The Department of Surgical Gastroenterology

In-Patient Services & In-patient facility

Endoscopy

Endoscopy suit of surgical gastroenterology department is situated at Room No 304 near the surgical gastroenterology OPD. Endoscopies are routinely performed on Wednesdays and Fridays. Endoscopy room is equipped with upper GI scope, side viewing and lower GI scope. Both diagnostic and therapeutic scopies are performed. The therapeutic procedures include esophageal stricture dilatation, variceal ligation, variceal injection, glue injection and biopsy. Endoscopic retrograde cholagio-pancreatographies (ERCP) are performed in the operation theatre complex. One nurse, one endoscopy technician and one nursing assistant helps in performing endoscopies. A recovery room is situated nearby where patients are kept for a while after endoscopy. Endoscopies and therapeutic procedures are mostly performed on a day care basis without admission. Strict asepsis if followed during the procedure. Prior appointment is given for endoscopy.

Intervention services

Intervention services provided by the department include percutaneous drainage of abdominal collections, percutaneous transhepatic biliary drainage (PTBD) and trans-hepatic arterial chemoembolization (TACE). The department has ultrasound machine and image intensifier. Feasible procedures are done bedside. PTBD is done in collaboration with radiology and TACE is done in collaboration with cardiology. The biliary intervention procedures include PTBD, internalization, stenting, trans-PTBD biopsy stricture dilatation. The intervention procedures are being performed as a part of pre-operative biliary drainage or as permanent palliation. Facility for metallic stenting is also available. Angiographic interventions include TACE and trans-hepatic arterial chemotherapy (TAC). Macro aggregated albumin (MAA) scan is done in the department of nuclear medicine before TACE to rule out significant systemic shunting. Pre-operative portal vein embolization both through ileocolic and trans-hepatic approaches are being performed. In patients with big tumors, pre-operative therapies help to reduce the size of tumors so that they can be resected later.

Quality and safety

Maintaining Quality and safety in patient care is one of the foremost priorities of the department. This is continuously maintained through various mechanisms. JIPMER quality council (JQC) guidelines in the JIPMER manual on patient safety are followed in all patient care areas. All staff in the department are motivated in patient safety and are given regular training by quality managers of various domains. Standard operating procedures (SOPs), checklists and guidelines are developed, followed and audited. WHO surgical safety checklist, patient transfer SOP, quality rounds checklist (QRC), medication prescription-administration chart etc. are followed. Patient identification accuracy is maintained before all interventions. Hospital-acquired infections, medication safety, operation room safety, workforce safety, blood transfusion safety etc. are given prime importance. The department has an event reporting system in which all adverse events are recorded and reported. Root cause analysis (RCA) are done for all significant adverse events.

The department of surgical gastroenterology was the first department to establish a comprehensive departmental clinical auditing system in JIPMER in 2011. Electronic patient record and data keeping are given care and precision. All the discharges are presented in weekly morbidity-mortality meetings (MNMs). Clinical auditing is done at doctors and nurses levels. Service area wise auditing system (OPD, ward, ICU, OT) was initiated in the year 2015. Annual MNMs and audit meetings help us in identifying the system performance and areas of improvement. The department supports other departments to establish good clinical auditing systems. Two research studies in the area of patient safety are ongoing in the department. Surgical Gastroenterology ICU is acting as the nodal station for needle stick injury reporting and body fluid exposure management for staff in the super speciality block. Monthly orientation programme on various aspects of patient safety is a regular affair.

Best efforts are put in place to maintain quality and safety of the highest order matching international standards.

Clinical programmes

Hepato-pancreato-biliary (HPB) surgery:

The area of HPB surgery focuses on complex operative procedures related to liver, pancreas and biliary tract. The department has keen interest in dealing with such problems and various research projects are also being carried out. The key area of interest are hepatocellular carcinoma, portal hypertension, NCPF, EHPVO, chronic pancreatitis, carcinoma gall bladder, hilar cholangiocarcinoma and bening biliary stricture. The department is equipped with 3D Myrian software for preoperative planning of liver resections.

