Vaibhav Varshney

All India Institute of Medical Sciences Jodhpur · Department of Surgical Gastroenterology

To formulate and evaluate the diagnostic performance and utility of a new CT difficulty score in predicting difficult laparoscopic surgery in cases of gallbladder (GB) perforation. This prospective single centre study included a total of 48 diagnosed cases of GB perforation on CT between December 2021 and June 2023, out of which 24 patients were op...

Purpose This study examines the impacts of omitting nasogastric tube (NGT) placement following cervical esophagogastric anastomosis (CEGA) in Enhanced Recovery After Surgery (ERAS) protocols, comparing outcomes to those from early NGT removal. Methods In a retrospective cohort of esophagectomy patients treated for esophageal cancer, participants w...

A BSTRACT Mature cystic teratoma is a benign ovarian tumor that usually presents in reproductive-age females. This tumor usually presents with pain abdomen, bloating, and a lump. Hereby, we describe a case of an ovarian dermoid presented with features of intestinal obstruction secondary to ileo-dermoid fistula formation. A 55-year-old postmenopausa...

Introduction Diffuse esophageal leiomyomatosis is a rare esophageal tumor characterized by circumferential thickening of smooth muscle layers of the entire esophagus. Clinical Case Herein, we describe the case of a 19-year-old girl, who presented with a history of long-standing dysphagia. On evaluation she was found to have diffuse esophageal leio...

Hepaticojejunostomy is currently the best treatment for post-cholecystectomy biliary strictures. Laparoscopic repair has not gained popularity due to difficult reconstruction. We present case of 43-year-old-female with Bismuth type 2 stricture following laparoscopic converted open cholecystectomy with bile duct injury done elsewhere. Position was m...

Objective: The purpose of the study was to analyze the anatomy and variations in the origin of the dorsal pancreatic artery, greater pancreatic artery and to study the various types of arterial arcades supplying the pancreas on multidetector CT (MDCT). Methods: A retrospective analysis of 747 MDCT scans was performed in patients who underwent tr...

Background: Gangliocytic paraganglioma (GP) is a rare tumor that most commonly arises from the duodenum and is characterized pathologically by 3 cell types: epithelioid, spindle, and ganglion cells. GP is often difficult to differentiate from a neuroendocrine tumor on the basis of preoperative imaging, and the diagnosis is based on final histopatho...

Background: Esophageal carcinosarcoma is an uncommon histologic variant of esophageal malignancy, occurring in approximately 0.5% to 2.8% of patients. Esophageal carcinosarcoma usually involves the middle and lower esophagus and consists of both epithelial and mesenchymal components. Case Report: A 54-year-old male presented with painless progressi...

Ingestion of toxic bottle gourd juice, particularly the bitter one, may pose a significant risk to life if not treated in time. Notwithstanding its usefulness, people drink it routinely without concern for fruit quality, extraction hygiene, and mixture with other fruits. We report two cases of bottle gourd juice poisoning with severe abdominal pain...

Background There is limited data from India with regard to presentation, practice patterns and survivals in resected pancreatic ductal adenocarcinomas (PDACs). Methods The Multicentre Indian Pancreatic & Periampullary Adenocarcinoma Project (MIPPAP) included data from 8 major academic institutions across India and presents the outcomes in upfront...

Background: Although fast-track treatment pathways are well established in colorectal surgeries, their role in oesophageal resections has not been well studied. This study aims to prospectively evaluate the short-term outcomes of enhanced recovery after surgery (ERAS) protocol in patients undergoing minimally invasive oesophagectomy (MIE) for oeso...

Hepatic arterioportal fistulae are abnormal communications between the hepatic artery and portal vein. They are reported to be congenital or acquired secondary to trauma, iatrogenic procedures, hepatic cirrhosis, and hepatocellular carcinoma, but less likely to occur spontaneously. Extrahepatic portal venous obstruction (EHPVO) can lead to pre-hepa...

Purpose: Feeding jejunostomy (FJ) is a critical procedure to establish a source of enteral nutrition for upper gastrointestinal disorders. Minimally invasive surgery has the inherent benefit of better patient outcomes, less postoperative pain, and early discharge. This study aims to describe our total laparoscopic technique of Witzel FJ and to com...

