Tag: Dr Ravi Mohanka

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Team at Global Hospitals, Mumbai, Performs Western India’s First Total Laparoscopic Donor Hepatectomy for Transplant of a 1-Year-Old Child

Dec 22, 2020 by Rekha Nair 0 Comments #Chief Surgeon and Head of Department, #Dr Ravi Mohanka, #Dr. Anurag Shrimal, #Dr. Prashantha Rao, #Global Hospital, #Lead – Cadaveric Liver Transplant, #Lead – Pancreas and Pediatric Liver Transplant Surgeon, #Liver Transplant and HPB Surgery, #Mumbai, #Senior Consultant

Mumbai: A team led by Dr. Ravi Mohanka, Chief Surgeon and Head of Department, Liver Transplant and HPB Surgery, Global Hospital, Mumbai successfully performed liver resection by laparoscopic surgery on a 32-year-old live donor for liver transplantation and gave a new lease of life to his 1-year-old son.

A liver resection surgery is the surgical removal of all or a portion of the liver. The procedure is largely performed through a traditional open procedure. In a total laparoscopic donor hepatectomy, the surgery is done through keyhole incisions with the graft being taken out of the body through a small incision under the navel. Living donor liver transplant (LDLT) has distinctly reduced waiting list mortality and expanded access to life-saving treatment for many patients.

32-year-old Mr. Wazir Khan from South Africa donated a part of his liver (Left lateral Lobe) to his one-year-old ailing son Baby Nayum Khan, suffering from a congenital condition called Biliary Atresia, a rare disease of the liver and bile ducts that occurs in infants (1 out of every 10,000 live births) which requires transplantation. Biliary atresia is a disorder in which the biliary system (link of tiny tubular structures and ducts that drain bile from the liver to the small intestine, where it helps the digestive process) is either absent or closed. Early diagnosis of this disease is important for successful treatment. The baby underwent surgery in South Africa but failed to get any relief. Hence, the doctor suggested taking further treatment at Global Hospital, Mumbai.

Dr. Ravi Mohanka, Chief Surgeon and Head of Department, Liver Transplant and HPB Surgery, Global Hospital, Mumbai said “The patient came to us after a failed Kasai surgery for Biliary atresia. After clinical tests, the father was found to be a suitable donor and he agreed to donate a part of his liver to save his child. It was decided to perform hepatectomy (surgical removal of part or entire liver) using minimally invasive laparoscopic surgery technique. A total laparoscopic donor hepatectomy is a safe and feasible option as it has benefits that include less pain, less blood loss, less morbidity, and complications, quicker recovery, and cosmetically good for a young donor. All of these will encourage more donations.

Dr. Prashantha Rao, Senior Consultant, Lead – Cadaveric Liver Transplant, Global Hospital Mumbai, said “In open surgery, a long (approximately 15-20 cm) T shaped incision is made, and pain can be there for 2-3 years. In this patient, a minimally invasive technique was used for hepatectomy, keyhole incisions, and a small incision was made in the lower part of the abdomen for graft retrieval. Post-surgery, there is no sign of scar and the recovery period of the donor is reduced. The minimally invasive technique benefits the living donor, who experiences better postoperative recovery and a quicker return to normal life, less pain, smaller scars, and lower risk of an incisional hernia compared with traditional open surgery”

Dr. Anurag Shrimal, Senior Consultant, Lead – Pancreas and Pediatric Liver Transplant Surgeon, Global Hospital Mumbai said “Following all guidelines and protocols, Baby Nayum Khan underwent a successful liver transplant surgery. He had an excellent post-op recovery and the family will be ready shortly to travel back to South Africa”.

Health

How hospitals are managing transplants during COVID-19 By Dr Ravi Mohanka, Chief Liver Transplant Surgeon at Global Hospital, Mumbai

Sep 14, 2020 by Gouri Achary 0 Comments #COVID 19 infection., #Dr Ravi Mohanka, #Global Hospital, #transplants

COVID-19 pandemic came unannounced and has taken everyone by surprise, including the government, the healthcare industry and especially the hospitals. The anxiety related to the infection among people, frequently changing diagnosis and treatment guidelines and lack of availability of any preventive modality or effective treatment lead to the pandemic of fear.

Patients were afraid to come to the hospital for any treatment. Most patients and doctors postponed their planned surgeries, procedures and treatments for a later date. Patients on regular dialysis or chemotherapy did not have a choice of stopping treatment but had to find a way to ensure a safe way to undergo the same. Patients with a serious illness such as heart disease, stroke, liver failure and in need of life-saving operations such as angioplasty, transplants had others.

In the beginning, i.e. April 2020, all transplants in most hospitals across the country were put on hold except emergency cases. Initial studies from the western countries reported higher risk in COVID patients undergoing surgeries. Many meetings of Indian and international transplant professional societies published guidelines about which types of transplants should be undertaken, the screening and testing protocol for the patient, donor and the transplant team were outlined.

With time, the mechanism of injury in COVID-19 infection became clearer. Its effect on transplant patients has also been reported by some centres. On the other hand, in most cities the number of COVD-19 patients has been increasing, thus all hospitals have been mandated by the government to reserve a proportion of their beds for COVID-19 patients. Since transplant patients are at higher risk of infections, various hospitals had to devise mechanisms to take care of both COVID-19 patients, who are highly infectious and transplant patients who had a higher risk of acquiring infections, such as:

• Transplants were not carried out in hospitals exclusively treating only COVID-19 patients
• In hospitals taking care of both COVID-19 and other patients, there were separate pathways for entry and exit of these patients. The patients were admitted in separate ICUs and ward (floors)
• The transplant and COVID-19 teams, including nurses, technicians, doctors and other staff were separate
• In case of cadaveric (deceased) donors, the donors were tested for COVID-19 with a nasopharyngeal swab PCR and CT scan of the chest before accepting them as donors. Due to the tests, the donation would take longer (1 – 2 days) compared to the normal situation. Families of such donors have exhibited exceptional patience, resilience, and determination in helping other patients get a second chance at life.
• Each family donor and recipient were screened for their symptoms, travel history and only accepted for transplant after they were tested and found to be negative for COVID-19 infection by a nasopharyngeal swab PCR and a CT scan of the chest. The patients cared for by the hospital staff without any family members until discharge, except in children where the family member taking care of the child was also tested.
• In our hospital, the donor, recipient and the family members are also tested before discharge from the hospital.
• Any members of the transplant team that were symptomatic were tested and if positive were quarantined and excluded from transplants until the infection resolved.
• In case of cadaveric (deceased donor) transplants, patients were advised to avoid travelling from other cities those residing locally were offered an opportunity to undergo a transplant.
• The supply chain was also disrupted, and most manufacturers faced difficulties in manufacturing or distribution. Some of the units refocussed their manufacturing units to make masks, disinfectants, and ventilators.
• Cases were planned according to the availability of material and manpower, and in certain dire situations, the cooperation between hospitals, that are competitors was exceptional.
With these and many other efforts, transplants have been safely and successfully performed since May 2020 in most units with very good outcomes.