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  • 1
    Online Resource
    Online Resource
    Evaluating postoperative outcome assessment tools in hepato-pancreato-biliary surgery: A comparative analysis of the comprehensive complication index and Clavien–Dindo classification in a cohort of 1240 patients at a tertiary care center
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Annals of Medicine & Surgery Vol. 86, No. 6 ( 2024-04-29), p. 3288-3293
    Details
    In: Annals of Medicine & Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 86, No. 6 ( 2024-04-29), p. 3288-3293
    Abstract: The comprehensive complication index (CCI) has emerged as a new tool for reporting postoperative complications. The aim of this study is to evaluate and compare the efficacy of CCI and Clavien–Dindo Classification (CDC) in measuring postoperative outcomes in patients undergoing hepato-pancreato-biliary (HPB) surgery. Materials and methods: In this single-centered, prospective, comparative study conducted between January 2022 and March 2023, 1240 patients underwent HPB surgery, including laparoscopic cholecystectomies and complex HPB surgery. Postoperative complications were evaluated utilizing the CCI and CDC indices, and their relationships with length of ICU stay, hospital stay, and return to activity were compared. Results: A total of 117 patients (9.44%) experienced complications of varying grades. There was a strong correlation between CCI and CDC (r=0.982, P 〈 0.001). Both CCI and CDC demonstrated a strong correlation with the length of hospital stay, ICU stay, and return to normal activity. While CCI showed a better correlation with the length of hospital stay (r=0.706 vs. 0.695) and return to normal activity (r=0.620 vs. 0.611) than CDC, the difference was not statistically significant. Conclusion: CCI exhibited a stronger correlation with the length of stay and return to activity; however, no statistically significant advantage was observed over CDC.
    Type of Medium: Online Resource
    ISSN: 2049-0801
    URL: Article
    DOI: 10.1097/MS9.0000000000002116
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 2745440-X
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  • 2
    Online Resource
    Online Resource
    Indications and outcome of surgical management of local complications of acute pancreatitis: a single-centre experience
    Medip Academy ; 2021
    In:  International Surgery Journal Vol. 8, No. 11 ( 2021-10-28), p. 3238-
    Details
    In: International Surgery Journal, Medip Academy, Vol. 8, No. 11 ( 2021-10-28), p. 3238-
    Abstract: Background: Acute pancreatitis is a common and challenging disease that can develop both local and systemic complications. According to the Atlanta classification, local complications include peri-pancreatic collection, acute necrotic collection, pseudocyst and walled-off necrosis.Methods: A hospital-based retrospective study was conducted in the department of surgery at Kathmandu medical college teaching hospital. Patients were recruited using purposive sampling method and those who underwent laparoscopic, retroperitoneal or open surgical procedures for the management of local complications of acute pancreatitis from June 2017 to July 2021. The indication, perioperative outcome and associated complications were evaluated in all the cases.Results: Between June 2017 to July 2021, 432patients were admitted to the surgery department with acute pancreatitis or with complications of acute pancreatitis. Twenty-one patients required surgical intervention in the form of external drainage, cysto-enterostomy, VARD or open necrosectomy due to failure of endoscopic or radiological intervention or due to positions of lesions being inaccessible to these techniques. All patients had clinical improvement following surgery with an acceptable complication rate given the severity of the disease.Conclusions: Although various endoscopic techniques are now available to manage the pancreatic fluid collection and pancreatic necrosis, surgery remains essential in managing the disease.
    Type of Medium: Online Resource
    ISSN: 2349-2902 , 2349-3305
    URL: Article
    DOI: 10.18203/2349-2902.isj20214358
    Language: Unknown
    Publisher: Medip Academy
    Publication Date: 2021
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  • 3
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    Correlation of Inferior Vena Cava diameter and IVC Collapsibility Index with Central Venous Pressure (CVP) in critically ill surgical patients
    Nepal Journals Online (JOL) ; 2021
    In:  Journal of Society of Surgeons of Nepal Vol. 24, No. 1 ( 2021-12-14), p. 19-22
    Details
    In: Journal of Society of Surgeons of Nepal, Nepal Journals Online (JOL), Vol. 24, No. 1 ( 2021-12-14), p. 19-22
    Abstract: Introduction: Central Venous Pressure is a valuable parameter in the management of critically ill surgical patients in the ICU. Non-invasive methods to extrapolate the volume status of the patient can aid clinicians in expediting proper treatment. The objective of this study is to find a correlation between Inferior Vena cava (IVC) diameter and collapsibility index (CI) with Central venous pressure (CVP) in critically ill surgical patients. Methods: This cross-sectional study included  60 critically ill patients from  September 2020 – 31st February 2021. We recorded the patient's age, sex, heart rate, blood pressure, CVP, volume status, IVC minimum, and maximum diameter. After taking consent and explaining the procedure to the patient, the maximum IVC anteroposterior diameter was noted at the end of inspiration and end of expiration in centimeters. IVC collapsibility index was calculated using the formula ([IVCdmax-IVCdmin] /IVCdmax*100%). Following this, the CVP of the patient was measured. Results: Among the patients evaluated, 32 were females. The mean age of the participants was 44.90 ± 15.76 years. The mean central venous pressure maintained was 11.10 ± 2.11cm H2O with an inferior vena cava collapsibility index of 29.69 ± 8.75. There was a negative correlation between CVP and IVC collapsibility index (%), which was statistically significant (r = -0.701, n = 60, p 〈 0.01). A strong positive correlation between CVP and maximum IVC diameter (r = 0.712, n = 60, p 〈 0.01) and minimum IVC diameter (r = 0.796, n = 60, p 〈 0.01) was found. Conclusion: Inferior Vena Cava diameter and IVC Collapsibility Index can be used as a reliable substitute to central venous pressure to determine the patient's volume status.
