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Rohatgi A, Forshaw MJ, Sutcliffe RP, Strauss DC, Mason RC. Transhiatal oesophagectomy: techniques, tips and outcomes. Surgeon 2009; 6:335-40. [PMID: 19110820 DOI: 10.1016/s1479-666x(08)80004-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To demonstrate our technique and valuable tips for transhiatal oesophagectomies. METHOD 215 patients underwent transhiatal oesophagectomies in our unit between 2000 and 2006. RESULTS In-hospital mortality was 0.9%. Anastomotic leak in 12 patients (5.6%). Chyle leak was seen in five patients and recurrent nerve neuropraxia in six patients. Iatrogenic splenectomy rate was 6%. The median operative time was 151 minutes (range 93-276 minutes). Overall median length of hospital stay was 15 days (range 8-95 days). The median survival for all patients undergoing transhiatal oesophagectomy for invasive malignancy was 42.9 months and the one-year and five-year survival were 81% and 48% respectively. CONCLUSION This is a safe and oncologically sound procedure. We feel that the tips can be helpful for anyone performing this procedure.
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Sutcliffe RP, Forshaw MJ, Tandon R, Rohatgi A, Strauss DC, Botha AJ, Mason RC. Anastomotic strictures and delayed gastric emptying after esophagectomy: incidence, risk factors and management. Dis Esophagus 2008; 21:712-7. [PMID: 18847448 DOI: 10.1111/j.1442-2050.2008.00865.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The aim of this study was to report the incidence, risk factors, and management of gastric conduit dysfunction after esophagectomy in 177 patients over a 3-year period in a single center. Patients with anastomotic strictures or delayed gastric emptying (DGE) were identified from a prospective database. Anastomotic strictures occurred in 48 patients (27%). Eighty-three percent of early anastomotic strictures (<1 year) were benign, and all late strictures (>1 year) were malignant. Dilatation was effective in 98% of benign and 64% of malignant strictures. DGE occurred in 21 patients (12%), and was associated with both anastomotic leak (P = 0.001) and anastomotic stricture (P = 0.001). 4/8 patients with late DGE (>3 months postesophagectomy) were tumor-related. Pyloric dilatation was effective in 92% of early and 63% of late DGE. Pyloric stents were inserted in 3 patients with tumor-related DGE. After esophagectomy, early anastomotic strictures (within 1 year) and early delayed gastric emptying (within 3 months) are usually benign and respond to dilatation. However, patients presenting later with tumor-related obstruction are unlikely to respond to anastomotic or pyloric dilatation and should be stented.
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Rohatgi A, Sutcliffe R, Forshaw MJ, Strauss D, Mason RC. Training in oesophageal surgery--the gold standard: a prospective study. Int J Surg 2008; 6:230-3. [PMID: 18499545 DOI: 10.1016/j.ijsu.2008.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 04/08/2008] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Competency in complex oesophagogastric surgery, within the current climate of changes to medical training and reduced hours, requires repeated, focused, hands-on training. We describe the training methods for oesophagectomy in our institution. METHODS All oesophageal resections under the care of one consultant surgeon are regarded as training cases. When trainees start they are shown the first resection; subsequently, the trainees then perform every case with the consultant scrubbed. Consultant input consists of retraction and tips in difficult situations. All data were collected on a prospective database. RESULTS Two hundred and seventy patients (215 males, median age=64 years) underwent primary oesophagectomy under the consultant, between January 2000 and May 2007. Fifteen resections (6%) were performed solely by the consultant. ASA grading was: I=15, II=154, III=95, IV=5, and unrecorded=1. In-hospital mortality and clinically apparent leak rate was 1.9% (5 deaths) and 6.2% (n=17), respectively. Reoperation was required in 15 patients (5.5%). The median length of hospital stay was 14 days (range=8-95 days). Median lymph node yield was 13 (range=0-64). CONCLUSIONS Trainees under supervision can competently perform an oesophagectomy without compromising patient care. An early hands-on approach leads to a rapid ascent of the learning curve and is essential in today's climate of limited training opportunity.
