Department of Advanced Laparoscopic & GI Surgery deals with all the benign and malignant Gastro-Intestinal problems. All diagnostic & therapeutic facilities are available under one roof. We aim to provide Minimally invasive treatment to all GI problems, so that patient can get to normal life rapidly after Surgery
A 23 year old young mother of a child had been presented at Ruby General Hospital with complaints of a gradual increasing swelling in the lower limbs and abdominal heaviness for two years. She was initially admitted under the care of a Gynaecologist with a suspicion of a large uterine fibroid compressing the Inferior Vene Cava (IVC) which was causing decreased venous return of lower limbs. After a thorough evaluation relevant tests were done which revealed two large desmoids tumours (They are noncancerous growths occurring in the connective tissue and also known as aggressive fibromatosis) arising from the right and left rectus muscle. The larger endophytic desmoid measuring 20 X 19 X 10 cms was compressing all adjacent intra abdominal structures including small bowel, urinary bladder, uterus, Inferior Vene Cava (IVC) and right ureter causing right hydroureteronephrosis (Dilatation of the renal pelvis, calyces and ureter caused by the obstruction to free flow of urine from the kidney), and the exophytic growth from right uterus was 8 X 8 X 5 cms, but, there was no direct invasion to any other viscera. It was followed by a trucut biopsy which confirmed Desmoid Fibromatosis. Desmoid fibromatosis is a rare, locally aggressive benign tumour developing in musculoaponeurotic tissues with a reported incidence of 2 – 4 per million population and account for 0.03% of all neoplasms occurring most commonly in females with a previous history of trauma or surgery. After discussion with the family members, pre-operative evaluation and optimization, a multidisciplinary treatment was planned for the lady. After obtaining written informed consent from the family, the lady was posted for surgery. A Wide Local Excision of Desmoid Tumours had been done with plastic reconstruction of abdominal wall defect. A right ureteric stent had been placed beforehand to relieve the pressure over right kidney. The exposed anterior abdominal wall had been covered with 30 X 22 cms polypropylene mesh. The surgery took around five hours with epidural block for pain relief and a blood loss of only 90ml. The surgical team comprised of Dr. Sumanta Dey (Advanced Laparoscopic, Bariatric and GI Surgeon), Dr. Deepanjan Dey (Reconstructive and Plastic Surgeon), Dr. Sujoy Basak (Consultant Urologist), Dr. Ratul Kundu (Consultant Anaesthetist), Dr. Anindita Saha (Consultant Anaesthetist) and Dr. Sadanand Reddy (Consultant Anaesthetist). The postoperative period is uneventful and we wish her a speedy recovery.
A 66 year old senior citizen had been presented in Ruby General Hospital as a diagnosed case of Myasthenia Gravis for nearly three years and admitted under the expert care of Dr. Sumanta Dey (Advanced Laparoscopic, Bariatric and GI Surgeon). The lady had a thymoma (A tumour in the thymus gland) measuring 2.5 X 2 cms at the lower pole of thymus gland. Myasthenia gravis is a rare chronic autoimmune disease characterized by muscular weakness and rapid fatigue without atrophy and caused by a breakdown in the normal communication between nerves and muscles. The incidence of myasthenia gravis is 3 – 30 per 10 lakh people per year and out of this thymoma is found in only upto 10% patients. After the required consent the lady had been posted for surgery. Total Thoracoscopic Thymectomy had been done where total thymus gland had been removed with complete clearance of Pre – pericardial and Anterior mediastinal fat had been done. The surgery took around 95 minutes with a blood loss of 5 – 10 ml. Double lumen tube with single lung ventilation had been done and the lady had been extubated on the table. Special thanks to Dr. S. N. Mitra (HOD Anaesthesia) for his amazing support from head end, Dr. Sankhadip Pramanik (Cardiothoracic and Vascular Surgeon) for referring the patient to do it thoracoscopically, so that, the morbidity of sternotomy could be avoided, Dr. Prasenjit Chakraborty (Consultant Neurologist) for bringing the patient to Ruby General Hospital for best possible care, and finally, the entire OT team for their awesome teamwork. Wishing the lady for a speedy recovery
Laparoscopy has become the gold standard for colorectal cancer surgery over the past few decades. Multiple multicenter trials and Review Literature studies have proven that, compared to traditional open surgery, laparoscopy surgery gives equivalent oncological and long term outcome and better short term and functional outcome resulting in short term benefits such as less pain, shorter hospital stay, minimal blood loss, negligible scar leading to faster recovery maintaining equivalent oncologic outcomes. A 49 year old lady had been admitted in Ruby General Hospital under the expert care of Dr. Sumanta Dey (Consultant Advanced Laparoscopy, Bariatric, GI Oncosurgery) with complaints of severe anaemia (Hb – 4.5) and a past history of iron deficiency, Type II Diabetes Mellitus and hypothyroidism along with blood transfusion of five units of Packed Red Blood Cells (PRBC) during the previous hospitalization. After a thorough evaluation she was diagnosed with Stage III Colon Cancer. After discussion with the family and with written informed consent the lady had been posted for surgery. After oncological workup and adequate optimization, the lady underwent Laparoscopic Right Hemicolectomy with Central Mesocolic Excision (CME) and Central Vascular