    Type of Medium: Online Resource
    ISSN: 2392-4772 , 1815-3984
    URL: Article
    DOI: 10.3126/jssn.v24i1.41005
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2021
    detail.hit.zdb_id: 3091149-7
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  • 4
    Online Resource
    Online Resource
    Correlation of the Nutritional Risk Screening 2002 Score With Post-operative Complications in Gastrointestinal and Hepatopancreatobiliary Oncosurgeries
    Springer Science and Business Media LLC ; 2024
    In:  Cureus
    Details
    In: Cureus, Springer Science and Business Media LLC
    Type of Medium: Online Resource
    ISSN: 2168-8184
    URL: Article
    DOI: 10.7759/cureus.58514
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2024
    detail.hit.zdb_id: 2747273-5
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  • 5
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    Online Resource
    Achalasia Cardia: A Case Series
    Journal of Nepal Medical Association (JNMA) ; 2024
    In:  Journal of Nepal Medical Association Vol. 62, No. 275 ( 2024-06-30), p. 474-477
    Details
    In: Journal of Nepal Medical Association, Journal of Nepal Medical Association (JNMA), Vol. 62, No. 275 ( 2024-06-30), p. 474-477
    Abstract: Achalasia cardia is a rare disorder that impacts the lower esophageal sphincter and esophageal body. Due to its wide range of symptoms, it can be difficult to diagnose. Here we report three cases of Achalasia Cardia during a period of 9 months. The first patient, an 18-year-old male, presented with dysphagia and was evaluated with barium swallow and high-resolution manometry (HRM) revealing Achalasia Cardia. In the second case, a 37-year-old female had a prolonged diagnostic journey due to multiple comorbidities before a barium swallow finally revealed achalasia cardia. The third patient, a 47-year-old female was promptly diagnosed with barium swallow. All the cases were successfully treated with laparoscopic Heller’s myotomy with anterior Dor’s fundoplication. This case series highlights the potential for delayed diagnosis and the importance of early recognition, tailored diagnostic approaches, and the efficacy of surgical management.
    Type of Medium: Online Resource
    ISSN: 1815-672X , 0028-2715
    URL: Article
    DOI: 10.31729/jnma.8649
    Language: Unknown
    Publisher: Journal of Nepal Medical Association (JNMA)
    Publication Date: 2024
    detail.hit.zdb_id: 2209910-4
    detail.hit.zdb_id: 138059-X
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  • 6
    Online Resource
    Online Resource
    Outcome of laparoscopic vs open appendectomy in the management of acute appendicitis
    Nepal Journals Online (JOL) ; 2023
    In:  Nepal Medical College Journal Vol. 25, No. 4 ( 2023-12-22), p. 330-334
    Details
    In: Nepal Medical College Journal, Nepal Journals Online (JOL), Vol. 25, No. 4 ( 2023-12-22), p. 330-334
    Abstract: The worldwide trend of appendectomy is shifting from conventional open to the laparoscopic technique. The study’s objective was to compare laparoscopic and open appendectomy in terms of various operative and postoperative parameters to find the best operative technique. A prospective comparative study was conducted on 142 patients undergoing laparoscopic (n=43) or open appendectomy (n=99) from 1st February 2022 to 30th January 2023 under the Department of Surgery of Kathmandu Medical College Teaching Hospital (KMCTH). In five patients, laparoscopic appendectomy was later converted to open and excluded from the study. The mean operating time for the open appendectomy group was 44.1±13.1 minutes while for the laparoscopic appendectomy group, it was 48.4±14.0 minutes (p=0.047). Visual analogue score taken on 1st, 7th and 30th post-operative day for open and laparoscopic appendectomy were 4.0±2.2 vs 3.6±1.9 (p=0.160); 1.4±1.3 vs 0.6±0.9 (p 〈 0.001) and 0.2±0.5 vs 0.02±0.15 (p=0.107) respectively. The total days of postoperative hospital stay were 1.57±0.96 for open appendectomy and 1.58±1.07 for laparoscopic appendectomy (p=0.843). However, laparoscopic appendectomy group had an earlier return to normal activity (7.30±1.15 days) when compared to the open appendectomy group (8.05±2.42 days) (p=0.023). The laparoscopic appendectomy group also had fewer postoperative complications than the open appendectomy group (18.6% vs 24.2%) (p=0.411). Thus, laparoscopy is a safe and effective method of removal of appendix for acute appendicitis.
