Govind Purushothaman - Academia.edu (original) (raw)

Papers by Govind Purushothaman

Research paper thumbnail of Two layered modified duct to mucosa and two layered dunking – a new method of pancreatico-jejunostomy after pancreatico-duodenectomy – comparison with standard pancreatico-jejunostomy

Research paper thumbnail of Patient-reported outcomes after pancreatoduodenectomy – a follow up study

Research paper thumbnail of Primary aorto enteric fistula as a cause of massive upper gastro-intestinal bleed-a very rare case presentation

International Surgery Journal, Aug 26, 2022

Primary aortoenteric fistula (PAEF) is spontaneous development of communication between the nativ... more Primary aortoenteric fistula (PAEF) is spontaneous development of communication between the native aorta and anywhere within the gastrointestinal tract. It is extremely rare and fatal condition which usually presents as a painless upper gastrointestinal bleed. This condition is often overlooked because of it's rarity and low index of suspicion by physicians despite the availability of a wide range of diagnostic tools. Computed tomography angiography (CTA) is the most common investigation done to diagnosis PAEF. This paper reports a case of 49 years old female with massive upper gastrointestinal (GI) bleeding. A PAEF was diagnosed by CTA which called for an emergency laparotomy with surgical repair of the fistula with a synthetic vascular bypass graft. The patient recovered well.

Research paper thumbnail of Primary aorto enteric fistula as a cause of massive upper gastro-intestinal bleed-a very rare case presentation

International Surgery Journal

Primary aortoenteric fistula (PAEF) is spontaneous development of communication between the nativ... more Primary aortoenteric fistula (PAEF) is spontaneous development of communication between the native aorta and anywhere within the gastrointestinal tract. It is extremely rare and fatal condition which usually presents as a painless upper gastrointestinal bleed. This condition is often overlooked because of it's rarity and low index of suspicion by physicians despite the availability of a wide range of diagnostic tools. Computed tomography angiography (CTA) is the most common investigation done to diagnosis PAEF. This paper reports a case of 49 years old female with massive upper gastrointestinal (GI) bleeding. A PAEF was diagnosed by CTA which called for an emergency laparotomy with surgical repair of the fistula with a synthetic vascular bypass graft. The patient recovered well.

Research paper thumbnail of Letter to the Editor: Intra-Abdominal Hemorrhage Control: The Need for Routine Four-Quadrant Packing Explored

World Journal of Surgery

We read the article published by Jakob DA et al. [1] in your prestigious journal with great inter... more We read the article published by Jakob DA et al. [1] in your prestigious journal with great interest. The authors attempt to challenge the conventional/routine use of the fourquadrant packing (4QP) method to achieve hemostasis in trauma-related laparotomy [1]. We concur with the conclusion drawn by the authors but would like to touch on a few aspects. The authors of this retrospective analysis summarize that in 148 patients, 22 would have benefitted from fourquadrant packing(4QP), 90 from direct packing (DP), and in 36 packings would have not helped in controlling hemorrhage. But in table:2; 36 are listed under no bleeding from liver/RIVC, spleen, or retroperitoneal zone 3, which was unclear to us from the summary which states ‘‘in 36 packings would have not helped in hemostasis.’’ The authors found the liver to be the most common source of bleeding in single bleeding sites (SBS) (42%) and multiple bleeding sites (MBS) (54%). The in-hospital mortality was 39% in MBS (i.e., 4QP) and 20% (i.e., DP) in SBS (p = 0.012). They did 4QP in bleeding from liver ? spleen (n = 14) as per definition. Is it safe to say liver and spleen packing (2 quadrant packing) can be safely be done avoiding a 4QP? Which can further reduce the need for 4QP. We believe this can be done rapidly and is equally effective. We would also like to know what was the ICU stay in each group. How many needed re-packing? How many had issues like rebleeding? This should have been mentioned in the results or outcome as it provides a clearer contrast pertaining to this issue. As the liver is the commonest site of bleed and it is evident from literature too that perihepatic packing carries less mortality; compared to situations when liver resection was deployed. The method used for 4QP and DP (especially liver) should be described in detail [2]. Grade 4/5 injuries to the liver are challenging to manage and more complex are bleeder from the suprahepatic region (zone III of IVC) in which suprahepatic packing can cause more tear and exsanguination [2]. Hence, prompt perihepatic packing technique should be applied here [2, 3]. Due to the risk of higher mortality and morbidity, bile leak, sepsis, and eventually multiorgan failure, many methods of liver packing are described by various authors to reduce such collateral damages [3, 4]. The need of the hour is to standardize these techniques by studying the larger population and by using randomized trials [4, 5]. We should have a universal approach and standardize the technique used for abdominal packing in intra-abdominal hemorrhage related to trauma tailored for specific clinical scenarios.

Research paper thumbnail of Gallbladder Neuroendocrine Tumors: Is There a Need for a Specific Approach?

Gastrointestinal Tumors, 2021

Neuroendocrine tumors (NETs) of the gallbladder or the biliary tree are rare. Most of the current... more Neuroendocrine tumors (NETs) of the gallbladder or the biliary tree are rare. Most of the current guidelines and protocols are derived from the experience of managing lung small cell neuroendocrine carcinoma or gastrointestinal NETs. But, the overall outcome of gallbladder NETs (GB-NETs) seems worse than similarly staged lung NETs and adenocarcinoma of the gallbladder. This may be due to its rarity and lack of literature for a focused approach toward its treatment. Hence, the need for a specifically designed approach might help improve results of treatment for these rare tumors. We share our experience of 2 patients with GB-NETs and their 5-year outcome.

