Department Manual

Department of Surgical Gastroenterology
Jawaharlal Institute of Postgraduate Medical
Education & Research
Puducherry
India
Department Manual
Department
Manual
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 0
Issue No.
1.0
Date
01/01/2016
Contents summary
History
Department profile
Mission and vision
Department policies
Organogram
Faculty and staff details
Job description
Responsibilities and role of HOD
Responsibilities and role of consultant
Responsibilities and role of senior resident
Responsibilities and role of chief resident
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Departmental administration
Policies on documentation
Services
Inpatient services
Outpatient services
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Clinical programmes
Classification of diseases and conditions
Academic schedule and review meetings
Fire safety plan
Standard operating procedures
Information materials for patients
Inpatient and outpatient statistics
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Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
19
24
Control Status
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 1
Issue No.
1.0
Date
01/01/2016
History
The department of Surgical Gastroenterology has been conceptualized with three sanctioned
faculty posts - one professor/additional professor and two assistant professors and six senior
resident posts. The Department was started on 03/03/2010 with the joining of Dr V Ranjit Hari as
Assistant Professor. Dr. Vikram Kate, Professor of Surgery was appointed as faculty in charge. Dr
Vishnu Prasad, Additional Professor in General surgery, was deputed to the department in May
2010. Dr Biju Pottakkat, joined as Assistant Professor on 30/06/2011. Dr V Ranjit Hari
resigned from the post and was relieved on 14th June 2013. Dr R Kalayarasan joined as Assistant
P r o f e s s o r o n 15/07/2013 on adhoc basis and later joined on regular basis on 26/11/2013.
Dr. Biju Pottakkat was promoted as Associate Professor on 01/07/2014 and later recruited as
Additional Professor on 09/09/2014. Dr Vikram Kate was relieved from the post of faculty in
charge and Dr Biju Pottakkat was appointed as Head of the department on 01/12/2014. Dr Sandip
Chandrasekar A joined as Assistant Professor on 02/02/2015 on adhoc basis.
Dr Alwin Gunaraj and Dr Senthil Kumar joined as senior residents on 01/06/2010.
MCh Surgical Gastroenterology course was commenced on 16/08/2011 with two sanctioned seats
per year. Dr Pradeep Joshi and Dr Salil Kumar Parida were the first MCh trainees of the
department. From January 2015, select ion of MCh candidates is taking place in two sessions one candidate each in January & July session. There are two junior residents working in the
department currently.
The outpatient clinics started during March 2010 and the inpatient facilities started with
eight general beds including two intensive care unit beds. Operation theatre services were
initiated from 02/06/2010. The dedicated surgical gastroenterology ward was begun with 16 beds on
01/08/2012. Dedicated ICU with six beds started functioning from 06/08/2012. Endoscopy
services were also initiated at the same time. Additional four general and four pay wards were included
to expand the services. Dedicated ostomy services were begun by 06/06/2013. Specialized dietary
services started on 01/11/2014. Obesity & metabolic surgery programme was started on 24/03/2015
and has been catering bariatric surgery services to those who could only dream of such
surgeries which involve high costs elsewhere. The department office commenced functioning
from 09-03-2011.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 2
Issue No.
1.0
Date
01/01/2016
Department Profile
The department of surgical gastroenterology at JIPMER was established in the year 2010
with an aim provide advanced treatment, for training and extend research in the area of surgical
gastroenterology.
The department aims to act as a leader in this domain in the country. It is
located in the JIPMER superspeciality block. It is a 32 bedded clinical unit with 3 full time
faculty, 6 resident doctors, 2 junior residents, 33 nursing staff and other supporting staff. The
department manages patients with complicated surgical problems in the GI tract and has
outpatient clinics, general and special wards, intensive care unit and operation theatre.
Superspeciality degree programme is running with two trainees per year. Regular residency
teaching programmes and continuing nursing programmes are ongoing. The department runs a
simulation laboratory, stoma clinic and a diet clinic. State of the art facilities and equipment’s are
available to fulfil the needs of complicated patients. Patient centered research in various arenas is
one of the foremost priorities of the department. The planned expansion in terms of new services,
programmes and infrastructure development are ongoing. Patients are treated at a highly
subsidized rate. Quality and safety of high order is maintained in patient care.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 3
Issue No.
1.0
Date
01/01/2016
Mission and Vision
The department of surgical gastroenterology at JIPMER is envisioned to act as the leader
in the specialty in the country. The goal is to act as a department of excellence in patient care,
teaching and research.
Patient care- The aim is to develop innovative strategies in diagnosis and treatment of
common surgical diseases in the gastrointestinal tract which are common in southern India. The
core areas include cancer of liver, chronic pancreatitis, portal hypertension and cancer of
esophagus. The innovations include new concepts in etiology, re-look in to the existing definitions
and descript ions, novel diagnostic and evaluation algorithms and new management strategies.
Existing standard operating procedures for a particular disease will be relooked and modifications
will be suggested. Developing new concepts in equipment and instrument designs will be a priority.
Teaching- The aim is to include new systems of teaching in superspeciality training.
Endoscopy and percutaneous interventions will be part of the training. Simulation methods will be
used in a big way in training the procedures. Short and long term goals of training in MCh
curriculum will be specified with due emphasis to the recent advances. Specialty nursing at the
departmental level rather than nursing college
level
will be
explored
adopting the
methodology of ‘post qualification nursing training’ and the curriculum will be developed as
‘qualified in specialty’ concept.
Research- Lacunae in available scientific information in the specialty will be kept
as a prerequisite for new research initiatives in clinical management. Research in nursing care will
be given top priority. Research into systems and practices will be performed so as to create
new models for the country in care delivery.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 4
Issue No.
1.0
Date
01/01/2016
Department policies

Quality and safety in patient care

Patient first approach in services

Inter area co-ordination

Equipment mutual sharing policy

Unit wise concept in department as well as area functioning

Transparency in concepts, plan and executions
 Policy of internal audit of systems and practices

Faculty consultant system in individual patient care

Paper less policy, electronic transfer and storage policy for information and
communication

