Department of General Surgery

The Department of General Surgery was very primitive prior to 1972 when radical changes were made and a fresh batch of consultants in all disciplines inducted into the hospital. There has been a rapid continuous growth of this department both in manpower, growth of surgical expertise and to provide infrastructure in teaching and research. Today it is one of the department of excellence recognised by both patients as well as the medical fraternity.

The department acquired the first laparoscopic surgery set in 1992. This expertise is now available to all the general surgeons who have included video endoscopic surgery in their armamentarium and have a high level expertise not only in biliary tract surgery but the other allied problems tackled by minimal access surgery methodology. This department has an extensive experience in doing laparoscopic hernias. The extraperitoneal approach (TEP repair) has now been taught to a large number of surgeons. The expertise in minimally invasive surgery in colo-rectal disease is being pursued with vigour. The special units with consultants taking interest in areas like thyroid surgery, breast surgery and colo-rectal surgery have also been demarcated. Two special clinics are being conducted.

• Colo-Rectal Clinic

• Breast Clinic

The academic activities of the department were reinforced when it obtained accreditation from the National of Examination for providing training to the DNB candidates. The faculty of the department including retired consultants form a well knit team, for the didactic as well as practical training of the students. The track records of the department has improved over the years reaching 100% pass figures for the year 1997. The programme for their academic content and professional improvement is unique, comprehensive recognised as a role model in the country. The faculty not only consist of active visiting consultants but large number of retired consultants working in tandem and taking considerable load of teaching of the postgraduate students.

The thrust of the consultants in the department is on the complex abdominal surgery, laparoscopic surgery, thyroid and breast surgery. These areas are undergoing a phase of development and shall form the future expansion zones of the surgical fields.

Oncology surgery is a part of department of surgery and takes up a considerable part of the repertoire. In this endeavour, the help provided by the department of Critical Care Medicine has been of great help.

The department is involved in innovation and rapid progress to better performance in the near future.

The Department of General Surgery is regarded as the mother of all surgical specialties and continues to hold its own pride of place even in the face of stiff competition from its own “progeny”. 2006 has been a good year for the department that has shown an impressive growth over the period.

The statistics speak for themselves. The total number of admissions and operations have shown a growth of 16.2% and 17.9% respectively over the previous year and the department has maintained an envious mortality rate of less than 1%. A striking feature has been the increase in the number of day-care procedures, which are not only economical but also result in an early return to normal activity for the patients. Approximately 40% of the total operations were laparoscopic procedures, which has also contributed to the increase in the number of day care surgeries. The largest operative groups are related to the gall bladder, hernias, colo-rectal and skin & soft tissues.

The department has also been active on the academic front with the faculty travelling all over India as well as abroad to participate in various surgical conferences and CME programs. The participation has been in the form of lectures and paper presentations but also in conducting workshops.

The department also holds and conducts the MRCS examination for the Royal College of Surgeons of Glasgow in the hospital premises, which has now become an annual feature. Members of the faculty have served as examiners for the MRCS as well as for the DNB general surgery examination. Members of the faculty have also been honored as reviewers for some of the major international journals.

The department continues to maintain the ongoing DNB (general surgery) programme and admits two young aspiring surgeons every year. The postgraduate students have a rigorous training schedule which includes a busy academic programme which is strictly followed and the results speak for themselves - being 100% in the current year. The postgraduates are not only trained for patient management but also take part in mandatory research activities.

The continuing evolution of medical science in general and the surgical specialties in particular is challenging enough for the faculty to be on its toes to keep abreast with the best in the world. The Department of General Surgery pledges to continue its efforts in improving its results with a goal to provide the best healthcare for its patients and maintain the pride of place Sir Ganga Ram Hospital enjoys among its peers.

First operation for fistula using Fistula Plug carried out by Dr. Vijay Arora in Sir Ganga Ram Hospital on 26th Feb 2008.

Operations for fistula till now results in excision (removal) of fistula. This is usually done in two stages and leaves large wounds, which need daily dressing and can take upto 6 weeks to heal.