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Singh KK, Rohatgi A, Rybinkina I, McCulloch P, Mudan S. Laparoscopic gastrectomy for gastric cancer: early experience among the elderly. Surg Endosc 2007; 22:1002-7. [PMID: 17768658 DOI: 10.1007/s00464-007-9561-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 05/28/2007] [Accepted: 06/13/2007] [Indexed: 01/05/2023]
Abstract
BACKGROUND The data are scarce on the outcome for elderly patients presenting with resectable gastric cancer in the West who have been treated with minimally invasive surgery. This report presents the authors' early experience with totally laparoscopic gastric resections for cancer in elderly patients. METHODS A total of 20 patients underwent laparoscopic gastrectomy procedures: 14 distal, 5 subtotal, and 1 total gastrectomy. The male-to-female ratio was 15 to 5. The ages ranged from 75 to 88 years (mean, 80 years). RESULTS All cases were managed laparoscopically with R0 resection. Four patients needed high-dependency unit care postoperatively. There were no perioperative deaths. The median time required for the procedure was 212 min, and time to diet was 4 days. The hospital stay was 8 days. Four patients experienced significant complications, with two patients requiring reoperation. The pathology was adenocarcinoma for 17 patients and high-grade dysplasia for 3 patients. CONCLUSION Among elderly patients for whom conventional gastric surgery carries a high morbidity and mortality risk, minimal access surgery may offer equivalent oncologic integrity but with superior safety and economy. The primary aim is to remove the tumor with at least a D1 lymphadenectomy.
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Padmanabhan J, Rohatgi A, Niaz A, Chojnowska E, Baig K, Woods WGA. Does rectus sheath infusion of bupivacaine reduce postoperative opioid requirement? Ann R Coll Surg Engl 2007; 89:229-32. [PMID: 17394704 PMCID: PMC1964741 DOI: 10.1308/003588407x168398] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this work was to assess the effect of intermittent bupivacaine infusion into rectus sheath space on postoperative opioid requirement, postoperative pain score and peak expiratory flow rate. PATIENTS AND METHODS A prospective, randomised study involving patients undergoing midline laparotomy. Patients were randomised to receive either intermittent infusion of bupivacaine 0.25% or normal saline via catheters placed in the rectus sheath for 48 h after operation. All patients received intravenous morphine infusion on demand with a patient-controlled analgesic device (PCAD). RESULTS Forty ASA I-III patients were studied. Nineteen were randomised to receive bupivacaine and 21 patients received normal saline. Patient characteristics and surgical variables were comparable in the two groups. The mean wound lengths were similar. There was no statistically significant difference in postoperative opioid requirement, postoperative pain score and peak expiratory flow rate between the two groups. CONCLUSIONS Intermittent bupivacaine infusion into the rectus sheath space after midline laparotomy does not reduce postoperative opioid requirement nor does it affect postoperative pain score or peak expiratory flow rate.
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Jehle KS, Rohatgi A. Use of porcine dermal collagen graft and topical negative pressure on infected open abdominal wounds. J Wound Care 2007; 16:36-7. [PMID: 17334145 DOI: 10.12968/jowc.2007.16.1.26988] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reports on two cases in which porcine dermal collagen grafts were used successfully alongside topical negative pressure therapy in order to close open abdominal wounds in which severe infection was present.
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Abstract
Torted appendices are a rare occurrence but should be considered when encountering a haemorrhagic congested appendix on laparoscopy. As adhesions are rarely present, laparoscopic excision is usually a feasible option.
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Rohatgi A, Singh KK. Mirizzi syndrome: laparoscopic management by subtotal cholecystectomy. Surg Endosc 2006; 20:1477-81. [PMID: 16865619 DOI: 10.1007/s00464-005-0623-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 02/15/2006] [Indexed: 12/16/2022]
Abstract
BACKGROUND The authors present their experience with laparoscopic subtotal cholecystectomy for the management of Mirizzi's syndrome and their review of the literature. METHODS Over a period of 24 months, five cases of Mirizzi's syndrome were encountered, representing 1.5% of all the laparoscopic cholecystectomies performed in the authors' unit. The sex ratio was 4 females to 1 male, and the mean age of the patients was 66 years. All underwent a subtotal cholecystectomy. RESULTS All procedures were completed laparoscopically. Morbidities involved one case of biliary peritonitis and a one case of biliary leak requiring endoscopic stenting. CONCLUSION Mirizzi's syndrome cannot always be anticipated on the basis of preoperative staging, and often is encountered during the procedure. The "anatomic scenario" of this condition should be suspected for patients presenting with conditions such as empyema or mucocoele when there is a likelihood of stone impaction in the infundibulum of the gallbladder. Subtotal cholecystectomy with secure intraperitoneal biliary drainage appears to be a safe option for these patients.
