Ibrahim Rajput MD FRCS

@drmehul21787 I had exactly the same thing in a patient 2 years ago. Very nice case!

“Completed a challenging Whipple surgery with a rare anatomical variation: an anomalous common hepatic artery arising from the SMA, arching in front of the pancreas, and grooving into it! Meticulous dissection preserved this vital vessel. Anatomy truly never ceases to amaze! 🩺✨ #SurgeryLife #HPBSurgery #WhippleProcedure”

@eifelronaldo The sound is just epic! Miss the v10s.

@falconerstuart Looks amazing!!

@wannabehawkeye 👋

Application going in next month for #tpn in #emgensurg #rct - if UK based consultant and interested in participating, please message - need some more info on 'standard care'. Thanks #surgicalresearch

@DerbyPBunit @drterrylo @Innov_Medicine @MISIRG1 @IHPBA @EAHPBA @SAGES_Updates @roux_group @T4UGIS @hpb_so @altaf_awan12 @ib9994 No split legs? I’ve done a few in the the last few months and have assumed suturing is easier with split legs.

@drterrylo @Innov_Medicine @MISIRG1 @IHPBA @EAHPBA @SAGES_Updates @roux_group @T4UGIS @hpb_so @altaf_awan12 @ib9994

LCBDE + Removal of Stent + EHL: 🔵Cholangitis 🔵Large CBDS➡️ERCP + stent 🔵Urgent LCBDE + EHL 🔴Vertical choledochotomy 🔴Stent➡️MCS 🔴EHL + retrieval of fragments 🔴1° closure 4/0 vicryl 🟢Remove stent 1st 🟢Completion choledochoscopy or IOC post EHL 🟢🔪 4-6 wks post stent #hpb

@ahmadnassar Same thing happened to a patient of mine 2 weeks ago. Negative MRCP. OTC - stone.

If we rely on preoperative MRCP “report” (or ERCP) to exclude CBD stones we would sooner or later discover that they do not exclude stone migration. Operative cholangiography (or ultrasonography) is still prudent in some patients. If you can explore the CBD why preoperative MRCP?

@lmcbelfast Mirror dipping when in reverse gear!

Tell me the feature in a car you really miss when it’s not there. Mine is rain-sensitive wipers

@liveRPancSurg @rupert_pearse @sgeorgebarreto @thetimes @OsirisProgramme @NIHRresearch In an elderly cohort, mortality is not my fear. It is more significant morbidity that will take them off their baseline, which for many is actually a good quality of life. For them to lose independence is a significant life changing issue.

@rupert_pearse @sgeorgebarreto @thetimes @OsirisProgramme @NIHRresearch A very difficult area for patients who need cancer surgery. What level of mortality risk is acceptable? 10%, 20%, 30%? How important is % to an individual patient? Open, honest discussion with patient & family is essential to explore options, possible outcomes and expectations.

@bacteriollygy Old school. Love it!

Tonight a surgeon told me they didn't want a CT as they were confident in their clinical exam and diagnosis. Is the heat getting to me? Did I hallucinate this?

Congratulations Vicki Stevenson-Hornby who has won the Outstanding Achievement Award. They have driven the need for diagnostics to be quicker and hosted formal and informal education sessions to enhance knowledge and skills of colleagues across departments. #elhtSTARaward2022

@chris_nahm Move the table? Up and tilt….

Any other HPB surgeons out there finding themselves pretty much sitting on a chair to get a good view for a true SMA first dissection in an open whipples? This is one unspoken major advantage of MIS whipples.

@BradleyPhilpot I thought the exact same thing!

The stewards decisions are largely random at this point, after Albon is penalised for the exact thing the Red Bull drivers went unpunished for last week. #F1 #AustrianGP

@OctaneJames Same today on M62. Quite frankly it’s dangerous.

Why will no one use this lane? 😡🤬🥵

@MStott88 @h3yhp Do some big sarcomas. Can always end up with some vascular recon at times!

Stuff like this makes me miss vascular. Too late to change? @h3yhp 😂

@EzraTeitelbaum I have started to use veres and the a visiport.

In a patient with a previous midline laparotomy, what’s the best way to obtain initial access for laparoscopic surgery? (Comment on rationale and technique specifics…)

@willissean @LTHTAMS @LeedsHospitals @UniversityLeeds Congratulations! 🎉🎉🎉

Time for pint, thanks you @LTHTAMS @LeedsHospitals for all the support. @UniversityLeeds

@mikejkemp @goldstone_tony @kungfudoctor @Vish_Sharm @PayReviewBodies @TheBMA @Doctors_Vote @BMA_JuniorDocs @BMA_Consultants @trentconsultant @DHSCgovuk Funny how the parliamentary review body allows a pay rise annually! 🤔

If confirmation needed that the @PayReviewBodies process is broken here it is👇🏽 After everything NHS staff have been through they are ‘rewarded’ with a 6% effective pay cut. The pay recommendation for @TheBMA doctors is awaited. What’s your guess - HIGHER or LOWER than 4%

@MStott88 @MiguelTobonL @AHPBA Completely agree. However, things naturally take time to evolve, just have to be patient !

@dribrahimrajput @MiguelTobonL @AHPBA It epitomises a well functioning team when the patient and their complications belong to the unit and not an individual. And when juniors and nursing staff are not afraid to push patient progress informed by a well established and agreed protocol.

How fast do you feed patients after a whipple? Any specific diet preference? Whats the rationale? @AHPBA #Juniorsurgeonscommittee #HPBweekly hpbonline.org/article/S1365-…

@MStott88 @MiguelTobonL @AHPBA Still happens. But sometimes one individual has to do things differently in order to demonstrate that doing things, demonstrated by evidence can improve outcomes and LOS. Hopefully others in the unit will follow!

@dribrahimrajput @MiguelTobonL @AHPBA I think most important thing is the unit all do the same and promote ERAS principles. The worst thing for junior and nursing staff is all the surgeons doing things differently with nutrition, octreotide, feeding, tubes etc.