    Type of Medium: Online Resource
    ISSN: 2676-1424 , 2676-1319
    URL: Article
    DOI: 10.3126/nmcj.v25i4.60922
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2023
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  • 7
    Online Resource
    Online Resource
    Grading the Whipple’s procedure: a strategy for structured skill advancement in surgical training
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  International Journal of Surgery: Global Health Vol. 7, No. 3 ( 2024-05-9)
    Details
    In: International Journal of Surgery: Global Health, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 3 ( 2024-05-9)
    Abstract: The Whipple’s procedure or pancreatoduodenectomy (PD), is recognized for its technical intricacy in surgical practice. This study aims to categorize PD into four types based on procedural complexity and anticipated postoperative outcomes, intending to integrate this classification into the progressive training of surgical fellows. Methods: In this retrospective cohort study, 242 PDs, performed by a single unit across multiple centers from January 2016 to December 2022, were categorized into four types based on technical complexity and extent of surgical intervention. These types were: Type 1 (dilated duct, firm pancreas), Type 2 (as Type 1 + vascular reconstruction), Type 3 (nondilated duct, soft pancreas), and Type 4 (as Type 3 + vascular reconstruction). The study assessed patient characteristics, surgical parameters, and perioperative morbidity and mortality, comparing the outcomes of the four PD types. Results: Type 1 PD was predominant (65.2%), with the lowest 30-day mortality (2.53%). Conversely, Type 4 PD, though least performed (3.3%), exhibited the highest mortality (25%) and major complications (25%). Statistically significant differences were noted in the incidence of clinically relevant-postoperative pancreatic fistula, delayed gastric emptying, and wound complications among the PD types, with overall surgical morbidity being higher in Types 3 and 4. Conclusion: In conclusion, our data compellingly links morbidity, such as postoperative pancreatic fistula, with the technical challenges of the procedure, even though not all mortality can be attributed solely to surgical factors. The implementation of this system offers a structured approach to surgical training, paving the way for trainees to adeptly navigate and proficiently perform this complex surgical technique.
    Type of Medium: Online Resource
    ISSN: 2576-3342
    URL: Article
    DOI: 10.1097/GH9.0000000000000450
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
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  • 8
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    Online Resource
    Laparoscopic Cholecystectomy in Situs Inversus Totalis with Stage 5 Chronic Kidney Disease: A Case Report
    Journal of Nepal Medical Association (JNMA) ; 2023
    In:  Journal of Nepal Medical Association Vol. 61, No. 267 ( 2023-11-01), p. 893-896
    Details
    In: Journal of Nepal Medical Association, Journal of Nepal Medical Association (JNMA), Vol. 61, No. 267 ( 2023-11-01), p. 893-896
    Abstract: Situs inversus totalis is a rare congenital anomaly in which the abdominal and thoracic organs aretransposed in a mirror image. Diagnosis and management of cholelithiasis in patients with situsinversus totalis pose a challenge due to the anatomical variation. A laparoscopic cholecystectomy in such a case can be technically challenging, especially for a right-handed surgeon. In this case report, we present a case of a 38-year-old male with symptomatic cholelithiasis in a chronic kidney disease stage five patient under maintenance hemodialysis planned for recipient renal transplant. A laparoscopic cholecystectomy considered the gold standard for symptomatic cholelithiasis was performed with a three-port technique. The technical challenges anticipated due to anatomical variation were managed by intraoperative modifications. In conclusion, laparoscopic cholecystectomy in patients with situs inversus totalis can be done with technical modifications and re-orientation of visual motor skills.