Congenital duplication of the extrahepatic bile duct (DEBD) is an unusual anomaly of the biliary system. It occurs due to inability of the embryological duplex biliary system to regress. DEBD has various subtypes depending on the morphology and opening of the aberrant common bile duct. It can have distinct complications. We encountered a 38-year-ol...

Colorectal cancers are more common in the West than in Asian subcontinent. An increasing trend in the occurrence of colorectal signet cell carcinomas has been observed, exhibiting association with inflammatory bowel disease. Its distinct clinical features, pathognomonic, histologic, and radiologic appearance make it an unmissable entity. We report...

Post-esophagectomy hiatal hernia is a rare complication having varied presentation from asymptomatic cases detected incidentally on follow-up imaging to acute surgical emergency for strangulation or gangrene. Patients presenting as a surgical emergency have a prolonged post-operative course with significant morbidity. We present three cases of post...

Background Surgical intervention has been shown to have good post-operative outcomes in patients with chronic pancreatitis with pain refractory to oral analgesics. We present our initial experience with robotic lateral pancreaticojejunostomy (LPJ) and modified Frey’s procedure (MFP). Methodology Patients with chronic calcific pancreatitis were eva...

With the advent of robotic surgery as an effective means of minimally invasive surgery in the last decade, more and more surgeries are being performed robotically in today's world. Robotic surgery has several advantages over conventional laparoscopic surgery, such as three-dimensional vision with depth perception, magnified view, tremor filtration,...

Gastrointestinal tuberculosis (TB) mainly presents as an ileocecal disease, and colonic TB is more often seen with terminal ileal involvement. Isolated involvement of the descending colon by TB is uncommon and usually presents with chronic colitis. An acute presentation as intestinal obstruction because of tubercular stricture of the descending col...

Objectives: The histopathological changes in the liver and their clinical implication in chronic pancreatitis (CP) have not been studied well. We analyzed the incidence, risk factors, and long-term outcomes of these changes in CP. Methods: Chronic pancreatitis patients who underwent surgery with intraoperative liver biopsy from 2012 to 2018 form...

Background Surgical site infection (SSI) remains the most common complication of surgery around the world. WHO does not make recommendations for changing gloves and instruments before wound closure owing to a lack of evidence. This study aimed to test whether a routine change of gloves and instruments before wound closure reduced abdominal SSI.

Background Heller myotomy (HM) with partial fundoplication is the standard of care for achalasia cardia. However, the choice of partial fundoplication is controversial. In this study, we compared both types of fundoplication concerning subjective and objective parameters. Methodology This prospective comparative study comprised a total of 30 consec...

Rapid adoption of a robotic approach as a minimally invasive surgery tool has enabled surgeons to perform more complex hepatobiliary surgeries than conventional laparoscopic surgery. Although various types of liver resections have been performed robotically, parenchymal transection is challenging as commonly used instruments (Cavitron Ultrasonic Su...

Introduction Choledochal cyst (CDC) excision with bilio-enteric anastomosis has been reported by a laparoscopic approach. With the advent of robotic surgery, it is likely to simplify the performance of such complex procedures. Herein, we present our technique of total robotic CDC excision with intra-corporeal Roux-en-Y hepaticojejunostomy (RYHJ)....

Background: Essential thrombocythemia is a chronic myeloproliferative neoplasm characterized by thrombotic and hemorrhagic complications. Essential thrombocythemia can be considered a risk factor for thrombotic events. Case Report: A 34-year-old female presented with sudden onset of abdominal pain from splenic infarction for which she underwent spl...

Introduction: Post-operative chylothorax is a dreaded complication after esophagectomy; hence real-time identification of the thoracic duct (TD) may aid in avoiding its injury or promptly tackling injury when it occurs. We utilized intra-nodal injection of Indocyanine green (ICG) dye to delineate TD anatomy while performing esophagectomy for esoph...

Mirizzi and Bouveret syndromes are uncommon but important complications of calculous cholecystitis. Mirizzi syndrome commonly presents with jaundice due to extrinsic compression on the common bile duct by an impacted stone at the gall bladder infundibulum, whereas Bouveret syndrome presents with gastric outlet obstruction due to a large stone in th...