The new procedure of “Plugging the Gap” using the Fistula Plug makes sure that there is no large wounds. This plug fills up the fistula cavity. No daily dressing of any large wound is required. It takes approximately 3 weeks to heal.

Advantages of Fistula Plug

• Non-invasive

• Little pain

• Early recovery & Less morbidity

• Short Hospitalization

• NO RISK of Incontinence

• ‘Biological’ closure & Minimal foreign body reaction

• Success rates up to 87%

• Can be used again after a failure

Disadvantages of Fistula Plug

• High Cost - The cost of the plug is on higher side which becomes a deterrent for a few.

• Failure in 10-13% (recurrence)

• But even in these patient with recurrence, this procedure can be repeated without any harm/risk.

Endoscopic (Colloquially known as Laser Surgery) Breast Surgery (No cut or scar on the breast for breast tumor surgery)

Our department has pioneered for the first time in India the technique of removing benign breast lumps and doing breast biopsies without any cut or scar on the breast. This is done by the minimally invasive buttonhole surgery. The breast tumor is approached from the invisible portion of armpit. This ensures accurate localization and complete removal of the lump without any cut or scar on the breast. The lady can resume her activity and all functions on the same day of surgery itself. There is no need of any dressings or special precautions. Apart from preservation of breast appearance this approach also has other advantages. There is no disturbance in the nipple-areola sensation. There is no chance of any pain in future during breast-feeding. This technique has been accepted by the international scientific community and published in the apex journal of Endoscopic Surgery. It is an innovation and advance in cosmetic breast surgery. Ours is the only institution doing it in India.

Pre-op

Post-op

Emeritus Consultant

Chairman

Consultants

Retired Consultants

Facilities available

1. Round the clock general surgery services. For any emergency please contact 9312941098 or 42252066

2. Daily Private OPD

3. Free General OPD every day between 9:00 – 11:30 am

   Unit I (Mon, Thur)

   • Dr. R. Sarangi (Head of unit)

   • Dr. B. B. Agarwal

   • Dr. Vishal Raj Saggar

   Unit II (Tue, Fri)

   • Dr. Vijay Arora (Chairman & Head of unit)

   • Dr. C. S. Ramachandran

   • Dr. Pramoj Jindal (Clinical Assistant)

   Unit III (Wed, Sat)

   • Dr. Vinod K Malik (Head of unit)

   • Dr. Naresh Garg

DNB in General Surgery

Department of General Surgery holds a two-year DNB course in General Surgery. Two candidates are taken every year. The candidate rotates through all the three units and other surgical specialties and a well-structured teaching programme is conducted for these DNB students

TEACHING

The academic programme for postgraduate students includes formal lectures, case discussions, seminars, Journal Clubs, experience in the wards and outpatient department and in the operation theatre. Seminars / journal clubs are held on a weekly basis in which a postgraduate student, assisted by a consultant, presents a surgical topic.

REQUIREMENTS

Log books: Postgraduate students record all operations (assisted or performed) in their log books which are countersigned by the consultants.

Case Records: The postgraduate record daily case notes as well as admission case notes in the patient’s case sheet.

Attendance: A minimum attendance of 75% is mandatory.

EXAMINATIONS

Board examinations : The DNB examinations in General Surgery are normally held twice a year. Our postgraduate students take the examination in August, there being only one batch of students admitted per year.

Internal examinations: Internal examinations are held twice a year. The examination is based on the format of the DNB examination.

DUTIES

Postgraduate students of all years perform on-call duties which average 6 per month under the guidance of a senior resident. The duties involve attending to emergencies in the ward as well as in the Casualty.

OUTPATIENT TEACHING SCHEDULE

Postgraduate students attend outpatient clinics twice a week along with the rest of the unit in which they are posted.