Ecofriendly policy

Promotion of research and development in all areas

Promotion of Hindi and Tamil among staff

Policy of staff wellness

Extra mile project – work beyond duty apart from duty
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 5
Issue No.
1.0
Date
01/01/2016
Organogram
Head of Department
Senior Residents (6)
Year I (2)
II (2)
Department In-charge ANS
Medico social worker
Ward, OPD, OT, ICU,
Endoscopy Sister In-Charge
Dietician
Stoma nurse
III (2)
Junior residents (2)
Faculty: Assistant Professors (2)
Staff nurses
Store keeper
Office assistant
Multi-tasking staff
Multipurpose worker
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 6 of 94
Private Circulation only
Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 6
Issue No.
1.0
Date
01/01/2016
Faculty and staff details
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Name
Dr. Biju Pottakkat
Dr. Kalayarasan. R
Dr. Sandip Chandrasekar. A
Dr. Gourav Kaushal
Dr. Gajendra Bhati
Dr. Shahana Gupta
Dr. Kapil Nagaraj. P
Dr. Santhosh Anand. K.S
Dr. Pavan Kumar. V
Mrs. Thilagavathi. T
Mrs. Uma Prakash Babu
Mrs. Sumathy. M
Mr. Midhun K
Mrs. Priyankamol. V.C
Mr. Dhinakaran. S
Mr. Biji. K
Mrs. Mangaleshwari. M
Mr. Gopalakrishnan. G
Mrs. Kiruthigadevi. E
Mrs. Rajakumari. R
Mr. Shine. P.S
Mrs. Lanit ha. N.T
Mrs. Divya. K.S
Ms. Vyshnavi. M
Ms. Anju jose
Mrs. Neda. S
Mr. J. Muktatman Pandya
Ms. R. Yogaramya
Mrs. Indirani. M
Mrs. Aruna Sundari Devi. V.G
Mr. Mudavath R. Nayak
Mr. Binny George
Ms. Pavithra. M
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Designation
Additional Professor & Head
Assistant professor
Assistant professor
Senior Resident
Senior Resident
Senior Resident
Senior Resident
Senior Resident
Senior Resident
Assistant Nursing Superintendent
Nursing sister in charge (OT)
Nursing sister in charge (OT)
Staff nurse (OT)
Staff nurse (OT)
Staff nurse (OT)
Staff nurse (OT)
Staff nurse (OT)
Staff nurse (OT)
Nursing sister in charge (ward)
Nursing sister in charge (ward)
Staff nurse (ward)
Staff nurse (ward)
Staff nurse (ward)
Staff nurse (ward)
Staff nurse (ward)
Staff nurse (ward)
Staff nurse (ward)
Staff nurse (ward)
Nursing sister in charge (ICU)
Nursing sister in charge (ICU)
Staff nurse (ICU)
Staff nurse (ICU)
Staff nurse (ICU)
Control Status
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Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
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Ms. Saranya. S
Ms. Nithyakalyani. C
Mr. Sreevalsan. K
Mr. B. Ramshankar Naik
Ms. Tency George
Mrs. Krishnaveni. N
Mrs. Priya Grace Prakash
Mrs. Thilagavathi Sasikumar
Mrs. Vijaya Balasubramanian
Mrs. Punidavathi. A
44
Mrs. Navamani
45
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Mrs. Priyadarsini. B
Mrs. Amirthavalli. A
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Mrs. Dhilshath Begum. A
Mrs. Hena Melya
Mr. Sivasubarmanian. K.R
Mr. Lalan Kumar Ray
Mr. Ajeesh Sathyan
Ms. Saranya. R
Mrs. Ramya Esther Rani
Mr. Tamaraselvane
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Section No. 6
Issue No.
1.0
Date
01/01/2016
Transplant co-ordinator
Staff nurse (ICU)
Staff nurse (ICU)
Staff nurse (ICU)
Staff nurse (ICU)
Staff nurse (ICU)
Ostomy nurse
Ostomy nurse
Nursing sister in charge (OPD)
Nursing Sister in charge
(Endoscopy)
Nursing Sister in charge
(Endoscopy)
Technician (Endoscopy)
Nursing sister in charge (Liver
Transplant)
Dietician
Medical Social Worker
Store keeper (Office)
Multi-Tasking Staff
Multi-Tasking Staff
Office Assistant
Multi-Purpose Worker
Nursing Assistant
Control Status
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 7
Issue No.
1.0
Date
01/01/2016
Job description
Responsibilities & Role of HOD
1.
To be responsible for the overall functioning of the department
2.
To develop mission and vision for department after consulting with all staffs
3.
To be an example by setting good standards in teaching, research and patient care
4.
To take active steps in fostering cordial interpersonal relationships in the department and
ensuring that there is a smooth working relationship among all the members of the
department.
5.
To co-ordinate teaching and research programmes of the department
6.
To plan, conduct and monitor quality management systems of the department
7.
To be known for humility, transparency and integrity
8.
Conduct weekly departmental academic meetings and regular mortality and audit meetings.
9.
Conduct monthly gastro pathology and gastro radiology meetings
10.
Conduct monthly staff in-charge meetings
11.
Conduct faculty meetings once in 3 months
12.
Conduct MCh residents review meetings once in 6 months
13.
Conduct annual departmental meeting
14.
Interact with the administrators and external agencies on behalf of the department
15.
Conduct model theory and practical exam for all MCh residents annually
16.
Evolve direct ion plan and programme for the department
17.
Attend inter departmental and other meetings with administration
18.
Operate departmental funds
19.
Interact with all groups of staff to ensure smooth functioning of department
20.
Acquire, maintain and ensure optimal utilization of equipments
21.
Plan and approve capital budget requests
22.
Organize functions in department
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 7
Issue No.
1.0
Date
01/01/2016
Job description
Responsibilities & role of Consultant
1. To be responsible for the care of patients admitted
2. Supervise, guide, teach and assist the trainee residents in the care of patients
3. Supervise and guide the residents in various procedure
4. Required to teach the residents on daily rounds
5. Carry out research work
6. Participate in the departmental training program and other training courses that will enhance
personal development, skills, knowledge and practice requirements
7. Co-ordinate and moderate seminars and journal clubs
8. To ensure implementation of the quality assurance programme &conducting clinical audits.
9. Formulating Guidelines & protocols
10. Support the HOD in all management responsibilities of the department
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 7
Issue No.
1.0
Date
01/01/2016
Job description
Responsibilities & role of Senior Resident
The department admits one candidate biannually for the superspeciality degree, MCh in
Surgical Gastroenterology (SGE) through a national eligibility written test. They are considered as
temporary employees of the institute and are assigned as senior residents. They are involved in
dedicated full time surgical training, research and academic activities.
Surgical training is self-motivated and directed towards the needs of the community. They
are involved in identifying ailments relevant to GI tract and associated basic sciences. The
residents perform diagnostic and therapeutic GI endoscopic procedures, basic and advanced GI
(open and minimal access) operations independently and with the guidance of a senior surgeon.
They also undertake comprehensive GI perioperative intensive care management.
The trainees complete a dissertation during their curriculum. The conduct of this
dissertation is in accordance with institutional ethical and research monitoring committee. They
acquire basic knowledge of statistics to understand and critically evaluate published article. They
also prepare research paper for publication. Attending few lectures related to research, human
behavior studies, pharmaco-economics and non-linear mathematics are included in their training
period.
Senior residents study standard text books of GI surgery and keep updating themselves
with recent publications and journals. They have scheduled ongoing academic sessions including
monthly audit, case presentations, seminar in assigned topics and discussion of complex multidisciplinary cases. They attend national and international GI surgery conferences and update
themselves with recent advances in the field.
Residents maintain record of important activities
during the training in the log book. They also have periodic assessment of their theory and
practical knowledge.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 7
Issue No.
1.0
Date
01/01/2016
In addition, the trainees are expected to demonstrate empathy and humane approach
towards patients and their families in accordance with the societal norms and expectations. They
also play the assigned role in the implementation of national health programme, effectively and
responsibly. They acquire the ability to organize and supervise the health care services
demonstrating adequate managerial skills in the clinic/hospital or the field situation. The
residents develop skills as a self-directed learner; recognize continuing educational needs; select
and use appropriate learning resources. They evolve as an effective leader of a health team
engaged in health care, research and training by the end of training programme.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 7
Issue No.
1.0
Date
01/01/2016
Job description
Responsibilities & role of chief resident
The concept of chief residency was introduced in department of surgical gastroenterology,
so that residents will be well trained with responsibilities of a consultant and able to run a
department immediately after completion of their three year residency. Chief resident is the
resident who is in third and final year of his residency. He is virtual consultant bearing all
responsibilities of the department. He is key link between senior residents and the faculty. Chief
resident is expected to make all decisions regarding patient management and to discuss with
consultant as and when required. He is expected to involve in teaching of first and second year
senior resident and to coordinate all department and patient related work with them. Daily evening
ward round is conducted by chief resident which includes daily progress of patients presented to
him by senior residents. It includes comprehensive case by case discussion and formulation of
treatment plan on the basis of best available current evidence.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 8
Issue No.
1.0
Date
01/01/2016
Departmental Administration
Surgical gastroenterology department office
Surgical Gastroenterology office shortly called as SGE Office is located at fourth floor of
SS Block IPD, Complex No.551. SGE Office complex comprising of ten rooms viz., offices of
the head of the department, three consultants, one female doctor, one male doctor, one
seminar room, one office staff room, one data room and one stores.
Department office functions as the link between the departmental and institute
administration. All the institute and external communications are channeled through the
office. SGE -Office plays the role of back end office administration for the main wing of
the department viz- outpatient clinics, in patient facility, intensive care unit, operation theatre
and endoscopy besides auxiliary wings like stoma clinic, diet clinic, skills lab & SGE office
itself. Office administration activit ies include human resource management (HRM) of 50
personnel (including doctors, nursing staff & para medical staff), continues medical
education (CME) to doctors & nurses, conducting symposiums & training Programmes, MCh
Courses & exams etc. Three national conferences, 07 regional level seminars, 20 departmental
level training programs are conducted. Office is manned by two multitasking staff and one
assistant.
The departmental store, manned by a storekeeper, provide logistics support to above
main & auxiliary wings of this department as regards to equipments, consumables, nonconsumables, information technology infrastructures, office contingencies, etc. Store activities
include forecasting of requirements, project ion, budgeting, procurement, and technical/price bids
evaluation, receipts of stores/ equipment, storing, distributions to its wings, maintenance contracts
for equipments etc. The department hosts equipment assets to the tune of Rs.10 crores and has
been procuring consumables/non-consumable products to the tune of one to two crores every
year. A separate procurement scheme is in place for those patients covered under insurance
scheme. Surgical gastroenterology store has a model smart bin location system and also taken a
lead of compiling a partial study report on JIPMER Inventory Management System called
“JIMS” which is likely to be integrated into upcoming hospital information system.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 8
Issue No.
1.0
Date
01/01/2016
Departmental Administration
Head of the department (HOD)
The department is headed by a senior faculty in the cadre of professor or additional
professor. Dr Biju Pottakkat is currently the head of the department. The head of the
department is acting as the chief executive officer of the department. As the staff in the
department are working in diverse do mains, each faculty is allotted various areas for
the betterment of services, teaching and research. Head of the department is responsible for
all the academic and administrative activities. Clinical services are designated to individual
consultants to ensure better patient care through individualized approach. Head of the department
is the chairman of all the academic programs and courses running in the department. He is the
convener of the MCh exit examination. All research proposals need clearance from the head of
the department. As the chairman of the department purchase committee, HOD has to generate all
the purchase requirement for the department and conduct the committee meetings. HOD is the
member of institute council and infect ion control committees. HOD chairs faculty meetings, in
charge nurses meetings and
all
other meetings in the department. Head of the department
initiates system changes taking inputs from ongoing feedbacks and discussions. Annual
performance of each employee will be assessed by HOD and will be forwarded to the director.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 8
Issue No.
1.0
Date
01/01/2016
Departmental Administration
Nursing administration
36 nurses are working
in the department. Mrs. Thilagavathi. T, Assistant Nursing
Superintendent (ANS) heads the nursing services. Mrs E Kiruthiga Devi and Mrs Rajakumari R
are acting as nursing in charges in the ward and ten staff nurses are working under them. Mrs.
Indirani Mohanraj and Mrs Aruna Sundari Devi VG are heading the Intensive Care Unit (ICU)
and eight nurses are working there. Operation theatre services are supervised by Mrs Uma
Prakash Babu and Mrs M Sumathi and eight trained operation room nurses are involved in
operation theatre management. Mrs Vijaya Balasubramanian is heading the outpatient services
including ostomy care and diet clinic. Mrs. Amirthavalli is heading the liver transplant unit.
ANS oversees the systematic functioning and acts as a link with the institute
nursing administration. She acts as the representative of nursing services of the department
in all the hospital and departmental meetings. All the nursing training and academic programmes
are conceptualized and co-chaired by ANS. ANS is the in charge of nursing education and
nursing research. Interdepartmental co-operation in nursing services are ensured through ANS.
All the institute and hospital policies in patient and personnel care regarding quality
control, staff welfare etc. are communicated to all nurses through ANS. ANS convenes
nursing in charge meetings on a monthly basis and attend all the care review meetings.
Nursing in charges are responsible for overall wellbeing of the patients and ensures
smooth running of all services in their respective areas. They are actively involved in
education and training.
All store indents from department store, central store, pharmacy,
laundry and linen section are handled by in charge nurses. Duty scheduling are effected in
respective service areas by in-charge nurses. In charge nurses are responsible for implementing
all the institute guidelines like
infection control, workforce safety, JIPMER quality council
guidelines etc.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 9
Issue No.
1.0
Date
01/01/2016
Policies on Documentation
Documentation in OP chart
Only faculty and senior residents can make entries in the OP chart
Whenever a patient is seen, the date, time and name of consultant is noted in the OP chart.
List out the chief complaints, personal, past and family history. The drugs the patient is on
is listed. Any new changes are marked
A relevant clinical examination is documented
A clinical impression and a plan of management is clearly written, along with the list of
tests ordered
Other details, if applicable that are documented are: Instructions or education given to
the patient, follow up instructions, health tips and diet instructions.
Documentation of assessments in IP
Visit summary is prepared by the senior resident as soon as the patient arrives. It is
typed and print out is kept in patient file
The chief complaint and clinical examination is documented and provisional diagnosis written
A plan of action is outlined based on entries made in the OP chart/discussion with the
consultant
Blood and other investigations sent are documented
Follow up of investigations and appropriate treatment is started and documented
Treatment, investigation & patient monitoring charts are prepared for ward & ICU separately
which furnishes the necessary progress of the patient.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 17 of 94
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 9
Issue No.
1.0
Date
01/01/2016
Policies on Documentation
Discharge summary







Contains the name of all consultants & residents in department with department contact
number
Contain name of treating consultant, SGE number, Diagnosis, date of admission, date of
operation and date of discharge
Should contain visit summary
Investigations – biochemical, microbiological, radiological
Operation record
Hospital course
Plan, follow up, advice on discharge and drug slip
Discharge summary delivery procedure








