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Questions related from Rangarajan M
Dysphagia after fundoplication: are we blaming a tight wrap only? Waht about a tight cruroraphy?
last month 6,659 0 View
Traditionally, the crura are sutured together below the OG junction. However, the location of the hiatal hernia is always above the OG junction. So should we not perform the cruroraphy above the...
06 August 2025 2,497 5 View
Logically, a migrated wrap is due to a failed crural repair. So why not simply reduce the migrated wrap, mobilize adequate length of esophagus into the abdomen and close the crura securely?
06 August 2025 3,811 1 View
The endoscopic sleeve mimics the gastric suture plication technique, which fell out of favour. So what's the logic or principle behind the endoscopic sleeve?
19 August 2019 7,709 0 View
Some surgeons anchor the sleeve with several interrupted stitches along the 'new' greater curve to the omentum, with the hope that this will prevent torsion. Should this be routinely done in all...
11 August 2019 1,826 1 View
According to literature, if the goiter is abutting the aortic arch, a sternotomy is indicated. In my experience of 8 cases over many years, there were no sternotomies. I was able to perform a...
13 June 2019 1,167 3 View
I have a morbidly obese patient who is due for a gastric bypass. He also has severe GERD due to a hiatus hernia. I know that reflux symptoms improve just by doing the bypass and weight loss...
28 February 2018 2,247 10 View
I have read only contradictory commentaries on this subject - should cholecystectomy (for confirmed gallstones, not routine prophylactic) and hiatal hernia repair be done along with gastric bypass...
06 December 2017 3,568 17 View
After creating the gastric pouch, a single anastomosis (GJ) is done with a 200 cm loop of intestine. Then do a jejunostomy (Braun type), connecting the afferent loop with the efferent loop. This...
13 June 2017 1,022 5 View
I have a patient with typical reflux symptoms in whom adequate medical management has failed. So I'm planning fundoplication for her. Since she also complained of a "choking sensation" after...
05 October 2016 4,161 8 View
This is for a patient with severe GERD with previous ischemic heart disease, so anti-reflux surgery needs to be done at the shortest time possible to avoid anesthesia complications
31 July 2016 7,694 7 View
Currently, bariatric & metabolic surgeons offer surgery for remission of DM in 'poorly controlled' T2DM patients. What exactly is 'poorly controlled' DM? Are there any guidelines?
18 September 2015 7,278 7 View
After the introduction of duodeno-jejunal bypass as a simpler alternative to other malabsorptive procedures, it seems to be very similar to the mini-gastric bypass described by Dr.Rutledge in...
18 September 2015 5,711 9 View
Literature is rife with many surgical techniques for obese diabetics. Is duodeno-jejunal bypass + sleeve gastrectomy superior to Roux-en-Y gastric bypass regarding T2DM control ?
16 September 2015 8,881 5 View
Sleeve gastrectomy by itself gives reasonable T2DM control in obese diabetics. So then what is the indication for adding a duodeno-jejunal bypass to sleeve gastrectomy ? Will it provide better...
16 September 2015 4,271 6 View
Recently, I've been using a single Hem-o-lok clip to secure the appendicular base following single-site-two-trocar appendectomy. So far, I've had no complications in the short-term. Any thoughts...
14 May 2015 5,098 12 View
Is the term 'paraumbilical' hernia redundant ? If a defect is present within the umbilicus, its termed''umbilical' hernia. Any other defect anywhere else on the anterior abdominal wall is called...
23 January 2015 9,195 5 View
Many of you would have performed many incisional hernia repairs, some specialists even in the thousands. Ever wonder why the defects are always circular ? .
02 December 2014 2,482 24 View
Is it enough to resect only the redundant sigmoid colon, or resect the entire sigmoid or anything more?
26 August 2014 3,791 16 View
The current recommendation is that mesh size should be calculated with a 5cm margin all around from the defect edge. So if defect size is 4cm, mesh size should be (5+4+5) 14cm. Now this means the...
14 August 2014 2,122 19 View
Traditionally, we use a 11 x 6cm in open hernia repair. In laparoscopic repair, most surgeons use one of these sizes: 15 x 10cm, 15 x 12cm or 15 x 7.5cm. The recommendation is to adequately cover...
07 August 2014 8,080 27 View
I have a 25-year-old patient who underwent laparoscopic appendectomy for a ruptured appendix with peritonitis 9 days ago. He still has not opened bowels, has abdominal distension and one episode...
07 August 2014 6,331 16 View
The common methods to secure the base are: single endoloop (in laparoscopy) application double endoloop (in laparoscopy) application purse-string suture primary simple closure to bury the...
15 July 2014 7,495 40 View
I'm sure this situation arises more often than not in all surgeon's practice. Typically, these burns leave a 'whitish' mark on the serosa. In my experience, I keep observing these injuries once...
18 June 2014 4,552 31 View
Several dedicated centers have published data regarding this, but our diabetology friends beg to differ. Any (unbiased!) thoughts?
02 April 2014 8,145 8 View
After disconnecting the uterus, I think suturing is faster and easier if its done transvaginally. Laparoscopy & CO2 insufflation times can be reduced as well. Is there any specific advantage of...
28 March 2014 7,472 14 View
There are several articles in the literature on this subject (including publications by many members of ResearchGate): some studies say it is beneficial while others differ. So definite...
20 March 2014 2,959 4 View
Transhiatal esophagectomy was championed by American Dr. Orringer since 1976. The issues were: inadequate field exposure; inadequacy of node clearance, use of blind & blunt dissection & (rarely)...
14 March 2014 4,560 15 View
With an increased incidence of APD, more and more patients are taking long-term PPIs. However, there is recent evidence that long-term PPIs can cause renal damage, more so in diabetics. Can...
12 March 2014 5,815 2 View