TEACHING WARD ROUNDS

In addition to daily ward rounds, teaching ward rounds are conducted by the consultants as per the following schedule: 

Unit Consultants Days Time

Unit 1 

• Dr. R. Sarangi Mon, Thurs 11:45 am

• Dr. B. B. Agarwal

• Dr. V. Saggar

Unit 2 

• Dr. Vijay Arora Tue, Fri 12 noon

• Dr. C. S. Ramachandran

Unit 3 

• Dr. V. K. Malik Wed, Sat 12 noon

• Dr. Naresh Garg

OPERATION THEATRE

Postgraduate students attend the operation theatres twice a week where they assist in or perform operations under supervision

FORMAL LECTURE / CASE PRESENTATION

POSTINGS

Postgraduate students rotate through the various surgical specialties as per the following schedule:

SEMINAR / JOURNAL CLUB

Time: 1:15 pm (Saturday)
Venue: Seminar Room / Auditorium

Audit

Facilities, processes, protocols and patient outcome in the Department of General Surgery are under constant peer review by consultants of the department. There are regular (monthly) departmental meetings to present and discuss difficult medical cases; morbidity and mortality discussions and interdisciplinary discussions are held whenever necessary for difficult decision making. A medical audit of annual admissions, operations, annual growth, list and number of procedures (organ wise), mortality and morbidity details is done every year and measures taken to assure quality care.

Examination Centre

The Department conducts the following international examination

Intercollegiate MRCS (Glasgow) PART 3 Examination in Surgery, The Royal College of Physicians and Surgeons of Glasgow. The examinations are usually held in September every year, for further details you are suggested to visit their website (www.rcpsg.ac.uk).

Publications

• Arora V. Minimally invasive colorectal surgery. JIMSA 2007

• Agarwal BB, Agarwal S, Sinha BK, Mahajan KC. New inventions and innovations in Endoscopic Surgery. JIMSA 2007

• Mishra AK, Sood J, Agarwal BB. Fast Track Surgery: Current Concepts. JIMSA 2007

• Sarin D, Agarwal BB, Rao BK. Ethics for surgeons: the role of trainees, surgical innovations and the informed consent. JIMSA 2007

• Agarwal B. Laparoscopic Surgeon and Basics of Technology- Is There a Need to Revisit the Classrooms? JIMSA 2007

• Jindal P, Ramachandran CS, Arora V. Role of diagnostic laparoscopy in patients of chronic abdominal pain. JIMSA 2007

• Krishna AA, Agarwal N, Pant P. Communication skills –An area of concern in medical education. JIMSA 2007

• Agarwal BB, Gupta MK, Agarwal S, Mahajan KC Laparoscopic Cholecystectomy without using any energy source – Journal of Laparoendoscopic & Advanced Surgical Techniques DOI: 10.1089/lap.2006.0142 Volume 17, Number 3, 2007

• Agarwal BB Are energy sources required in laparoscopic cholecystectomy? Or should they be stand by. Surg Endosc, 2007, Epub Mar 13 DOI: 10.1007/s00464-007-9259-z

• Agarwal BB, Gupta MK, Agarwal S, Mahajan KC Anatomical footprint for safe laparoscopic cholecystectomy without using any energy source – a modified technique. Surg Endosc, 2007, Epub May 4 DOI: 10.1007/s00464-007-9320-y

• Agarwal BB, Agarwal S, Gupta MK, Mahajan KC Transaxillary endoscopic excision of benign breast lumps – A new technique. - Surgical Endoscopy DOI : 10.1007/s00464-007-9435-1

• Agarwal BB, Agarwal S Man-Machine interface, a paradox of technology. Is the Black Box (BB) concept an angel or a demon? - Surgical Endoscopy DOI: 10.1007/s00464-007-9439-x

• Mehrotra PK, Goel D, Ramachandran CS, Arora V. Inflammatory variant of a well-differentiated retroperitoneal liposarcoma. Indian Journal of Cancer, Jan – Mar 2006, Vol 43, Issue 1, Pages 35-37.

