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Papers by adarsh chaudhary
Journal of Gastroenterology and Hepatology, 2001
Journal of the Pancreas, 2016
Pancreatoduodenectomy (PD) remains the standard curative procedure for malignancies of the pancre... more Pancreatoduodenectomy (PD) remains the standard curative procedure for malignancies of the pancreatic head and periampullary region [1]. Refinements in the procedure over the last few decades were accompanied by a concomitant fall in perioperative morbidity and mortality [2]. However, increased surgical aggression in recent years aimed at treating borderline resectable tumours [3], namely tumours involving the superior mesenteric and portal vessels, has led to a resurgence of increased morbidity and mortality rates [4] prompting calls for careful introspection [5].
HPB, 2016
Results: The emergency pancreaticoduodenectomy subgroup of patients showed an overall morbidity o... more Results: The emergency pancreaticoduodenectomy subgroup of patients showed an overall morbidity of 80%, and mortality of 40%. In 80% (4/5) of patients treated by emergency pancreaticoduodenectomy, the pancreatic stump was closed and not reconstructed (CPS), and in 20% (1/5) a pancreaticojejunostomy (PJ) was performed. Conclusion: Emergency pancreaticoduodenectomy is an effective life-saving operation reservable to pancreatoduodenal trauma, perforations, and bleeding, unmanageable by a less invasive approach. It should be preferentially approached by surgeons with a high level of experience in hepatobiliary and pancreatic surgery and in trauma centers too, but it should also be in the armamentarium of general surgeons performing hepatopancreato-biliary surgery.
The National medical journal of India
JOP : Journal of the pancreas, Jan 10, 2006
Pancreatic pseudocysts (PPs) comprise more than 80% of the cystic lesions of the pancreas and cau... more Pancreatic pseudocysts (PPs) comprise more than 80% of the cystic lesions of the pancreas and cause complications in 7-25% of patients with pancreatitis or pancreatic trauma. The first step in the management of PPs is to exclude a cystic tumor. A history of pancreatitis, no septation, solid components or mural calcification on CT scan and high amylase content at aspiration favor a diagnosis of PP. Endoscopic ultrasound (EUS)-guided FNAC is a valuable diagnostic aid. Intervention is indicated for PPs which are symptomatic, in a phase of growth, complicated (infected, hemorrhage, biliary or bowel obstruction) or in those occurring together with chronic pancreatitis and when malignancy cannot be unequivocally excluded. The current options include percutaneous catheter drainage, endoscopy and surgery. The choice depends on the mode of presentation, the cystic morphology and available technical expertise. Percutaneous catheter drainage is recommended as a temporizing measure in poor surg...
Indian Journal of Critical Care Medicine, 2013
Digestive Surgery, 2007
Background: Hepatic venous outflow obstruction (HVOO) is a rare disorder that occurs predominantl... more Background: Hepatic venous outflow obstruction (HVOO) is a rare disorder that occurs predominantly due to a hypercoagulable state. The syndrome may result from hepatic vein obstruction, inferior vena cava obstruction or a combination of both and manifests with post-sinusoidal portal hypertension. The presentation may be fulminant with poor prognosis or as either acute, subacute or chronic forms with relatively better prognosis. Portosystemic shunt surgery (PSS) has thus far been the mainstay of treatment for HVOO. However, over the last decade, transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation have emerged as viable options. This review aims to evaluate the available treatment options and the current relevance of PSS for the management of HVOO. Methods: A literature review on investigations and treatment was performed using Medline and additional library searches. Results: Portosystemic shunts form the mainstay of treatment for patients with subacute pre...
Annals of Oncology, 2014
Gallbladder cancer, although regarded as the most common malignancy of the biliary tract, continu... more Gallbladder cancer, although regarded as the most common malignancy of the biliary tract, continues to be associated with a dismal overall survival even in the present day. While complete surgical removal of the tumour offers a good chance of cure, only a fraction of the patients are amenable to curative surgery owing to their delayed presentation. Moreover, the current contribution of adjuvant therapies towards prolonging survival is marginal, at best. Thus, understanding the biology of the disease will not only enable a better appreciation of the pathways of progression but also facilitate the development of an accurate genetic model for gallbladder carcinogenesis and dissemination. This review provides an updated, evidence-based model of the pathways of carcinogenesis in gallbladder cancer and its dissemination. The model proposed could serve as the scaffolding for elucidation of the molecular mechanisms involved in gallbladder carcinogenesis. A better understanding of the pathways involved in gallbladder tumorigenesis will serve to identify patients at risk for the cancer (and who thus could be offered prophylactic cholecystectomy) as well as aid oncologists in planning the most suitable treatment for a particular patient, thereby setting us on the vanguard of transforming the current treatment paradigm for gallbladder cancer.
