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  • HARSHAL SHYAM RAJEKAR
  • MS GENERAL SURGERY, MRCS ONCOSURGERY, FELLOWSHIP GASTROENTEROLOGY - SURGERY, FELLOWSHIP HEPATOLOGY
  • GASTROENTEROLOGY - SURGERY, HEPATOLOGY, ONCOSURGERY, TRANSPLANT SURGERY
  • Specialist In: LIVER SURGERY.,HEPATO-BILIARY AND PANCREATIC SURGERY.,TRANSPLANT SURGERY.,SURGERY OF PANCREAS, GALL BLADDER, PANCREAS, BILE DUCTS.,LIVER SURGERY.,UPPER GI CANCER SURGERY.,LIVER TRANSPLANT SURGERY.,LDLT, DDLT, ORGAN HARVESTING,PANCREATIC CANCER,,GALL BLADDER CANCER,,BILE DUCT CANCER,,KLATSKIN TUMORS,,LIVER CANCER,,
  • Experience : 1. Presently working as Consultant in Hepatobiliary, GI and transplant surgery at Jupiter
    Hospital, Baner, Pune. (370 bedded super-speciality tertiary care hospital). Since
    October 2016 – Present.
    2. Served as Consultant HPB, GI and transplant Surgeon at Ruby Hall Clinic, Pune. (RHC is a
    550 bedded multi-speciality hospital). (Sep 2012 – Sep 2016).
    Also worked as consultant Hepatobiliary and Transplant Surgeon at KEM hospital,
    Pune.
    Was attached as Liver transplant Surgeon at Hiranandani hospital, Powai, Mumbai.
    Was attached to the following hospitals as consultant in GI surgery and Hepatobiliary
    surgery:
    - Jehangir Nursing Home, Pune.
    - MJM Hospital, Ghole Road, Pune.
    - Aditya Birla Memorial Hospital, Pune.
    - Inamdar Multispeciality Hospital, Pune.
    - Rao Nursing Home, Satara Road, Pune.
    - Sanjeevan Hospital, Kothrud, Pune.
    - Sharada Clinic and hospital, Karad.
    - Satara Diagnostic Centre and Satara Hospital, Satara.
    Working as Assistant Professor in General Surgery at Bharati Vidyapeeth Medical College
    and HPB and GI surgeon at Bharati Hospital, Dhanakwadi, Pune.

    3. Assistant Professor (Initially as Pool officer) in General Surgery, PGIMER, Chandigarh,
    since Apr 2011. Was appointed as a faculty member, in general surgery with a view to
    further develop the liver transplant program.
    June 2010 – April 2011 : Pool officer.
    April 2011 – Sep 2012 : Assistant Professor.
    Established the liver transplant program at PGIMER, and the team performed 5 liver
    transplants in 18 months.
    Resigned for personal reasons.
    4. ACADEMIC PROGRAM IN ABDOMINAL ORGAN TRANSPLANTATION
    Mount Sinai School of Medicine and Recanati Miller Transplant Institute New York.
    Jan 2009 – Dec 2009. Job title: Research fellow/ visiting physician.
    Job responsibilities included 6 months of assisting with organ transplant surgery for
    Liver, pancreas and small bowel transplant and pre- and post-operative assessment and
    care. For 6 months in charge or organ procurement for the centre and participated in

    retrievals or liver, pancreas, small bowel and kidneys for the Transplant Institute. During
    the whole year, was required to assist with clinical research and help in laboratory
    experiments.
    5. Worked as a Fellow/ Senior Registrar in Liver Transplantation and GI surgery at Sir
    Ganga Ram Hospital (SGRH) in New Delhi, India since June-Dec 2008.
    Was admitted with a view to pursue a PhD at SGRH research topic: Cytokine and T-cell
    profiling in liver transplant recipients with a view to predicting graft tolerance.
    However, had to quit due to delay in setting up research infrastructure, with further
    delay expected.

    6. Worked as a CLINICAL FELLOW/ SURGICAL FELLOW in a training capacity at the Asian
    Centre for Liver diseases and Transplantation, Singapore at the Gleneagles hospital.
    Designation – Clinical/Surgical fellow in Hepatobiliary and Transplantation.
    Grade -SPR.

    Duties included assisting/performing Surgery, including transplant and HPB surgery, pre-
    op evaluation post operative care, patient and donor counseling and managing patients

    in the Liver ICU. Also included academic Journal club every 2 weeks and transplant
    meetings every week.

    7. Was employed as Registrar in GE surgery, in the Wakefield hospital, and Wakefield
    Gastroenterology center, Wellington, New Zealand.
    Completed a fellowship/ training programme for a period of 18 months in the capacity
    as registrar(SPR) to:
    1. Mr Richard Stubbs in upper GI and HBP surgery and
    2. Mr John Groom in colorectal and laparoscopic surgery (1 day per week).
    Duties include the primary care of patients including pre-op assessment and post
    operative care, assisting with all surgery and 1 in 4 on call. Took active part in research
    activities, principally clinical research related to insulin resistance and colorectal liver
    metastases.
    Grade – SPR, Title – Surgical Fellow.

    8. Was convener of the “ Inter Institutional tumor board” in Sassoon general hospitals,
    Pune for a period of 18 months from Jun 2004 till Dec 2005.
    Was involved in coordinating the activities of approx 12 cancer specialists to cater to all
    diagnostic and therapeutic difficulties in cancer patients, Pune, India.
    (Essentially a Multi-disciplinary Cancer Clinic, the first in the city of Pune.)