• Siddiqui MK, Jyoti, Singh S, Mehrotra PK, Singh K, Sarangi R. Comparison of some trace elements concentration in blood, tumor free breast and tumor tissues of women with benign and malignant breast lesions: An Indian study. Environ Int. 2006 Mar 6

• Mehrotra PK, Ramachandran CS, Gupta L. Laparoscopic management of gallstone presenting as obstructive gangrenous appendicitis. J Laparoendosc Adv Surg Tech A. 2005 Dec;15(6):627-9.

• Siddiqui MK, Anand M, Mehrotra PK, Sarangi R, Mathur N. Biomonitoring of organochlorines in women with benign and malignant breast disease. Environ Res. 2005 Jun;98(2):250-7.

• Mehrotra PK, Ramachandran CS, Goel D, Arora V. Giant pseudocyst of the anterior abdominal wall following mesh repair of incisional hernia: a rare complication managed laparoscopically. Hernia. 2006 Apr;10(2):192-4. Epub 2005 Sep 1.

• Ramachandran CS, Agarwal S, Dip DG, Arora V. Laparoscopic surgical management of perforative peritonitis in enteric fever: a preliminary study. Surg Laparosc Endosc Percutan Tech. 2004 Jun;14(3):122-4.

• Singh K, Singhal A, Saggar VR, Sharma B, Sarangi R. Subcutaneous carbon dioxide emphysema following endoscopic extraperitoneal hernia repair: possible mechanisms. J Laparoendosc Adv Surg Tech A. 2004 Oct;14(5):317-20.

• Saggar VR, Sarangi R. Endoscopic totally extraperitoneal repair of incarcerated inguinal hernia. Hernia. 2005 May;9(2):120-4. Epub 2004 Oct 29.

• Saggar VR, Singh K, Sarangi R. Retroperitoneoscopic heminephrectomy of a horseshoe kidney for calculus disease. Surg Laparosc Endosc Percutan Tech. 2004 Jun;14(3):172-4.

• Saggar VR, Singh K, Sarangi R. Endoscopic total extraperitoneal management of Amyand's hernia. Hernia. 2004 May;8(2):164-5. Epub 2003 Nov 19.

• Ramachandran CS, Goel D, Arora V, Kumar M. Gastroscopic-assisted laparoscopic cystogastrostomy in the management of pseudocysts of the pancreas. Surg Laparosc Endosc Percutan Tech. 2002 Dec;12(6):433-6.

• Acharya R, Ramachandran CS, Singh S. Laparoscopic management of abdominal complications in ventriculoperitoneal shunt surgery. J Laparoendosc Adv Surg Tech A. 2001 Jun;11(3):167-70.

• Ramachandran CS, Goel D, Arora V. Laparoscopic surgery in hepatic hydatid cysts: a technical improvement. Surg Laparosc Endosc Percutan Tech. 2001 Feb;11(1):14-8.

• Ramachandran CS, Arora V. Laparoscopic surgical management of giant post-traumatic lymphocele involving sacrum and the lower extremity. J Laparoendosc Adv Surg Tech A. 2000 Dec;10(6):341-5.

• Ramachandran CS, Arora V. Laparoscopic transabdominal repair of hernia of Morgagni-Larrey. Surg Laparosc Endosc Percutan Tech. 1999 Oct;9(5):358-61.

• Ramachandran CS. Umbilical hernial defects encountered before and after abdominal laparoscopic procedures. Int Surg. 1998 Apr-Jun;83(2):171-3.

• Ramachandran CS, Arora V. Two-port laparoscopic cholecystectomy: an innovative new method for gallbladder removal. J Laparoendosc Adv Surg Tech A. 1998 Oct;8(5):303-8.

• Ramachandran CS, Singh K. Modified shouldice technique: a rapid and safe method of inguinal hernia repair. J Indian Med Assoc. 1988 Nov;86(11):292-5. No abstract available.

• Ramachandran CS, Rajagopalan M. Syndrome of intestinal pseudo-obstruction. J Indian Med Assoc. 1986 Feb;84(2):64-5. No abstract available.

