Complex Gastrointestinal Surgery

Dr. Amit Javed performs more than 1000 surgeries each year helping patients with complicated abdominal diseases, gastrointestinal cancers and obesity. He performs all types of bariatric surgeries for weight loss, and laparoscopic and open surgeries for all types of abdominal problems. Some of his areas of expertise are as follows.

Fundoplication for Hiatus Gernia And Gastroesophageal Reflux Disease (GERD)

In hiatus hernia a part of the stomach goes into the chest. These patients complain of burning sensation in the chest, heartburn, regurgitation, hoarseness of voice, at times breathing difficulty and chest infections. Most of these patients take acid suppression medication. Chronic reflux is a risk factor for cancer of the esophagus. The surgery for hiatus hernia and GERD is done laparoscopically. The reflux symptoms improve immediately after surgery.

Vagotomy for Acid Peptic Disease

In hiatus hernia a part of the stomach goes into the chest. These patients complain of burning sensation in the chest, heartburn, regurgitation, hoarseness of voice, at times breathing difficulty and chest infections. Most of these patients take acid suppression medication. Chronic reflux is a risk factor for cancer of the esophagus. The surgery for hiatus hernia and GERD is done laparoscopically. The reflux symptoms improve immediately after surgery.

Surgery for Corrosive Stricture of Esophagus and Stomach

Ingestion of acid or an alkali leads to severe scarring and stricture formation in the esophagus and or the stomach. These patients often require surgery to reconstruct their narrowed food pipes. This surgery is traditionally performed by an open surgery. Dr Amit Javed report one of the largest experience of managing such patients during his stay at the All India Institute of Medical Sciences, New Delhi, which was published in the Annals of Surgery. Dr Javed subsequently described techniques for laparoscopic surgery in these patients (using both stomach and colon conduit) which were published in Surgical Endoscopy journal. Dr Javed has a vast experience of managing these patients and has demonstrated the technique in various national and international conferenced and has received awards for the same.

Surgery for Gastric Trichobezoar

Trichobezoar is a ball of hair in the stomach. Usually seen in young ladies. The surgery can be done by both open and laparoscopic approach. Dr Javed described an innovative minimal access surgery technique for successful removal of gastric trichobezoar which was published in the Journal of Minimal Access Surgery.

Surgery for Annular pancreas

This is an aberration in the development of the pancreas in which the pancreas surrounds the duodenum causing mechanical obstruction to the passage of food which manifests as vomiting in the affected patient. This problem can be rectified by a laparoscopic surgery wherein the obstructed duodenum is drained into the jejunum bypassing the obstruction

Necrosectomy for Acute Pancreatitis

This procedure is reserved for severe cases of acute necrotising pancreas wherein the pancreas gets necrosed due to self-digestion by pancreatic enzymes and there is super-added infection.

Lateral Pancreaticojejunosotmy and Freys Procedure for Chronic Calcific Pancreatitis

Stones not only form in the gall bladder and kidneys but can also form in the pancreas. The patients usually have severe pain in the upper abdomen which radiates to the back. In addition, patients can diabetes, malabsorption, diarrhoea and failure to gain weight. The surgery can be done both laparoscopically and by open technique. The choice of the surgical procedure depends upon the magnitude of the patient’s disease. Dr Javed has published one of the largest experience of laparoscopic surgery for chronic pancreatitis.

Distal pancreatectomy for Pancreatic Cysts

In this procedure part of the pancreas is removed either by the laparoscopic, or by the open approach. Dr. Javed was invited to demonstrate the Surgery at the IHPBA Conference 2020.

Enucleation of Pancreatic Tumors

Enucleation is done for benign or low grade malignant tumors like insulinoma and neuroendocrine tumors.

Cholecystectomy for Gall Bladder Stones and Gall Bladder Polyps

Gall bladder stones is a very common problem. They can present with intermittent abdominal pain, severe acute abdominal pain, and dyspeptic symptoms. The potential complications include jaundice due to slipped stone, acute pancreatitis and risk for gall bladder cancer. Certain gall bladder polyps also have a risk for gall bladder cancer.

The surgery for gall bladder stones and gall bladder polyps is done laparoscopically. Dr Amit Javed once removed 838 stones from a single gall bladder. This was widely reported in the media.

CBD Exploration for CBD Stones

Stones may slip from the gall bladder into the common bile duct. They may obstruct the follow of bile from the liver to the intestine resulting in jaundice. The stones are most commonly removed by endoscopy (ERCP). If the stone is impacted and cannot be cleared by ERCP, they are removed by laparoscopic surgery.