HPB, 2009
Objectives: Pancreatic fistula (PF) predicts mortality and morbidity in patients undergoing pancr... more Objectives: Pancreatic fistula (PF) predicts mortality and morbidity in patients undergoing pancreaticoduodenectomy (PD). This study aimed to assess whether isolated Roux loop pancreaticojejunostomy (IPJ) is superior to conventional pancreaticojejunostomy (CPJ).h pb_051 326..331 Methods: Between September 2003 and July 2007, we performed 108 PDs. All patients underwent classical Kausch-Whipple PD with pancreaticojejunostomy (PJ). Patients were divided into two groups based on the type of PJ. Patients in group 1 underwent IPJ and those in group 2 underwent CPJ. A retrospective analysis of prospectively maintained data was performed to compare outcomes in the two groups. Results: There were 53 patients in group 1 and 55 in group 2. The two groups were comparable in both pre-and intraoperative parameters. The overall incidence of PF was 10.1% (five cases in group 1 vs. six in group 2). The course of clinically significant PF was similar in both groups in terms of fistula behaviour, management and the duration of spontaneous closure. Two patients in each group died. Overall complications, mortality and length of hospital stay were also similar; however, duration of surgery was significantly higher in group 1 vs. group 2 (442 min and 370 min, respectively; P = 0.005). Conclusions: Isolated Roux loop pancreaticojejunostomy is not superior to conventional PJ; instead, it increases the duration of surgery.
JOP : Journal of the pancreas, 2010
CONTEXT There is limited information available about the feasibility and benefits of synchronous ... more CONTEXT There is limited information available about the feasibility and benefits of synchronous resection of liver metastases in patients with pancreatic and periampullary cancer undergoing pancreaticoduodenectomy. OBJECTIVE We report on our experience with 7 such patients. DESIGN Analysis of the prospective database was carried out to identify patients who underwent synchronous resection of liver metastases with pancreaticoduodenectomy. PATIENTS Two-hundred and thirty patients underwent pancreaticoduodenectomy for pancreatic and periampullary cancer in our unit between September 2003 and September 2009. MAIN OUTCOME MEASURES The primary aim of our study was to determine the survival benefits and the secondary aim was to evaluate their safety and influence on the results of a pancreaticoduodenectomy. RESULTS Seven patients (3%) underwent synchronous resection of a solitary liver metastasis. In these patients, the operative time and intra-operative blood loss was marginally high as ...
Future oncology (London, England), 2017
Unnecessary preoperative ordering of blood and blood products results in wastage of a valuable li... more Unnecessary preoperative ordering of blood and blood products results in wastage of a valuable life-saving resource and poses a significant financial burden on healthcare systems. To determine patient-specific factors associated with intra-operative transfusions, and if intra-operative blood transfusions impact postoperative morbidity. Analysis of consecutive patients undergoing pancreatoduodenectomy (PD) for pancreatic tumors. A total of 384 patients underwent a classical PD with an estimated median blood loss of 200 cc and percentage transfused being 9.6%. Pre-existing hypertension, synchronous vascular resection, end-to-side pancreaticojejunostomy and nodal disease burden significantly associated with the need for intra-operative transfusions. Intra-operative blood transfusion not associated with postoperative morbidity. Optimization of MSBOS protocols for PD is required for more judicious use of blood products.
Principles and Management of Cancer, 2016
Indian Journal of Surgery, 2011
We present a case of primary esophageal tuberculosis presenting as solitary submucosal mass in ce... more We present a case of primary esophageal tuberculosis presenting as solitary submucosal mass in cervical esophagus with clinical features of dysphagia, thus mimicking a submucosal leiomyoma on imaging in a 39 year old lady. Excision of this mass revealed features suggestive of tuberculosis on histopathology.