Corrosive-induced stricture of the esophagus is associated with long-standing morbidity. Though required in particular situations, esophagectomy circumvents the long-term complications of the remnant scarred native esophagus. We performed a robotic Ivor-Lewis esophagectomy for corrosive esophageal stricture and demonstrated its feasibility for the...

Duodenal gastrointestinal stromal tumours (D-GISTs) are a rare disease. It may arise commonly from the second or third part of the duodenum and can be erroneously diagnosed as a pancreatic head tumour due to proximity and morphology on imaging studies. We present a case of a 60-year-old woman who presented with abdominal pain and was diagnosed as a...

Echinococcal liver cysts are predominantly located in the right lobe of the liver and are mostly asymptomatic. A frank intra-biliary rupture (IBR) of hydatid cyst is uncommon, having variable clinical presentation and treatment options. We present a case of a 60-year-old male patient who presented with pain in the upper abdomen associated with vomi...

Mucinous adenocarcinoma of jejunum is a rare tumor of the gastrointestinal tract. Patients usually present after fifth decade of their life with non-specific symptoms. Delayed diagnosis is commonplace and often the reason for advanced disease and poor prognosis. These tumors may masquerade as other common malignancies, with a conclusive diagnosis o...

Cervical cancer is the most common malignancy in Indian women. After primary treatment, distant recurrence is rare and occurs at liver, lung or bone. Distant metastases to other abdominal sites are very rare. We present a case of pancreatic metastasis from cervical cancer, which has not been reported in literature. A 53-year-old woman presented wit...

Background: The development of infection in pancreatitis significantly increases the mortality rate up to 100% in the absence of any intervention. Therefore, it is extremely important to diagnose these cases at an early stage. The objectives of this study were to assess the diagnostic performance of computed tomography (CT) and diffusion-weighted...

Background Gastric conduit has emerged as the preferred treatment option for both esophageal bypass and replacement for corrosive stricture of the esophagus. There is a lack of consensus and a dearth of published literature regarding the short- and long-term complications of using a gastric conduit. This meta-analysis aims to evaluate the outcomes,...

Objective The purpose of the study was to investigate the incidence of pancreatic contour variations on multidetector CT (MDCT) for abdominal examinations. Methods A retrospective analysis of 700 MDCT scans was performed in patients who underwent triple phase CT abdomen between October 2018 and January 2021. After excluding 176 patients, finally t...

Gall bladder tuberculosis (GB TB) is a very rare disease and scarce data is available on exact incidence and clinicopathogenesis even in endemic areas. The aim is to provide an insight into epidemiology, pathophysiology and management for better understanding of gall bladder tuberculosis. We collected data available from the literature on all histo...

Primary adenocarcinoma of the fourth portion of the duodenum (D-IV) is reported infrequently than other parts of the duodenum. Its diagnosis is often late because of non-specific symptoms and signs. We encountered a 48-year-old male patient who was diagnosed as duodeno-duodenal intussusception, underwent segmental duodenal resection with duodenojej...

Introduction: Robotic pancreatoduodenectomy (RPD) has gained ground in recent past. Pancreaticojejunostomy with modified Blumgart technique is less often used with minimally invasive approach due to its technical complexity, however it is feasible with robotics due to its multi-arm platform, three-dimensional view and an extended range of motion....

Introduction: Mucinous cystic neoplasms (MCNs) are uncommon non-invasive lesion of the liver. The diagnosis of such lesions relies heavily on the histopathological findings. They are often misinterpreted as hydatid cysts clinically and on imaging leading to impartial resection. Methods: A 32-year-female presented with pain in upper abdomen and a...

Duodenal gastrointestinal stromal tumours (D-GISTs) are rare disease. It may arise commonly from second or third part of the duodenum and can be erroneously diagnosed as a pancreatic head tumour due to proximity and morphology on imaging studies. We present a case of a sixty-year-old woman who presented with abdominal pain and was diagnosed as a ca...

Mucormycosis is a rare infection caused by fungi of the order Mucorales. The infection frequently involves the rhino-cerebral or respiratory system and involvement of the gastrointestinal (GI) tract and kidney are rare. It usually infects immunocompromised individuals due to various causes and an upsurge is hypothesized to be linked with irrational...

