#hpbsurgery

How a Complex Whipple's Procedure with Portal Vein Involvement Was Successfully Performed in Pune

Pancreatic cancer involving major blood vessels is considered one of the most technically demanding surgical challenges in HPB surgery. When a 60-year-old gentleman was diagnosed with pancreatic cancer involving the portal vein and abutting the Superior Mesenteric Artery (SMA), most surgeons would consider it extremely high risk. Dr. Manoj Dongare, a leading HPB and Liver Transplant Surgeon, took on this challenge and delivered a successful outcome.

The Patient and His Complaint

A 60-year-old male presented with persistent pain in the abdomen. A CT scan of the abdomen revealed a serious finding:

A tumour in the pancreas involving the portal vein

The tumour was abutting the Superior Mesenteric Artery (SMA) — one of the most critical blood vessels supplying the intestines

The case was referred to Dr. Manoj Dongare specifically for portal vein resection — given his expertise as an HPB and Liver Transplant Surgeon

Confirming the Diagnosis

Before planning surgery, Dr. Manoj Dongare performed:

EUS (Endoscopic Ultrasound) with biopsy — to obtain tissue from the pancreatic tumour

Biopsy result — confirmed pancreatic cancer

Full pre-operative staging and surgical planning completed

The Surgery — A Technically Demanding Whipple's Procedure

Dr. Manoj Dongare performed a Whipple's Procedure (Pancreaticoduodenectomy) using a highly specialised surgical approach.

Step-by-step surgical highlights:

SMA First Approach — Instead of the conventional approach, Dr. Manoj Dongare used the SMA first technique — exposing and completely baring the Superior Mesenteric Artery first to ensure clear surgical margins and safe dissection around the most critical vessel

Complete removal of the Uncinate Process — The uncinate process of the pancreas, which was closely involved with the SMA, was completely excised

Portal vein management — The tumour's involvement with the portal vein was carefully addressed with precise dissection

Pancreatic duct reconstruction — The pancreatic duct was extremely small and could not initially be cannulated even with a 24-gauge cannula. Dr. Manoj Dongare serially dilated the duct step by step until adequate size was achieved

Duct-to-mucosa Pancreaticojejunostomy (PJ) — A precise connection was created between the tiny pancreatic duct and the small intestine — one of the most technically demanding steps in the entire procedure

Post-Operative Recovery

Following this complex surgery, the patient's recovery was smooth:

✔️ No major post-operative complications

✔️ No pancreatic leak — despite the tiny duct reconstruction

✔️ Patient was discharged on Postoperative Day 12

✔️ Patient doing well on follow-up

Key Takeaways from This Case

Pancreatic cancer involving the portal vein is not always inoperable — the right surgeon with vascular expertise can still achieve a curative resection

SMA first approach is a specialised technique that improves safety and surgical margins in complex pancreatic cancer cases

Tiny pancreatic ducts require innovative intraoperative solutions — serial dilation and precise duct-to-mucosa anastomosis

EUS with biopsy is essential for confirming pancreatic cancer before surgery

Early referral to an experienced HPB surgeon significantly improves outcomes

If you or a loved one has been diagnosed with pancreatic cancer involving major vessels, do not lose hope. Consult an expert today.

How a Complex Pancreatic Tumour Nearly Invading the Portal Vein Was Successfully Treated in Pune

When a pancreatic tumour grows close to or involves major blood vessels, surgery becomes extremely high risk — and only a handful of specialists in India have the expertise to handle such cases. This is the story of a 45-year-old lady whose complex pancreatic tumour was successfully managed by Dr. Manoj Dongare, one of the best HPB Surgeons and best Pancreatic Surgeons in Pune.

The Patient and Her Complaint

A 45-year-old lady presented with persistent pain in the abdomen. Initial investigations including USG and CT scan revealed a serious finding:

A large tumour in the neck of the pancreas

The tumour was almost invading the portal vein — the major blood vessel supplying the liver

Surgery was deemed very high risk due to vascular involvement

There was a clinical dilemma — should this be treated with a Whipple's Procedure or a Distal Pancreatectomy?

