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Speciality

Hepato-Pancreato-Biliary (HPB) Surgery

Dr. Viniyendra Pamecha  
Dr. Viniyendra Pamecha
Professor and Head, Liver Transplant and Hepato Pancreato Biliary Surgery
 
Experience

Professor Pamecha has over 20 years of clinical, academic and teaching experience. He has been spearheading the department at ILBS over the last 10 years. Department has become a high volume center for Liver Transplant and Hepato Pancreato Biliary Surgery under his leadership.   

He has successfully established Liver Transplant program for both Adults and Children’s at ILBS, with results at par with best International centers – a first for public sector hospital in India. He has extensive experience in Hepato Pancreato Biliary cancer surgery. Under his leadership department has become one of the high volume referral centers for complex resections for HPB malignancy.

He was instrumental in starting MCI recognized super specialty M.Ch. training program in Hepato Pancreato Biliary Surgery – a first in the Country. Under his leadership the M.Ch. seats have increased by three times and the program has become one the most sought Super-specialty training program in the country. He has also trained teams from many public sector Institutes such as JIPMER Pondicherry, SGPGI and KGMC Lucknow, SMS Jaipur, IGIMS Patna, RML New Delhi. Under his leadership Liver Transplant program at SMS Jaipur was started.

He is one of the rare doctors who after having such an extensive experience from abroad have joined a public sector hospital. Before joining ILBS he has worked in UK, from 2003 to 2010, initially at the renowned Liver Unit of King's College Hospital (2003 - 2005) and subsequently at Sheila Sherlock Liver Centre, Royal Free Hospital (2005 - 2010). He was awarded Fellowships in Multi organ Retrieval, Liver Transplantation & Hepato Pancreatico Biliary Surgery by the European Board of Surgery in 2009. He received the prestigious FRCS in Hepato Pancreatico Biliary Surgery in 2010. His clinical and basic science research has been published extensively in leading journals of the specialty.

Qualification

FRCS 2010 : Hepato Pancreato Biliary and Upper GI Surgery
Intercollegiate Speciality Board, UK

F.E.B.S 2009 : Hepato Biliary and Pancreatic Surgery - European Board of Surgery

F.E.B.S, 2008 : Multi Organ Retrieval - European Board of Surgery

F.E.B.S 2009 : Liver Transplantation - European Board of Surgery

M.R.C.S 2002 : Royal College of Surgeons of Edinburgh, UK

M.B.B.S 1993 : M .R. Medical College, Gulbarga University, India

M.S 1998 : R.N.T. Medical College, Udaipur, Rajasthan University, India

Number of publications
72
Publications

Innovative and Influential Scientific Work 

Living Donor Liver Transplantation for Acute Liver Failure: Donor Safety and Recipient Outcome.

Pamecha V, Vagadiya A, Sinha PK, Sandhyav R, Parthasarathy K, Sasturkar S, Mohapatra N, Choudhury A, Maiwal R, Khanna R, Alam S, Pandey CK, Sarin SK.

Liver Transpl. 2019 Sep;25(9):1408-1421.

doi: 10.1002/lt.25445.

First of its kind study, sharing experience one of the largest single center experience of LDLT for ALF. Our experience showed emergency LDLT is lifesaving in select patients with ALF. Outcomes of emergency living liver donation were comparable to that of elective donors. Postoperative worsening of CE, preoperative SIRS, and sepsis predicted outcome after LDLT for ALF.


Antegrade Arterial and Portal Flushing Versus Portal Flushing Only for Right Lobe Live Donor Liver Transplantation-A Randomized Control Trial.

Pamecha V, Sandhyav R, Sinha PK, Bharathy KGS, Sasturkar S.

Transplantation. 2018 Apr;102(4):e155-e162.

doi: 10.1097/TP.0000000000002088

Graft dysfunction following LDLT is multi-factorial. This is a unique RCT and the first study show the impact of antegrade arterial perfusion on live donor liver graft. Graft function improved significantly with antegrade arterial perfusion on bench. This concept can contribute in improving the outcome of patients undergoing LDLT.

Deceased donor liver transplant: Experience from a public sector hospital in India.

Pamecha V, Borle DP, Kumar S, Bharathy KGS, Sinha PK, Sasturkar SV, Sharma V, Pandey CK, Sarin SK. Indian J Gastroenterol. 2018 Jan;37(1):18-24.

doi: 10.1007/s12664-017-0801-1.