HPB, 2009
Background: There have been an increasing number of reports worldwide relating improved outcomes ... more Background: There have been an increasing number of reports worldwide relating improved outcomes after pancreatic resections to high volumes thereby supporting the idea of centralization of pancreatic resectional surgery. To date there has been no collective attempt from India at addressing this issue. This cohort study analysed peri-operative outcomes after pancreatoduodenectomy (PD) at seven major Indian centres. Materials and Methods: Between January 2005 and December 2007, retrospective data on PDs, including intra-operative and post-operative factors, were obtained from seven major centres for pancreatic surgery in India. Results: Between January 2005 and December 2007, a total of 718 PDs were performed in India at the seven centres. The median number of PDs performed per year was 34 (range 9-54). The median number of PDs per surgeon per year was 16 (range 7-38). Ninety-four per cent of surgeries were performed for suspected malignancy in the pancreatic head and periampullary region. The median mortality rate per centre was four (range 2-5%). Wound infections were the commonest complication with a median incidence per centre of 18% (range 9.3-32.2%), and the median post-operative duration of hospital stay was 16 days (range 4-100 days). Conclusions: This is the first multi-centric report of peri-operative outcomes of PD from India. The results from these specialist centers are very acceptable, and appear to support the thrust towards centralization.
International Journal of Gastrointestinal Cancer, 2001
Background. Involvement of the biliary tract in pancreatic necrosis is rare. The authors are pres... more Background. Involvement of the biliary tract in pancreatic necrosis is rare. The authors are presenting six patients with this unusual complication. Methods. Retrospective analysis of a case series. Results. The necrotic process involved the bile duct in four patients (bile duct alone in two and bile duct with duodenum in two) and the gall bladder in two patients. It was not possible to make a preoperative diagnosis of biliary tract involvement in any of these patients. The lesions in the biliary tract were caused by the direct erosion by the necrotic tissue in five patients, and in one patient with gangrene of the gall bladder, it was a "remote" complication of the necrotizing process. All patients underwent surgery. Necrosectomy and cholecystectomy were performed in patients with gall bladder lesions, and proximal biliary drainage was the method of choice in patients with erosion of the bile duct. One patient died postoperatively. During follow-up, another patient who had bile-duct involvement developed a stricture in the damaged part of the bile duct and needed hepaticojejunostomy Conclusions. Necrotizing pancreatitis can involve the biliary tract, both by direct extension and by its secondary effects. Although cholecystectomy is the treatment of choice in the presence of gallbladder involvement, proximal biliary diversion may be indicated in patients with erosion of the bile duct.
Journal of Gastroenterology and Hepatology, 2001
Journal of the Pancreas, 2016
Pancreatoduodenectomy (PD) remains the standard curative procedure for malignancies of the pancre... more Pancreatoduodenectomy (PD) remains the standard curative procedure for malignancies of the pancreatic head and periampullary region [1]. Refinements in the procedure over the last few decades were accompanied by a concomitant fall in perioperative morbidity and mortality [2]. However, increased surgical aggression in recent years aimed at treating borderline resectable tumours [3], namely tumours involving the superior mesenteric and portal vessels, has led to a resurgence of increased morbidity and mortality rates [4] prompting calls for careful introspection [5].
HPB, 2016
Results: The emergency pancreaticoduodenectomy subgroup of patients showed an overall morbidity o... more Results: The emergency pancreaticoduodenectomy subgroup of patients showed an overall morbidity of 80%, and mortality of 40%. In 80% (4/5) of patients treated by emergency pancreaticoduodenectomy, the pancreatic stump was closed and not reconstructed (CPS), and in 20% (1/5) a pancreaticojejunostomy (PJ) was performed. Conclusion: Emergency pancreaticoduodenectomy is an effective life-saving operation reservable to pancreatoduodenal trauma, perforations, and bleeding, unmanageable by a less invasive approach. It should be preferentially approached by surgeons with a high level of experience in hepatobiliary and pancreatic surgery and in trauma centers too, but it should also be in the armamentarium of general surgeons performing hepatopancreato-biliary surgery.
The National medical journal of India
JOP : Journal of the pancreas, Jan 10, 2006
Pancreatic pseudocysts (PPs) comprise more than 80% of the cystic lesions of the pancreas and cau... more Pancreatic pseudocysts (PPs) comprise more than 80% of the cystic lesions of the pancreas and cause complications in 7-25% of patients with pancreatitis or pancreatic trauma. The first step in the management of PPs is to exclude a cystic tumor. A history of pancreatitis, no septation, solid components or mural calcification on CT scan and high amylase content at aspiration favor a diagnosis of PP. Endoscopic ultrasound (EUS)-guided FNAC is a valuable diagnostic aid. Intervention is indicated for PPs which are symptomatic, in a phase of growth, complicated (infected, hemorrhage, biliary or bowel obstruction) or in those occurring together with chronic pancreatitis and when malignancy cannot be unequivocally excluded. The current options include percutaneous catheter drainage, endoscopy and surgery. The choice depends on the mode of presentation, the cystic morphology and available technical expertise. Percutaneous catheter drainage is recommended as a temporizing measure in poor surg...