Given the complexity and the possibility of requiring portal vein resection, the patient was referred to Dr. Manoj Dongare, a highly experienced HPB and Liver Transplant Surgeon practising at D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune and Cloverleaf Speciality Clinic, Wakad, Pune-PCMC.

The Surgical Challenge — Why Was This Case So Difficult?

The pancreas sits deep in the abdomen, surrounded by major blood vessels. When a tumour grows at the neck of the pancreas, it sits right next to the portal vein and superior mesenteric vein — vessels that cannot simply be cut without serious consequences.

Key challenges in this case:

Tumour location at the neck of the pancreas — a technically demanding area

Near invasion of the portal vein — risking massive bleeding

Uncertainty about the right surgical approach — Whipple's vs distal pancreatectomy

Need for a surgeon experienced in both pancreatic tumour removal surgery in Pune and vascular reconstruction

The Surgery — Subtotal Pancreatectomy with Splenectomy

After careful pre-operative planning, Dr. Manoj Dongare and his team proceeded with surgery. Here is what was done step by step:

Careful exploration of the abdomen to assess the full extent of the tumour

Meticulous dissection of the portal vessels away from the tumour — avoiding the need for portal vein resection

Successful separation of the tumour from the portal vein — a technically demanding and critical step

Subtotal pancreatectomy — removal of the majority of the pancreas including the tumour

Splenectomy — removal of the spleen, which shares blood supply with the pancreatic tail

The decision to perform a subtotal pancreatectomy with splenectomy rather than a Whipple's procedure was a key intraoperative judgement call — one that reflects the deep surgical expertise of Dr. Manoj Dongare as the best Pancreatic Surgeon in the region.

Post-Operative Recovery — Smooth and Complication-Free

The patient's post-operative course was remarkably smooth:

No major complications following surgery

Gradual recovery with careful monitoring

The patient was very satisfied with the treatment and outcome

Discharged in good condition

This excellent outcome in such a high-risk case reflects the value of choosing the right specialist for pancreatic tumour removal surgery in Pune.

Key Takeaways from This Case

Pancreatic tumours near the portal vein require a specialist with vascular expertise — not just a general surgeon

Proper pre-operative planning and intraoperative decision-making are critical in complex pancreatic surgeries

Subtotal pancreatectomy can be a better option than Whipple's procedure in selected cases

Multidisciplinary and HPB expertise significantly improves outcomes in vascular-involvement cases

Early referral to the best HPB Surgeon can make the difference between a successful outcome and a life-threatening complication

Why Choose Dr. Manoj Dongare for Pancreatic Tumour Surgery?

Dr. Manoj Dongare is one of the most trusted names for pancreatic tumour removal surgery in Pune. As the best HPB Surgeon and best Pancreatic Surgeon, he brings exceptional expertise in complex pancreatic, liver, and biliary surgeries. He practises at D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune and Cloverleaf Speciality Clinic, Wakad, Pune-PCMC.

If you or a loved one has been diagnosed with a pancreatic tumour or any complex abdominal condition, do not delay seeking expert care.

How an 8 cm Pancreatic Pseudocyst Was Successfully Treated with Cystogastrostomy in Pune

Pancreatitis is a painful and potentially serious condition — and when it leads to complications like a pancreatic pseudocyst, timely and expert management becomes absolutely critical. This is the story of a 35-year-old gentleman whose acute pancreatitis led to a large pseudocyst, and how Dr. Manoj Dongare successfully treated it with a well-planned surgical procedure.

The Patient and His Presenting Complaint

A 35-year-old male patient with a history of chronic alcohol consumption presented with severe abdominal pain. After thorough clinical evaluation and imaging, he was diagnosed with acute pancreatitis with fluid collection around the pancreas.