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Rohatgi A, Widdison AL. An audit of cystic duct closure in laparoscopic cholecystectomies. Surg Endosc 2006; 20:875-7. [PMID: 16738973 DOI: 10.1007/s00464-004-2253-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2004] [Accepted: 09/02/2005] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cystic duct leak is an infrequent but potentially serious complication of laparoscopic cholecystectomy. The aims of this audit were to assess the efficacy of locking absorbable clips for closing the cystic duct and to compare the results with those for simple clips used previously. METHODS The records for all laparoscopic cholecystectomies performed in one hospital over a 5-year period were reviewed. The results were compared using Fisher's exact test. RESULTS Of 518 laparoscopic cholecystectomies attempted, 24 were excluded. There was no difference in age or sex ratio between the two groups. Cystic duct leaks were identified either on endoscopic retrograde choloangio pancreatography or at laparotomy. No cystic duct leak occurred in any of the 344 locking clip cases, as compared with 3 leaks in the 146 (2%) simple clip cases (p < 0.03). CONCLUSION Locking clips are a safe and effective method for cystic duct closure. They are associated with a reduced cystic duct leak rate, as compared with that for simple clips.
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Rohatgi A, Sharma SK, Gurtoo A, Gupta S. A study of neurological disorders during pregnancy and puerperium. Ann Indian Acad Neurol 2006. [DOI: 10.4103/0972-2327.27657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rohatgi A, Widdison AL. Left subcostal closed (Veress needle) approach is a safe method for creating a pneumoperitoneum. J Laparoendosc Adv Surg Tech A 2005; 14:278-80. [PMID: 15630943 DOI: 10.1089/lap.2004.14.278] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The left subcostal closed approach utilizing the Veress needle has been the preferred method at one surgical practice for the past 5 years. The aims of this study were to determine whether this was a safe method for creating a pneumoperitoneum and its success rate. METHODS The medical records for all laparoscopic procedures performed at one practice from 1996 through 2001 were reviewed. RESULTS A total of 352 laparoscopic cases were reviewed. The median age of the patients was 55 years (range, 14-72), with a sex ratio of 1 male to 3.5 females. The left subcostal closed approach was not attempted in 8 patients (2%) due to left subcostal surgical scars. The left subcostal approach was successful in 342 of 344 attempts (99%). In 2 patients the method failed because the Veress needle hole could not be placed in the peritoneal cavity. An omental hematoma in one patient was the only complication. CONCLUSION The left subcostal closed approach is a safe and effective method for creating a pneumoperitoneum.
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Rohatgi A, Pardasani V, Sharma SK, Gupta AK, Gurtoo A. Louis Bar syndrome. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2003; 51:286. [PMID: 12839353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Gupta AK, Rohatgi A. IgA myeloma presenting as diabetes mellitus with refractory anaemia. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2003; 51:237-8; author reply 238. [PMID: 12725284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Rohatgi A, Cherian T. Spontaneous rupture of a left gastroepiploic artery aneurysm. J Postgrad Med 2002; 48:288-9. [PMID: 12571386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Gastroepiploic aneurysms are extremely rare. They occur mainly in elderly men and in 90% of cases are ruptured at presentation. Visceral aneurysms though rare should be borne in mind in cases of unexplained haemorrhagic shock. We present a case of a 79-year-old man who presented with abdominal pain, hypotension and anaemia but no obvious source of bleeding. He had undergone a prior aorto-bifemoral graft. The patient refused an operation and died the following day.
