Department of Surgical Gastroenterology
Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER) Puducherry, India
About the Department
The department of surgical gastroenterology at JIPMER was established in the year 2010 with an aim to provide advanced treatment, conduct quality training and research in the field of surgical gastroenterology. The department aims at leading this domain in the country. It is located in the JIPMER Super Specialty Block. It is a 32 bedded clinical facility with three full-time faculties, nine resident doctors, one Post-doctoral fellow, junior residents, PhD students, nursing staff, technicians, paramedical and supporting staff. The department manages patients with complicated surgical problems in the Gastro Intestinal tract and has outpatient clinics, general wards, special wards, and intensive care unit and operation theatres. Both clinical and basic research is being held in the department. Planned expansion in terms of new services, programs and infrastructure development are on-going. Patients are provided treatment at a highly subsidized rate. The quality of patient care and safety are maintained at the highest level. The department of Surgical Gastroenterology at JIPMER envisions itself to be a path-breaker in this speciality in the country. The goal is to act as a department of excellence in patient care, teaching and research. Various domains of the department’s functioning are governed by new systems and practices which include standard operating procedures, checklists and guidelines. These systems can be viewed as a model for other departments and institutions, especially for those in public sector.
The Department of Surgical Gastroenterology has been conceptualized with three faculty posts. The Department was started on 3rd of March 2010 with joining of Dr V Ranjit Hari as Assistant Professor, who served till 14th June, 2013. Dr. Vikram Kate, Professor of Surgery was appointed as the faculty in charge. The outpatient clinics commenced from March 2010 and the inpatient facilities were started with eight general beds including two intensive care unit beds. Operation theatre services were initiated from June 2010. Dr Senthil and Dr AlwinGunaraj joined as senior residents on 1stJune 2010.The department office commenced functioning from 9thMarch 2011. Dr Biju Pottakkat, joined as Assistant Professor on 30thJune 2011. Since 2nd August 2012, a dedicated Surgical Gastroenterology ward with 16 beds and 6 beds Intensive care unit became functional Endoscopy services became operational at the same time. Additionally, four general and four pay wards were included to expand the services. Dedicated ostomy services were begun by 6th June 2013. On 15thJuly 2013 Dr. R Kalayarasan joined as Assistant Professor as an ad-hoc consultant, and was regularized on 26th November 2013. Dr. Biju Pottakkat was promoted as Associate Professor on 01stJuly 2014 and later recruited as Additional Professor on 09thSeptember 2014. Subsequently Dr Vikram Kate was relieved from the post of faculty in charge and Dr Biju Pottakkat took over as Head of the department on 01stDecember 2014.
Dr Sandip Chandrasekar served as Assistant Professor from 02ndFebruary 2015 to 27th January 2018 on ad hoc basis. Dr.Senthil.G joined as Assistant professor on 14th April 2017. Dr Kalayarasan was promoted as Associate Professor on 01st July 2017. Dr. Biju Pottakkat was promoted as professor on 01st July 2019.
On the patient care side, specialized dietary services started on 01st November 2014. Obesity & metabolic surgery programme was started on 24th of March 2015 and has been catering bariatric surgery services. The first Cadaveric liver transplantation was done in 2017. Robotic surgery using Davinci Xi surgical robot was started in August 2017.
Along with the expansion of the Department, a milestone development was achieved on 16th August 2011 with the commencement of MCh Surgical Gastroenterology with two seats per year. Dr Pradeep Joshi and Dr Salil Kumar Parida were the first MCh trainees of the department. From January 2019, three MCh trainees are selected based on a national eligibility test. The department started PhD programme in October 2016 and Jyothi Vennela became the first candidate to join in PhD. One year Post-Doctoral fellowship in HPB surgery course commenced from July 2017, with single candidate uptake per year. Dr. Subrahmaneswara Babu was the first candidate. Certificate course in ostomy care commenced in September 2019 and Periyannan became the first candidate to join the course.
