The department of Minimal Access and General Surgery of GMC Srinagar has always been on the forefront and first in Laparoscopic surgeries conducted around the state. In this perspective a new procedure of Bariatric surgery titled SLEEVE PLUS surgery which is a new entrant in the menu of Bariatric surgery was recently performed by the team of surgeons and anaesthetists. The patient was discharged safely with the positive outcome of weight loss and metabolic problems.

Another milestone was laid by the same team of surgeons and anaesthetists couple of days before in laparoscopic oncosurgery making it possibly one of the rarest surgeries performed laparoscopically worldwide. Probing the literature in this regard makes Government Medical College Srinagar among very few institutions in the world to contemplate this extensive oncosurgery in the shortest span of time, which is good for the total outcome of patient safety. The surgery was performed by Prof. Dr .Mushtaq Chalkoo, Prof. and HOU of minimal access surgery and his team coupled with the team of Anaesthesia headed by PROF. Dr.Hina Bashir and consultant anaesthetist Dr. Mushtaq Ahmad Rather . The surgery lasted for 5 hours and ended successfully with one unit of blood transfusion, making it possibly the first successful laparoscopic advanced tumour surgery in the shortest span of time.
A 60-year-old postmenopausal female with no known medical comorbidities, hailing from Kishtwar, was referred to us and presented to the OPD with complaints of right lower abdominal pain for the past 6 months and significant weight loss for 4 months.
On general physical examination, the patient was hemodynamically stable. She had post-inflammatory hyperpigmentation secondary to a fixed drug eruption. Chest and cardiovascular system examinations were unremarkable.
On abdominal examination, a vague lump measuring approximately 3 × 3 cm was palpable in the right lower abdomen. It was non-tender, had an irregular surface, was non-mobile, and its margins were not well defined.
Biochemical parameters were within normal limits except for haemoglobin (7.7 g/dL) and serum albumin (2.9 g/dL). Tumour markers showed CEA of 8.5 ng/mL and CA 19-9 of 43.15 U/mL.
Ultrasonography of the abdomen and pelvis revealed heterogeneous solid areas in close relation to the liver, measuring 37 × 48 mm, with the growth extending into the right iliac fossa.
CECT of the abdomen and pelvis showed that the second part of the duodenum was dilated, measuring 8.5 cm (craniocaudal) × 6.5 cm (transverse). A large solid enhancing mass was seen along the lateral and posterior aspect of the dilated second part of the duodenum. The medial wall appeared normal. A polypoidal mass arising from the right lateral wall of the duodenum was seen extending into the adjacent high/subhepatic cecum, which had a thickened wall, with a possible communication between the lumen of the duodenum and cecum. Multiple enlarged mesenteric lymph nodes were noted, the largest measuring 10 mm in diameter. No ascites or retroperitoneal lymphadenopathy was seen.
Triple-phase CT abdomen showed circumferential enhancing soft tissue thickening involving the cecum, fistulating with the second part of the duodenum and extending into the lateral duodenal wall. Mild ascites was present. The cecum appeared pulled up and was located in a subhepatic position.
Upper gastrointestinal endoscopy (UGIE) revealed an ulcero-proliferative growth in the second part of the duodenum (D2), starting from the D1/D2 junction. Another stalked 2 cm polyp was seen in D2, just distal to the growth.
Lower gastrointestinal endoscopy (LGIE) showed an ulcero-proliferative growth at the hepatic flexure causing luminal narrowing; however, the scope was negotiated beyond the lesion.
Duodenal biopsy revealed features of adenocarcinoma with areas of mucinous differentiation.
The patient was taken up for diagnostic laparoscopy followed by laparoscopic Whipple’s procedure with D3 right hemicolectomy. Postoperative period was uneventful.