein involvement. Prakash K, Regimbeau JM, Farges O, Sauvanet A, Belghiti J. J Gastrointest Surg 2003 Feb;7(2):282.
  • Port-site Tuberculosis after laparoscopy. Ramesh H, Prakash K, Lekha V, Jacob G, Venugopal A, Venugopal B. Surg Endosc 2003 Mar 7.
  • Resection of hepatocellular carcinoma prior to liver transplantation. Lesurtel M, Prakash K, Regimbeau JM, Durand F, Sommacale D, Dondero F, Sauvanet A,Farges O, Valla D, Belghiti J. Presented in Journee du Francophones 2003. Gastroentérologie Clinique et Biologique 2003; 27 HS1: p A18.
  • Are Some Cases of Infected Pancreatic Necrosis Treatable without Intervention? Ramesh H, Prakash K, Lekha V, Jacob G, Venugopal A: Dig Surg 2003;20:296-300 (DOI: 10.1159/000071694).
  • Biliary access loops for intrahepatic stones: results of jejunoduodenal anastomosis. Ramesh H, Prakash K, Kuruvilla K, Philip M, Jacob G, Venugopal B, Lekha V, Varma D. ANZ J Surg. 2003 May;73(5):306-12.
  • Resection Prior to Liver Transplantation for Hepatocellular Carcinoma. Belghiti J, Cortes A, Abdalla EK, Régimbeau JM, Prakash K, Durand F, Sommacale D, Dondero F, Lesurtel M, Sauvanet A, Farges O, Kianmanesh R. Annals of Surgery 2003; 238(6):885-893.
  • Multidisciplinary approach in the long-term management of intrahepatic stones: Indian experience. Prakash K, Ramesh H, Jacob G, Venugopal A, Lekha V, Varma D, Ramesh GN, AugustineP. Indian J Gastroenterol 2004; 23 (6): 209-213.
  • Outcome of pancreatic ascites in patients with tropical calcific pancreatitis managed using a uniform treatment protocol. Prakash Kurumboor • Deepak Varma • Mahendra Rajan • Naduthottam Palanisami • Kamlesh Roshin Paulose •Ramesh Ganesh Narayanan • Mathew Philip. Indian J Gastroenterol 28:102-6. 2009.
  • Laparoscopic Colonic Resection for Rectosigmoid Colonic Tumours: A Retrospective Analysis and Comparison with Open Resection. Prakash Kurumboor; Varma, Deepak; Rajan, Mahendra; Kamlesh, Naduthottam; Zacharias, Prakash; Ganesh Narayanan, Ramesh; Philip, Mathew. Indian Journal of Surgery, Volume 72, Number 4, August 2010 , pp. 318-322(5).
  • Ileal Ganglioneuromatosis with Adenocarcinoma in a Patient with Multiple Neurofibromatosis. K. Prakash, Deepak Varma, G. N. Ramesh, Mathew Philip and Pushpa Mahadevan. Indian J of Surgery 2011, Volume 73, Number 5, Pages 375-376.
  • Successful adoption of Laparoscopic Colorectal Surgery: Tips for reducing learning curve. Moderator, Prakash K, Panel discussion in Laparoscopic Colorectal Summit, October 2013, Kochi India.
  • Pancreatitic Ascites and Pleural Effusion: Chapter 13 by Prakash K, Pancreatitis and its complications; Intech Publishers, 2012."http://www.intechopen.com/books/pancreatitis-treatment-and-complications""Pancreatitis: Treatment and Complications".
  • Dense calculi formation resulting in impaction of pancreatic stent: a rare complication due to an unretrieved stent. Prakash Kurumboor, Kamalesh NP, Pramil K, Sylesh Aikot, Prakash Zacharias, Ramesh GN, Mathew Philip. Indian J Gastroenterol 12/2012; DOI:10.1007/s12664-012-0287-.
  • Large mucocele of appendix. Kamlaesh NP, Prakash K, Pramil K, Vipin IS. Indian J Gastroenterol. 2012 Apr; 31 (2):87.
  • Intrahepatic rupture of empyema gall bladder. Kamalesh NP, Prakash K, Pramil K. Indian Journal of Gastroenterology 07/2012; DOI:10.1007/s12664-012-0230-0
  • Malignant paraganglioma of the bile duct: a case report. Tropical Gastro (article in press).
  • Prevalence and patterns of diverticulosis undergoing colonoscopy in a southern Indian hospital- Kamlaesh NP, Prakash K, Pramil K, Sylesh A, Prakash Zacharias, Ramesh GN, Mathew Philip. Indian Journal of Gastroenterology 08/2012; DOI:10.1007/s12664-012-0222.
  • Primary posterior perineal herniation of urinary bladder. Prakash K, Kamalesh NP. J Min Access Surg 2013;9:126-7.
  • Does case selection and outcome following laparoscopic colorectal resection change after initial learning curve? Analysis of 235 consecutive elective laparoscopic colorectal resections. Prakash K, Kamalesh NP, Pramil K, Vipin IS, Sylesh A, Jacob M. J Min Access Surg 2013;9:99-103
  • Previous cholecystectomy is not a contraindication for right lobe liver donation. SyleshAikot, NeeravGoyal, ManavWadhavan, Subhash Gupta. Liver Transplantation 2013; 19 ( 6) , S 209
  • Paralytic Ileus due to Strongyloidosis. Sylesh A, Rajan R, Subhalal N, Srikant, Lekha, Priyadarsini R. Indian J Gastroenterol. 2005 Sep-Oct;24(5):228
  • Postoperative Liver Failure Rate after Liver Resection for HilarCholangiocarcinoma in the Absence of Preoperative Biliary Drainage Rajan, Ramesh, Natesh, Bonny, A.Sylesh , Kumar, Arun R S, Sindhu N, Subhalal A P, Kuruvilla. HPB, 2008; 10:178
  • Krishnan P, Sudheer OV, Dhar P, Surendran S, Ponnambathayil S. Laparoscopy in suspected abdominal tuberculosis is useful as an early diagnostic method. ANZ journal of surgery. 78:987-989, 2008 Oct.
  • Mammen A. Ponnambathayil S. Varma KK. Kumar EK. A rare complication of appendicitis: appendiculorenal sinus with renal cellulitis. Pediatric Surgery International. 21(7):582-4, 2005 Jul.
  • Mathew AT. Zacharias P. Ponnambathayil S. Kumar A. Madhavan L. Harris M. Ramakrishnan KG. Bhagyanathan PV. Massive gastrointestinal bleeding in a patient with AIDS. National Medical Journal of India. 18(2):76-7, 2005 Mar-Apr.
  • Puneet Dhar, Sudhindran Surendran, Sudheer Othiyil Vayoth and Shaji Ponnambathayil. Surgery for Symptomatic Portal Biliopathy. Gastroenterology 134(4):A-897 (2008).
  • A. Sewkani, V. Singh, R. Varshney, P. Shaji, A. Jat, S Varshney. Managemnet of Pancreatic Necrosis: Single Centre Experience. Pancretology 11(suppl 1):AP-C51, 2011
  • V. Singh, S Varshney, A. Sewkani,, R. Varshney, G. Deshpande, P. Shaji, A. Jat. Radiofrequency Ablation of Unresectable Pancreatic Carcinoma: 10 Year Experience From Single centre. Pancretology 11(suppl 1):PT-C6, 2011.