Discharges are decided at least one day prior and informed to patient and relatives in
advance
The patient-in-charge doctor prepares the discharge summary by filling in details on a
typed standard format available in the department
The discharge summary has patient’s clinical history, findings, diagnosis, investigation
results, treatment given/procedure done, condition at discharge, advice on medication and
other instructions on discharge
Discharge summary also contains the details of follow up visits and whom to contact in
case of emergency
In case a patient dies in the ward a death summary is g iven stating the cause of death
Discharge summaries are prepared by resident doctors and the consultant verifies and signs
before handing over to patient and is kept in the depart mental folder for future reference
A copy of discharge summary and letter about the course of patient in hospital is send to the
referred doctor
A folder is maintained in departmental computer which includes complete detail of patient
including visit summary, discharge summary, operative photographs, clinical photographs,
representative radio logical imaging, operative videos and follow up details
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 18 of 94
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 10
Issue No.
1.0
Date
01/01/2016
Services
In-patient services
Surgical gastroenterology Ward (46/47)
Surgical Gastroenterology ward is located in the fourth floor of Super specialty block, with
20 sanctioned general beds, and four individual special pay rooms. Ward is well equipped with the
upgraded infrastructure for patient care needs, run by trained nursing staff who have special interest
in gastro intestinal care and round the clock doctors to extend the best health care support to
patients.
Infrastructure includes adjustable cots with side railings, cardiac tables,
separate oxygen
and vacuum pipelines for individual patients, water heater systems, water purification systems, cold
storage systems, non-touch infrared thermometers, separate digital weighing machines including a
200 Kg machine used exclusively for bariatric patients. Procedure room hosts an examination table
with all essential equipments. Adjustable trolleys have made transfer of patients comfortable and
safe. Also equipped with desktop computer, high definition display, printers to facilitate digital data
maintenance and cordless phones to support staff at work. With infusion pumps, pulse oximeters,
automated BP apparatus, the infrastructure is state of the art for perusal of doctors and nursing staff.
Safety mechanisms like fire safety are periodically checked and monitored. Technical and
mechanical support has always been prompt and service expedious.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 19 of 94
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 10
Issue No.
1.0
Date
01/01/2016
Services
Intensive care unit (ICU)
Surgical Gastroenterology intensive care unit shortly called as SGE ICU (146A/SSB18)
is a state of the art surgical care facility. It is situated in the first floor ICU Complex of
Super specialty Block. It is an air conditioned 6 bedded intensive care unit exclusively for
critically ill patients and post-operative patients with gastrointestinal surgical ailments. SGE ICU
provides individualized continuous medical attention. It has the facility of cardiac respiratory
monitors for each bed along with oxygen, air and suction supply. Apart from this it has three
mechanical ventilators (Carefusio n USA, Neumovent Schiller), infusion syringe pumps, aerosol
nebulizers, bair-hugger warmer & thermocare disposable warmer blankets, PCA syringe pump &
disposable ambulatory PCA pumps to manage all the needs of a critically ill patient. It also has 12
lead ECG equipment & defibrillator for cardioversion. A state of art Motorola EPOC cartridge
based portable Arterial Blood Gas (ABG) machine with blue tooth printer helps in
management of critically ill patients. The prosound HITACHI ultrasound machine helps in bed
side imaging. CT and MRI Image viewing through PACS helps for quick decision making and
interventions for critically ill patients.
Fully equipped emergency cart makes it possible to face any kind of medical
emergencies that may arise in the ICU. Appropriate storage of medicines is ensured by a 277 liter
storage capacity refrigerator. To maintain proper anti septic measures, 500ml hand rub is placed
outside entrance of ICU and its made mandatory to use hand rub for all entering inside and a
coat stand to place coats. Besides a 500ml hand rub is placed in all bedsides, segregation of biomedical wastes at source, needle burner and sharp container help to fight against hospital
acquired infect ions and ensures personnel safety. Patient’s nutritional needs are calculated by a
full time dietitian. Enteral feeding is promoted, parenteral nutrition support is provided when
needed. SGE ICU is provided with an induct ion cooker and a mixer grinder for customized food
preparation. The SGE team including the faculty rounds twice a day that helps in early
interventions and treatment planning. One senior resident is stationed in ICU round the clock.
There are totally ten staff nurses, two in charge sisters and one nursing orderly in ICU who render
excellent nursing care. Nursing rounds are done three times a day apart from continuous nursing
care.
Many standard operating procedures (SOPs) and checklists including quality rounds
checklist (QRC) are being followed. Learning atmosphere is created among staff nurses by
promoting continuing nursing education by formal presentations weekly and bed side teaching
daily. Handover protocols ensures effective information transfer during duty shifts. HIS (Hospital
information system) connectivity in ICU helps to retrieve real time information, digitalize patient
records and foster patient’s privacy. Twice daily status report of the patient’s condition will be
provided to the relatives. The Notice board outside ICU displays the ongoing events as well as
provides patient family education regarding disease conditions, management, and home care.
Resources are optimized to save the cost without compromising care, efficacy and safety. All the
events in the ICU are audited through weekly morbidity mortality meetings at the departmental
level.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 20 of 94
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 10
Issue No.
1.0
Date
01/01/2016
Services
Surgical gastroenterology operation theatre
Surgical Gastroenterology operating room (OR No. 10) is located in the OT complex in
the first floor inpatient block of super specialty block. It is a dedicated operating room
exclusively for surgical gastroenterology patients. Endoscopic procedures and percutaneous
interventions are performed in OR No 6. Operation room is functioning five days a week. This is a
centrally air conditioned modular OT with laminar flow, HEPA filters and positive air
pressure system. Temperature is maintained at 20± 3°C and humidity between 40 – 60% which
will be constantly monitored in control panel display inside the O.R suite. Two fully equipped
emergency carts and a defibrillator make possible any kind of emergency arising pre operatively
or intra-operatively to be managed effectively. Appropriate storage of medicines, blood products and
hemostatic agents are ensured by a refrigerator. Advanced anesthesia machine incorporates a
ventilator, suction unit and a cardio respiratory monitoring device. Infusion pumps, Blair hugger
patient warmer, blood & fluid warmers (Ranger and EnFlo) prevent hypothermia. HIS and PACS
are available inside OT. Myrian XP liver radiology workstation helps in virtual reconstruction and
effective contemplation of liver resections. Complex hepatopancreatobiliary, gastrointestinal and
advanced laparoscopic procedures are being performed in this department. Basic instruments,
retractors, different types of vascular and special instruments are available for performing simple
to complex cases. Recording systems are used to record the operative procedures. Stryker
modular laparoscopic console and all laparoscopic instruments are available to perform advanced
laparoscopic and bariatric surgeries. New version Harmonic generator, Ultrasonic liver
dissection workstation from Soring, Karl storz choledochoscope, radio frequency ablator and
advanced electro cautery from ALSA makes the OT state of the art. OT store ensures adequate
supply of consumables like staplers and hemostats. Focusing on patient safety and ensuring
quality, use of WHO surgical safety checklists, patient transfer slips, visible white boards
for counts, patient strapping, shifting trolleys with side rails etc. are well in practice. To prevent
infect ion, strict procedures for surgical scrubbing, gowning, gloving, and use of three layered
water resistant surgical gown/drapes are followed. Systems for segregation of bio medical wastes
at source, needle burning and containers for sharp item disposal are in use. Autoclaving, ETO and
Plasma sterilization are ensured as per protocol. Weekly washing, AC vent cleaning and
fumigation processes are being done strictly. Focusing on personnel safety, orientation sessions
on hand hygiene, infect ion control, needle stick and fluid splash injuries and hepatitis B
vaccination are conducted regularly.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 21 of 94
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Section No. 10
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Services
OT-6
OT-6 is utilized by both Medical and Surgical Gastroenterology units. It is fully equipped
with advanced endoscopic and fluoroscopic gadgets. Diagnostic and therapeutic endoscopic
procedures
including
endoscopic
ultrasound
and
Endoscopic
Retrograde
Cholangio
Pancreatography (ERCP) are done in a regular basis by Medical Gastroenterologists. Percutaneous
interventions including Percutaneous Transhepatic Biliary Drainage (PTBD) and Percutaneous
Catheter Drainage (PCD) are done under fluoroscopic guidance by Surgical Gastroenterologists.
Surgeries requiring endoscopic assistance including Intraoperative enteroscopy are done there.
Rendevous procedures combining use of endoscopic and percutaneous approach for difficult
biliary strictures, endoscopic ultrasound guided aspiration cytology and drainage, percutaneous
endoscopic gastrostomy and other advanced interventions are also being done. Protective measures
against radiation hazard are ensured.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 22 of 94
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 10
Issue No.
1.0
Date
01/01/2016
Services
Endoscopy
Endoscopy suite of surgical gastroenterology department is shared with the
department of medical gastroenterology and is situated at Room No 304 near the surgical
gastroenterology OPD. Endoscopies are routinely performed on Wednesdays and Fridays.
Endoscopy room is equipped with upper GI scope, side viewing and lower GI scope. Both
diagnostic and therapeutic scopies are performed. The therapeutic procedures include
esophageal stricture dilatation, variceal ligat ion, variceal injection, glue inject ion and biopsy.
One nurse, one endoscopy technician and one nursing assistant helps in performing endoscopies.
A recovery room is situated nearby where pat ients are kept for a while after endoscopy.
Endoscopies and therapeutic procedures are mostly performed on a day care basis without
admission. Strict asepsis is followed during the procedure. Prior appointment is given for
endoscopy.
Intervention services
Intervention services provided by the department include percutaneous drainage of
abdominal collections, percutaneous trans-hepatic biliary drainage (PTBD) and trans-hepatic
arterial chemoembolization (TACE). The department has ultrasound machine and image
intensifier. Feasible procedures are done bedside. PTBD is done in collaboration with radio logy
and TACE is done in collaboration with cardio logy. The biliary intervention procedures include
PTBD, internalization, stenting, trans-PTBD biopsy a n d stricture dilatation. The biliary
intervention procedures are being performed as pre-operative biliary drainage or permanent
palliation. Facility for metallic stenting is also available. Angiographic interventions include
TACE and trans- hepatic arterial chemotherapy (TAC). Macro aggregated albumin (MAA) scan
is done in the department of nuclear medicine before TACE to rule out significant systemic
shunting. Pre-operative portal vein embolization both through ileocolic and trans-hepatic
approaches are being performed. In patients with big tumors, pre-operative therapies help to
reduce the size of tumors so that they can be resected later.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 23 of 94
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 10
Issue No.
1.0
Date
01/01/2016
Services
Out-Patient Services
Outpatient clinic
Surgical Gastroenterology OPD (SGE OPD) is situated in the second floor of
superspeciality OPD block room No 305. Initially OPD was started with 2 working days
(Monday and Friday). From 2013 it was increased to thrice weekly (Monday, Wednesday and
Friday). In 2015, it was extended to 6 days a week (Monday to Saturday).
Working hours: Monday to Friday: 9 AM to 1 PM Saturday: 9 AM to 11 AM
The Department faculty and MCh residents takes care of OPD patients after registration
in OPD reception. Separate consultation rooms are allotted for consultants and residents. OPD
dressing room is equipped with instruments for dressings and stoma dressing room is available
to take care of stoma patients. OPD complex also has separate stoma clinic, diet clinic and
MSW clinic on all OPD days to cater needs of ever y patient. OPD is equipped with audio
visual system in the waiting hall which plays department introductory video and other health
awareness videos in local language for the benefit of patients
Procedure for admission of patient
Our department policy is to admit and evaluate patients visiting OPD if there is any
suspicion of malignancy. This is to avoid waiting period during evaluation on OPD basis.
Patients are admitted in SGE ward which is located in 4th floor of superspeciality IP block.
Patients are given choice of either general ward or special ward. General ward is completely free
and special ward is having minimal charges. Patients are admitted on priority basis with
malignancy patients getting first priority. Significant proportion of patients are transferred from
various specialities too for further expert management. Every effort will be made to borrow
beds from other departments on a temporary basis in case of shortage of beds.
Emergency admissions
Those requiring admission urgently will be admitted depending on the intensity of care
required in the ICU, General Ward or Private Ward as the case requires and availability of beds. In
case of need for emergency surgical intervention, emergency anaesthesia team is informed and
patient shifted to emergency OT in the 3rd floor of casualty block for surgery
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 24 of 94
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 10
Issue No.
1.0
Date
01/01/2016
Services
Ostomy services
The Stoma Clinic in the Department of Surgical Gastroenterology was
conceptualised and commenced from June 2013.Two staff nurses were sent for ostomy
training at Tata Memorial Hospital Mumbai in 2013 and 2014 (three months each).
Initially, stoma services were provided thrice a week. From 05.05.2014, these services are
available 5 days a week. Along with OPD services, the ostomy nurses pay daily visit s to all
stoma inpatients in the Department of Surgical Gastroenterology. They also receive direct
references from other Departments in JIPMER like Surgical oncology, Pediatric surgery,
Urology, General surgery, Radiotherapy, Medical oncology, Emergency Department, PMRC,
Neuromedicine, Neurosurgery and Gynecology for stoma care and also care of pressure
sores. The services provided by the Ostomy nurses include pre-operative stoma
counselling, stoma marking, select ion of stoma appliances, application of appliances, stoma
wash, care of bedsore and intestinal fistula management. They also provide advice to patients
with stoma during discharge for stoma care and provide follow up care. The types of stoma
managed by the team includes colostomy, ileostomy, jejunostomy, bowel fistula, duodenostomy,
caecostomy, esophagostomy and urostomy. They also manage stoma related complications like
peristomal skin excoriation and allergic dermatitis. Till date, the team has paid a total of 1613
visits to patients with stoma with a median of 3 visits per patient. 40 percent patients had
more than 5 visits. Since November 2015 Ostomy nurses have been dedicated full time to
ostomy service, provided from 7.30 am -3.30 pm. There is one ostomy nurse posted in
OPD and another ostomy nurse for IP service. On call emergency services are also available.
An Ostomy support group has also been formed recently and is scheduled to meet once in 3
months.
Their main area of services involves Superspeciality block (35%),Old block
(56%);others being EMSD,RCC,WCH,PMRC (1-3% each).The stoma in-patients are
provided with free stoma appliances. The process of provision of free appliances to OPD
patients is in the pipeline. Various activities like ostomy and wound care training
programmes, stoma product demonstration programmes and two stoma day celebrations
have been conducted by ostomy nurses in JIPME R. The team has been involved in mentoring
Ostomy clinic at Stanley Medical College, Chennai.
In future, augmentation of education material, extending advisory and training
services outside JIPMER, care of all bedsores in JIPMER, organizing monthly in service training
for other nurses and initiation of ostomy training course to make JIPMER a training centre
for ostomy care is planned.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 25 of 94
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Section No. 10
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Services
Nutritionist services
A full time Dietician is available in the SGE Department in all working days. Dietician
rounds is done once in a day regularly in SGE ICU and Ward. Separate diet order sheets are
used in ICU and
Ward
to
communicate
patients
nutritional
needs
to
the
staffs.
Assessment of patient’s nutritional status is done on the first day of admission and appropriate
intervention is carried out based on the nutritional status. Special attention is given to all
preoperative and postoperative patient’s nutritional needs by offering
nutritional support
counseling to the patients and their attenders. Diet chart are prepared according to patients
individual nutritional needs and regular monitoring is carried out to check the nutritional
intake of patient. Special blenderized feeds are prepared for achieving the nutritional needs of
enteral feeding patients.
Dietician is available in SGE OPD during the OPD days for consultation and
counseling of new cases and follow up cases.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 26 of 94
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Section No. 10
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Services
Medical social services
Medical Social worker acts as an intermediate link between the medical team and the
patients in order to make the patient at ease and well informed. The Patients, care givers and
family members are assisted to cope with problems resultant to illness and treatment through
comprehensive psychosocial support and care. The Patients are assessed for emotional
wellbeing, mental health, social support, financial problems for focused intervention. The
services
include
supportive
and
adjustment
counselling,
pre
and
post-operative
counselling, health education and clarifications on disease conditions and treatment procedures,
counseling on treatment adherence, individual, couple and family counselling, group therapy,
palliative support, crisis intervention, financial assistance, guidance on availing community
resources and referrals. The patients are regularly consulted in the OPD, the in-patients in the
ward and intensive care units are provided bedside counselling and support. Assessments and
interventions are done systematically and are being documented. Frequent surveys are
conducted to assess the patients’ satisfaction to the care delivery system.
Medical social worker ensures that the informed consent is being provided both to the
patient and the relatives in a structured way using comprehensive educational materials.
Diagnosis, the need of the operation, its antecedent advantages, possible complications, the
post-operative recovery and follow up plans are discussed in detail.
The availability of various government schemes and insurance schemes to get
treatment are appraised to the patient. They were motivated and guided to the insurance cell for
quick approval for support.
Medical social service extends to staff wellness as well. Various surveys are
conducted to assess the staff satisfaction and the departmental administration is appraised
about possible interventions.
The Medical Social Worker can be consulted in all working days in the OPD.
Research projects aimed at perception and interventional counseling are also conducted.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 27 of 94
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 10
Issue No.
1.0
Date
01/01/2016
Services
Quality and safety
Maintaining Quality and safety in patient care is one of the foremost priorities of the
department. This is continuously maintained through various mechanisms. JIPMER quality
council (JQC) guidelines in the JIPMER manual on patient safety are followed in all patient
care areas. All staffs in the department are motivated in patient safety and are given regular
training by quality managers of various domains. Standard operating procedures (SOPs),
checklists and guidelines are developed, followed and audited. WHO surgical safety checklist,
patient transfer SOP, quality rounds checklist (QRC), medication prescription-administration
chart etc. are followed.
Patient identification accuracy is maintained before all interventions. Hospital acquired
infect ions, medication safety, operation room safety, workforce safety, blood transfusion safety
etc. are given prime importance. The department has an event reporting system in which
all adverse events are recorded and reported. Root cause analysis (RCA) are done for all
significant adverse events.
The department of surgical gastroenterology was the first department to establish a
comprehensive departmental clinical auditing system in JIPMER in 2011. Electronic patient
record and data keeping are given care and precision. All the discharges are presented in
weekly morbidity-mortality meetings (MNMs). Clinical auditing is done at doctors and nurses
levels. Service area wise auditing system (OPD, ward, ICU, OT) was initiated in the year 2015.
Annual MNMs and audit meetings help us in identifying the system performance and
areas
of improvement. The department supports other departments to establish good
clinical auditing systems.
Two research studies in the area of patient safety are ongoing in the department.
Surgical gastroenterology ICU is acting as the nodal station for needle stick injury reporting and
body fluid exposure management for staff in the superspeciality block. Monthly orientation
programme on various aspects of patient safety is a regular affair. Best efforts are put in place to
maintain quality and safety of the highest order matching international standards.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 28 of 94
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 10
Issue No.
1.0
Date
01/01/2016
Services
Telemedicine and telehealth
JIPMER has been designated as Regional Resource Centre for telemedicine activities in
South India with an infrastructure of high speed (1Gbps) internet connectivity and
satellite connectivity with various
national and
international networks including
the
Telemedicine Development Center of Asia (TEMDEC), Asia Pacific Advanced Network
(APAN) and Trans-Eurasia Information Network (TEIN) which enable JIPMER, a tertiary
care Institute of National Importance, to share knowledge with different countries. Our
department participates in telemedicine programmes and webinars at frequent intervals w ith
well renowned national and international surgical gastroenterology centers.
Patient information materials and videos
Information materials are made available in departmental website for various
diseases like Anterior Resection, distal pancreatectomy, esophagectomy etc. for the benefit of
patient which includes details of various diseases, risk factors, preventive measures,
symptomatology, diagnostic measures and management options in a simple language for better
understanding. Patient information videos are being prepared for 20 common gastrointestinal
disorders in their local language.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 29 of 94
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 10
Issue No.
1.0
Date
01/01/2016
Services
Policies for assessment of patient