DDLT is uncommon in North India especially in public hospitals. A first study from India to report experience of DDLT from public sector hospital. The results were comparable to best international centers. The study also highlighted the logistic problems faced to establish DDLT program in India.

Selection and outcome of the potential live liver donor.

Pamecha V, Mahansaria SS, Bharathy KG, Kumar S, Sasturkar SV, Sinha PK, Sarin SK

Hepatololgy International 2016 Jul; 10(4): 657-64.

doi: 10.1007/s12072-016-9715-8.

In LDLT donor safety is paramount. This was the first of its kind study from India to describe the selection, surgical technique and outcomes of LDLT donors. Large sample showed outcomes with commendable results and extremely low complication rates. There was no donor mortality. The results were at par with the best mentioned in the literature. 

Biliary complications after living donor hepatectomy: A first report from India.

Pamecha V, Bharathy KG, Kumar S, Sasturkar SV, Sinha PK.

Liver Transplantation. 2016 May; 22(5): 607-14.

doi: 10.1002/lt.24374

Biliary complications are a major cause of live donor morbidity and rarely, mortality. This paper describes the technique for safe donor hepatectomy with special reference to the prevention of biliary complications. Overall biliary complications were 2% with only 0.6% grade III biliary complications. These results are among the best in world literature.

Association of thrombocytopenia with outcome following adult live donor liver transplantation.

Pamecha V, Mahansaria SS, Kumar S, Bharathy KG, Sasturkar SV, Sinha PK, Kumar N Transplant International 2016 Oct; 29(10): 1126-35.

doi: 10.1111/tri.12819

Platelets play an integral role in liver regeneration. This is the first study to evaluate the association of thrombocytopenia with outcome following an adult LDLT. Results showed postoperative PLT of <30 × 10(9)/l was a strong predictor of major postoperative complications, early graft dysfunction and perioperative mortality. This unique new information can be used to prognosticate patients post-transplant with respect to high risk of infection and can help modulate immunosuppression.

Serial changes of cytokines and growth factors in peripheral circulation after right lobe donor hepatectomy.

Sasturkar SV, David P, Sharma S, Sarin SK, Trehanpati N, Pamecha V

Liver Transplantation 2016 Mar; 22(3): 344-51.

doi: 10.1002/lt.24373.                                                                             

Although there is immense literature about liver regeneration in animals, very little is known in healthy normal humans. This was a first study in humans to evaluate various clinical factors and biomarkers involved in liver regeneration in healthy donors. Study described various biological markers (HGF, IL-6, TNF-α, TPO, TGF-β1, IFNγ, IFN α) involved in upregulation and downregulation of liver regeneration in healthy donors undergoing right lobe donor hepatectomy.

Preoperative Alanine Aminotransferase and Remnant Liver Volume Predict Liver Regeneration After Live Donor Hepatectomy.

Mohapatra N, Sinha PK, Sasturkar SV, Patidar Y, Pamecha V.

J Gastrointest Surg. 2019 Aug 6.

doi: 10.1007/s11605-019-04332-8.

Regeneration of the remnant liver in early postoperative period determines the outcome in live liver donors (LLDs). This study showed liver regenerates rapidly in LLDs following hepatectomy. Low RLV, RLVBWR, and preoperative ALT levels were predictors of liver regeneration in the first week following donor hepatectomy.

Liver transplantation in acute on chronic liver failure: challenges and an algorithm for patient selection and management.

Pamecha V, Kumar S, Bharathy KG.

Hepatology International. 2015 Oct; 9(4): 534-42.

doi: 10.1007/s12072-015-9646-9.

ACLF is associated with very high short term mortality and the timing of liver transplant is most important to change the natural history of disease. This was one of the first papers to describe natural history in the context of selection and timing of liver transplant in ACLF. A concept diagram was proposed on natural history and management algorithm based on the clinical condition of the patient.

All Knots Outside Technique of Biliary Reconstruction in Living Donor Liver Transplantation

V Pamecha, SV Sasturkar, PK Sinha, KGS Bharathy, S Kumar

Transplantation 100, S217-S217

Biliary complications remain the Achilles heel after LDLT. This paper described a new innovative technique of biliary reconstruction. The complication rate decreased significantly from 18% to 4%.

