Gastrointestinal Surgery

The Gastrointestinal Surgery department offers a wide range of surgical procedures for conditions related to the gastrointestinal tract. We specialize in gastric and esophageal surgeries, treating conditions such as gastric cancer, achalasia cardia, esophageal cancer, gastroesophageal reflux disease, ulcer disease, and more. The department also provides small intestine and colorectal surgeries, including procedures for colorectal cancers, polyposis syndrome, inflammatory bowel diseases, abdominal tuberculosis, rectal prolapse, complicated perianal conditions, and anal sphincter reconstruction. Hepato Pancreato Biliary services are available for liver surgery, pancreatic disorders, biliary system disorders, bile duct and gall bladder cancer. Laparoscopic surgeries are performed for various conditions, and the department has expertise in liver transplantation. We also have specialty clinics for liver transplantation, pancreas, and obesity, as well as a Stoma Care Centre and trauma and emergency services. The department works closely with the Department of Oncology to provide integrated care for gastrointestinal cancers.

Surgical Procedures

Gastric and Oesophageal Surgery

Minimally invasive gastric and oesophageal surgeries are offered to patients. The following conditions are treated on a regular basis:

• Gastric Cancer – Palliative and curative resections for gastric and gastro-esophageal junction cancers are performed frequently, along with gastrectomy with extended lymph node dissections.
• Achalasia Cardia – The initial work up is done in the esophageal motility lab in the Medical Gastroenterology department, then the GI Surgery department sees patients who need surgery. Laparoscopic myotomy is performed so that patients can avoid the risk of open surgery with its attendant morbidity.
• Esophageal Cancer – Transthoracic and transhiatal oesophagectomies are also performed regularly. Inoperable patients are palliated by expandable metallic stents or endoscopic feeding gastrostomies. The management of these patients is generally undertaken in consultation with an oncologist to plan the adjuvant treatment that may be needed.
• Gastro Esophageal Reflux Disease –The treatment is begun only after extensive evaluation in the motility lab of the Medical Gastroenterology department. Optional minimally invasive anti-reflux surgery is offered to the patient.
• Ulcer Disease – With the current advances in medical treatment, it is rare for patients to need surgical intervention. When such cases do arise, the department offers the options of laparoscopic as well as open acid reduction procedures.

Small Intestine and Colorectal Surgery

The GI Surgery department provides integrated oncology care. The treatment of patients with rectal cancer is planned in consultation with an oncologist to include pre-operative radiotherapy. This approach significantly reduces the risk of recurrence of the cancer. The department carries out a variety of procedures and treats conditions including:

• Colorectal Cancers – Low anterior resections and stapled pouch anastomosis are carried out routinely. All attempts are made at sphincter preservation. Laparoscopic colorectal resections are being taken up on depending on patient preference and suitability.
• Polyposis Syndrome – Patients with polyposis syndrome are evaluated fully in the department for coexisting pathology and are offered sphincter-preserving procedures like Ileal Pouch Anal Canal Anastomosis.
• Inflammatory Bowel Diseases – Inflammatory bowel disease like ulcerative colitis and Crohn’s Disease are handled in consultation with the Medical Gastroenterology department. Advanced procedures like Ileal Pouch Anal Canal Anastomosis are done regularly. Staged procedures for complicated IBD and management of fistulas utilize the services of the integrated stoma care services.
• Abdominal Tuberculosis – The advanced facilities available in the hospital permit noninvasive or minimally invasive confirmation of this often-obscure pathology.
• Rectal Prolapse – Rectal prolapse is being treated routinely by Laparoscopic Rectopexy, thus allowing early return to activity for the patients.
• Complicated Perianal Conditions – the evaluation and management of complex perianal fistulae is aided greatly by the excellent imaging modalities of conventional and MR fistulograms done in the Radiology department. Stapler hemorrhoidectomy is offered to patients at their choice, avoiding the painful and prolonged convalescence after piles surgery.
• Anal Sphincter Reconstruction and Augmentation –Reconstruction of anal sphincter with muscle transfer procedures are done for patients with incontinence due to traumatic injuries to the sphincter.

Hepato Pancreato Biliary Services

• Liver surgery – Major liver resections are undertaken routinely for primary cancers of the liver and the biliary tree.
• Pancreas – The unit has carried out more than 120 major pancreatic resections with results being comparable with the best centres in the world. Surgical treatment is offered to patients with pancreatic cancers as well as chronic pancreatitis.
• Disorders of the biliary system – The treatment of gallstone disease is done in coordination with the Medical Gastroenterology Department so as to allow planning of combined and sequential treatment procedures that would help in reducing the hospital stay. Surgical management of complicated benign biliary disorders is done by biliary reconstructive procedures.
• Bile duct and gall bladder cancer – Palliative and curative resections for biliary cancer and palliative drainage procedures are performed. Combined liver and bile duct resection for advanced bile duct cancers are being performed regularly with excellent results. Patients who have inoperable diseases are offered various palliative measures like stenting or bypass procedures.

