Whipple Pylorus Preserving PancreaticoDuodenectomy ( PPPD ) for Lower CBD Cholangio carcinoma

Pancreatico Jejunostomy

Hepatico Jejunostomy

Pancreatico Duodenectomy Specimen

Spleen Preserving Distal Pancreatectomy for Pancreatic Transection

Proximal Spleeno Renal Shunt ( PSRS ) for EHPVO, Portal Biliopathy and Hypersplenism

Laparoscopic Sleeve Gastrectomy - BMI 35

Division of Gastrocolic Ligament

Division of Gastrosplenic Ligament

Division of Gastric Fundus

Buttressing of Staple Line 

Buttressing of Staple Line with Vicryl

SOLID PSEUDOPAPILLARY TUMOUR OF PANCREAS - DISTAL PANCREATECTOMY WITH SPLENECTOMY

Distal Pancreatectomy with Spleenectomy for Solid Pseudopapillary Tumor of Pancreas

Patient Information

Age 19 year             Sex F              Date of Procedure 11- 03 – 2013

Brief Case History

Patient was asymptomatic 4 months back. She developed upper abdominal pain. The pain was severe intermittent and radiating to back. Pain was not associated with nausea, vomiting, jaundice, abnormal bowel habit. She was not having anorexia or weight loss. Pain was not associated with food habit. It was relieved by taking medicines. On examination she was vitally stable, on per abdomen examination upper abdominal tenderness mainly in epigastric and umbilical regions. 

Suspected Cause / diagnosis based on patient’s history / examination

On the basis of history and examination she could be having either acid peptic disease or disease related to pancreatic origin.

Diagnostic Tests

Her routine blood tests were normal. Her ultrasound was suggestive of solid mass arising from the pancreatic tail extending to the splenic hilum. She was asked for CECT abdomen. On CECT there was a solid tumour of 7 x 7 x 8 cm in size arising from body and tail of pancreas, displacing the superior mesenteric artery and vein. Splenic artery was involved in the tumour superiorly. It was not attached to stomach.

Surgery

Laparotomy was performed by “L” shape incision. On dividing the gastrocolic ligament there was a large tumour arising from pancreas and reaching up to the splenic hilum. Splenic artery was identified near to its origin and divided. Spleen was mobilised and gastrocolic, phrenosplenic, splenocolic ligaments were divided. Pancreas was mobilised from inferior surface and rotated to other site. Tumour was transacted just left of the superior mesenteric vein and removed with the spleen. Pancreatic stump was closed with prolene 4 – 0 in two layers. First duct was secured and then the stump closed separately.

Comments and Conclusion

Histopathology report turned out to be solid pseudopapillary tumour of pancreas. It is one of the rare tumour of pancreas, mainly seen in young female with low risk of metastasis. Surgery is the only modality of treatment with >95 % 5 year survival rate.

Large Solid Mass Arising from Body and Tail of Pancreas

Large Pancreatic Body and Tail Mass

Pseudopapillary Tumor of Pancreas

Pancreatic Stump Closure

Specimen Of Distal Pancreatectomy

Laparoscopic Sleeve Gastrectomy in a Male with Central Obesity ( BMI = 45)

Division of Gastro Splenic Lig

Division of Greater Omentum

Division of Gastro Colic Ligament

Creation of Gastric Sleeve

Completion of Gastric Sleeve

Sleeve Gastrectomy in 46 BMI Female with HTN, DM, Backache, Knee pain

Division of Greater Curvature

Division of Greater Omentum

Division of Stomach with Echelon 

Division of Stomach with Echelon

Bariatric Surgery: Sleeve Gastrectomy in 42 BMI Male with Obstuctive Sleep Apnoea

Mobilisation of Gastrocolic Ligament

Complete Division of Greater Omentum

Creation of Sleeve with Tri Staple Covidien 

Completion of Sleeve

Remaining Sleeve with no air leak

Laparoscopic Cholecystectomy with Sleeve Gastrectomy with TVTO ( BMI = 52, 118 kg)

Cholecystectomy

Division of Gastrosplenic Ligaments

Division of Gastric Sleeve

Completion of Gastrectomy

Strassburg Type A Bile Duct Injury Cystic Duct Blow Out

Cystic duct blow out after Laparoscopic cholecystectomy with biliary peritonitis

Rectal Duplication Cyst in 17 year Female

17 year Girl presented with the acute intestinal obstruction. She had history of rectovaginal fistula repair at the age of one year. Laparotomy was done through pfennestiel incision. On PR examination there was a hard mass anterior and to the right of rectum, CECT suggestive of ?? Cyst ?? Retain Foreign Body. Laparoscopic adhesiolysis followed by dissection of cystic tract, track was reaching up to the sigmoid colon. Whole track was excised through the pelvis anterior to the rectum. Sigmoid attachment was also released.

Altered Density Mass Anterior to the Rectum

Areas of Calcification in the Mass

Pelvic Removal of Duplication  Antro Rectal Duplication Cyst 

Long Rectal Duplication Cyst Extending upto Sigmoid Colon

Patient with 56 BMI Underwent Laparoscopic Sleeve Gastrectomy at Rahul Hospital, Surat

Division of Gastrocolic Ligaments

Division of GastroSplenic Ligament

Division of Gastric Sleeve

Transaction of Fundus of Stomach

LAPAROSCOPIC PLICATION OF DIAPHRAGM FOR EVENTRATION at RAHUL HOSPITAL, SURAT

58 year lady presented to the hospital. She was asymptomatic, had history of DM and HTN. Her recent health check up report was suggestive of Left Diaphragmatic Hernia. She was planned for Laparoscopic Diaphragmatic Hernia repair. Intra operatively it was found to be a Eventration of Diaphragm. Laparoscopic plication of diaphragm was done. Post operatively she behaved well and discharged on first post op day.

Left Eventration of Diaphragm

Eventration of Diaphragm

Diaphragmatic Plication

Plication of Diaphragm

Final Picture after Plication of Diaphragm