Ligation (CVL) (It is a potentially superior oncological technique in colon cancer surgery whose tenets of high vascular ligation at the origin and mesocolic dissection facilitate a greater lymph node yield) under General Anaesthesia. The surgery took around three hours using Advanced Laparoscopic techniques and was a challenging one as the cancer was locally advanced. The post operative period had been uneventful and the lady was back on her feet within a few hours post surgery. She was on liquid diet for a couple of days followed by normal diet from the third post operative day. The lady went home walking on the fourth post operative day. The fight against cancer is quite difficult requiring tremendous mental strength. We need to understand that certain lifestyle modifications can prevent cancer and early detection of cancer can lead to a complete cure.optimization, a multidisciplinary treatment was planned for the lady. After obtaining written informed consent from the family, the lady was posted for surgery. A Wide Local Excision of Desmoid Tumours had been done with plastic reconstruction of abdominal wall defect. A right ureteric stent had been placed beforehand to relieve the pressure over right kidney. The exposed anterior abdominal wall had been covered with 30 X 22 cms polypropylene mesh. The surgery took around five hours with epidural block for pain relief and a blood loss of only 90ml. The surgical team comprised of Dr. Sumanta Dey (Advanced Laparoscopic, Bariatric and GI Surgeon), Dr. Deepanjan Dey (Reconstructive and Plastic Surgeon), Dr. Sujoy Basak (Consultant Urologist), Dr. Ratul Kundu (Consultant Anaesthetist), Dr. Anindita Saha (Consultant Anaesthetist) and Dr. Sadanand Reddy (Consultant Anaesthetist). The postoperative period is uneventful and we wish her a speedy recovery.
A 67 year old lady had been presented at Ruby General Hospital with complaints of intermittent abdominal pain, vomiting and constipation for three months associated with weight loss. She also had a history of nausea, vomiting and constipation. The senior citizen had been admitted under the expert care of Dr. Sumanta Dey (Consultant Advanced Laparoscopic, Bariatric and GI Oncosurgeon) and after a thorough evaluation it was found that she was suffering from Ileo-Caeco-Colic Intussusception due to a neoplastic mass which was most likely benign. Intussusception is a rare cause in adults in which a segment of terminal small bowel invaginates into the adjacent large bowel blocking food or fluid from passing through and cutting off the blood supply to that part of the intestine because of a neoplastic mass acting as a lead point. This process causes severe colicky abdominal pain and blocks the intestinal lumen causing obstruction leading to abdominal distension and vomiting. Only two or three cases occur in a population of 1,00,000 per annum accounting for less than 0.1% of adult hospitalization. After discussion with the family members and with written informed consent, the lady had been posted for surgery which took almost three hours. Total Laparoscopic Limited Ileo – Colectomy (Excision of involved bowel segment) and Ileo – Colic anastomosis (Joining together of the end of the ileum, or small intestine to the first part of the large intestine i.e. the colon) had been done through few keyholes and a small cut in the lower abdomen to retrieve the specimen with no stitches on the outside, negligible scar and blood loss. The postoperative period had been uneventful with minimal pain and the lady had been able to sit from the night post surgery and started walking comfortably from the following day. The lady tolerated liquid diet from the first day post surgery followed by normal diet from the third postoperative day. She got discharged on the fourth postoperative day. The surgery had been a challenging one considering the age, comorbid conditions and nature of disease but the teams of Advanced Laparoscopy, Anaesthesia and supporting departments helped the lady with a smooth and rapid recovery.
A 65 year old lady had been presented with complaints of chronic cough, chest pain and discomfort associated with food regurgitation for a few years. She had a history of hypertension and hypothyroidism. After receiving treatment for sometime, the symptoms kept recurring and she consulted Dr. Sumanta Dey (Advanced Laparoscopic, Bariatric and GI Surgeon) at Ruby General Hospital. After a thorough evaluation relevant investigations were advised which revealed a giant Paraesophageal Hiatus Hernia (Type – III). A giant Paraesophageal Hiatus Hernia (Type – III) is a rare type of internal hernia where esophagus (food pipe) along with the stomach slides into the chest causing compression over lungs and heart. Thus, the patient usually presents with chest pain, breathing distress, dry cough, food regurgitation and bloating sensation. Sometimes, the blood supply of the stomach gets blocked and causes severe abdominal pain due to strangulated hernia which is a life threatening situation. After discussion with the family members and with written informed consent the lady had been posted for surgery. Laparoscopic Paraesophageal Hernia repair and Toupet’s Fundoplication, a complex surgery had been done. The surgery took almost three hours with negligible blood loss and it was very challenging as the operative area had been adjacent to the heart and lungs. The post operative period had been uneventful and the lady was back on her feet within four hours followed by her discharge in seventy two hours. The lady had been very grateful that she recovered from her complaints of many years within a few hours.