Functional hepatic venous outflow and its correlation with early graft function in live donor liver transplantation

V Pamecha, Appukuttan M, S Kumar, KGS Bharathy, SV Sasturkar, PK Sinha, SK Sarin

Journal of Clinical and Experimental Transplantation 2019

Outflow obstruction is a major cause of graft dysfunction in LDLT. This paper described a new concept showing functional obstruction because of high caval pressure can cause outflow obstruction which can be prevented by taking simple measures to decrease high caval pressure.

Explant portal vein for reconstructing middle hepatic vein in right lobe living donor liver transplantation - outcome analysis.

Borle DP, Pamecha V, Bharathy KGS, Sasturkar SV, Sinha PK, Patidar Y, Sureka B, Thapar Laroia S.

HPB (Oxford). 2018 Dec;20(12):1137-1144.

doi: 10.1016/j.hpb.2018.05.008. Epub 2018 Jun 27

Reconstruction of middle hepatic vein is a very important step in LDLT. This study showed explant portal vein which is easily available, cost effective and can be effectively used for reconstruction of Neo MHV with excellent patency rates.

"No go" donor hepatectomy in living-donor liver transplantation.

Pamecha V, Bharathy KGS, Mahansaria SS, Sinha PK, Rastogi A, Sasturkar SV.

Hepatol Int. 2018 Jan;12(1):67-74.

doi: 10.1007/s12072-017-9832-z.

In spite of all the evaluation, sometimes intraoperative surprises are found during live donor surgery. This paper highlighted the problems faced and made unique a contribution to literature on live donor selection and safety.

Upfront pancreaticoduodenectomy in severely jaundiced patients: is it safe?

Pamecha V, Sadashiv Patil N, Kumar S, Rajendran V, Gupta S, Vasantrao Sasturkar S, Kumar Sinha P, Arora A, Agarwal N, Baghmar S.

J Hepatobiliary Pancreat Sci. 2019 Nov;26(11):524-533.

doi: 10.1002/jhbp.671.

Usually severely jaundiced (serum bilirubin level ≥15 mg/dl) patients with malignant distal common bile duct (CBD) obstruction are not offered upfront Surgery. Analysis of our experience showed upfront PD can be performed safely in the selected severely jaundiced patients and is associated with significantly lower infective complications.

Major Liver Resection for Large and Locally Advanced Hepatocellular Carcinoma.

Pamecha V, Sasturkar SV, Sinha PK, Mahansaria SS, Bharathy KGS, Kumar S, Rastogi A.

Indian J Surgery 2017 Aug; 79(4): 326-331.

doi: 10.1007/s12262-016-1545

This is the first study from India to describe selection of patients with large and locally advanced HCC for resection. As per international guidelines, most of these patients will be offered palliative treatment but the study showed that in selected patients excellent results can be achieved by performing surgical resection.

Techniques for liver parenchymal transection: a meta-analysis of randomized controlled trials.

Pamecha V, Gurusamy KS, Sharma D, Davidson BR.

HPB (Oxford). 2009 Jun; 11(4): 275-81.

This study, which has been widely cited, evaluated various techniques of liver parenchymal transection described in the literature. It showed that expansive gadgets do not decrease the complication rates in comparison to precise old fashioned surgical transection.

Portal vein embolization prior to extensive resection for colorectal liver metastases.

Pamecha V, Davidson B.

Ann Surg Oncol. 2009 Nov; 16(11): 3214.

Effect of portal vein embolisation on the growth rate of colorectal liver metastases.

Pamecha V, Levene A, Grillo F, Woodward N, Dhillon A, Davidson BR.

British Journal of Cancer. 2009 Feb 24; 100(4): 617-22.

Long-term survival and disease recurrence following portal vein embolisation prior to major hepatectomy for colorectal metastases.

Pamecha V, Glantzounis G, Davies N, Fusai G, Sharma D, Davidson B.

Ann Surg Oncol. 2009 May; 16(5): 1202-7.

Prospective evaluation of two-stage hepatectomy combined with selective portal vein embolisation and systemic chemotherapy for patients with unresectable bilobar colorectal liver metastases.

Pamecha V, Nedjat-Shokouhi B, Gurusamy K, Davidson BR.

Digestive Surgery. 2008; 25(5): 387-93.

The above work on portal vein embolization was a unique contribution to the literature. The study evaluated the role of portal vein embolization to increase the future liver remnant, resectability and safety of major liver resection. This was one of the very few studies in the literature at that time showing long term results. The effect of PVE on tumor growth was evaluated – a first in the literature. The increase in tumor growth rate after PVE can be detrimental and recommendations were made to prevent this.

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