The patient care system of the department aims to develop innovative strategies in diagnosis and treatment of common surgical diseases involving gastrointestinal tract which are common in Southern India. The core areas include cancer of liver, chronic pancreatitis, portal hypertension and cancer of oesophagus. The innovations include new concepts in etiology; re-look into the existing definitions and descriptions, novel diagnostic and evaluation algorithms and new management strategies. Existing standard operating procedures for a particular disease will be relooked and modifications will be suggested. Developing new concepts in equipment and instrument designs are also being done. The outpatient clinics are run six days a week. Liver transplant clinics are run once in a week. Junior residents are posted on periodic basis in the department, to aid in the clinical work. There is a dedicated nutritionist, medical social worker and transplant co-ordinator who render services to both out patients and in-patients. Ostomy services run daily and cater for the patients in the entire hospital. The department has 20 general beds, six beds in intensive care unit and six beds in liver transplant facility. It has dedicated operation room. Care is given through nursing officers and senior nursing officers. Diagnostic upper and lower GI endoscopies are performed twice a week. The department performs all major operations in the speciality including that of liver, bile duct, pancreas, oesophagus, stomach, small and large intestines and rectum. Speciality services include liver transplantation and bariatric surgery. Half the proportion of the surgical procedures is being done with the minimally invasive laparoscopic or robotic techniques. More than 70% of the operations are performed for malignancies. Multi-disciplinary management is instituted keeping in mind the advances in therapeutic protocols. Regular quality and safety audits and clinical audits are conducted. The department holds an ISO 2015 certification in quality standards.
Teaching and training
On the academic front, the department runs a three year super-speciality programme, MCh in Surgical Gastroenterology, one year Post-Doctoral Clinical Fellowship (PDF) in HPB surgery, three year PhD programme and three months certificate course in ostomy care. The department houses basic and advanced surgical simulation centres with laparoscopic trainers, robotic simulator, ultrasound simulator, liver radiology simulator and nursing simulator. The academic programs are being held five days in a week. These include seminars, journal clubs, case discussions, interdepartmental sessions, tumour boards, and inter-institutional sessions through telemedicine. The department acts as a centre for exit examinations for MCh and National Board. Besides these, nursing teaching and training programmes are also being held regularly. 15 Continuing Medical and Nursing Education programmes of national, regional and institutional level are being held per year with participation of faculties and trainees across the country. These include academic conferences and skill based courses. Major conferences were the 27th National conference of the Indian Association of Surgical Gastroenterology (IASGCON, 2017), the 6th Annual conference of the All India Association of Medical Social Work Professionals (AIAMSWPCON 2018), the 31st Annual Conference of the Indian Society for Atherosclerosis Research (ISARCON, 2018) and the 7th National Conference of the Indian Association of Parenteral and Enteral Nutrition (IAPEN ICNC congress 2020).The department is recognised as a training centre in advanced GI nutrition by the Indian Society of Parenteral and Enteral Nutrition (IAPEN). The department also patronises the Puducherry Gut Club and the Puducherry chapter of IAPEN.
Basic and clinical research is a focus area of the department. There is a PhD programme running in the department with four scholars at a time. Core areas of research include hepatocellular carcinoma, chronic pancreatitis, oesophageal cancer and clinical nutrition. Types of research include clinical, imaging, drug trial, and molecular level research and product innovations. Inter-departmental, inter-institutional and international collaborative research works are also carried out. The department has research collaboration with Pondicherry Engineering College and also with Leeds teaching hospitals NHS trust UK. At a time more than 20 primary and collaborative research projects are active in the department. The department faculty and trainees also carry extramural and intramural grants for research. The process for the first patent has been commenced. The department publishes an average of 10 research papers per year in Indexed Journals.
The department is actively involved in the activities of Indian Association of Surgical Gastroenterology (IASG), Indian Chapter of International Hepato-Pancreato-Biliary Association (IHPBA), Association of Minimal Access Surgeons of India (AMASI) and Indian Society of Parenteral and Enteral Nutrition (IAPEN). Department faculty are members in various academic, research and administrative committees of JIPMER and also act as experts for other institutions.
Construction of dedicated facilities for liver transplantation and advanced minimally invasive surgery unit is complete and is waiting commissioning. The department faculties are playing a pivotal role in developing the upcoming Institute of Organ Transplantation, the first of its kind in the country.