Objective Dilated common bile duct (CBD) (8–15 mm) with normal liver function tests is seen not infrequently, while management of such patients is ambiguous. We propose a treatment algorithm for this cohort of patients after observing them over a period of 8 years.Methods Seventy-eight such patients were managed from 2009 to 2017 and categorized as...

Purpose Aberrant hepatic artery anatomy is a considerable challenge during pancreatic surgery as it warrants extreme caution for the preservation of vascular supply as well as achievement of R0 resection margin. Method We reviewed the literature about the aberrant anatomical variations of the hepatic artery and its relevance during pancreatoduoden...

Inferior vena cava (IVC) and azygos vein anomaly is very rare. Only few cases reports are available for difficult esophagectomy in patients of ca esophagus with IVC anomaly. Minimal invasive esophagectomy with preservation of azygos vein in such patients is technically challenging and not tried before. We report a case of 44-year-old female diagnos...

Feeding jejunostomy (FJ) is a common surgical procedure for patients presenting with absolute dysphagia. Jejunostomy tube-induced intussusception is an extremely rare complication associated with it and its recognition and proper management are necessary to prevent subsequent bowel ischemia of the intussusception. We present a rare case with simult...

Squamous cell carcinoma (SCC) of the ampulla of Vater is a rare pathology and only few cases are reported in the literature. With limited experience of primary SCC in the ampulla of Vater, its biological behaviour, prognosis and long-term survival rates are not well known. A 38-year-old woman presented with a history of painless progressive jaundic...

Pancreatic schwannoma is a rare, well-encapsulated tumor of the pancreas. Preoperative diagnosis of this tumor is uncommon due to marked degenerative change, its rarity, and overlapping clinical and imaging features with other pancreatic neoplasms. Here, we report two cases of pancreatic schwannoma, suspected preoperatively based on their multimoda...

Backgrounds/aims: Lymph node (LN) metastasis though, is a poor prognostic factor for ampullary carcinoma (APC), the impact of Lymph node ratio (LNR) and Logarithm odds of positive lymph node (LODDS) in the long-term survival remains controversial. We evaluated the factors affecting the long-term outcome in APC patients with emphasis on LNR and LOD...

Endoscopic retrograde cholangiography related duodenal perforation is an infrequent complication and associated with significant morbidity. The management of such perforations, especially in the setting of malignancy, is not standardized given the paucity of literature. We encountered a patient who was diagnosed with periampullary carcinoma and had...

Background Though preoperative biliary drainage (PBD) has been suggested to be linked with increased perioperative morbidity it is still practiced commonly. We studied the association of PBD and positive biliary culture with surgical site infection and also analysed the common pathogens and their antibiotic sensitivity spectrum. Methods Prospectiv...

Postcholecystectomy duodenal injuries are very rare complications. Early surgical intervention is a common practice due to its fatal consequences. Most of the patients with post laparoscopic cholecystectomy duodenal injury reported in literature have been successfully managed by early surgical repair. We present here a case of a 32-year-old female...

We encountered a 73-year-old patient who presented with right upper abdominal pain and jaundice. On evaluation, he was found to have cholelithiasis with choledocholithiasis. Endoscopic retrograde cholangiography was attempted, but during the procedure, the wire snapped and the dormia basket got retained in the common bile duct (CBD). Laparoscopic C...

Chylothorax, although an uncommon complication of esophagectomy, is associated with high morbidity and mortality if not treated promptly. Consequently, knowledge of the thoracic duct (TD) anatomy is essential to prevent its inadvertent injury during surgery. If the TD is injured, early diagnosis and immediate intervention are of paramount importanc...

Splenic abscess is an uncommon extra-intestinal complication of Salmonella Typhi in the postantibiotic era. It has high morbidity and mortality, if not diagnosed timely. We present a case of a 20-year-old male who presented with left upper abdominal pain, high-grade fever and awareness of lump. Ultrasound and computed tomography scan of abdomen rev...

Extrahepatic portal venous obstruction (EHPVO) usually presents with upper gastrointestinal bleed in the first decade of life. Symptomatic portal hypertensive biliopathy is seen in a minority of patients with EHPVO. With use of endoscopic intervention, biliary drainage is maintained in these patients. Various procedural complications have been link...