When patients are admitted, they are seen by a nurse and housekeeping instructions given
along with any stat orders if any

The doctor in charge of the bed or the duty doctor will see the patient as early as possible

The doctor will do an initial work up, write the care plan and the medications and send
necessary investigations required

Reports of blood investigations are available online through HIS from ward and
radio logical investigations through PACS

Dangerously abnormal results are intimated by concerned lab personal to treating resident
or consultant directly through telephone.

Patients are shown to respective consultants and plan discussed and decided in the round

Drug prescript ions are written in drug chart and it is changed daily or as and when
required.

Standard operating procedures prepared by the department according to Evidence based
surgery is used for managing the patients.

All the patient information’s are kept confidential and online access is restricted by
password

Patients are seen at least twice a day by the resident doctors. During each visit the clinical
status is recorded in the progress notes along with date, time and signature

When the concerned doctor is not available, the responsibility is handed over to another
doctor of the same unit or the duty doctor

Dietician will see, evaluate and advice diet for the admitted patient
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 30 of 94
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 11
Issue No.
1.0
Date
01/01/2016
Clinical programmes
Hepato-pancreato-biliary (HPB) surgery
The department has established itself as a center of excellence for HPB surgery in the
region of Puducherry, Tamilnadu, Kerala, Andhra Pradesh and Telangana. Benign and malignant
disorders of HPB system are being managed according to the standard operating procedure
protocol of the department. Advanced HPB surgeries performed in the department include
Hepatectomies (Major & minor) for Hemangioma of liver, Hepatocellular carcinoma, Intra hepatic
& hilar cholangiocarcinoma, Colorectal & neuroendocrine liver metastases, intra hepatic stones,
radical cholecystectomy for carcinoma gallbladder, choledochal cyst excision, common bile duct
exploration, Whipples pancreatoduodenectomy for periampullary carcinomas, head coring &
duodenum preserving pancreatic head resection, distal pancreatectomy for chronic pancreatitis,
cystoenterostomy for pseudocyst of pancreas and procedures for cystic neoplasm of pancreas,
necrosectomy for acute necrotizing pancreatitis. The energy devices required for advanced HPB
surgeries like Harmonic scalpel, CUSA, vessel sealer are available in the state of art operation
theatre of the department.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 31 of 94
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 11
Issue No.
1.0
Date
01/01/2016
Clinical programmes
Advanced laparoscopic surgery
Advanced minimally invasive surgery has been one of the thrust areas of the
department. Majority of the benign and malignant disease affecting the gastrointestinal
tract, liver, pancreas and biliary tract were managed laparoscopically/thoracoscopically in the
department. Minimally invasive surgery is the procedure of choice and no longer an
option for the majority of the gastrointestinal disorders treated in the unit. The department
is establishing itself as a center of excellence for minimally invasive surgery in the region of
Puducherry, Tamilnadu, Kerala, Andhra Pradesh and Telangana.
The department faculty received minimally invasive surgery training from best centers in
India and abroad. The operation theater is equipped with state of art full high definition
Stryker laparoscopic camera system with the video monitor. High-end energy devices like
laparoscopic harmonic ace plus probe, Enseal devices and laparoscopic CUSA are available to
perform complex laparoscopic and thoracoscopic procedures. In addition, the department is
equipped with advanced laparoscopic instruments like laparoscopic vascular clamps, flexible
trocars, gel port system, autosuture device etc. All types of laparoscopic staplers and cartridges are
available in the department.
Advanced minimally invasive procedures performed in this department include
thoracoscopic esophagectomy, thoracoscopic assisted esophagogastrectomy, laparoscopic total
gastrectomy, laparoscopic sleeve gastrectomy, laparoscopic cardio myotomy, laparoscopic
fundoplicat ion, laparoscopic retrosternal gastric bypass, laparoscopic right hemicolectomy,
laparoscopic anterior resection,
laparoscopic
low
anterior
resection,
laparoscopic
intersphincteric
resection, laparoscopic
abdominoperineal
resection,
laparoscopic
splenectomy, laparoscopic distal pancreato-splenectomy. JIPMER is one of the few centers in
India to perform the most complex laparoscopic procedures like laparoscopic
pancreatoduodenectomy and laparoscopic liver resection.
Research projects are underway to study the feasibility and significance of thoraco laparoscopic radical surgery in esophageal cancer and laparoscopic preconditioning procedures
which can minimize the complications after this radical surgery. The department had taken a
lead in minimally invasive training by conducting multiple minimally invasive surgery skills
courses for trainee surgeons, practicing surgeons and staff nurses. Basic and advanced
laparoscopic simulators including those with haptic feedback and robotic simulators were used
for these minimally invasive surgical skills courses.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 32 of 94
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 11
Issue No.
1.0
Date
01/01/2016
Clinical programmes
Obesity and metabolic surgery
Obesity is increasing in an alarming proportion and it is no longer a cosmetic concern
and is a risk factor for diabetes, hypertension, coronary heart disease and multiple
other non- communicable diseases. Although the surgery for obesity was originally developed
as a weight reduction therapy, it has been reported to improve type 2 diabetes and to reduce
rates of cardiovascular diseases and death. Hence, the term metabolic surgery is preferred over
bariatric surgery to highlight the metabolic benefits of these surgical procedures. JIPMER is
one of the few major Government institutes in the country to have an established metabolic
surgery programme.
The successful metabolic surgery program requires a comprehensive care that includes
adequate pre-operative education, nutrition and lifestyle counselling, challenging perioperative
care, as well as post-surgical support. A multidisciplinary expert team of Surgeons,
Endocrinologists, Pulmonologists, Cardiologist, Psychiatrist, Anesthesiologists and Nutritionists
ensures comprehensive care for these patients. Obesity and metabolic surgery programme was
inaugurated on 24/03/2015 by Dr S C Parija, Director, JIPMER. The department faculty trained
in advanced laparoscopic gastrointestinal surgery performs these complex operations.
The Surgical Gastroenterology operation theater is equipped with the battery
powered operation table with adequate width, weight capacity, leg separation and lithotomy
facilities. In addition a full high definition Stryker laparoscopic camera system with the video
monitor, long trocars and cannula, long laparoscopic instruments, vessel sealing systems and
endoscopic staplers are available to perform these operations. In the postoperative period these
patients are managed in a dedicated intensive care unit with real time monitoring of blood
pressure, oxygen saturation and electrocardiogram. In addition ventilators and continuous positive
airway pressure mask for the management of obstructive sleep apnea.
Currently, laparoscopic sleeve gastrectomy and laparoscopic Roux En Y gastric
bypass are the preferred metabolic surgical procedure offered to these patients. Patients are
advised to bear the cost of the consumables used in operation which is 20% of the expenses in
corporate hospitals.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 12
Issue No.
1.0
Date
01/01/2016
Classification of diseases and conditions
Organs
• Esophagus
• Stomach
• Duodenum
• Small bowel
• Colon and rectum
• Liver
• Gall bladder and biliary tract
• Pancreas
• Spleen
• Abdo minal wall
Diseases and conditions
• Esophagus- cancer, achalasia, hiatus hernia, corrosive injuries, stricture, perforation,
foreign body
• Stomach- cancer, stromal tumors, peptic ulcer, bleeding lesion , gastric outlet obstruction,
obesity
• Duodenum- cancer, ulcer, obstruction, malrotation, duplicat ion
• Small bowel- cancer, lympho ma, tuberculosis, perforation, obstruction, bleeding, fistula, and
acute appendicit is
• Colon and rectum- cancer, lymphoma, obstruction, vo lvulus, bleeding lesions, stoma
• Liver- cancer, cirrhosis, hydat id cyst, benign liver tumors, stone disease, abscess, portal
hypertension
• Gall bladder and biliary tract- cancer, benign tumors, stone disease, cholangitis
• Pancreas- cancer, benign tumors, acute pancreatitis, chronic pancreatitis , cyst
• Spleen- tumors, spleen in hematological condit ions
• Abdo minal wall and hernias- Incisio nal hernia, inguinal hernia.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 12
Issue No.
1.0
Date
01/01/2016
Classification of diseases and conditions
Surgical procedures performed
•
Esophagus- Transthoracic esophagectomy, Trans hiatal esophagectomy,
thoracoscopic esophagectomy, esophageal bypass, esophageal replacement,
laparoscopic esophageal bypass, laparoscopic cardio myotomy, laparoscopic
fundoplicat ion
•
Stomach- Radical gastrectomy, simple gastrectomy, laparoscopic gastrectomy,
laparoscopic gastric bypass, laparoscopic vagotomy
•
Small intestine - Duodenal resect ions, laparoscopic perforation closure, laparoscopic
segmental resections, laparoscopic feeding jejunostomy, laparoscopic adhesio lysis.
•
Colon and rectum- Laparoscopic right hemicolectomy, laparoscopic left hemicolectomy,
laparoscopic anterior resection, laparoscopic abdominoperineal resect ion, total colectomy,
ileal pouch anal anastomosis, sphincter preserving surgeries, stoma, stoma closure,
laparoscopic appendicetomy.
•
Liver- Right hepatectomy, left hepatectomy, trisectionectomy, segmental liver
resections, laparoscopic left lateral sectionectomy, portal vein embolization, Trans
arterial Chemo Embolization (TACE), percutaneous transhepatic biliary drainage
(PTBD), splenorenal shunts, mesocaval shunts, devascularisat ion.
•
Gall bladder and biliary tract- Laparoscopic cholecystectomy, laparoscopic CBD explorat ion,
radical cho lecystectomy, extended radical cho lecystectomy, hepatopancreatoduodenectomy
•
Pancreas- pancreatoduodenectomy, Frey’s procedure, Beger’s procedure, Duodenum
preserving pancreatic head resect ions, lateral pancreatojejunostomy, laparoscopic distal
pancreatectomy, spleen preserving pancreatectomy, pancreatic pseudocyst drainage,
necrosectomy
•
Spleen- Laparoscopic splenectomy, partial splenectomy
•
Abdo minal wall- laparoscopic incisio nal hernia repair, laparoscopic inguinal hernia repair
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 13
Issue No.
1.0
Date
01/01/2016
Academic schedule and Review meetings of the Department
Our department has regular scheduled programme for academic and monthly audit
meetings. This helps in improving scientific knowledge of the staffs and to review the
shortcomings, thereby overcoming them subsequently. The adverse events are promptly reported
and a record of such incidences are maintained.
There are various academic activities involving faculties and senior residents held in the
department. Journal club involves critical analysis of a published research paper, appraising its
limitations and finding its applicability. Seminars on selected topics, current evidence in
advances and future perspective are held in regular basis. Case presentations in a structured
format helps senior resident trainees well versed for their practical exams. Exclusive monthly
lecture by faculties provides in depth theoretical and practical concepts in particular topics.
Review of inpatients individually, their morbidities and follow up are recorded and reviewed in
monthly basis. We also have discussion of cases which have multidepartmental role in
management by conducting interdepartmental meets.
Monthly Academic schedule
Academic activity
Journal Club
Case presentations
Case capsule
Seminars
Individual patient audit meet
Mortality audit meet
Faculty lecture
Gastro Pathology meet
Gastro Radio logy meet
Numbers
4
4
3
2
1
1
1
1
1
The department monitors academic and research activities periodically, to assess progress
of senior residents. Review meetings with associated health care professionals regularly helps to
implement day to day practical shortcomings, thereby providing better patient care.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 13
Issue No.
1.0
Date
01/01/2016
Academic schedule and Review meetings of the Department
Review meetings schedule
Review meeting
Schedule
Annual department meeting
Once in a year
Faculty meeting
Once in three months
Resident progress meeting
Once in six months
Resident committee meeting
Once in six months