Laparoscopic Surgeries

• The unit operates with two fully equipped laparoscopic suites, which are also equipped with advanced equipment like Harmonic Scalpel, Argon laser, endoscopic stapling devices and endoscopic suturing devices. The unit is routinely conducting:
  • Lap cholecystectomy
  • Lap common bile duct exploration for stone disease
  • Lap appendicectomy
  • Laparoscopic hernia repair
  • Diagnostic laparoscopy for the evaluation of obscure abdominal symptoms,
  • pain or ascites
  • Lap assisted colorectal resections for cancer
  • Lap liver surgeries for cystic diseases of the liver
  • Lap directed small bowel surgeries
  • Lap myotomy for Achalasia Cardia
  • Lap splenectomy
  • Lap cysto-gastrostomy
  • Lap bariatric surgery

Liver Transplantation

• The treatment options for treatment of patient with end stage liver disease are limited and the patient usually follows a steady downhill course unless transplanted.
  • The liver transplantation team is credited with 850 liver transplants. Of the total of 850 transplants, 780 were from live donors and 70 were from deceased donors.
  • First and largest Liver Transplant Program in Kerala. Regular Live Donor programme from 2007.
  • The team has performed 103 Liver Transplants in the past one year.
  • Acute liver failure: 120 out of 850 transplants were done for Acute Liver Failure, where the work up of donor and recipient were often completed within 24 hours.
  • First Centre in India to perform ABO incompatible adult transplant. At 20 cases, this is currently the largest series in India.
  • First Centre in India to perform Partial Auxiliary Orthotropic Liver Transplantation {APOLT} where part of the recipient liver is left in situ allowing us to potentially withdraw immunosuppression once the native liver recovers. Total 6 APLOTs
  • 110 paediatric transplantations, the youngest being a 5-month-old baby weighing 5 Kilos.
  • First centre in Kerala to perform SWAP Transplantation. (When the members of two different families cannot donate their organ to their own family member due to blood group incompatibility there is an option for a pair of families to donate to each other. This is applicable mostly to A and B groups only.)
  • First robotic donor hepatectomy and largest series in India. Total 118.

Gastro Intestinal Oncology

• The department of Intestinal Oncology works closely with the Department of Oncology
• Patients receive integrated care for their diseases under one roof
• Adjuvant treatment for various types of cancers including colorectal, stomach, pancreas, cholangiocarcinoma, etc. 

Stoma Care Centre

• The department has a fully equipped Stoma Care Centre for patients with stomas
• Trained enterostomal therapists provide advice on types of stoma care materials and training on proper use and care of appliances
• Stoma care products available at subsidised rates through the hospital pharmacy
• Stoma counseling and products available for patients who have undergone surgery at other hospitals

Trauma and Emergency Services

• GI Surgery unit functions as a tertiary referral center for hepatobiliary and pancreatic trauma in Kerala
• Admits complicated postoperative GI and biliary fistulas through emergency services
• GI bleed team composed of critical care specialist, medical gastroenterologist, interventional radiologist, and GI surgeon manage patients with a coordinated approach
• Excellent conventional and interventional radiological facilities available for conservative treatment of major intra-abdominal injuries, including major intra-abdominal vascular trauma.

• India’s first fully robotic liver transpalnt
• Kerala’s first liver deceased donor transplantation (2004)
• Kerala’s first simultaneous Kidney Pancreas transplant (2014).
• Kerala’s first small bowel transplant (2021).
• The South Asian Coordinator for the International Cholangiocarcinoma (CCA) Registry.
• First to introduce MANOMETRY in KERALA
• Has the highest number of Cholangioscopies, which helps in visualizing the internal structures of the liver and digestive tract
• Installed the first Echosens Fibroscan 630 Expert in south India.

Liver Transplantation Clinic

• Transplant team composed of experienced transplant and vascular surgeons, supported by a large GI surgical and anesthetic team
• Pre-transplant workup and follow-up done at a monthly liver transplant clinic conducted by experienced hepatologists and the transplant team
• Treatment plans for individual patients with end-stage liver disease streamlined at the clinic
• Excellent intensive care and supportive services meet all requirements for a successful transplant setup.

Pancreas Clinic

• Surgical treatment offered to patients with pancreatic cancers and chronic pancreatitis
• Pancreas clinic conducted in coordination with Medical Gastroenterology and Endocrinology departments for integrated care of patients with chronic pancreatitis.

Obesity Clinic

Obesity clinic is conducted in association with the Department of Endocrinology.

Address
Centre for Digestive Diseases, Amrita Institute of Medical Sciences Ponekkara, AIMS (P.O.), Kochi, Kerala, India Pin: 682041

For Appointments
Phone: 0484 -2852100, 0484-2851234, 0484 - 6682100, 0484 - 6681234

• Training in Basic Laparoscopic Surgery 
• Training in Advanced Laparoscopic Surgery