Facilities

The operations suites are well occupied with most modern facilities like laminar air flow, Macquet operation table, Dr Mach’s operation theatre lights etc.

  • Auscelap 3D Laparoscopy system
  • High Definition 3-Chip Camera system from Karl-Storz
  • High Definition 3-Chip Camera system from Stryker
  • Ultrasonic Dissector for liver resection from Stryker
  • Gen X system of Harmonic scalpel and Enseal of Ethicon
  • Force Triad-Ligasure vessel sealing system of Covidien
  • Intraoperative Ultrasound from Aloka
  • Argon Plasma Coagulator from Erbe
  • Digital Fluoroscopy of Siemens
  • Thromboelastograph
  • Radiofrequency ablation system and is well equipped to perform all major GI surgeries like liver resections,
  • pancreatic resections and all advanced GI Laparoscopic surgeries.

Achievements

Achievements of the Department:

  • Track record of more than 22000 successful open GI surgery procedures
  • Successfully completed more than 5000 GI Laparoscopy procedures
  • Highest number of Laparoscopic Colorectal Surgeries in Kerala
  • First Single Incision Laparoscopic Surgery (SILS) Cholecystectomy in Kerala
  • First Single Incision Laproscopic Colectomy for colorectal cancer
  • Second laparoscopic Whipple’s resection for pancreatic tumour in Kerala.
  • Maximum number of laparoscopic liver surgery in the state.
  • Second centre for DNB GI Surgery in Kerala.
  • Best Poster Award. ISG Mid-Term Conference, Kollam, Oct 2006: Surgery for Crohn’s Disease involving Small Bowel.
  • Best Paper Award ISG mid-Term Conference, Kollam, October 2006: Laparoscopic colorectal surgery: preliminary experience.
  • Best Paper award ASI Annual Conference, May 2008. Laparoscopic Versus Open Colonic Resections for Left Sided Colonic Tumors: Short Term Results of 62 patients.
  • Best Paper Award and Palanivelu Gold medal in 8th International Congress of AMASICON, Indore, India, September 2013. An Audit of 423 Elective Laparoscopic Colorectal Surgeries in a Tertiary Care Center.
  • Best Paper Award in IASG National Conference, October 2013, Kolkatta, India. A Prospective Randomized Controlled Trial on use of Octreotide in patients with Soft Pancreas undergoing Pancreaticoduodenectomy