• Ramachandran CS. Gram-negative septic shock in surgical patients. J Indian Med Assoc. 1985 Jun;83(6):188-91. No abstract available.

• Ramachandran CS. Caecal volvulus. J Indian Med Assoc. 1985 Feb;83(2):53-5.

• Vohra BK, Sarangi R. Role of uroflowmetry in elderly patients without any symptoms of bladder outlet obstruction. Indian J Surgery, 1985 Vol 53. 7:452-456

• Khadanga MS, Sarangi RK, Sarangi R. Effect of low molecular weight Dextran in the prevention of peritoneal adhesion in Guinaepigs. Indian J Surgery, 1979, Vol 41,6:331-335

Forthcoming Events

• 12th Congress of Asian Federation of Coloproctology (AFCP) in conjunction with the 32nd National Conference of Association of Colon and Rectal Surgeons of India (ACRSI) and 13th Advanced Instructional Course & Pre-Conference Workshop of ACRSI
  Date: 22 - 26 September 2009
  Venue: India Habitat Centre & Auditorium, Sir Ganga Ram Hospital
  
  Organised by:
  Dr. Vijay Arora
  Organising Chairman, 12th AFCP
  Chairman, Department of General Surgery,
  Sir Ganga Ram Hospital, New Delhi, India
  Mob: 9811047384
  website: www.afcp2009.com
  Download Sponsorship Form
   

Services Provided

Treatments and procedures performed in the Department of General Surgery includes the following:

Thyroid

Hemithyroidectomy, Total thyroidectomy, Completion thyroidectomy, Parathyroid, Excision of single parathyroid adenoma, Endoscopic parathyroidectomy, Total parathyroidectomy, Submandibular gland excision, Superficial parotidectomy, Total parotidectomy, Drainage of parotid abscess

Breast

Excision biopsy of breast lump, Endoscopic breast lump excision, Breast lump incision biopsy, Wide local excision of breast lump, Wide local excision of breast lump + axillary clearance, Subcutaneous mastectomy, Modified Radical mastectomy, Simple mastectomy, Microdochectomy, Drainage of breast abscess, Endoscopic excision of breast lump

Abdomen

Open & Laparoscopic Cholecystectomy, Laparoscopic Roux-en-y hepatico-jejunostomy, CBD Exploration, Open Choledocholithotomy, Distal pancreatectomy, Cyst-jejunostomy, Cyst-gastrostomy, Whipple’s operation, Distal pancreatectomy, Laparoscopic transhiatal esophagectomy, Esophageal diverticulectomy, Enucleation of leiomyoma esophagus, Radical gastrectomy, Feeding gastrostomy, Laparotomy and repair of duodenal ulcer, Laparotomy with under running of bleeding peptic ulcer pyloric exclusion, Lap assisted resection and anastomosis, Lap repair of small bowel perforation, Laparoscopic adhesiolysis, Laparoscopic assisted splenectomy, Laparoscopic Splenectomy, Ileostomy, Closure of ileostomy, Repair of small bowel perforation, Splenectomy, Closure of small bowel perforation, Jejunal stricturoplasty, Feeding jejunostomy, Duodenojejunostomy, Appendicectomy, Drainage of appendicular abscess

