Dr Pradeep Jain Articles
Laparoscopic Thoracoscopic EcophagectomyA fifty five year male patient presented with complain of dysphagia (the feeling of food getting stuck several secondsafter swallowing, initially for solid food progressing to inability to eat even solid and liquid diet) was presented to our department of laparoscopic GI & GI OncoSurgery: Dr.Pradeep Jain and Dr Ashish Bhanot. Patient was evaluated carefully and thoracoscopic Esophagectomy was performed. Laparoscopic mobilization of stomach and thoracoscopic mobilization of esophagus was performed and stomach tube was created and brought out through cervical incision and anastomosis of cervical esophagus was performed in neck. The procedure was performed without any major incisions on chest and abdomen. Patient was able to walk very next day and recovered very well without any significant pain and other surgery related complications.
2017 Esophagectomy is the partial or complete surgical removal of the esophagus. It is most often performed to remove esophageal cancer or benign lesions. Often the procedure follows courses of chemotherapy and radiation, which might also be continued postoperatively. For decades; surgeons have approached this procedure via open thoracotomy, a large incision in the chest. Via open or laparoscopic approach, this surgery and anesthetization is complex because of the anatomical structures involved. Depending on the length of esophagus to be removed stomach tube or colon is mobilized to make a tube and esophagogastrostomy or colonic transposition is performed. Procedure carries high morbidity because of multiple large incisions causes’ severe pain and take long time to heal in debilitated patients who are already down in health because of cancer. Thoracoscopic esophagectomy is routinely performed by our GI Surgery team and has markedly reduced morbidity in esophageal cancer surgery
Our GI & Bariatric Surgery experts Dr Pradeep Jain & Dr Ashish Bhanot are also performing laparoscopic colorectal cancers, Bariatric, Pancreatic cancer surgery as well hepatobiliary and other GI surgeries by minimally access surgery techniques.
Laparoscopic Heller's MyotomyA 20 year old female presented to Dr Pradeep Jain, Head of Laparoscopic GI & GI Onco surgery, Department at Fortis Shalimar Bagh with complaints of difficulty in swallowing, regurgitation, heaviness after meals, vomiting on and off. Failure to thrive she had undergone endoscopic esophageal dilatation last year but symptoms recurred shortly after dilatation. Dr Pradeep Jain and Dr Ashish Bhanot performed a minimally invasive surgery to treat achalasia, called Laparoscopic Heller Myotomy.
Five small (<1 cm) incisions were given on abdomen. Stomach is mobilized along with lower part of esophagus and muscle fibers are divided (up to 6 cm proximally on esophagus and up to 2 cm distally on stomach) till the innermost part of the wall of esophagus is exposed. Then covering Fundoplication was done to prevent gastro-esophageal Oral liquids were started next day of the surgery and patient was discharged on 2nd day after starting liquid diet. Normal diet started in 2 weeks. Patient has started taking adequate diet and started gaining weight as well.
Achalasia is a rare esophageal disease that affects thousands of people in India, and often presents symptoms like difficulty in swallowing, heart burn and chest pain. Difficult to diagnose and often mismanaged, achalasia is the inability of the muscles in the lower esophageal sphincter to relax during swallowing in order to move food down the esophagus and into the stomach. Surgery is the best option for patients with achalasia as medication typically has no effect, and endoscopic treatments often must be frequently repeated. Surgery involves cutting the esophageal sphincter muscle to allow food and liquid to flow into the stomach and provides immediate improvement in most patients.
Thoracoscopic-laparoscopic OesopgaectomyAn experience of Thoracoscopic-Laparoscopic Esophagectomy in an octogenarian patient with Carcinoma esophagus
Eighty two year old hypertensive non-diabetic male patient was admitted to the deptt. of Laparoscopic Gastrointestinal and Oncosurgery, Fortis hospital Shalimarbag with complaints of progressive dysphagia for 1.5 months. At the time of admission patient was tolerating only liquids. There was no history of vomiting, hematemesis, hemoptysis or melena. Patient was well preserved reflecting the physiological age to be less than chronological age. Upper GI endoscopy, CECT abdomen and PET CECT radiological staging was T3NxMx. Chest X-ray and pulmonary function test, Stress echocardiography were normal. The relevant treatment modality in elderly patients with esophageal carcinoma remains a subject of debate. Prognosis is significantly influenced by age and co-morbidities. There is a significant inferior efficacy of chemo-radiotherapy in elderly patients because of more substantial toxicity.
Because this patient was in his eighties could not have tolerated definitive chemoradiotherapy so other two options either thoracoscopic-laparoscopic esophagectomy or palliative stenting were offered. Patients and family members were convinced for surgery and on 4.7.12 thoracoscopic-laparoscopic esophagectomy with cervical esopagogastrostomy and feeding jejunostomy was performed by Dr.Pradeep Jain/ Dr Ashish Bhanot/ Dr Parmanand. Recovery was excellent. There were no major or minor complications. Oral gastrograffin test was performed on 5th Post op day, which showed normal study and oral liquid diet was started and patient was discharged in a satisfactory condition.
Conclusion: Proper selection of treatment modalities in elderly patients for Ca esophagus is utmost important for a better outcome. Even an elderly well preserved patient with minimal co-morbidities does better after thoracoscopic-laparoscopic esophagectomy than younger obese patients with loads of co-morbidities. thoracoscopic-laparoscopic esophagectomy is definitely a better treatment option for localized Ca esophagus in elderly patients than definitive chemoradiotherapy.