Sister in charges meeting (Dr Biju)
1st Friday of month
ICU meeting (Dr Sandip)
1st Tuesday of month
Ward meeting (Dr Kalayarasan)
2nd Tuesday of month
OPD and stoma meeting
3rd Tuesday of month
OT meeting (Dr Biju)
3rd Friday of month
Office meeting
4th Tuesday of month
Department quality cell
(Dr Biju)
Nursing research cell
(Dr Biju)
Once in three months
Once in three months
In addition, we have regular teaching schedules at various levels including Continuous
Medical Education (CME), Continuous Nursing Education (CNE), workshops in basic
ventilator management, infect ion control, hospital waste management, postoperative ICU care and
transfusion guidelines, which helps our staffs to stay in line with current practices according
to international guidelines.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 13
Issue No.
1.0
Date
01/01/2016
Department quality cell
Quality cell was formed in the year 2015 with the aim of improving the quality of care provided to
the patients. Functions of quality cell are
1. Reporting of adverse events in department
2. Root cause analysis & auditing of such events
3. Implementation of corrective measures
4. Implement Jipmer Quality Council protocols in department
Department quality cell meets once in three months. Members of quality cell are:
1. Dr Biju Pottakkat – Additional Professor & Head
2. Mrs. Thilagavathi. T – ANS Nursing incharge
3. Ms. Vyshnavi. M – Staff nurse (Ward)
4. Mr. Dhinakaran. S – Staff nurse (OT)
5. Ms. Pavithra. M – Staff nurse (ICU)
Nursing research cell
Research forms a major part of our nursing faculties in the department. In order to further
promote and motivate research among nursing faculties, nursing research cell was formed in the year
2014. This body meets once in three months. Research topics are selected and ongoing which
ultimately helps in providing better patient care. Members of nursing research cell are
1. Dr Biju Pottakkat – Additional Professor & Head
2. Mrs. Thilagavathi. T – ANS nursing incharge
3. Ms. Saranya. S – Staff nurse (ICU)
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 38 of 94
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Department
Manual
Section No. 13
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Co-ordination of extra departmental training and orientation programmes
Following will act as organizing secretaries
1. Basic laparoscopic skills courses for doctors
2. Advanced abdominal surgery skills courses
3. Basic laparoscopic skills courses for nurses
4. All intensive care and infection related programmes
5. All quality and care related programmes
6. All stoma and wound care related programmes
7. All nutrition orientation programmes
8. All staff and patient communication orientation programmes
Dr Sandip
Dr Kalayarasan
Sr. Uma
Sr. Indirani
Sr. Kiruthiga
Sr Priya Grace
Ms Dhilshat
Ms Hena
HOD will act as organizing chairman of all programmes. ANS will act as convener of all
programmes except 1 and 2. All organizing teams are requested to organize a minimum of four
programmes in a year aimed for JIPMER staff and outside delegates.
Simulation laboratory
Simulation laboratory in the department is one of the best in the country in surgical
simulation. The skills lab room is located in OPD hall complex near Room No 305, second floor,
OPD block, superspeciality complex. Basic laparoscopy simulation room and advanced surgical
simulation room are located in two different halls.
Basic laparoscopy simulation centre:
Equipped with three box simulators (Ethicon endo-surgery) with hand instruments for
training.
Advanced laparoscopy simulation centre:
Equipped with following:
•
•
•
•
•
•
Two laparoscopic haptic simulators- Lap mentor express
One Virtual reality laparoscopic simulator- CAE
RoSS robotic surgery simulator – first of its kind in India
Ultrasound and echocardiography simulator- CAE
Myrian liver radio logy simulation work station
Ostomy trainer
The simulation centre in the department is pioneer in the country in initiating curriculum based
simulation surgery programme.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 39 of 94
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 14
Issue No.
1.0
Date
01/01/2016
Fire safety plan- Superspeciality Block (SSB) Fourth Floor
1. Resources:
i. Human resource: All staff working in the fourth floor of SSB.
ii. Firefighting resources in the fourth floor of SSB:
a. Active:
i.
ii.
iii.
iv.
Fire alarms -smoke detectors as well as manually activated alarms.
Fire extinguishers.
Fire sprinklers.
Fire hydrants and hose reel.
b. Passive:
i.
ii.
Fire exits are provided on either side in each floor.
Emergency power back up.
2. Common meeting place at the time of evacuation:
Open ground located near the garage of the EMS department.
3. Floor plan of the Wards in the Fourth Floor of SSB (See diagram)
Prepared By
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Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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Department
Manual
•
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 14
Issue No.
1.0
Date
01/01/2016
The Ward in the fourth Floor of SSB has a main corridor leading to exit corridors on either
end – the northern end corridor has the emergency (fire) exit on the eastern end.There is also
one elevator (lift) next to the emergency exit. The southern end of the main corridor leads to
the main landing elevators (lift) and staircase. There are four cubicles, two nursing stations,
pantries, four bathrooms, toilets, and special wards on the eastern side of the corridor.
•
There are six cubicles, three nursing stations, pantries, six bathrooms, toilets and
procedure rooms on the western side.
•
There are six cubicles, three nursing stations, pantries, six bathrooms, toilets and
procedure rooms on the western side.
•
There are six cubicles, three nursing stations, pantries, six bathrooms, toilets and
procedure rooms on the western side.
•
There are six cubicles, three nursing stations, pantries, six bathrooms, toilets and
procedure rooms on the western side.
•
The main entrance to the ward is fro m its southern end where the lift s and staircase landing
are located.
•
There is an Emergency (Fire) Exit on the eastern side of the north end of the main corridor.
•
There are signs indicating direct ion of the nearest exit along the corridors.
•
The emergency exits should be opened at all times. DO NOT LOCK. If locked keys should
be easily available.
4. Fire Extinguisher location
•
Available all along the corridor of the fourth floor and in the pantries.
5. Action to be taken for containing and extinguishing fire
The senior most nursing staff on duty in the ward opposite the one where fire event
occurred and on hearing the alarm ‘Code red’ must take the measures for containing and
extinguishing fire and act as the leader of the ‘fire control team’.
She/he will:
Prepared By
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Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 14
Issue No.
1.0
Date
01/01/2016
•
Remove or direct the nearest available staff member(s)to remove patients and other persons,
valuable records and equipment to the extent possible as well as any inflammable articles in
the vicinity of the fire.
•
Close or direct closing of all windows and doors after essential items and people have been
removed
•
Call the nearest person to retrieve the nearest fire extinguisher. Operate or direct the
operation of the fire extinguisher using the ‘PASS’ technique to extinguish the fire.
•
Fire extinguisher is best carried by two persons.
•
Instruct the switching off of the electrical mains supply of that section as early as
possible after informing the ‘fire marshal’ and the ‘ward medical care team’ leader.
•
Instruct the switching off of the medical oxygen supply of that section as early as
possible after making sure from the ‘fire marshal’ and the ‘ward medical care team’ leader
that patients needing oxygen support have been shifted to oxygen cylinders.
•
Not leave the fire unattended.
•
If fire occurs in one of the pantries, treatment/ procedure rooms, store rooms, linen rooms,
lab, special wards or doctors’ / nurses’ counter or duty rooms, then the door of that room
must be closed if the fire cannot be contained after confirming that all people, valuable
records and equipment and inflammable articles to the extent possible have been
removed. There is no door in the ward, hence the question of closing doors do not arise.
•
If patient is on fire
 Follow Stop, Drop and Roll.
 Wrap the person in a blanket before rolling.
•
She / he will keep the ‘fire marshal’ informed time to time regarding the gravity of fire and
ask for fire additional fire controlling resources including material and manpower.
•
She will also inform the ‘fire marshal’ regarding the need to order evacuation in the event that
fire is not getting contained.
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 42 of 94
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Department
Manual
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 14
Issue No.
1.0
Date
01/01/2016
Evacuation procedure
•
The instruction for evacuation will be given by the ‘fire marshal’ after receiving
communication from the ‘fire control team’ that fire is not getting controlled and she / he
will assign such staff as are available for the purpose to the evacuation team.
•
A scout(s) should first check safety of evacuation route(s) and report back the safe route
available Prepare and evacuate the building by way o f the nearest emergency exit. Walk as
fast as possible but do NOT run. Do NOT use elevators.
•
The elevators (lift s) should not be used for evacuation.
•
Before exiting through any closed door, check for heat and the presence of fire behind the
door by feeling the door with the back of your hand. If the door feels very warm or hot to
the touch, advise everyone to proceed to another exit.
•
Once instructions for evacuation are given the senior most nursing staff of the ward
adjacent to the one on fire must coordinate evacuation.
•
He / she will act as the leader of the ‘evacuation team’ and keep the ‘fire marshal’ informed.
•
First all visitors and attendants of patients not in need of assistance are asked to leave the
ward immediately.
•
Next patients who are stable and ambulatory are asked to walk down the corridor to nearest
exit leading away from the cubicle on fire i.e. the main exit, the fire exit, and from there walk
down the stairs and out of the building and assemble at the ‘common meeting point’ located
near the garage of the EMS department.
•
Thereafter non-ambulatory i.e. wheel chair patients and bed bound patients (in that order)
will be physically lifted and evacuated through staircases to the third floor and thereafter,
if possible, will be wheeled out through the corridor connecting to the EMS. Use trolley /
slings made of bed sheet /blanket for carrying the patients or the patients must be physical
carried out. For this purpose at least two persons are needed to carry one patient.
Prepared By
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Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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Department
Manual
•
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Section No. 14
Issue No.
1.0
Date
01/01/2016
All hospital staff will assist the different teams and will leave last after ensuring that all
patients have been evacuated on the instructions of the ‘fire marshal’.
•
The ‘evacuation team’ leader will assign a nursing staff for coordinating with the help of
hospital security the assembly of patients, other staff and the ‘common meeting point’. Only
patients and staff shall assemble at the ‘common meeting point’. Visitors must be asked to
leave.
•
In the event you are unable to exit the building:
 Remain calm; do not panic In a smoky room or corridor remain low; crawl if necessary.
 Place a cloth, wet if possible, over your mouth to serve as a filter
 If trapped in a room signal for help from a window. Use a towel, clothing, sign etc.
•
Do not block any driveways and approach to casualty, as Fire Department personnel will
need access to these areas.
•
The cessation of an alarm/departure of the fire department is not an "all clear" to re- enter
the building as corrective measures may still be in progress.
•
Stay clear of the building until your designated Fire Safety Officer has advised you to reenter the building/area.
•
In the event of an evacuation order, the priority is to evacuate patients. Visitors must be asked
to leave even before the evacuation order. However, once all patients are evacuated, do assist
visitors in need. Visitors may not be aware of exits/alternative exits and the procedures that
should be taken during alarm situations. Employees should calmly inform visitors of the
proper actions to be taken and assist them with the evacuation.
•
At the end of evacuation a roll call must be performed by the ‘fire marshal’ to make sure that
all patients and staff having been evacuated. In case someone is left behind, the fire service
teams that would have arrived by then must be informed to take steps for their search and
rescue