Excision for Choledochal Cyst

Choledochal cyst is a congenital dilatation of the bile duct. The disease may present in the childhood or in adults. Patient may present with abdominal pain, jaundice or rarely a lump. Stones may develop is the cyst, there can be recurrent infections, pancreatitis, portal hypertension and risk for malignancy. The treatment is surgical removal of the cyst with a hepaticojejunostomy. This is most commonly done by the laparoscopic approach. Dr Amit Javed was invited to demonstrate Laparoscopic Surgery for Choledochal Cyst at the Army Hospital Research and Referral (R and R).

Roux en Y Hepaticojejunostomy for Biliary Stricture

Bile duct strictures can result from various causes, the most common being injury during a cholecystectomy. The unfortunate patient develops leakage of bile, jaundice, infection. The curative surgery needs an expert surgery because the success depends on the first attempt at repair. Dr Amit Javed reported outcomes of early repair of bile duct injury which was published in the Indian Journal of Surgery. Dr Javed also described one of the largest series till date on the laparoscopic repair of bile duct injuries.

Pericystectomy and Drainage Surgery for Liver Hydatid Cysts

Hydatid cyst is an infection of which most commonly involves the liver but can also affect other organs like the pancreas and even the brain. Dr Javed reported the outcomes of various procedures (pericystectomy, liver resection, drainage operation, PAIR procedure) for the management of hydatid cyst of the liver. He also published about hydatid cysts in patients with HIV infection. Dr Javed also has significant experience of managing hydatid cyst of the pancreas.

Surgery for Intestinal Obstruction/Perforation

Intestines may get obstructed or perforated due to a large number of diseases including tuberculosis, ingestion of pain killers etc. The treatment is urgent surgery and can be done both by open and laparoscopic approach.

Pouch surgery for Ulcerative Colitis

Ulcerative colitis is a chronic disease affecting the large intestine. It is characterised by exacerbations and remissions. Medical treatment is the initial treatment of choice and involves steroids and immunosuppressive medications. Long standing ulcerative colitis is a risk factor for cancer. Surgery is often a staged procedure and involves removing all of the diseased large intestine and rectum and creation of a pouch from the small intestines. The procedure can be done laparoscopically.

Surgery for Diverticulitis

Diverticulae are small pouches that form in the intestine usually in patients with a long history of constipation. They can form in any part of the intestine, but most commonly involve the sigmoid colon. They are mostly asymptomatic but may cause symptoms when inflamed. Surgery is needed when the diverticulitis gets complicated and involves removal of the diseased part of intestine.

Rectopexy for Rectal Prolapse

Rectal prolapse is a condition wherein a part of the rectum protrudes out of the anus. It may be a partial or a complete rectal prolapse. The patient may feel a bulge or a red mass outside the anal opening. Its more common in women, elderly, with a long history of straining while passing stool. The repair can be performed through the abdomen or from the perineal side. Laparoscopic rectopexy is an effective procedure for the treatment.

Hernia Repair Surgery

Hernias are protrusion of intestine or other abdominal contents through a defect in the abdominal wall. They can be many different types of hernia depending on the site of muscle weakness. The most common hernia is the inguinal hernia which occurs in the groin. Another common type i.e Umblical hernia occurs around the navel/belly button. Laparoscopic and open surgery are both effective treatment and usually involve repair with a prosthetic mesh.

Surgery for Hemorrhoids

Commonly called as piles, these are masses of swollen veins which protrude through the anal verge and may cause bright red bleeding which appears as a splash in the pan. They are usually caused by straining during constipation, obesity of pregnancy. Treatment options include banding, sclerotherapy and surgery. Surgery involves excision of these veins. Stapled hemorrhoidectomy is an effective technique for prolapsed haemorrhoids.

Surgery for Anal Abscess Perianal Fistulae

Anal abscess results from infection of an anal gland. There is severe perianal pain, and there may be fever. A boggy swelling may be seen in the perineal region. The treatment involves surgical drainage of the abscess under anesthesia. Perianal fistula is an abnormal communication between the anal canal and the skin. They can develop spontaneously but most often are a preceded by anal abscess which either bursts through the skin or is surgically drained. There is a small opening near the anal verge which intermittently discharges pus. The surgical treatment depends on the location of the fistula.

If the fistula is below or crosses the lower part of the sphincter muscles, your surgeon will cut the fistula open to the skin and leave the wound open so that it can heal with healthy tissue. If the fistula has branches that pass through the upper part of the sphincter muscles, your surgeon may place a special stitch (called a seton stitch) in the fistula to allow pus to drain easily. If the fistula reaches above your sphincter muscles, you may need to have a temporary colostomy (bowel opening onto the skin). However, this is not common.

Surgery for Anal Fissure

Anal fissures are tears that occur at the anal verge from passing hard stool. The patient has intolerable pain while passing stool and there maybe some bleeding. Surgery done under anaesthesia provides immediate relief of pain.

Surgery for Pilonidal Sinus