All posts by Prakash Agarwal

Prof HOD, Pediatric Surgery, Sri Ramachandra University. Consultant Pediatric Surgeon, Apollo Children's Hospital.

Has corona messed up our life or made it more regularised

I have a feeling nobody at present would have faced such a situation of a pandemic, which has brought all of us to a new insight of once in a lifetime situation.

As weeks pass by during the lockdown, we are getting adjusted to the present lifestyle, keeping in mind that we should be maintaining strict social distancing, follow the government orders and guidelines.

Reading through lots of social media and newspapers article has made me ponder over few questions:

  1. Are we really in a mess or we were living in a messier world?
  2. Is the suffering worth it or do we have a better world ahead?
  3. Will we be able to return back to the way we use to live or our lifestyles will change forever?

I don’t want to post too many questions and make the blog longer.

Coming to the 1st question, after reading so much and seeing changes in nature like unseasonal rain, animals walking in the streets, peacock dancing on the roofs makes me feel we were either very busy with our daily schedule to give attention or had battered nature so much that it was not possible for any such things to happen. I don’t remember exactly the last time I saw a rainbow. Yesterday the social media was full of pictures from all over showing beautiful pictures.

Beautiful view of a rainbow behind a housing complex

There is no doubt that the air is becoming more cleaner, the water in the river is less polluted and nature looks to be in harmony. The biggest hole in the ozone layer over the artic has closed. It goes on to prove that nature is correcting in its own way what we have messed up over the years.

Coming to my 2nd question and being a medical practitioner, I feel suffering is a perception and may vary from people to people. It is with regards to the disease only that I can tell and looking at the data coming up that number of deaths related to other disease have come down. I always wonder where are all the patients which use to be a part of our daily routine and used to fill our hospitals. If they are all at home hail and hearty, there can be nothing rejoicing than that. If they are in real problem, they would have definitely contacted us. If not then it will be something to ponder upon and we can know after the lockdown opens. I am very much aware of other suffering like guest labourers and economic setback which is beyond the scope of my discussion.

With regards to my 3rd question regarding our lifestyle change, it is for sure that lot of changes are expected throughout. The world will be more civilised. Masks will become a fashion rather than a taboo and people are going to be less socialising than they would like to be. Less of crowded Malls, theatres, vacation, leisure shopping. Jobs will see changes like work from home and especially for medical profession fewer attenders, less of physical examination, more usage of protective gears. Internet and electronic media may play a bigger role. 5G technology will be the need of the hour.

God has pressed the reset button to balance the nature and bring about changes in the maddening world which was moving at a hectic pace. I hope we all have learnt a lot and now know the priorities in life.

Laparoscopic Puestow’s for chronic pancreatitis in children

Chronic pancreatitis is a sequelae characterized by recurrent attacks of pancreatitis leading on to fibrosis and calcification of both ductal and parenchymal elements of pancreas. Most of these if left untreated at the right time will lead on to burnt out pancreas with complete atrophy of the parenchyma leading on to endocrine/exocrine insufficiency. The pain in such patients is most likely due to ductal hypertension, parenchymal hypertension and head mass causing perineural inflammation.

Puestows procedure (longitudinal pancreaticojejunostomy) is the surgery of choice in select patients with ductal hypertension where decompression of the duct provides symptomatic relief. Performance of such procedures in children by minimal access laparoscopic method is still evolving.

Operative technique

Under General anesthesia, supine position with legs spread out and the primary operating surgeon standing between the legs. With a slight reverse trendlenberg tilt, 10mm optical port in the umbilicus is made and two 5mm lateral working Para-rectal ports slightly above the level of umbilicus in the mid clavicular line is introduced. Pneumoperitoneum using carbondioxide is created at 10-12mm Hg.

As a first step, lesser sac was entered by opening the gastrocolic omentum with harmonic scalpel. A silk stitch was taken on the posterior aspect of stomach and is anchored to the anterior abdominal wall to facilitate retraction. Following which the anterior, superior and inferior surface of the pancreas was bared of all attachments and soft tissues. Localization of the pancreatic duct (PD) is the rate-limiting step in the entire procedure. The pancreatic duct is completely laid open with electrocautery from head region till tail. The pancreatic duct is flushed with saline after removing all the intra-ductal stones.

A 40 cm roux limb is taken retro-colic and ostomy on the jejunum corresponding to the length of the duct length using monopolar hook is made extracorporeally. A single layer side-to-side Pancreatico-jejunostomy is done using 3-0 mersilk from pancreatic head to tail.

Further Reading:

Meehan JJ, Sawin R.Robotic lateral pancreaticojejunostomy (Puestow).J Pediatr Surg. 2011 Jun;46(6):e5-8.