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Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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STANDARD OPERATING
PROCEDURES (SOPs) FOR
DISEASES
Section No. 15
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Achalasia cardia
Achalasia cardia
Evaluation with Barium swallow/ UGI endoscopy
Low surgical risk
High surgical
risks
Laparoscopic Myotomy +Fundoplication
Medical Management
Failure
Pneumatic dilation/
Esophagectomy
Prepared By
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Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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Section No. 15
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Acute Pancreatitis
Acute Pancreatitis
USG/Serum Amylase/CECT
General: Pain relief; Fluid
resuscitation; Nutrition
(Enteral preferred); Antibiotics
(Controversial)
Non Gallstone Pancreatitis
Local Complications
Gall stone pancreatitis
Mild
Severe with cholestasis
Conservative
Pancreatic Necrosis
Peripancreatic fluid collection
ERCP +Stone
extraction
Infected necrosis
Conservative management
Delayed
Intervention
weeks)
(>4
Laparoscopic cholecystectomy
Step-Up approach
Step-Down
approach
Open necrosectomy with:
1)Closed packing 2)Open packing 3)Continuous closed postoperative
lavage 4)Programmed open necrosectomy
Percutaneous /
Endoscopic/Laparoscopic
Drainage with necrosectomy
If no improvement
Percutaneous Radiological Drainage of residual collections
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Open Surgical Drainage with
Necrosectomy
Control Status
Page 46 of 94
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Section No. 15
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Benign Biliary Stricture (BBS)
Benign Biliary Stricture (BBS)
Clinical Features: Jaundice, Recurrent cholangitis,
Portal Hypertension
Complete Blood Count, Liver Function Tests, Kidney Function
Tests, Ultrasound abdomen(USG) Magnetic Resonance
Pancreatography (MRCP), Contrast Enhanced Computed
Tomography(CECT) in cases of suspected atrophy hypertrophy
complex and malignancy
Cirrhosis
Present
Absent
Early
Late
Modified Bismuth Classification of BBS
Liver Transplantation
Types IIIB, IV& V
Types I,II,IIIA
Atrophy- Hypertrophy Complex
Roux- En Y Hepaticojejunostomy with HeppCouinaud approach
Absent
Drain all atrophic ducts
during surgery
Present
Preop biliary
stenting
Liver resection if stricture
extends into subsegmental ducts
Prepared By
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Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 15
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Benign Gastric Outlet Obstruction
Benign Gastric Outlet Obstruction (GOO)
Stomach decompression
and wash
Malnourished
/Nutritionally
depleted
Upper GI Endoscopy and antral
biopsy
Anti H pylori
treatment
H. pylori
Parenteral
nutrition
No improvement
After conservative
Treatment
Laparoscopic/open Truncal
vagotomy and Gastrojejunostomy
Endoscopic balloon
dilation
Prepared By
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Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
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Section No. 15
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Carcinoma colon
Carcinoma Colon
Non obstructed
obstructed
Contrast enhanced CT abdomen & pelvis;
Carcinoembryonic antigen (CEA), Complete blood
count, Liver & kidney function tests, Colonoscopy
Emergency surgery
Resectable (metastatic/
non metastatic)
Unresectable (metastatic/
non metastatic)
Metastatic
Non metastatic
Surgery
Resection  adjuvant
chemotherapy
Resectable
metastasis
Unresectable
Adjuvant
chemotherapy
Staged resection/
combined resection
Palliative
chemotherapy
Stoma/ bypass
Adjuvant chemotherapy
Palliative chemotherapy
Prepared By
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Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 49 of 94
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No. 15
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Carcinoma Esophagus
Esophageal cancer
Most common presentation - Dysphagia
Evaluation
UGI endoscopy and biopsy, USG abdomen and CECT neck thorax and abdomen
Carcinoma middle and
lower third esophagus and
within 5 cms of GE junction
Carcinoma upper third
(Within 4 cms of
cricopharynx)
Severe dysphagia (grade III- VI)
Definitive chemo radiation
Feeding jejunostomy
Fit patient
Unfit patient
Neoadjuvant chemoradiation
Reassessment with CECT scan
C T 1-3/ N 0-1, MO
T4,N2-3,M1
Esophagectomy
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 50 of 94
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Section No. 15
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Carcinoma Rectum
Carcinoma Rectum
Non- obstructed
Obstructed
Sigmoid colostomy
CECT abdomen & MRI
pelvis, CXR, CEA
Contrast enhanced CT
abdomen & MRI pelvis,
CXR, Carcinoembryonic
antigen
Metastatic
Early cancer/ lymph node
negative on imaging
Neoadjuvant
chemoradiotherapy
Lymph nodes +/ locally
advanced
Surgery
Surgery
Neoadjuvant
chemoradiotherapy
Unresectable
Resectable
Surgery
Neoadjuvant
chemotherapy
Palliative
chemotherapy
Surgery for primary & metastasis: combined or staged
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 51 of 94
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Department
Manual
Section No. 15
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Carcinoma Stomach
Carcinoma Stomach
Upper GI endoscopy/ CECT abdomen and pelvis
No metastasis
Metastasis
SymptomaticBleeding/obstruction
Asymptomatic
Palliative
Resection/bypass
Palliative CT
Site
GE junction and the
Cardia
Proximal Gastrectomy
with partial
esophagectomy
Body and fundus
Total Gastrectomy
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Antrum and pylorus:
Distal Gastrectomy
Control Status
Page 52 of 94
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Section No. 15
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for CBD Stones
Choledocholithiasis +Cholelithiasis
Evaluation by USG/MRCP
Laparoscopic
cholecystectomy +IOC/LUS
Open Surgery
Jaundice,cholangitis
Multiple
stones/Dilated
CBD/impacted
ampullary
stones/ampullary
stenosis
ERC/ES
CBDE/T Tube
Transcystic CBDE
Retained
stones
Choledochoduodenostomy
Laparoscopic
choledochotomy and CBDE
Remove via TTube
Laparoscopic
cholecystectomy
Multiple(>8) or
large (>1cm)stones;
stones in CHD
Debililated or elderly
patient
Failure/Retained stones
Follow up
Postoperative ERC/ES
Open CBDE
CBDE: Common Bile Duct Exploration; ERC:Endoscopic retrograde cholangiography; ES:Endoscopic
Sphincterotomy; CHD: Common Hepatic Duct; IOC: Intraoperative cholangiography; LUS: Laparoscopic
Ultrasound
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 53 of 94
Private Circulation only
Section No. 15
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Chronic Pancreatitis
Established Chronic Pancreatitis
Trail of conservative therapy, analgesics, alcohol
avoidance & enzyme replacement therapy
Persistent symptoms
Additional symptoms / Complications
Differentiate duct morphology by
USG abdomen or CECT abdomen
Small duct disease
- More aggressive pain
management
- Izbicki procedure
Large duct disease
- Duct drainage procedure
mostly Frey’s procedure
Only tail involved
- Distal pancreatectomy
+/- splenectomy
Symptomatic
pseudocyst
Bile duct stricture
– LFT, MRCP
Pancreatic head mass –
Pancreatic protocol CT
Pseudoaneurysm –
CT angiogram
Cystogastrostomy /
cystojejunostomy
usually with added
duct drainage
Roux-en-Y
Hepaticojejunostomy
with Frey’s procedure
Malignancy / suspicious of
malignancy / head
dominant disease Pancreatoduodenectomy
Massive GI bleed angioembolization
followed by Surgery
later
Persistent pain
even after Surgery
Pain management, celiac
plexus block
Portal
hypertension
Endoscopic duct
drainage preferable
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Pancreatic ascites
and pleural effusion
Bowel rest, parenteral nutrition
and octreotide
Control Status
Page 54 of 94
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Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Corrosive Injury Esophagus
Corrosive Injury Esophagus
Early admission (48-72hrs)
Late admission (> 3 weeks)
Delayed admission
(72hrs- 3 weeks)
Early Endoscopy
Endoscopy
and dilation
No endoscopyFJ- if severe
dysphagia
Mild lesions
Severe lesions
Endoscopy +/dilation every
3 weeks
Discharge and
follow up
Feeding
jejunostomy
Successful
Endoscopy +/dilation every
3 weeks
Endoscopy
Follow up
Unsuccessful
Feeding
jejunostomy
Esophageal
bypass
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 55 of 94
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Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Crohns disease
Crohn’s disease
Medical management [e.g.
Budesonide/ 5-aminosaliclic acid
(5-ASA) and its derivatives]
Remission
Complications:
obstruction, abscess,
perforation
Moderate to severe
Mild to moderate
Systemic steroids +/_
azathioprine, 6mercaptopurine (6MP)
Surgery
No remission
Maintenance 5ASA/
observation
Remission
Relapse
No remission
Maintenance
azathioprine, 6-MP,
methotrexate, 5-ASA
Relapse
Anti TNF alpha +/_
Azathioprine/ 6-MP
Remission
Newer biological agents/ surgery
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Relapse
Maintain on Anti TNF
alpha, azathioprine/ 6MP
Control Status
Page 56 of 94
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Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Esophageal Perforation
Signs and symptoms of esophageal perforation
Contrast esophagography /chest X ray and CECT
Contained perforation
Uncontained perforation
Broad spectrum antibiotics
and parenteral nutrition
No
improvement
<24 hrs
Cervical
Thoracic
Abdominal
Drainage
Surgical repair tolerable
Evaluation of perforation
Surgical repair Intolerable
Malignancy
Primary repair
Controlled fistula
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Exclusion and diversion
Resection
Control Status
Page 57 of 94
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Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for GERD
GERD symptoms
Atypical GERD symptoms
Typical GERD symptoms
Esophagogastroduodenoscopy (EGD), Barium
swallow +/- Reflux Scintigraphy study
Symptoms persist
Life style modification
& trail of Proton pump
inhibitors (PPIs) +/Prokinetics
Symptoms resolve
Associated with
dysphagia /chest
pain
No esophagitis
or reflux
Manometry + / esophageal motility
scintigraphy studies
GERD complications
like Barrett’s
esophagus, Peptic
stricture
24 Hr – pH
monitoring
Continue life style
modification and taper
PPIs
If symptoms recur - EGD,
Barium swallow +/- Reflux
Scintigraphy study
Associated motility
disorders, then treat
accordingly
GERD present
No GERD
Seek alternate
diagnosis
Antireflux surgery + / Hiatus hernia repair
Maintenance therapy
with PPIs
Option of antireflux surgery
considered even if medical
management is successful
(quality of life considerations,
lifelong medication, expense
of medications etc.)
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 58 of 94
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Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for GIST
GIST
Primary GIST,
Resectable
Primary GIST,
Unresectable
Primary GIST,
Metastatic
Recurrent GIST
Imatinib therapy
Biopsy
Biopsy
Surgery
Neoadjuvant
Imatinib therapy
Low risk of
recurrence or
metastases
(<3 cm and
<5 mitoses/ hpf)
Imatinib therapy
Moderate to high
risk of recurrence
or metastases
( >3 cm or >5
mitoses/ hpf)
Responsive
Progressive
Imatinib +/_
Surgery
Sunitinib
Reimaging
Surveillance
Imatinib therapy
Resectable
Unresectable
Surgery
Imatinib therapy
Imatinib therapy
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 59 of 94
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Department
Manual
Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Ileo caecal tuberculosis
Ileocecal Tuberculosis
Non- obstructed
Obstructed
X ray abdomen, CXR,
baseline blood
investigations,
resuscitate
CXR; Sputum AFB &
culture
Sputum
AFB/culture- +ve
AFB Negative
Emergency surgery:
Resection anastomosis/
stoma
CECT abdomen
with oral and rectal
contrast
IC thickening
Yes
No
Colonoscopy
& biopsy
Negativee
Diagnostic
Laparoscopy
& biopsy
Anti tubercular
treatment
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 60 of 94
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Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Lower GI bleed
Acute lower GI bleed
Ruleout upper GI bleed by
esophagogastroduodenoscopy
Ruleout low anorectal disorders by
DRE and proctoscopy
Intermittent or mild to moderate
persistent bleed
Persistent or severe acute bleeding
Assess severity &
Resuscitate
Unstable
Stable
Emergency surgery
Colonoscopy
Source not identified,
continued bleeding
Source
identified
Source not
identified
Treat lesion
accordingly
Serial clamping or
Intraoperative
enteroscopy and
identification of
lesion – treat
accordingly
Tagged RBC scan
Positive
Angiography and
embolization or
surgery
Negative
Repeat Colonoscopy,
small bowel studies &
CECT abdomen
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 61 of 94
Private Circulation only
Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Liver Abscess
Suspected liver abscess
USG abdomen*
U
Un-ruptured
Ruptured