Colon and Rectum

Right hemicolectomy, Subtotal colectomy, Seton revision, Colovesical fistula, Rectal biopsy, Hartman’s procedure, Thiersch Wiring for rectal prolapse, Laying open of low fistula in ano, Laying open of high fistula in ano + seton tie, Seton Removal, Incision and drainage of perianal abscess, Lateral sphincterotomy, Abdomino-perineal resection, Caecostomy, Colostomy closure, Examination under anaesthesia, Laying open of high fistula in ano, Laying open of residual anal fistula & Seton removal, Excision of fistula-in-ano, Incision and drainage of ischiorectal abscess, Anal dilation, Anal canal reconstruction, Excision of perianal nodule, Digital hemorrhoidal artery ligation, Doppler hemorrhoidal dearterialization, Seton replacement, Core excision of fistulous tract, Fistula repair by gracilis myocutaneous flap, Fissurectomy, Anal polypectomy, Laparoscopic assisted colectomy, Laparoscopic assisted APR, Endoscopic Stapled Haemorrhoidectomy, Laparoscopic left colectomy, Laparoscopic assisted colostomy, Laparoscopic abdominal rectopexy, Laparoscopic anterior resection, Laparoscopic appendectomy, Laparoscopic excision of ovarian cyst, Exploratory Laparotomy + biopsy, Diagnostic Laparoscopy, Diagnostic laparoscopy converted to open laparotomy, Laparoscopic assisted excision of retroperitoneal tumour, Exploratory Laparotomy, Diagnostic Laparoscopy + biopsy, Diagnostic laparoscopy with adhesiolysis, Exploratory laparotomy with adhesiolysis, Exploratory laparotomy with repair of liver laceration, Laparoscopic extraction of abdomen foreign body, Laparoscopic deroofing of hydatid cyst, Laparotomy with TAHBSO, Laparoscopic omentectomy, Omental resection, Drainage of abscess, Ovarian cystectomy, Retroperitoneal mass,

Hernia

Open inguinal mesh hernioplasty, Mini mesh hernioplasty, Litchenstein mesh repair of inguinal hernia, Anatomical repair of hernia, Onlay mesh repair of hernia, Inguinal herniotomy, Shouldice repair of inguinal hernia, Bassini repair of inguinal hernia, Repair of femoral hernia (preperitoneal approach), Mayo's repair (double breasting) of hernia, Mesh repair of hernia, Abdominoplasty, Parastomal hernia, Mesh repair of spigelian hernia, Mesh repair of incisional hernia, Laparoscopic transabdominal preperitoneal repair of inguinal hernia, Laparoscopic intraperitoneal inlay mesh repair, Laparoscopic transabdominal preperitoneal repair of inguinal hernia, Laparoscopic transabdominal preperitoneal repair of ventral hernia, Endoscopic total extraperitoneal repair of inguinal hernia, Laparoscopic TEP repair of femoral hernia, Laparoscopic intraperitoneal onlay mesh repair, Laparoscopic Mayo’s repair with meshplasty, Laparoscopic transabdominal preperitoneal repair of incisional hernia

Urology

Nephrectomy, Nephrolithotomy, Pyelolithotomy, Extended pyelolithotomy, Retroperitoneoscopic nephrectomy, Ureterolithotomy, Orchiectomy, Orchidopexy for undescended testis, Circumcision, Excision of hydrocele sac, Debridement of Fournier's gangrene scrotum, Pyeloplasty, Palomo's operation, Testicular biopsy, Vasectomy, Eversion of hydrocele sac, Excision of epididymal cyst, Excision of haematocele sac, Laparoscopic adrenalectomy, Laparoscopic pyeloplasty, Laparoscopic pyelolithotomy, Laparoscopic ureterolithotomy, Laparoscopic ligation of varicocele, Laparoscopic orchiectomy, Laparoscopic orchiectomy,

Vascular and Lymphatics

Amputation of digits, Below knee amputation, Insertion of drain (CT Guided), Fasciotomy, Transmetatarsal amputation, Removal of infected mesh, Bullet extraction, Trendelenburg’s procedure with stripping of SV & multiple phlebectomies, Tongue biopsy, Endoscopic sub-fascial ligation of varicose veins

Skin And Soft Tissue

Excision of lump, lipoma, parasitic cyst, sebaceous cyst, ganglion, wart. Incision biopsy, Excision biopsy, Incision & Drainage, Excision of carbuncle, Lymph node biopsy, Wedge excision of ingrowing toe nail, Removal of foreign body, Repair of torn ear lobule, Exploration of sinus, Wide excision, Excision of pilonidal sinus, Drainage of pilonidal abscess, Excision and primary closure of pilonidal sinus, Secondary suturing of wound, Debridement wound, Split skin grafting, Wound Exploration

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