Indian Journal of Critical Care Medicine, 2013
Digestive Surgery, 2007
Background: Hepatic venous outflow obstruction (HVOO) is a rare disorder that occurs predominantl... more Background: Hepatic venous outflow obstruction (HVOO) is a rare disorder that occurs predominantly due to a hypercoagulable state. The syndrome may result from hepatic vein obstruction, inferior vena cava obstruction or a combination of both and manifests with post-sinusoidal portal hypertension. The presentation may be fulminant with poor prognosis or as either acute, subacute or chronic forms with relatively better prognosis. Portosystemic shunt surgery (PSS) has thus far been the mainstay of treatment for HVOO. However, over the last decade, transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation have emerged as viable options. This review aims to evaluate the available treatment options and the current relevance of PSS for the management of HVOO. Methods: A literature review on investigations and treatment was performed using Medline and additional library searches. Results: Portosystemic shunts form the mainstay of treatment for patients with subacute pre...
Annals of Oncology, 2014
Gallbladder cancer, although regarded as the most common malignancy of the biliary tract, continu... more Gallbladder cancer, although regarded as the most common malignancy of the biliary tract, continues to be associated with a dismal overall survival even in the present day. While complete surgical removal of the tumour offers a good chance of cure, only a fraction of the patients are amenable to curative surgery owing to their delayed presentation. Moreover, the current contribution of adjuvant therapies towards prolonging survival is marginal, at best. Thus, understanding the biology of the disease will not only enable a better appreciation of the pathways of progression but also facilitate the development of an accurate genetic model for gallbladder carcinogenesis and dissemination. This review provides an updated, evidence-based model of the pathways of carcinogenesis in gallbladder cancer and its dissemination. The model proposed could serve as the scaffolding for elucidation of the molecular mechanisms involved in gallbladder carcinogenesis. A better understanding of the pathways involved in gallbladder tumorigenesis will serve to identify patients at risk for the cancer (and who thus could be offered prophylactic cholecystectomy) as well as aid oncologists in planning the most suitable treatment for a particular patient, thereby setting us on the vanguard of transforming the current treatment paradigm for gallbladder cancer.
HPB, 2009
Objectives: Pancreatic fistula (PF) predicts mortality and morbidity in patients undergoing pancr... more Objectives: Pancreatic fistula (PF) predicts mortality and morbidity in patients undergoing pancreaticoduodenectomy (PD). This study aimed to assess whether isolated Roux loop pancreaticojejunostomy (IPJ) is superior to conventional pancreaticojejunostomy (CPJ).h pb_051 326..331 Methods: Between September 2003 and July 2007, we performed 108 PDs. All patients underwent classical Kausch-Whipple PD with pancreaticojejunostomy (PJ). Patients were divided into two groups based on the type of PJ. Patients in group 1 underwent IPJ and those in group 2 underwent CPJ. A retrospective analysis of prospectively maintained data was performed to compare outcomes in the two groups. Results: There were 53 patients in group 1 and 55 in group 2. The two groups were comparable in both pre-and intraoperative parameters. The overall incidence of PF was 10.1% (five cases in group 1 vs. six in group 2). The course of clinically significant PF was similar in both groups in terms of fistula behaviour, management and the duration of spontaneous closure. Two patients in each group died. Overall complications, mortality and length of hospital stay were also similar; however, duration of surgery was significantly higher in group 1 vs. group 2 (442 min and 370 min, respectively; P = 0.005). Conclusions: Isolated Roux loop pancreaticojejunostomy is not superior to conventional PJ; instead, it increases the duration of surgery.
