Dr Harpal Gastro Care

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Dr Harpal Gastro Care

Dr Harpal is a foremost Gastro Intestinal Surgeon in Ludhiana, Punjab. He is the product of premier Asian Institute of Gastroenterology, Hyderabad

12/05/2025

Happy International Nurses Day 💐

09/04/2025

Component separation techniques especially Rives Stoppa repair and Transversus Abdominus Release( TAR) has revolutionized the modern hernia repairs. The large complex hernias which have loss of domain( where most of the intraabdominal organs like small bowel, colon and omentum are in the hernia sac instead of the peritoneal cavity) are now being treated successfully with minimal recurrence by these techniques. We at AGI the Gastrociti have done arround 25 TAR in last 3 years , the special mention is that arround 13 pts were in obstruction with dilated small bowel and failed conservative approach. Usually these pts are treated conservatively and they are put on liquid and low residue diet and discharged and they are operated electively once obstruction is relieved. Over the time we are innovating the techniques for the best results.
1. Low molecular weight heparin preoperative as in major abdominal surgery is required.
2. Scrubbing bath and scrub after the induction in these pts is very important to decrease the Surgical site infection.
3. Botulinum toxin with Progressive pneumoperitoneum in hernia with loss of domain helps in better results.
3. One should be very careful in adhesiolysis ,utmost care to avoid enterotomy.
4. We have developed this new technique of covering the bowel after adhesiolysis. Plastic sheet is sutured to the normal cotton drape like a composite material with plastic sheet on the inner side( bowel side). The benefit of putting is that plastic sheet very easily gets slided over the bowel and omentum till the flanks and the drape over it keeps it wrinkle free while cutting the Transversus Abdominus muscle , so preventing inadvertant holes in the thin Transversus fascia. It's very easy to pull it out after dissection , it just slides out and bowel does not come out with the pull before reconstruction of visceral sac.
4. The technique and steps of TAR are very well standardized now in literature.

27/01/2025

Intussusception
Practical points

1. Intussusception is an invagination of a proximal segment of the intestine into a distal segment of the intestine that may result in bowel obstruction, venous congestion, bowel wall edema and Ischemia or gangrene.
2. Common in infants and young children , 90 percent are idiopathic and spontaneously reduce , 5 percent can have lead point. This is in contrast to adults where mostly they have lead point, thatswhy most of the adults need surgery.
3. Symptoms include sudden colicky Pain abdomen , bilious vomiting , red currant jelly stools( blood mixed mucous stools) and a palpable lump .

4. USG and in some cases CT is required to confirm the diagnosis with classic target sign ( bowel within bowel)

5. Treatment options include non surgical ( Air e***a, hydraulic e***a, and surgical ( laparoscopic , open)
6. Surgical reduction always should be push and gentle pull of the intussuscipiens. Forceful pull can tear the bowel wall.

10/12/2024

Laparoscopic Distal pancreaticosplenectomy by Radical Antegrade Modified Pancreaticosplenectomy ( RAMPS PROCEDURE-
50 Yrs old Diabetic female with vague left upper abdominal pain and early satiety evaluated elsewhere with USG and CECT abdomen with diagnosis of probably Solid pseudopapillary tumour ( SPEN) , underwent MRCP and then surgery . Pt had uneventful recovery and discharged on 5th post operative day .

12/03/2024

Complicated gall stones
36 yrs male had sudden severe pain upper right abdomen in April 2020 , diagnosed as acute calculus cholecystitis , underwent surgery , found to have gangrenous gall bladder with frozen hepatocystic triangle, fenestrating subtotal cholecystectomy was done. Pt recovered gradually. Started having recurrent pain left upper abdomen , with inbetween severe episodes after every 2-3 months. Diagnosed as recurrect acute pancreatitis with pseudocyst in tail of pancreas going into splenic hilum. 4 days back , had very severe pain in left hypochondrium, requiring fentanyl infusion. Triphasic CT showed pseudocyst in tail of pancreas with hyperdense contents with pseudoaneurysm of the splenic artery with splenic vein thrombosis with left sided portal hypertension . Pt was planned for distal pancreatico splenectomy. Intraoperative there was frozen left hypochondrium with adherant tail of pancreas with stomach, splenic flexure and diaphragm.
Pancreas approached from lesser sac, and encircled , splenic artery was retropancreatic , ligated after transection of pancreas.
Gastro colic ligament had large varices, ligated and stomach mobilized . Then spleen along with tail of pancreas along with mass mobilized by AIRD manoeuvre.

Lessons learnt

Fenestrating type of subtotal cholecystectomy is life saving but can lead onto recurrent gall stones .

Sudden severe pain in pts with pseudocyst may be due to bleed, infection , increase in size or pseudoaneurysm.

Splenectomy is curative for left sided portal hypertension.

Pseudoaneurysm of splenic artery can be dangerous and should be tackled by either intervention radiology or by surgery

Thank you for reading.

Address

Ludhiana
141002

Telephone

+918872036060

Website

http://www.drharpalgastrosurgeon.com/

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Dr Harpal Gastro Surgeon in Ludhiana, Punjab

Dr. Harpal is a well-known Gastrointestinal and Laparoscopic surgeon in Ludhiana, Punjab.He completed his matriculation with Merit position. He did his Senior secondary from MGMN Senior Secondary School, Ahmedgarh with flying colours. He was among toppers in All India Medical Entrance Test conducted by CBSE. He chose Govt medical College , Patiala for his MBBS ( 1996-2001). He did his MS (General Surgery, 2002- 2005 ) from prestigious Dayanand Medical College and Hospital , Ludhiana. During his MS days he developed special interest in advanced laparoscopic surgery and gastrointestinal surgery. Gastrointestinal Surgery being most challenging and sought after branch, he was lucky to be trained from most advanced, busiest and one of the best G I center of Asia( Asian Institute of Gastroenterology, Hyderabad). He Was Awarded Fellowship Of Association Of Surgeons Of India (Fais) By Association Of Surgeons Of India In 2015. He is lifetime active member of :

ASSOCIATION OF SURGEONS OF INDIA (ASI)

2. INDIAN ASSOCIATION OF SURGICAL GASTROENTEROLOGY (IASG)

3. SOCIETY OF GASTROINTESTINAL ENDOSCOPY (SGEI)