    Type of Medium: Online Resource
    ISSN: 1815-672X , 0028-2715
    URL: Article
    DOI: 10.31729/jnma.8301
    Language: Unknown
    Publisher: Journal of Nepal Medical Association (JNMA)
    Publication Date: 2023
    detail.hit.zdb_id: 2209910-4
    detail.hit.zdb_id: 138059-X
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  • 9
    Online Resource
    Online Resource
    Indocyanine green fluorescence imaging in gastrointestinal surgery
    Nepal Journals Online (JOL) ; 2023
    In:  Journal of Kathmandu Medical College Vol. 12, No. 2 ( 2023-06-30), p. 80-86
    Details
    In: Journal of Kathmandu Medical College, Nepal Journals Online (JOL), Vol. 12, No. 2 ( 2023-06-30), p. 80-86
    Abstract: Background: Prevention of post-operative anastomotic leak (AL) is significant challenge for surgeons, with roughly half of all AL cases linked to insufficient vascular supply, often undetectable during anastomosis. Recently, indocyanine green fluorescence (ICG) emerged as promising tool in visceral surgery due to its low cost, ease of use, wide availability, and low toxicity. In gastrointestinal surgery, ICG is primarily used for real-time intraoperative angiography, allowing surgeons to assess anastomotic stumps' perfusion before and after procedure. Objectives: To assess efficacy of ICG as an adjunct in preventing AL. Methods: This descriptive study conducted after ethical approval at Kathmandu Medical College Teaching Hospital from 2022 February 15 to 2023 January 30 included 111 patients enrolled via convenience sampling. During operation, surgeon used ICG fluorescence angiography on patients to determine perfusion status, which allowed for evaluation of transection line and post-anastomotic viability. Data were entered in Microsoft Excel sheet 2019 and descriptive analysis done regarding demographic data, changes in the transection line, and post-operative anastomotic leaks. Results: Total 111 patients with age 55.41 ± 13.63 years and male-female ratio of 2:1 participated in this study. ICG use resulted in changes to proximal resection margin for five (4.5%) patients. Clinical judgment and ICG fluorescence imaging showed a difference in bowel transection line of 0.5-1.5 cm. None of the patients who underwent proximal resection margin revision with the assistance of ICG experienced post-operative anastomotic leaks. Conclusion: ICG fluorescence can be used as an adjunct in determining the viability of anastomosis and prevent post-operative anastomosis leak.
    Type of Medium: Online Resource
    ISSN: 2091-1793 , 2091-1785
    URL: Article
    DOI: 10.3126/jkmc.v12i2.45509
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2023
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  • 10
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    Online Resource
    Apical tissue resection in triangle operation during Whipple’s surgery
    Nepal Journals Online (JOL) ; 2020
    In:  Journal of Kathmandu Medical College Vol. 9, No. 4 ( 2020-12-31), p. 213-218
    Details
    In: Journal of Kathmandu Medical College, Nepal Journals Online (JOL), Vol. 9, No. 4 ( 2020-12-31), p. 213-218
    Abstract: Background: In pancreatic ductal adenocarcinoma, standardised concepts of radical surgical clearance have not been universally applied. Objectives: The main objective of this study is to reveal the status of circumferential resection margin of the apical tissue of the triangle namely the confluence of SMA and coeliac trunk in relation to circumferential resection margin of triangle tissue bounded by superior mesenteric artery, common hepatic artery and portal vein when performing the TRIANGLE operation. Methodology: This was a hospital-based cross-sectional study conducted at Kathmandu Medical College and Teaching Hospital, from September 2020 to December 2020. The study was done after ethical clearance from the Institutional Review Committee of Kathmandu Medical College. All consecutive patients who were subjected for Whipple’s operation for pancreatic head and uncinate process were included. Results: Fifteen patients underwent the “TRIANGLE” operation during a four months period. Median age of the patients was 65 ± 13.34 years (range 32–84 years). Medianpreoperative BMI 21.75± 2.5 (range: 18 to 26.7). Regarding histopathological results, an R0 resection was achieved in 9/15 patients. In nine patients,circumferential resection margin(CRM) of both the apical tissue and the rest of the triangle was negative. In the next three patients, the CRM of apical tissue was negative but  the triangle tissue  was positive whereas in the other three patients CRM of both the apical tissue  and the triangle tissue  were positive. Conclusion: This study emphasises the importance of inclusion of apical tissue dissection at the confluence of SMA and coeliac trunk in order to achieve R0 resection without significant short-term morbidity. However, a long-term follow is awaited.
    Type of Medium: Online Resource
    ISSN: 2091-1793 , 2091-1785
    URL: Article
    DOI: 10.3126/jkmc.v9i4.38094
    Language: Unknown
    Publisher: Nepal Journals Online (JOL)
    Publication Date: 2020
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