Alcohol-related pancreatitis is one of the most common causes of acute pancreatitis in India, particularly in young and middle-aged men. The pancreas becomes severely inflamed, and in many cases, fluid begins to collect around it — which can later develop into a pseudocyst if not managed properly.

The patient was referred to Dr. Manoj Dongare, one of the best HPB Surgeons and best Pancreatic Surgeons practising at D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune and Cloverleaf Speciality Clinic, Wakad, Pune-PCMC.

Initial Management — Conservative Approach First

Not every case of pancreatitis requires immediate surgery. In this case, Dr. Manoj Dongare followed the correct and evidence-based approach of conservative management first.

Initial conservative treatment included:

Complete bowel rest and nil by mouth

Intravenous fluids and nutritional support

Pain management and monitoring

Close observation for signs of complications

This careful, non-surgical approach in the acute phase is standard practice and gives the pancreas time to settle down before any intervention is considered.

Follow-Up Imaging — The Pseudocyst is Discovered

Six weeks after the initial episode of pancreatitis, the patient underwent follow-up imaging as planned.

What the imaging revealed:

An 8 cm pancreatic pseudocyst — a large, fluid-filled sac that had formed adjacent to the pancreas

The pseudocyst had not resolved on its own despite conservative management

What is a Pancreatic Pseudocyst?

A pancreatic pseudocyst is a collection of fluid that forms after an episode of pancreatitis. Unlike a true cyst, it does not have a proper lining. It develops when the pancreatic ducts are disrupted and pancreatic fluid leaks out and collects in a enclosed space.

When does a pseudocyst need treatment?

When it is large (generally more than 6 cm)

When it causes symptoms like pain, nausea, or vomiting

When it does not resolve on its own after several weeks

When there is a risk of infection or rupture

In this patient's case, the 8 cm size and persistent symptoms clearly indicated that surgical intervention was necessary.

The Surgery — Cystogastrostomy

Dr. Manoj Dongare performed a Cystogastrostomy — a well-established and highly effective surgical procedure for draining pancreatic pseudocysts.

What is Cystogastrostomy?

Cystogastrostomy is a surgical procedure in which the pancreatic pseudocyst is connected directly to the stomach. This creates an internal drainage pathway, allowing the fluid inside the pseudocyst to drain naturally into the stomach and pass out of the body through the digestive system.

Step-by-step surgical process:

Patient preparation and anaesthesia — The patient was prepared for general anaesthesia

Surgical access — The abdomen was opened to access the pseudocyst

Identification of the pseudocyst — The 8 cm cyst was identified adjacent to the posterior wall of the stomach

Creation of the cystogastrostomy — An opening was created between the pseudocyst and the stomach wall, allowing internal drainage.

Closure and completion — The surgical site was closed carefully after confirming adequate drainage

This procedure effectively eliminates the pseudocyst by using the body's own digestive system as a natural drainage route — avoiding the need for repeated external drainage or more complex surgery.

Post-Operative Recovery — Smooth and Straightforward

Following the surgery by Dr. Manoj Dongare, the patient's recovery was excellent.

Post-operative course:

Day 1–4 — Patient monitored closely; pain well controlled

Day 5–6 — Gradual introduction of oral diet; patient tolerating well

Day 7 — Patient discharged in good condition

Follow-up — Patient is currently doing well with no complications

Being discharged on Postoperative Day 7 after a cystogastrostomy is an excellent outcome and reflects the high standard of surgical care provided.

If you or a loved one has been diagnosed with pancreatitis, pancreatic pseudocyst, or any complex pancreatic condition, do not delay seeking expert care.

How a Complex 18 cm Liver Tumour Was Successfully Treated Without a Full Liver Removal

When a 36-year-old man walked into the clinic with persistent pain in his right upper abdomen, nobody expected what the scans would reveal — an 18 cm cystic lesion occupying almost the entire right lobe of the liver. This is the story of how careful diagnosis, expert surgical planning, and multidisciplinary teamwork led to a successful outcome.