A 53 year old lady had been suffering from a gradually increasing constipation for last 4 – 5 months and did not consult any doctor until an episode of blood mixed stool. She consulted at a local hospital where she had been evaluated and was found to have a mass which was nearly obstructing her colon. The biopsy report had also been negative for malignancy. Her physical condition started deteriorating and was admitted under the expert care of Dr. Sumanta Dey (Advanced Laparoscopic Bariatric and GI Oncosurgeon). After evaluation, with a high clinical suspicion few other investigations had been advised which were conclusive of locally advanced malignancy. After discussion with the family members and with an informed consent, the lady had been posted for surgery without further delay. After almost a four hour long surgery the cancer mass had been completely removed from the abdomen. The surgery had been done by Advanced Laparoscopic techniques (making small holes in the abdomen). The post operative period had been uneventful. Within six hours of such a major surgery, the lady was on her feet and walking. She was started on oral diet within 24 hours of the surgery and was discharged within seventy two hours. She went home walking accompanied by her family. Cancer surgery has created a stigma in the general population and most of them tend to avoid surgery and try alternate treatment which in turn leads in the progression of the disease. Laparoscopic Cancer surgery has become a boon for the patients as they have minimal suffering and rapid recovery. The battle for a cancer patient and their family almost lasts long as was the case of the lady. Though the cancer mass had been completely removed, the cancer had been diagnosed at a relatively advanced stage. She will require adjuvant treatment, but, the Laparoscopic Surgery helped her cross the first hurdle with minimal suffering. The strong will of the lady and her family’s faith will help her overcome this toughest battle. People should take their health problems seriously and not delay the treatment of other health problems due to Corona.
Dr. Sumanta Dey – MS , DNB , MNAMS , FMAS , FNB – Minimal Access Surgery
A 58 year old lady had come from Jharkhand with complaints of abdominal pain associated with low grade fever, decreased appetite and weight loss for the last four months. On evaluation, she was found to have a large Hydatid Cyst of liver, an uncommon parasitic infestation by a tapeworm. Hydatid disease in people is mainly caused by infection with the larval stage of the dog tapeworm Echinococcus granulosus. Cystic hydatid disease usually affects the liver. Infection of the cyst can facilitate the development of liver abscesses. Traditionally, open surgery is preferred for liver Hydatid disease, but, the patient and her relatives were very anxious , and they wanted laparoscopy. Moreover, the cyst was located in a critical place of the liver which was difficult to acces. After consultation with the family members and with due consent, followed by relevant investigations and thorough evaluation, the lady had been posted for surgery. A laparoscopic excision of Hydatid cyst had been done within one and half hours which required excellent advanced laparoscopic skills.. The post operative period was speedy and uneventful because of minimal pain, key hole size incision and minimal blood loss. She was discharged on the third post operative day.
A 75 year old obese hypertensive lady had been presented in the Emergency department of Ruby General Hospital at midnight after being referred by a couple of hospitals of the city, with complaints of severe pain, breathing distress and eviscerated bowel (bowel came out of the body through a perforation on the skin covering of Hernia sac) from a long standing ventral hernia. It is an extremely rare surgical emergency. She had been admitted under the expert care of Dr. Sumanta Dey (Advanced Laparoscopic, Bariatric and GI Surgeon), who had rushed to the Emergency so late in the night, that also, at a time when all are refraining from staying outdoors. After initial measures, he put the bowel inside the hernia sac under local anaesthesia and closed the hole of the skin. After further evaluation, the lady had been shifted to the ICU and necessary investigations were carried out. Unfortunately, she tested positive for COVID 19 and was kept in isolation ward under close observation and the condition of the huge hernia had been checked daily as there was a chance of getting it strangulated or obstructed. The family members were very anxious as they were losing all hope for their dear one. On the fifth day of admission, she tested negative for COVID 19 and the consultant decided to operate on her with all precautionary measures. It was a real challenge to manage such a big hernia both from surgical and anaesthetic point of view as these patients can have abdominal compartment syndrome (ACS results from the progression of steady-state pressure within the abdominal cavity to a repeated pathological elevation of pressure above with associated organ dysfunction) in the postoperative period and lead to cardiorespiratory failure followed by death of the patient. The lady had been posted for surgery which took almost three hours and abdominal wall reconstruction along with mesh repair had been done under general anaesthesia. The post operative period was uneventful and she is back on her feet to walk back home to her family whom she thought she would never be able to meet again. The lady had also been seen by Dr. Arindam Roychoudhury (Consultant Medicine), Dr. Dibyadip Mukhopadhyay (Consultant & In – Charge Critical Care & Pain Management), and Dr. Dwaipayan Jha (Consultant Anaesthetist). At this age she has beaten both Corona and a complex ventral hernia. She has also said, “I am extremely happy with Dr. Sumanta Dey and the nurses at Ruby, they gave me a second life. I will suggest everyone …. not to neglect their other medical issues by being afraid of Covid 19” Her family members had been in home quarantine during the treatment period and they were extremely happy to take her home.
