Meet the Team Leading the Charge
- Dr. Rohith Manepalli (Surgical Oncologist): Specialising in complex Hepatobiliary and Gastrointestinal (GI) oncology, Dr. Rohith’s “precision-first” philosophy ensures complete disease clearance (R0 resections) in every case.
- Dr. Abhishek (Medical Gastroenterologist): An expert in advanced interventional GI procedures, Dr. Abhishek provides essential pre-surgical stabilisation such as ERCP and stenting.
- Dr. Bhairav Muthyapu (Anaesthesia & Critical Care): With over 12 years of experience, Dr. Bhairav ensures the physiological safety of elderly and comorbid patients undergoing major high-stress surgeries.
A Collaborative Triumph in High-Risk Periampullary Surgery
- Lead Surgical Oncologist: Dr. Rohith Manepalli
- Medical Gastroenterologist: Dr. Abhishek
- Anesthesiologist: Dr. Bhairav Muthyapu
- Prudence Hospital, Nizamabad
Surgical oncology often demands operating on the edge of possibility. However, when a high-risk case—such as an 80-year-old gentleman with uncontrolled diabetes, hypertension, and a periampullary growth—reaches a successful outcome, it is the result of a collaborative effort. At Prudence Hospital, this case became a masterclass in Multidisciplinary Team (MDT) collaboration.
- The Critical Bridge: Medical Gastroenterology
Before a single incision could be made, the patient’s obstructive jaundice and bilious vomiting had to be addressed. This is where the expertise of Medical Gastroenterologist Dr. Abhishek proved indispensable.- ERCP Intervention: Dr. Abhishek performed a successful ERCP with biliary stenting. This was not merely a procedure; it was the foundation of the patient’s recovery.
- Biological Optimisation: By relieving the biliary obstruction, Dr. Abhishek allowed the patient’s liver function to recover and reversed the coagulopathy associated with jaundice. This “pre-habilitation” period transformed a physiologically fragile patient into a viable surgical candidate.
- The Physiological Shield: Anaesthesia & Perioperative Care
Operating on an 80-year-old with long-standing comorbidities requires a “tightrope” approach to anaesthesia. Dr. Bhairav Muthyapu provided the critical physiological shield that allowed the surgical team to focus on the pathology.- Intraoperative Stability: Dr. Bhairav meticulously managed the patient’s cardiovascular stress and glycemic levels throughout the complex procedure. In a surgery of this magnitude, maintaining organ perfusion while minimising fluid overload is a delicate balance that directly impacts postoperative healing.
- The Safety Net: His management ensured that the patient remained stable despite the metabolic demands of a Whipple procedure, allowing for a 48-hour uneventful ICU recovery.
- The Surgical Execution: Precision under Pressure
With the patient optimised by Dr Abhishek and protected by Dr Bhairav, Dr Rohith Manapalli was able to execute a meticulous resection. - Anatomical Discipline: As demonstrated in the intraoperative images, the team navigated a 4 × 4 cm tumour.
The Reconstruction: The success of the hepaticojejunostomy and pancreaticojejunostomy was dependent on the stable operative field provided by the anaesthetic team.
A Unified Result: The Pathological Verdict The team’s collective effort resulted in a perfect oncological profile (as seen in the specimen in Image 3):
- R0 Resection: Surgical margins were completely free of disease.
- Prognosis: A well-differentiated adenocarcinoma with no lymphovascular or perineural invasion and zero lymph node metastasis.
The Takeaway: Why Teamwork Matters
The patient was discharged on Postoperative Day 7—a timeline that would be impressive for a patient half his age. This success reinforces an enduring principle at Prudence Hospital: Oncological outcomes are not solely determined by the surgery; they are influenced by the sequence of thoughtful decisions made by a unified team.
From the initial stent placed by Dr. Abhishek, to the vigilant physiological monitoring by Dr. Bhairav, and the technical precision of Dr. Rohith, this case demonstrates that when specialists collaborate effectively, we can offer a second chance to even the most high-risk patients.
Prudence Hospital, Nizamabad
Specialised Oncology, Gastroenterology, and Critical Care.
Clinical Excellence in Surgical Oncology
This successful outcome in Geriatric Surgical Oncology at Prudence Hospital, Nizamabad, underscores the critical importance of a Multidisciplinary Team (MDT) approach.
Case Summary
Strategic Prehabilitation: Led by Medical Gastroenterologist Dr. Abhishek, the use of ERCP and biliary stenting proved essential for preoperative stabilisation.
Precision Anaesthesia: Dr. Bhairav Muthyapu provided high-level perioperative care, ensuring haemodynamic stability for a patient with a high ASA physical status.
Oncological Intent: Dr. Rohith Manapalli performed a meticulous R0 Resection, achieving complete pathological clearance of the Ampullary Adenocarcinoma.
This case serves as a benchmark for complex hepatobiliary surgery in the region, demonstrating that advanced age is not a contraindication for life-saving cancer intervention when managed with disciplined, collaborative care.
Our Promise
At Prudence Hospital, we believe that age and complexity should not be barriers to a cure. By combining advanced technology with compassionate, team-based care, we are providing a “second chance” to the heart of Nizamabad.
- Name:Prudence Hospital, NIZAMABAD
- Contact: +91 90939 66666
- Website: www.prudencehospitals.com