Department of Surgical Gastroenterology

Department Of Surgical Gastroenterology And GI Oncology

The department has grown both in terms of manpower and infrastructure. It functions as a single unit headed by Prof. Dr. A. Sivasankar, with two Associate Professors, five Assistant Professors and two M.Ch. postgraduates.

a) Name & Designation of Faculties

a) OP — 6 Days / Week

Outpatient services are conducted from 8:00 AM to 12:00 PM on all days except Sundays.

b) Special Clinics

Venue: OP 146, 2nd Floor, PMSSY Block, GMKMCH, Salem.

c) IP — 38 Beds

d) Advanced Procedures

• Advanced laparoscopic surgeries
• Advanced HPB (hepato-pancreato-biliary) surgeries
• Minimally invasive GI oncology surgeries
• Bariatric surgery
• Interventional endoscopic procedures
• GI reconstructive surgery for corrosive injuries of the GI tract

e) Tech / Equipment

The department has a state-of-the-art operating theatre with advanced surgical equipment — a Karl Storz Spies advanced HD laparoscopy system in addition to a 3-chip laparoscopy setup, advanced vessel sealing devices such as the Gen 11 harmonic scalpel, LigaSure and Argon Plasma Coagulator, and a Cavitron Ultrasonic Aspirator (CUSA) system. The department also has powered Echelon endo-stapling devices, a constant supply of advanced GI surgical staplers, high-definition endoscopy with FICE technology, and semi-flexible ureteroscopy for managing common bile duct stones.

f) State of the Art Services

• Comprehensive open and advanced laparoscopic GI surgical services with a special focus on GI Oncology
• Bariatric surgery services
• Ongoing efforts towards regular liver transplantation services
• Consistently among the top performing SGE departments in Tamil Nadu under the CMCHIS scheme

A structured training programme for M.Ch. postgraduates is followed as per the regulations laid down by The Tamil Nadu Dr. MGR Medical University. A monthly academic schedule with special emphasis on recent advances, controversies and consensus in GI Surgery and GI Oncology is framed every month. Postgraduates are also encouraged to focus on genetics in GI Surgery and undertake research activities. The department conducts yearly CMEs and Liver Surgical workshops with a special focus on GI Oncology, and has successfully conducted National Board of Examination DrNB Surgical Gastroenterology practical exams for the past two years.

PG Teaching

The department imparts scientific and surgical training to two M.Ch. postgraduates every year, and encourages MS postgraduates to undertake dissertation topics related to Surgical Gastroenterology. It works in close liaison with the Department of Medical Gastroenterology and provides expert surgical support in the field of GI Surgery to other super-speciality and broad-speciality departments.

• Primary early surgery for internal pancreatic fistulas
• Search for specific genetic signature in colorectal cancer in our population
• The trend in LFT and its prognostic significance in liver trauma
• Transgastric laparoscopic necrosectomy for WON
• Laparoscopic CBD exploration with semi-rigid ureteroscope
• Management of pancreatic trauma based on a modified AAST grading system
• Step-up approach in the conservative management of high-grade liver injuries
• Genetic studies in colorectal cancer
• A comparative study of open and laparoscopic management of choledocholithiasis
• Primary early surgery for chronic calcific pancreatitis vs step-up approach

Paper Presentations

Laparoscopic management of common bile duct stones using semi-rigid ureteroscopy — presented at AMASICON & ASICON

Management of common bile duct stones – a single centre experience — IASGCON

Early surgery in internal pancreatic fistula — XXXI IASGCON, 9–10 Oct 2021 (virtual)

Management of pancreatic trauma in a tertiary care hospital — Indian Association of Surgical Gastroenterology, 9 Oct 2022

Pancreatic duct fluid culture & sensitivity and its implications on post-operative outcomes in chronic pancreatitis surgery — Indian Association of Surgical Gastroenterology, 10 Oct 2021

Laparoscopic transgastric necrosectomy and cystogastrostomy for WOPN — IHPBA, 12 Feb 2022

Sahana B P — single centre observational study on management of diaphragmatic disorders — XXXIst National Conference IASGCON 2021 (Virtual)