The Patient and the Problem

A young, otherwise healthy gentleman presented with discomfort in the right side of his abdomen. CT and MRI scans told a concerning story:

An 18 cm cystic lesion in the right lobe of the liver

The lesion was extending into the left lateral segment

It was splaying the left hepatic veins

Both right and left hepatic veins were not clearly visible on imaging

Given the size and location of the lesion, the patient was referred to Dr. Manoj Dongare, a leading HPB Surgeon and best liver specialist practising at Cloverleaf Speciality Clinic, Pune-PCMC, for further evaluation and possible liver resection surgery.

Thorough Investigation Before Surgery

Rather than rushing into the operation theatre, Dr. Manoj Dongare followed a systematic, evidence-based approach to fully understand the nature of the lesion.

Investigations performed included:

PET Scan — Showed no evidence of disease anywhere else in the body

Tumour Markers — AFP, CEA, and CA 19.9 were all within normal limits

Provisional Diagnosis — Cystadenoma or Cystadenocarcinoma of the liver

This comprehensive pre-operative workup is what distinguishes expert HPB surgery from routine care. Knowing the lesion was localised gave the surgical team the confidence to proceed with curative intent.

The Surgery — Extended Right Hepatectomy with Precision

Dr. Manoj Dongare performed what is technically described as an almost extended right hepatectomy — one of the most complex liver surgeries in HPB surgical practice.

What made this surgery especially challenging:

The lesion was massive — 18 cm in size

It had encroached upon the left lateral segment

The hepatic veins were compressed and poorly visualised

Preserving enough healthy liver tissue was critical for patient survival

What the surgical team achieved:

Complete removal of the cystic lesion along with the right lobe

Preservation of the branches of the left hepatic vein — ensuring adequate blood drainage from the remaining liver

Clear surgical margins — meaning no tumour cells were left behind

This level of precision is what patients can expect when consulting a best liver specialist with dedicated HPB expertise.

The Surprise Finding — A Neuroendocrine Tumour

Post-operative histopathology (HPR) revealed something unexpected — the lesion was not a cystadenoma or carcinoma as initially suspected.

Final Diagnosis: Grade 2 Neuroendocrine Tumour (NET) of the liver

Neuroendocrine tumours presenting as large cystic lesions in the liver are rare. They can closely mimic other cystic liver lesions on imaging, which is why histopathology remains the gold standard for final diagnosis.

Post-operative steps taken by Dr. Manoj Dongare:

A DOTA scan was performed after surgery

Results confirmed no evidence of disease anywhere else in the body

Surgical margins were confirmed as free of tumour

This meant the patient had achieved a complete surgical cure — a remarkable outcome for such a complex case.

Key Takeaways from This Case

This case managed by Dr. Manoj Dongare at Cloverleaf Speciality Clinic offers several important lessons for patients and medical professionals alike:

Large liver lesions require expert evaluation — not all cystic liver masses are simple cysts

Pre-operative imaging and tumour markers are essential but may not always give a final diagnosis

PET and DOTA scans play a vital role in staging and post-operative surveillance

Liver-sparing surgery, when technically feasible, significantly improves recovery and quality of life

Multidisciplinary management — involving radiology, pathology, oncology, and surgery — is non-negotiable in complex liver cases

Regular follow-up is essential, especially for neuroendocrine tumours, which can recur

Why Consult Dr. Manoj Dongare for Liver Conditions?

Dr. Manoj Dongare is a highly experienced HPB Surgeon based in Pune-PCMC, specialising in complex liver, pancreas, and biliary surgeries. As the best liver specialist at Cloverleaf Speciality Clinic, he combines advanced surgical techniques with a patient-first approach.

Whether you are dealing with a liver cyst, liver tumour, or any complex hepatobiliary condition, early consultation with a dedicated specialist can make all the difference.

If you or a loved one has been diagnosed with a liver lesion, do not delay. Reach out to Dr. Manoj Dongare for a thorough evaluation and expert surgical opinion.