JOP : Journal of the pancreas, 2010
CONTEXT There is limited information available about the feasibility and benefits of synchronous ... more CONTEXT There is limited information available about the feasibility and benefits of synchronous resection of liver metastases in patients with pancreatic and periampullary cancer undergoing pancreaticoduodenectomy. OBJECTIVE We report on our experience with 7 such patients. DESIGN Analysis of the prospective database was carried out to identify patients who underwent synchronous resection of liver metastases with pancreaticoduodenectomy. PATIENTS Two-hundred and thirty patients underwent pancreaticoduodenectomy for pancreatic and periampullary cancer in our unit between September 2003 and September 2009. MAIN OUTCOME MEASURES The primary aim of our study was to determine the survival benefits and the secondary aim was to evaluate their safety and influence on the results of a pancreaticoduodenectomy. RESULTS Seven patients (3%) underwent synchronous resection of a solitary liver metastasis. In these patients, the operative time and intra-operative blood loss was marginally high as ...
Future oncology (London, England), 2017
Unnecessary preoperative ordering of blood and blood products results in wastage of a valuable li... more Unnecessary preoperative ordering of blood and blood products results in wastage of a valuable life-saving resource and poses a significant financial burden on healthcare systems. To determine patient-specific factors associated with intra-operative transfusions, and if intra-operative blood transfusions impact postoperative morbidity. Analysis of consecutive patients undergoing pancreatoduodenectomy (PD) for pancreatic tumors. A total of 384 patients underwent a classical PD with an estimated median blood loss of 200 cc and percentage transfused being 9.6%. Pre-existing hypertension, synchronous vascular resection, end-to-side pancreaticojejunostomy and nodal disease burden significantly associated with the need for intra-operative transfusions. Intra-operative blood transfusion not associated with postoperative morbidity. Optimization of MSBOS protocols for PD is required for more judicious use of blood products.
Principles and Management of Cancer, 2016
Indian Journal of Surgery, 2011
We present a case of primary esophageal tuberculosis presenting as solitary submucosal mass in ce... more We present a case of primary esophageal tuberculosis presenting as solitary submucosal mass in cervical esophagus with clinical features of dysphagia, thus mimicking a submucosal leiomyoma on imaging in a 39 year old lady. Excision of this mass revealed features suggestive of tuberculosis on histopathology.
HPB, 2009
Background: There have been an increasing number of reports worldwide relating improved outcomes ... more Background: There have been an increasing number of reports worldwide relating improved outcomes after pancreatic resections to high volumes thereby supporting the idea of centralization of pancreatic resectional surgery. To date there has been no collective attempt from India at addressing this issue. This cohort study analysed peri-operative outcomes after pancreatoduodenectomy (PD) at seven major Indian centres. Materials and Methods: Between January 2005 and December 2007, retrospective data on PDs, including intra-operative and post-operative factors, were obtained from seven major centres for pancreatic surgery in India. Results: Between January 2005 and December 2007, a total of 718 PDs were performed in India at the seven centres. The median number of PDs performed per year was 34 (range 9-54). The median number of PDs per surgeon per year was 16 (range 7-38). Ninety-four per cent of surgeries were performed for suspected malignancy in the pancreatic head and periampullary region. The median mortality rate per centre was four (range 2-5%). Wound infections were the commonest complication with a median incidence per centre of 18% (range 9.3-32.2%), and the median post-operative duration of hospital stay was 16 days (range 4-100 days). Conclusions: This is the first multi-centric report of peri-operative outcomes of PD from India. The results from these specialist centers are very acceptable, and appear to support the thrust towards centralization.
International Journal of Gastrointestinal Cancer, 2001
Background. Involvement of the biliary tract in pancreatic necrosis is rare. The authors are pres... more Background. Involvement of the biliary tract in pancreatic necrosis is rare. The authors are presenting six patients with this unusual complication. Methods. Retrospective analysis of a case series. Results. The necrotic process involved the bile duct in four patients (bile duct alone in two and bile duct with duodenum in two) and the gall bladder in two patients. It was not possible to make a preoperative diagnosis of biliary tract involvement in any of these patients. The lesions in the biliary tract were caused by the direct erosion by the necrotic tissue in five patients, and in one patient with gangrene of the gall bladder, it was a "remote" complication of the necrotizing process. All patients underwent surgery. Necrosectomy and cholecystectomy were performed in patients with gall bladder lesions, and proximal biliary drainage was the method of choice in patients with erosion of the bile duct. One patient died postoperatively. During follow-up, another patient who had bile-duct involvement developed a stricture in the damaged part of the bile duct and needed hepaticojejunostomy Conclusions. Necrotizing pancreatitis can involve the biliary tract, both by direct extension and by its secondary effects. Although cholecystectomy is the treatment of choice in the presence of gallbladder involvement, proximal biliary diversion may be indicated in patients with erosion of the bile duct.