A 75 year old lady had been admitted in Ruby General Hospital with complaints of abdominal pain for twelve days associated with nausea, vomiting, intermittent fever and severe pain abdomen. Prior to Ruby Hospital she had been admitted at a local hospital where it had been diagnosed as acute intestinal obstruction. After admission under the expert care of Dr. Sumanta Dey (Consultant Advanced Laparoscopic, Bariatric and GI Surgeon), the lady had been evaluated and relevant investigations were done. She was totally dehyfrated with multiple abnormal blood parameters and the CT Scan of whole abdomen revealed an uncommon hernia known as Femoral Richter’s Hernia which caused intestinal obstruction. After discussion with the family members about the complexities entailed and with high risk consent, the lady had been posted for an emergency operation. Laparoscopic Transabdominal Peperitoneal (TAPP) repair of obstructed left femoral hernia had been done. Postoperatively, the patient was on ventilator support for 36 hours and after extubation she recovered well with the supreme care of the ICU doctors and skilled nurses. She had an almost painless recovery and it gave us immense satisfaction to see her going home to her family in smiles.
(A 74 year old, female senior citizen had been admitted under the expert care of Dr. Sumanta Dey Consultant Advanced Laparoscopic, Bariatric and GI Surgeon) with complaints of bleeding per rectum for three months, chronic constipation and also associated with loss of weight and decreased appetite. After evaluation of the lady, relevant investigations were sent. CT scan of abdomen revealed hypodense lesion in sigmoid colon lumen and likely neoplastic (Abnormal growth of cells also known as a tumour). Surgery had been suggested and opinion of Oncologist had been taken. Sigmoidoscopy had been performed and tattooing of tumour had been done. After a high risk written informed consent, the lady had been posted for surgery. Laparoscopic Anterior Resection and Loop Ileostomy had been done. Ulcerproliferative growth had been found in lower sigmoid colon. There were no enlarged pericolic (around or encircling the colon) lymph nodes, ascites or liver metastasis. Post operation, she had an episode of atrial fibrillation (Irregular and rapid heart rate) which was medically managed. She also developed Dyselectrolytemia (Electrolyte imbalance) which was gradually corrected. Gradually, Loop Ileostomy fuction had been satisfactory and the lady had been discharged. Her anxious family took her home and thanked Ruby Hospital for answering their silent prayers.
A 32 year old lady had been presented with a history of Jejunoileal Perforative Peritonitis along with Uterine Perforation which had been repaired earlier and multiple small bowel injury which is a complication of Dilatation and Curettage and Exploratory Laparotomy. She was admitted under the care of Dr. Sumanta Dey (Consultant Laparoscopic, Bariatric and Metabolic Surgeon) and Dr. Supratim biswas (Consultant Gyanecologist). After detailed discussion with the family members and with informed consent the lady had been posted for surgery. An Exploratory Laparotomy had been performed followed by bowel resection anastomosis and bilateral tubal ligation. During the O.T. it was found that there were multiple distal jejunal perforation, jejuno -ileal anastomotic leakage and bilio haemorrhagic collection in the pelvis. Postoperatively she was on I.V. Fluids, I.V. Antibiotics and other supportive measures, but, after eighteen days post surgery she had to be rushed to the OT again due to postoperative entero – uterine fistula. Another Exploratory Laparotomy had been done followed by Total Abdominal Hysterectomy, Adhesiolysis, Resection of Fistula and Feeding Jejunostomy. Postoperatively, Broad Spectrum Antibiotics had been started for sepsis. The lady had been kept on ventilator support. Later she developed septic shock, Acute Kidney Injury (AKI), Disseminated Intravascular Coagulation (DIC), Acute Respiratory Distress Syndrome (ARDS), and anaemia. Multiple units of concentric RBC had been transfused. On the sixth postoperative day Tracheostomy had been done for difficult weaning. Gradually, her condition improved and she was weaned off from ventilator. It had been a long journey for the lady and our team of experts made sure she went home to her family, especially her child, all of whom had been waiting for her more than a month and a half.
