Prof Brice Gayet ,The Living Legend IHPBA 2022 and his team contributed a chapter for our book . IHPBANYC 22 gave me an opportunity meet him in person and give a copy to him .obliged @IHPBA @AHPBA n team. @dhireshmaharjan @EAHPBA @ILLS_LAPLIVER

Our dept did LDLT. Congrats my friend @drroshanghimire few properly trained . And @dhireshmaharjan behind the scenes. 🙏🙏to all ot guys in OR.@APHPBA @IHPBA

RT @BMJSurgTech: 📢 New research indicates that ensuring sufficient vascular supply at the pancreatic remnant using indocyanine green may al….

RT @dhireshmaharjan: Role of ICG to look for vascularity of the pancreatic stump during Whipple’s procedure and its clinical implications i….

My team mate for 13 yrs did liver transplant with only Nepalese team @drroshanghimire.Did his residency from our department,@dhireshmaharjan.LT training from super high volume centre in Delhi, involved in 25+ LDLTin KTM highest in Nepal.@IHPBA @APHPBA 👏👏.A beginning for team

Complete pathological response of Primary .yToNo. Now what next?.Chemo- for how long?.Surveillance - MRI +?PET. Ca 19.9 . Role of ctDNA??.valuable opinion pl as this is 1st in our 350+ PD. @ihpba @eahpba @aphpba

@IHPBA @TeamSurgery247.Falconi and Bassi group show benefit in selected cases Opinion varies here.No surgery at all.Chemo better .Surgery .after >4 cycles chemo.after >6months observation.with fiducial marker.after ca 19.9 value is normal.Thanks all for expert opinion.Will update

Let some more similar datas pour in to address this contentious issue in future.@IHPBA @APHPBA @EAHPBA @TeamSurgery247

Preop-Multiple liver mets PDAC,.Post 4 cycles chemo. cect MRI PETct- vanishing liver mets n reduced primary ca19.9 from>1000 to<100. Per op -laparoscopy with ICG given 12 hrs prior ot. USG without contrast @dhireshmaharjan.PD done. WWYD?.@IHPBA.@APHPBA.@EAHPBA

We have done few. However, vascularity of remaining pancreas may be an issue leading to pancreatitis. Thus we use ICG.

Root of messentry dissection for post NACT PDAC.Infracolic approach @dhireshmaharjan.Dominant jejunal vein,.Nonreconstructible iliocolic vein, MCV MCA sacrificed. RT colectomy for devascularised colon.@ihpba @APHPBA @Gio_Marchegiani @TeamSurgery247

HPD for cagb.If done for Conglomerated LN 13, Ro achievable .For biliary infiltration, proximal -ve margin??.NACT .Acceptable perioperative outcome in selected cases in expert centres @dhireshmaharjan @APHPBA.@IHPBA @TeamSurgery247

Thank you for inviting me as a faculty 🙏 a great learning opportunity @AHPBA .@HoggNDMD obliged us by including ourOR videos and manuscripts in her lecture on ICG in pancreas surgery. Fun was meeting son after months too. @dhireshmaharjan.@IHPBA @APHPBA @TeamSurgery247

RT @Gio_Marchegiani: I met the 🔝 of the surgeons from the top 🏔️ of the world! . Such a honor to be hosted by the 🇳🇵 HPB community in beaut….

Peritoneal patch for PV repair.@dhireshmaharjan.Suture mesothelial surface( not the edge of patch) with PV to prevent its inversion into the lumen. Coeliac Lymphatic draining into cysterna chyli ties n clipped.@ihpba @APHPBA @TeamSurgery247 @Gio_Marchegiani .Type 4 grading.

Enteroatmospheric fistula managed with blood bag tube, vacuum dressing and stoma appliance. @dhireshmaharjan Anyone using this technique?@TeamSurgery247 .@SWexner @me4_so

ROOT OF MESSETRY dissection for ventra/ uncinate mass in PD technically n oncologically challenging .@dhireshmaharjan .Inferior infracolic SMA approach in all post NACT.Chyle leak high.CL manageable with Ro margin.@IHPBA .@APHPBA .@TeamSurgery247 .doi: 10.12998/wjcc.v13.i8.97887

IPMN with worrisome features .Malignant cells inEUS guided FNA. @dhireshmaharjan .PD n pancreatoscopy of MPD.@IHPBA @APHPBA @TeamSurgery247 @hpb_so

ICG to evaluate pancreatic stump perfusion in PD and refashioning it if needed. Applicable to any anastomosis.@dhireshmaharjan @drroshanghimire.Can it mitigate PPAPnPOPF? DOI: 10.1002/hsr2.70153.@IHPBA @APHPBA @TeamSurgery247 @ProfW_edinsurg .@Gio_Marchegiani .@ShridharIyer17

Being a collaborator to Prof Pierre Clavien's project on 'surgeon-scientists' does give the feeling of accomplishment. @EAHPBA @Unispital_USZ

CaGb neck with replaced rt HA infiltration which we embolised and extended chole with resection of extra hepatic biliary tree and replaced rt HA done. @dhireshmaharjan.Major hepatectomy avoided.WWYD @IHPBA @TeamSurgery247 @hpb_so @APHPBA @JSHBPS