Poster Presentations

Pancreatic ascites — study of therapeutic options analyzing operative and non-operative interventions — IHPBA

Internal pancreatic fistula — a single centre experience — 18th Annual Conference IHPBA, PGIMER Chandigarh, 11–13 Feb 2022

Sahana B P — early surgery for chronic calcific pancreatitis — 18th Annual Conference Indian Chapter of IHPBA 2021 (Virtual)

Accepted for Publication

Swaminathan Rajan, Sivasankar Amarapathy, Somasekar Durairajan — "Takotsubo cardiomyopathy complicating acute on chronic pancreatitis – A Case Report" — Asian Journal of Medical Sciences (e-ISSN: 2091-0576; p-ISSN: 2467-9100)

Book Chapter (Forthcoming)

"Patients with pancreatic duct fluid culture and chronic pancreatitis undergoing surgical intervention and its effects on the course of the disease after surgery" — to be published in Current Progress in Medicine and Medical Research, Vol. 9 (Print ISBN 978-81-19491-66-7 / E-ISBN 978-81-19491-67-4). The book is currently at the typesetting stage.

• Cystic lesion of pancreas – management options. A. Sivashankar, GMKMC Salem, Tropical Gastroenterology, Vol 30 No. 3 (Suppl.), Jul–Sep 2009
• Acute gastric volvulus – report of 3 cases. A. Sivashankar, GMKMCH Salem, Tropical Gastroenterology, Vol 30 No. 3 (Suppl.), Jul–Sep 2009
• Locally advanced oesophagogastric junction carcinoma – treatment options. A. Sivashankar, GMKMCH Salem, Tropical Gastroenterology, Vol 30 No. 3 (Suppl.), Jul–Sep 2009
• Role of devascularisation procedure in non-cirrhotic portal hypertension and outcome analysis. Sivashankar Amarapathy, TN Dr. MGR Medical University, Tropical Gastroenterology, Vol 31 No. 3 (Suppl. 1), Jul–Sep 2010
• Role of Frey's procedure in inflammatory head mass of chronic calcific pancreatitis and outcome analysis. Sivashankar Amarapathy, TN Dr. MGR Medical University, Tropical Gastroenterology, Vol 31 No. 3 (Suppl. 1), Jul–Sep 2010
• Spectrum of upper GI lesions in dyspeptic patients and association with H. pylori infection in western Tamil Nadu. Vajravelu Jayanthi, Amarapathy Sivasankar — International Journal of Scientific Research, Apr 2017
• Association of H. pylori with differentiation of gastric adenocarcinoma — tertiary care experience. Vajravelu Jayanthi, Amarapathy Sivasankar — Indian Journal of Applied Research, May 2017
• Histological detection of H. pylori: Giemsa vs immunohistochemistry in gastric adenocarcinoma specimens. Vajravelu Jayanthi, Amarapathy Sivasankar — Indian Journal of Pathology: Research and Practice, Jun 2017
• Demography and histomorphological spectrum of colorectal polyps – a 5-year tertiary care study. Vajravelu Jayanthi, Amarapathy Sivasankar — Indian Journal of Research, May 2018
• Management of GI surgical disorders in retroviral patients – tertiary care experience. Ravikumar Subbarayan, Somasekar Ramalingam Durai Rajan — International Journal of Scientific Research, Nov 2018
• Clinico-pathological spectrum of GI malignancies – a 5-year tertiary care experience. Vajravelu Jayanthi, Amarapathy Sivasankar — Indian Journal of Research, Feb 2019
• A rare tumour of pancreas – case report. P. SaiKrishna, Amarapathy Sivasankar — International Journal of Surgery Case Reports, May 2020
• Primary reinforcement with rectus abdominis muscle flap – salvage technique for tenuous post-traumatic duodenal perforation – case report. Somasekar Ramalingam Durai Rajan, Amarapathy Sivasankar, P. SaiKrishna — International Journal of Surgery Case Reports, Aug 2020
• Foreign bodies in the oesophagus – surgery for failed endoscopic retrieval — International Surgery Journal, Apr 2017
• Spectrum of upper GI lesions in dyspeptic patients and association with H. pylori infection in western Tamil Nadu — Indian Journal of Scientific Research, Apr 2017
• Demography and histomorphological spectrum of colorectal polyps – a 5-year tertiary care study, May 2018
• Krishna SP, Somasekar RDR, Sivasankar A, Kesavan B, Chidambaram PM, Ramamurthy C — pancreatic duct fluid culture in chronic pancreatitis patients and its implications on post-operative course — Int Surg J 2021;8:3569–75
• Katheresan V, Sivasankar A, Ponchidambaram M, Kesavan B, Somasekar RDR — non-operative management for pancreatic ascites: a case series — Edorium J Gastrointest Surg 2021;6:100007G02KV2021
• Somasekar R, Krishna P S, Kesavan B, et al. — a pragmatic approach to pancreatic trauma: single-centre experience — Cureus 2022;14(5):e24793
• Katheresan V, Ramamurthy C, Kumar DK, Kesavan B, Ponchidambaram M, Sivasankar A — case series of acute abdomen with midgut malrotation presenting in adulthood — Gastroenterol Hepatol Endosc Pract 2022;2:20–3
• Sivasankar A, et al. — management of common bile duct stones: a single-centre experience — IOSR Journal of Dental and Medical Sciences 2021;20(07):14–19
• Siva Sankar A, O K P, Banu K J, et al. — a single-centre experience of internal pancreatic fistulas — Cureus 2022;14(9):e29181
• Sahana BP, K Dinesh Kumar, Sivasankar A, Ponchidambaram M, Kesavan B — surgical management of diaphragmatic hernia and eventration — a single-centre experience — Int J Gastroenterol Hepatol Endosc 2022;01(02)
• Ramamurthy C, Khamar J Banu, A Sivasankar — early percutaneous drainage of fluid collection in acute pancreatitis – a prospective study — JOP. J Pancreas 2023;24:799