Free peritoneal rupture
Peritonitis
Contained rupture


Per cutaneous drainage
(PCD)/ percutaneous needle
aspiration (PNA) of the
abscess
PCD of collection if not
communicating with abscess
Surgery
 Laparoscopy
 laparotomy
Pyogenic liver abscess (PLA) likely
 When secondary biliary causes
identified
 Recent biliary intervention
 Multiple small abscesses
 Negative amoebic serology
 Positive culture
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Start empirical antibiotics against gram
negative and anti amoebic drugs (eg- third
generation cephalosporins + Metronidazole
or ampicillin + aminoglycoside +
Metronidazole)
Amoebic liver abscess (ALA) likely
 Single large abscess
 Recent history of diarrhea/
Dysentery (within 6 months)
 Stool for ova cyst positive
 Nested PCR for E. Histolytica
DNA positive in stools/ saliva/
pus aspirate (if done)
 Positive amoebic serology
(poor positive predictive value
in India)
Control Status
Page 62 of 94
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Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
ALA
PLA
Indeterminate
etiology
Continue anti amoebic drugs
Early drainage of abscess
 PNA if multiple small
abscesses < 5 cm in size
 PCD if abscess > 10 cm
 For abscess 5- 10 cm both can
be used with more likelihood
of multiple procedures with
PNA
 Identify secondary causesadditional investigations as
indicated*