Research paper thumbnail of Two layered modified duct to mucosa and two layered dunking – a new method of pancreatico-jejunostomy after pancreatico-duodenectomy – comparison with standard pancreatico-jejunostomy

Research paper thumbnail of Patient-reported outcomes after pancreatoduodenectomy – a follow up study

Research paper thumbnail of Primary aorto enteric fistula as a cause of massive upper gastro-intestinal bleed-a very rare case presentation

International Surgery Journal, Aug 26, 2022

Primary aortoenteric fistula (PAEF) is spontaneous development of communication between the nativ... more Primary aortoenteric fistula (PAEF) is spontaneous development of communication between the native aorta and anywhere within the gastrointestinal tract. It is extremely rare and fatal condition which usually presents as a painless upper gastrointestinal bleed. This condition is often overlooked because of it's rarity and low index of suspicion by physicians despite the availability of a wide range of diagnostic tools. Computed tomography angiography (CTA) is the most common investigation done to diagnosis PAEF. This paper reports a case of 49 years old female with massive upper gastrointestinal (GI) bleeding. A PAEF was diagnosed by CTA which called for an emergency laparotomy with surgical repair of the fistula with a synthetic vascular bypass graft. The patient recovered well.

Research paper thumbnail of Primary aorto enteric fistula as a cause of massive upper gastro-intestinal bleed-a very rare case presentation

International Surgery Journal

Primary aortoenteric fistula (PAEF) is spontaneous development of communication between the nativ... more Primary aortoenteric fistula (PAEF) is spontaneous development of communication between the native aorta and anywhere within the gastrointestinal tract. It is extremely rare and fatal condition which usually presents as a painless upper gastrointestinal bleed. This condition is often overlooked because of it's rarity and low index of suspicion by physicians despite the availability of a wide range of diagnostic tools. Computed tomography angiography (CTA) is the most common investigation done to diagnosis PAEF. This paper reports a case of 49 years old female with massive upper gastrointestinal (GI) bleeding. A PAEF was diagnosed by CTA which called for an emergency laparotomy with surgical repair of the fistula with a synthetic vascular bypass graft. The patient recovered well.

Research paper thumbnail of Letter to the Editor: Intra-Abdominal Hemorrhage Control: The Need for Routine Four-Quadrant Packing Explored

World Journal of Surgery

We read the article published by Jakob DA et al. [1] in your prestigious journal with great inter... more We read the article published by Jakob DA et al. [1] in your prestigious journal with great interest. The authors attempt to challenge the conventional/routine use of the fourquadrant packing (4QP) method to achieve hemostasis in trauma-related laparotomy [1]. We concur with the conclusion drawn by the authors but would like to touch on a few aspects. The authors of this retrospective analysis summarize that in 148 patients, 22 would have benefitted from fourquadrant packing(4QP), 90 from direct packing (DP), and in 36 packings would have not helped in controlling hemorrhage. But in table:2; 36 are listed under no bleeding from liver/RIVC, spleen, or retroperitoneal zone 3, which was unclear to us from the summary which states ‘‘in 36 packings would have not helped in hemostasis.’’ The authors found the liver to be the most common source of bleeding in single bleeding sites (SBS) (42%) and multiple bleeding sites (MBS) (54%). The in-hospital mortality was 39% in MBS (i.e., 4QP) and 20% (i.e., DP) in SBS (p = 0.012). They did 4QP in bleeding from liver ? spleen (n = 14) as per definition. Is it safe to say liver and spleen packing (2 quadrant packing) can be safely be done avoiding a 4QP? Which can further reduce the need for 4QP. We believe this can be done rapidly and is equally effective. We would also like to know what was the ICU stay in each group. How many needed re-packing? How many had issues like rebleeding? This should have been mentioned in the results or outcome as it provides a clearer contrast pertaining to this issue. As the liver is the commonest site of bleed and it is evident from literature too that perihepatic packing carries less mortality; compared to situations when liver resection was deployed. The method used for 4QP and DP (especially liver) should be described in detail [2]. Grade 4/5 injuries to the liver are challenging to manage and more complex are bleeder from the suprahepatic region (zone III of IVC) in which suprahepatic packing can cause more tear and exsanguination [2]. Hence, prompt perihepatic packing technique should be applied here [2, 3]. Due to the risk of higher mortality and morbidity, bile leak, sepsis, and eventually multiorgan failure, many methods of liver packing are described by various authors to reduce such collateral damages [3, 4]. The need of the hour is to standardize these techniques by studying the larger population and by using randomized trials [4, 5]. We should have a universal approach and standardize the technique used for abdominal packing in intra-abdominal hemorrhage related to trauma tailored for specific clinical scenarios.

Research paper thumbnail of Gallbladder Neuroendocrine Tumors: Is There a Need for a Specific Approach?

Gastrointestinal Tumors, 2021

Neuroendocrine tumors (NETs) of the gallbladder or the biliary tree are rare. Most of the current... more Neuroendocrine tumors (NETs) of the gallbladder or the biliary tree are rare. Most of the current guidelines and protocols are derived from the experience of managing lung small cell neuroendocrine carcinoma or gastrointestinal NETs. But, the overall outcome of gallbladder NETs (GB-NETs) seems worse than similarly staged lung NETs and adenocarcinoma of the gallbladder. This may be due to its rarity and lack of literature for a focused approach toward its treatment. Hence, the need for a specifically designed approach might help improve results of treatment for these rare tumors. We share our experience of 2 patients with GB-NETs and their 5-year outcome.