1. GASTROCON 2017

A state-level Gastrointestinal Oncology conference with more than 300 delegates from across the state. A live surgical workshop demonstrated various GI oncology procedures — both open and advanced laparoscopic — along with live endoscopic procedures. The conference was awarded 30 CME credit points by The Tamil Nadu Dr. MGR Medical University.

2. GASTROCON 2019

A one-day conference with a live surgical and endoscopic workshop, themed on GI Oncology with a main focus on laparoscopic GI Oncology. Live ERCP and endoultrasound procedures were also demonstrated. About 400 participants attended from across the state, and 20 CME credit points were granted by The Tamil Nadu Dr. MGR Medical University.

3. GASTROCON 2023

A state-level, one-day Gastroenterology conference with surgical, endoscopic and laparoscopic workshops, themed on biliary tract injuries, prevention and management. Discussions covered biliary system anomalies, biliary injuries, preventive measures including ICG fluorescence and MRI 3D reconstruction imaging, and management strategies. About 350 members attended, including a live endoscopic and laparoscopic training session for postgraduates. The Tamil Nadu Dr. MGR Medical University granted 10 credit hours for the conference.

General Gallery

During the COVID years 2020 and 2021, the performance of the SGE Department was highest in the entire state of Tamil Nadu under the CMCHIS scheme. The department has consistently been among the top two highest-performing SGE departments in the state under the CMCHIS scheme.

CMCHIS Achievements

• Cancer stomach — surgical management
• Gall bladder cancer — surgical management
• Bile duct cancer — surgical management
• Liver cancer — surgical resection, including CUSA-assisted resection
• Colon and rectal cancer — open and laparoscopic surgery
• Pancreatic tumours — laparoscopic surgery
• Oesophageal cancer — including video-assisted thoracoscopic surgery (VATS)
• Obesity — laparoscopic bariatric surgery
• Corrosive (acid) poisoning — GI reconstructive surgery
• Biliary cysts and choledochal anomalies — laparoscopic surgery
• Chronic and acute pancreatitis, pancreatic trauma and internal pancreatic fistulas
• Common bile duct stones — laparoscopic exploration with semi-rigid ureteroscopy
• Periampullary and pancreatic head tumours — laparoscopic Whipple's procedure