The complex HPB surgeries performed in the department are all major hepatectomy with vascular resection, central inferior bisegementectomy for gall bladder carcinoma, ALPS, Proximal splenorenal shunt, mesocaval shunt, devascularisation procedure, freys procedure, pancreatoduodenectomy and total pancreatectomy.

Advanced laparoscopic surgery :

Advanced minimally invasive surgery has been one of the thrust areas of the department. Majority of the benign and malignant disease affecting the gastrointestinal tract, liver, pancreas and biliary tract were managed laparoscopically/thoracoscopically in the department. Minimally invasive surgery is the procedure of choice and no longer an option for the majority of the gastrointestinal disorders treated in the unit. The department is establishing itself as a center of excellence for minimally invasive surgery in the region of Puducherry, Tamilnadu, Kerala, Andhra Pradesh and Telangana.

The department faculty received minimally invasive surgery training from best centers in India and abroad. The operation theater is equipped with state of art full high definition Stryker laparoscopic camera system with the video monitor. High-end energy devices like laparoscopic harmonic ace plus probe, enseal devices, and laparoscopic CUSA are available to perform complex laparoscopic and thoracoscopic procedures. In addition, the department is equipped with advanced laparoscopic instruments like laparoscopic vascular clamps, flexible trocars, gel port system, autosuture device etc. All types of laparoscopic staplers and cartridges are available in the department.

Advanced minimally invasive procedures performed in this department include thoracoscopic esophagectomy, thoracoscopic assisted esophagogastrectomy, laparoscopic total gastrectomy, laparoscopic sleeve Gastrectomy, laparoscopic cardiomyotomy, laparoscopic fundoplication, laparoscopic retrosternal gastric bypass, laparoscopic right hemicolectomy, laparoscopic anterior resection, laparoscopic low anterior resection, laparoscopic intersphincteric resection, laparoscopic abdominoperineal resection, laparoscopic splenectomy, laparoscopic distal pancreatic-splenectomy. JIPMER is one of the few centers in India to perform the most complex laparoscopic procedures like laparoscopic pancreatoduodenectomy and laparoscopic liver resection.

Various research projects related to advanced minimally invasive surgery are currently underway in the department. The department had taken a lead in minimally invasive training by conducting multiple minimally invasive surgery skills courses for trainee surgeons, practicing surgeons and staff nurses. Basic and advanced laparoscopic simulators including those with haptic feedback were used for these minimally invasive surgical skills courses.

Advanced Robotic surgery:

JIPMER is one of the few centers in the country to perform advanced robotic surgery using the Da Vinci Xi (the advanced surgical robot). The Surgical robots which have four arms the movement of which is controlled by the surgeon. The 3 D vision, tremor filtration and enhanced maneuverability allows surgeons to perform complex minimally invasive surgical procedure with high precision.

The Robotic GI procedures performed in the department include Robot assisted thoracoscopic esophagectomy, Robot assisted thoracoscopic esophagogastrectomy, Robot assisted total gastrectomy, Robot assisted fundoplication, Robot assisted right hemicolectomy, Robot assisted anterior resection, Robot assisted low anterior resection, Robot assisted intersphincteric resection, Robot assisted abdominoperineal resection, Robot assisted splenectomy, Robot assisted  distal pancreatic-splenectomy. The complex procedure like pancreatoduodenectomy is also performed with robotic assistance. Various research projects related to robotic surgery are currently underway in the department.

The expensive procedure is made affordable to all patients of the country at a highly subsidized rate.

Services

S.No.	Title	Details
1	In-patient facility Operation rooms	Download (213.67 KB)
2	In-patient facility Intensive care unit (ICU)	Download (218.83 KB)
3	Patient information materials and videos	Download (2.14 MB)
4	Standard operating procedures for diseases	Download (598.27 KB)