Isolated gallbladder tuberculosis is a rare entity, even in endemic zones. Preoperative diagnosis is usually not possible, with most of the cases being diagnosed either as cholecystitis or malignancy. Histopathological examination of the resected specimen clinches the diagnosis. We present a middle-aged man with obstructive jaundice who was diagnos...

Backgrounds/aims: Proximal splenorenal shunt (PSRS) is usually done in symptomatic non-cirrhotic portal fibrosis (NCPF). The outcomes of splenectomy with endotherapy in non-bleeder NCPF patients has not been well studied. We here by aimed to study the post-surgical outcomes on short and long-term basis between PSRS and splenectomy among non-bleede...

Clozapine induced gastrointestinal hypomotility (CIGH) has been suggested as one of the most common causes of significant morbidity and mortality. It commonly presents as constipation, but the reports of other small or large intestinal complications with fatal outcomes are not uncommon. Hereby, we report the case of a 24-year-old male, suffering fr...

Corrosive-induced stricture of the digestive tract is a dreaded complication following corrosive ingestion. When surgical reconstruction is needed, esophagectomy helps to avoid the long-term complications related to leaving behind the scarred native esophagus. We tried to ascertain the feasibility and safety of a thoracolaparoscopic-assisted esopha...

Mixed adenocarcinoma with neuroendocrine tumour of pancreas has been reported infrequently and consists of both epithelial and neuroendocrine component. We encountered an 81-year-old male patient who presented with clinical features of painful progressive jaundice for 1 month. Contrast-enhanced CT abdomen reported a mass in the pancreatic head with...

Mucinous cystic neoplasms of liver (MCN-L; previously referred to as cystadenomas or cystadenocarcinoma) are rare cystic tumors that occur within the liver parenchyma, or less frequently, in the extrahepatic bile ducts. It is reported to account for <5% of all liver cysts. The differential diagnosis of MCN-L includes intraductal papillary neoplasm...

Background/aims: The development of infection in pancreatitis increases the mortality rate up to 32%. Therefore, it is important to identify patients who are at high risk of developing infection, at an early stage. The objectives of the study were (a) to analyze the quantitative parameters of diffusion-weighted magnetic resonance imaging (DW-MRI)...

Natural history of duodenal adenocarcinoma is not well known. Although extremely rare, the incidence of primary small bowel adenocarcinoma has been increasing. Primary duodenal cancer is a very rare, which has accounted for only 0.3% of all gastrointestinal cancers. Isolated ovarian metastasis from duodenal carcinoma is extremely rare entity. We re...

Objective: The aim of the study was to evaluate the long-term functional outcome (exocrine and endocrine) and morphological changes in remnant pancreas after pancreatoduodenectomy and its clinical impact. Methods: Periampullary carcinoma patients with minimum follow-up of 2 years and without recurrence were included (N = 102). Exocrine insuffici...

We report a previously unreported case of a pancreatic neuroendocrine tumor with a central scar mimicking a serous neoplasm. To our knowledge, this atypical imaging morphology of pancreatic neuroendocrine tumor has not been described before. Our report adds to the body literature that describes atypical imaging variants of neuroendocrine tumors and...

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. We analyzed the clinicopathological features, resectability, immunohistochemical markers, and various factors predictive of disease recurrence and survival. Materials and methods: Retrospective analysis of prospectively mai...

There has been significant increase in the detection of incidental pancreatic lesions due to widespread use of cross-sectional imaging like computed tomography and magnetic resonance imaging supplemented with improvements in imaging resolution. Hence, accurate diagnosis (benign, borderline, or malignant lesion) and adequate follow-up is advised for...

Introduction: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. We evaluated our experience over a decade to analyse the clinico-pathological features, resectability, immunohistochemical markers, and various factors predictive of disease recurrence and survival.

Corrosive injuries of the oesophagus are the major health and financial burden on society [1]. The nature, intent and incidence of ingestion of a corrosive substance vary considerably among developing and developed countries. It is difficult to provide an accurate estimate of the burden of corrosive injuries as the incidence of attempted suicide is...

Entamoeba histolytica infection can lead to colitis, peri-colic abscess, ameboma, perforation and rarely colonic stricture. Amebic colitis is usually managed with medical management and rarely needs surgical management. We hereby report a case of colonic amebiasis, presenting as a stricture in transverse colon, mimicking malignancy, and managed suc...