Improvement





Culture based antibiotics for 23 weeks
Treat secondary causes if
present



Metronidazole for 2 weeks
Luminal amoebicide (eg
diloxanide furoate) for 10 days
No improvement in 3-4
days
Impending rupture (<
1mm overlying liver
parenchyma)
Subcapsular/ contained
rupture
Secondary bacterial
infection suspected
> 10 cm size especially
in left lobe
Abscess drainage
 PNA if small abscess <
5 cm in size
 PCD if abscess > 10 cm
 For abscess 5- 10 cm
both can be used
Inability to positively identify
any of the two types
 Continue empirical
antibiotics and anti amoebic
drugs for 2 weeks followed
by luminal amoebicides
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 63 of 94
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Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Liver space occupying lesion (SOL)
SOP-Liver SOL
Complete Blood Count, Liver Function Tests, Kidney Function Tests, Serum
.alphafetoprotein, Upper Gastrointestinal Endoscopy, Ultrasound abdomen,
Triple phase Computed Tomogram abdomen
Typical features of Hepatocellular
Carcinoma (HCC) on imaging
Atypical features on imaging
percutaneous biopsy
Typical features of Non HCC
tumor on imaging
Follow HCC Protocol
Follow Non HCC Protocol
HCC Protocol
Features of chronic liver disease
Present
CPT score >8 or S.
Bilirubin > 2 mg% or
FLR< 80%
Absent
FLR <30%
FLR>30%
CPT score < 8
and FLR>
80%
Can Tolerate Major
surgery
Good performance
status
No
Yes
Present
Absent
Lesions size
TransarterialChemoem
bolisation
Resection
> 5 cm
supportive therapy
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
< 5 cm
Radiofrequency
Ablation(RFA)
Control Status
Page 64 of 94
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Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Liver SOL – Non HCC
Non- HCC Protocol
Asymptomatic
benign lesions
Symptomatic
benign and
premalignant
lesions
Metastasis in
liver
Intrahepatic
cholangiocarcinoma
Chest XRay,
Serum.CEA
Observe
Liver only mets with Resectable primary
colorectal ca and genitourinary malignancy
Surgery for primary malignancyand
5 FU based Chemotherapy for
colorectal ca
Unresectable colorectal
primary or otherprimary
sitewith liver metastasis
Functional liver Remnant (FLR)>30%
Fit for major surgery
FLR<30%
Performance status
Good
Yes
Poor
No
Resection
Palliative
chemotherapy
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Supportive therapy
Control Status
Page 65 of 94
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DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No.
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Liver Trauma
Liver trauma
Initial resuscitation
Grouping and cross matching
Unstable
Stable
Associated injuries requiring surgery
(eg. Hollow viscus perforation)
Operating room
CECT
Isolated liver injury
No contrast blush
Contrast blush present
Conservative management
 ICU care
 6 hourly hemoglobin estimation
 Heart rate and blood pressure monitoring
 Watch for compartment syndrome/ peritonitis
 Watch for sepsis
Successful
Clinical deterioration
Unsuccessful
Angioembolisation
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 66 of 94
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Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Morbid Obesity
BMI >40 kg/m2 or BMI >35 kg/m2 with an associated medical comorbidity worsened by obesity







Failed dietary therapy
Psychiatrically stable without alcohol dependence or illegal drug use
Knowledgeable about the operation and its sequelae
Motivated individual
Ambulating patient
Prader-Willi syndrome ruled out
Age group (> 18yrs & < 65 yrs)

Cardiovascular evaluation
•
Pulmonary assessment - obstructive sleep apnea, reactive asthma, pickwickian syndrome






Renal function.
Musculoskeletal conditions
Diabetes control
Clinical examination for umbilical or ventral hernias
USG abdomen to R/O cholelithiasis
UGIE to R/O GERD, Barrett’s & Hiatal hernia
BMI > 50 (Super Obese)
YES
MALABSORPTIVE PROCEDURE
1) Biliopancreatic diversion
2) Duodenal switch
NO
Failure of surgery
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
RESTRICTIVE PROCEDURE
1) Sleeve gastrectomy
2) Roux en Y gastric byepass
Control Status
Page 67 of 94
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Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Portal hypertension
Complete Blood Count, Liver Function Tests, Kidney
Function Tests, UpperGI Endoscopy, Ultrasound abdomen,
Doppler Ultrasound portal axis
Portal cavernoma
Present
Absent
Extrahepatic Portal Vein Obstruction (EHPVO)
Chronic Liver Disease(CLD),Noncirrhotic Portal Fibrosis(NCPF)
Moderated to massive
splenomegaly
Computed
Tomogram(CT)portovenogra
m if portal venous anatomy
not clear or Portomesenteric
venous thrombosis suspected
or pseudoaneurysms in the
portomesenteric circulation
or if Rex shunt is planned
Present
NCP
F
Patient on chronic
endoscopic therapy
for varices
Symptoms of
hypersplenism and
no Varices
Absent
CLD
If varices
,endoscopic
therapy for
variceal
eradication
Splenectomy and
introp portal
pressure
If portal pressure> 12
cm H2O
Left portal vein > 3
mm in EHPVO
Diffuse splanchnic
venous thrombosis
Prepared By
Rex shunt
Compatible splenic
vein anatomy
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Gastroesophageal
devascularisation
Assistant
Professor
Proximal Splenorenal
Additional
Professor
Shunt
& Head
If portal pressure <12
cm H2O, Observe
Spenicvein not
available but patent
SMV or portal vein
Control Status
Interposition mesocaval or
portocaval shunt
Private Circulation only
Page 68 of 94
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Section No.
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Rectal Prolapse
Rectal Prolapse
Clinical Features: mass protruding per anum, mucus discharge per anum,
difficulty in evacuation of stool, History of constipation, history of prolonged/
difficult labour
Complete Blood Count, Liver Function Tests, Kidney Function
Tests, Examination in squatting position,
History of constipation
Absent
Present
Laparoscopic mesh rectopexy
Laparoscopic anterior resection
and mesh rectopexy
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 69 of 94
Private Circulation only
Department
Manual
Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operating Procedure for Surgical Obstructive Jaundice
Painless progressive jaundice
Associated with anorexia/weight loss
Short duration of symptoms
No
Yes
Suspect malignant
cause cause
Suspect benign cause
Initial investigation: liver function test and ultrasound abdomen
- To confirm obstructive nature of jaundice, to identify etiology (benign
or malignant), if malignant - level of obstruction (lower end or hilar) and
stage the disease
Choledocholithiasis
ERCP & stone extraction
followed by laparoscopic /
open cholecystectomy Or
laparoscopic / open
cholecystectomy with CBD
exploration
Malignant lower end
obstruction and no evidence
of metastasis
Malignant hilar
obstruction
Follow treatment
algorithm for lower end
obstruction
Follow treatment
algorithm for malignant
hilar obstruction
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 70 of 94
Private Circulation only
Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operative Procedure for Malignant lower end obstruction
Malignant lower end
obstruction – periampullary
and pancreatic head carcinoma
Assess indications for biliary drainage
– cholangitis, severe malnutrition and
Total bilirubin > 15mg/dl
Yes
No
Dual phase CECT (Pancreatic protocol)
or MRI with MRCP for accurate
staging followed by ERCP & stenting
Side viewing endoscopy +/- biopsy
followed by cross sectional imaging
with CECT or MRI abdomen
Metastatic disease
Rescetable disease
Locally advanced disease
Palliative therapy metallic biliary stenting or
triple bypass
Pancreatoduodenectomy
Neoadjuvant
chemotherapy therapy
and reassess with imaging
If unresectable disease
If resectable disease
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Control Status
Page 71 of 94
Private Circulation only
Department
Manual
Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operative Procedure for Malignant hilar obstruction
Malignant hilar obstruction
Assess for resectability using
Triple phase CT abdomen or MRI
with MRCP abdomen carcinoma
Rescetable disease
Unrescetable disease
Assess indications for biliary drainage –
cholangitis, severe malnutrition, Total bilirubin
> 10mg/dl and prolonged jaundice > 4 weeks
irrespective of bilirubin level
Palliative biliary drainage
No
Yes
ERCP and stenting if hilar confluence is patent,
PTBD if hilar confluence is not patent
Adequate > 40 %
Surgical resection
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Assess future liver
remnant
Inadequate < 40 %
Portal vein embolization
Control Status
Page 72 of 94
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Section No.
DEPARTMENT OF SGE
JIPMER, PUDUCHERRY
Department
Manual
SGE/JIPMER/DM/01
Issue No.
1.0
Date
01/01/2016
Standard Operative Procedure for Ulcerative colitis
Ulcerative colitis
Complications
e.g: perforation,
massive
hemorrhage or
toxic megacolon
Moderate to severe
Mild to moderate
severity
Proctitis
Extensive
Left sided
Oral 5- ASA
Aminosaliclic acid
(ASA) suppositories
Urgent surgery: total abdominal
colectomy and end ileostomy 
ileal pouch anal anastomosis
(IPAA) at later stage
Response
yes
yes
Rectal 5-ASA
maintenance
NO
NO
Oral 5- ASA
maintenance
Surgery: Total
proctocolectomy and ileal
pouch anal anastomosis
Oral steroids
Yes
Response
Taper steroids,
consider oral 5ASA
NO
Cyclosporine or
infliximab
Prepared By
Approved By
Dr. Sandip Chandrasekar. A
Dr. Biju Pottakkat
Assistant Professor
Additional Professor
& Head
Refractoriness/ dependence/ toxicity
to medical therapy or carcinoma/
DALM
Control Status
Page 73 of 94
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