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Yadav KK, Rohatgi A, Sharma SK, Kulshrestha M, Sachdeva S, Pardasani V. Oculomotor palsy associated with hepatitis E infection. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2002; 50:737. [PMID: 12186141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Chakraborty D, Agarwal CS, Rohatgi A, Ranjan R, Rai D. A case of a destructive lesion of sphenoidal sinus. Indian J Otolaryngol Head Neck Surg 2002; 54:146-7. [PMID: 23119878 DOI: 10.1007/bf02968736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This interesting case deals with the possible origin of pituitary tumor from cell rests located outside the pituitary gland. In the present case we found an elderly lady presenting with a suspected mass lesion of the sphenoidal sinus, clinically suspected to be either an infective granuloma or a chordoma which finally turned out to be an adenoma of the pituitary gland.
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Rohatgi A, Houghton PW. Duodenal tamponade in the treatment of an intractable peptic ulcer bleed. Ann R Coll Surg Engl 2001; 83:335-6. [PMID: 11806560 PMCID: PMC2503396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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Rohatgi A, Sachdeva S, Kulshrestha M. An unusual clinical presentation of cobalamine deficiency. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2001; 49:496. [PMID: 11762639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Rohatgi A, Monga R, Goyal D. Japanese encephalitis with movement disorder and atypical magnetic resonance imaging. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2000; 48:834-5. [PMID: 11273482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
With the advent of magnetic resonance imaging, brain lesions associated with Japanese encephalitis are increasingly being recognized and correlated with movement disorder. Bilateral haemorrhagic thalamic infarcts on MRI, suggested as a characteristic finding in Japanese encephalitis were conspicuous by their absence in this case report of Japanese encephalitis.
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Rohatgi A, Kulshrestha M, Sachdeva S. Familial parkinsonism with peripheral neuropathy. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2000; 48:752-3. [PMID: 11273520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Rohatgi A, Monga R, Goyal D. Metronidazole induced acute confusional agitated state. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2000; 48:261. [PMID: 11229167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Sharma P, Rohatgi A, Haq W, Mathur KB, Katiyar JC. Stimulation of nonspecific resistance by thymopentin and its analogs against Leishmania donovani infection in hamsters. Peptides 1999; 20:1381-3. [PMID: 10612455 DOI: 10.1016/s0196-9781(99)00146-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Thymopentin and its analogs have been synthesized by the solution phase method of peptide synthesis and evaluated for their prophylactic efficacy against L. donovani infection in hamsters. Thymopentin and some of the analogs were found to stimulate nonspecific resistance of the host against Leishmania donovani infection in hamsters.
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Amory DW, Croughwell ND, Kirchner JL, Blumenthal JA, White WD, Gerstle L, Rohatgi A, Baudet B, Grocott H, Newman MF. THE QUANTITATIVE ELECTROENCEPHALOGRAM (QEEG). Anesth Analg 1998. [DOI: 10.1213/00000539-199804001-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Doshi P, Jellison GE, Rohatgi A. Characterization and optimization of absorbing plasma-enhanced chemical vapor deposited antireflection coatings for silicon photovoltaics. APPLIED OPTICS 1997; 36:7826-7837. [PMID: 18264309 DOI: 10.1364/ao.36.007826] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We have optimized plasma-enhanced chemical vapor deposition (PECVD) of SiN-based antireflection (AR) coatings with special consideration for the short-wavelength (<600 nm) parasitic absorption in SiN. Spectroscopic ellipsometry was used to measure the dispersion relation for both the refractive index n and the extinction coefficient k, allowing a precise analysis of the trade-off between reflection and absorption in SiN-based AR coatings. Although we focus on photovoltaic applications, this study may be useful for photodetectors, IR optics, and any device for which it is essential to maximize the transmission of light into silicon. We designed and optimized various AR coatings for minimal average (spectrally) weighted reflectance (? R(w) ?) and average weighted absorptance (? A (w) ?), using the air mass 1.5 global solar spectrum. In most situations ? R (w) ? decreased with higher n, but ? A (w) ? increased because k increased with n. For the practical case of a single-layer AR coating for silicon under glass, an optimum refractive index of ~2.23 (at 632.8 nm) was determined. Further simulations revealed that a double-layer SiN stack with an n = 2.42 film underneath an n = 2.03 film gives the minimum total photocurrent loss. Similar optimization of double-layer SiN/SiO(2) coatings for silicon in air revealed an optimum of n = 2.28 for SiN. To determine the allowable tolerance in index and film thickness, we generated isotransmittance plots, which revealed more leeway for n values below the optimum than above because absorption begins to reduce photocurrent for high n values.
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