    9. LECTURER(ASSISTANT PROFESSOR) IN GENERAL SURGERY at Sassoon General Hospitals
    (Government medical college and general hospital) and B.J. Medical College, Pune for
    two years from April 2004 to December 2005.
    Job responsibilities included that equivalent to a junior Consultant/ Senior registrar.
    Involved in performing 15 – 20 surgeries per week, including Oncosurgery, minimally
    invasive surgery and general and GI surgery.
    One in six on-call with A&E surgery, and Trauma surgery, supervising the pre operative
    assessment and the post operative management of all patients and the training of
    Junior surgical staff.

    10. Worked as Lecturer/ SPR in General and Onco- Surgery in Jehangir Hospitals and Apollo
    group of Hospitals, Pune in the year 2004.
    Responsibilities included that equivalent to a senior surgical registrar involved
    performing Surgery, assisting with major surgery and pre – operative assessment and
    post operative day to day management of patients. The team did between 10 – 15
    cancer surgeries per week.

    11. Worked as resident/ house officer in GENERAL SURGERY for three years in charge of
    primary care of all patients admitted in the surgery wards for elective and all trauma
    and emergency general surgery, as part of the curriculum for training for M.S. [Masters
    in general surgery].
    (Jan 2001 - Jan 2004).
    At Sassoon general hospitals, Pune - A 1400 bedded tertiary care center, with approx
    4500 emergency surgeries per year and about 9500 planned surgeries per year. Intake
    of about 48,000 indoor patients per year.

    12. Worked as Primary/ Chief Medical Officer in charge P.H.C.(primary health centre),
    Tokawde: A tribal area in District Thane, Maharashtra for one year (March 2000 –March
    2001).
    Catering to primary care of a population of 35,000 including child and maternal health,
    Immunization programme and other primary health care. Was in charge of
    implementing National Health Programmes.
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Queries Answered by Dr HARSHAL SHYAM RAJEKAR

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Query Answered
Query : Need liver enlargement treatment at Delhi.

What is your height?

Body weight?

Diabetes?

Cholesterol?

Lifestyle?

Previous medical history, previous medications, surgeries and other significant illness?

Get blood tests done : i.e. LFT, CBC, INR, HBsAg, Anti HCV, HbA1C and Lipid profile.

Query : Need advice for piles surgery ans Hep C infection.
Hello,

As you mentioned:

1. Patient has hepatitis C.

2. Patient is having bleeding piles.

Laser treatment is possible, but before offering any treatment, let us get some facts.

i. Has he taken treatment for hepatitis C? If yes, what?

ii. What is the latest blood tests. Kindly upload LFT, INR, CBC, Serum creatinine, Serum Sodium, Serum albumin reports.

iii. has the patient undergone colonoscopy? If not please get a colonoscopy.

iv. Get a CT scan abdomen with contrast (if renal function is normal).

All this needs to be done considering the age of the patient, to rule out a colon cancer, and to confirm the status of the liver cirrhosis (yes or no) and presence of ascites. Important from finding the safest treatment for the patient.

A laser surgery may be done, but may not be the most appropriate. Let us get a complete picture of the current medical status first.
Query : Need medication advice for Chronic hepatitis b infection.

I saw the reports.

Inference - 3 lesions at least. Tumor thrombus in Portal Vein.

The liver function is normal and the patient is well compensated. The liver cirrhosis has not resulted in abnormality of liver function yet.

In this situation - TACE may be helpful, but it may not result in a significant improvement in the patients survival. The best option in this situation would be TARE (trans arterial radio embolization). It is an expensive proposition with an increased risk of side effects, but TARE will likely result in improved patient survival, we may be able to prolong the patients life by 6-12 momnths on an average. 

The next best option would be to do an RFA (radio frequency ablation) of all three lesion. However, this will probably not add to the patients survival.

The next step would be to rule out metastases of the tumor (spread of the tumor) by doing a PET-CT/ CT chest and abdomen with a bone scan.

If there was a live donor in the family there may be some centers agreeing to do a liver transplant (an LDLT). However the risk of recurrence is prohibitively high. 

Meanwhile start treatment for the HBV (an antiviral - entecavir or tenofovir), start the sorafenib. 

Query : What is the estimate for liver transplant?

Liver cirrhosis is irreversible scarring of the liver. Even with liver cirrhosis, liver function may be well maintained, called as well compensated. If the liver decompensates, i.e. the liver function is unable to meet the requirements of the body; then there is probably no alternative to a liver transplant. 

If the cause of liver cirrhosis like Hepatitis B, Hepatitis C or alcohol intake or autoimmune liver disease is treatable, then treatment may result in am improvement in liver function.

With decompensated liver cirrhosis, liver transplant is the only option available.

From the reports there is evidence that the liver function is abnormal. Please get a CT scan or an MRI of the liver/ abdomen.
Query : Need second opinion regarding the removal of Gall bladder as advised by doctors.
Hello.
Thank you for the mail.
Firstly, only presence of gall stones does not mean that surgery is required. Many people have stones (especially women after the age of 40) and have no problems. Many people have stones and vague abdominal pain, that too does not require as the pain is unrelated to the gall stones. Gall bladder stones may cause severe pain in the right upper abdomen that radiates to the back, which is called biliary colic. If she has biliary colic, then surgery for the gall stones is required.
Removal of the stones only is not advised, since the stones will form again. When surgery is done for gall stones the gall bladder is removed, usually laparoscopically (key hole surgery). Whoever advised you only removal of the stones was misguiding you. If she has pain due to the gall stones, then surgery for removal of the gall bladder is advised (laparoscopic cholecystectomy). I will be happy to see her and advise further.
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