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  1. Article ; Online: Complications among Patients Undergoing Pancreaticoduodenectomy in Tertiary Care Centers of Nepal: A Descriptive Cross-sectional Study.

    Neupane, Harish Chandra / Tamang, Tseten Yonjen / Timalsina, Santosh / Tamrakar, Kishor Kumar / Bhattarai, Abhishek

    JNMA; journal of the Nepal Medical Association

    2022  Volume 60, Issue 245, Page(s) 77–82

    Abstract: Introduction: Pancreaticoduodenectomy (Whipple procedure), even after significant evolution, continues to be associated with a high morbidity. The study aimed to find out the prevalence of complications following pancreaticoduodenectomies performed by a ...

    Abstract Introduction: Pancreaticoduodenectomy (Whipple procedure), even after significant evolution, continues to be associated with a high morbidity. The study aimed to find out the prevalence of complications following pancreaticoduodenectomies performed by a single surgeon over a span of 20 years in tertiary care hospitals of Nepal.
    Methods: This was a descriptive cross-sectional study conducted from hospital records of patients who underwent pancreaticoduodenectomy between 1999 and 2019 at different institutions in Chitwan, where the principal author was involved. Ethical clearance was taken from the Institutional Review Committee. Convenience sampling was done. Patients' clinical characteristics and diagnoses were noted. Data entry was done using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage.
    Results: Out of 327 patients who underwent pancreaticoduodenectomy, complications were found in 125 (38.2%) (32.9-43.7 at 95% Confidence Interval). Respiratory complications were the commonest 32 (9.8%), followed by septicemia 25 (7.6%) and cardiac complications 24 (7.3%). Delayed gastric emptying and postoperative pancreatic fistula were seen in 11 (6.8%) and 4 (2.5%) in the first decade respectively. In the second decade, delayed gastric emptying was noted in 2 (1.2%) and postoperative pancreatic fistula in 1 (0.6%) patient.
    Conclusions: The prevalence of complications in our study was comparable to other national and international studies. Surgery-specific complications such as delayed gastric emptying and postoperative pancreatic fistula showed a decline over the decade.
    MeSH term(s) Cross-Sectional Studies ; Humans ; Nepal/epidemiology ; Pancreatic Fistula/complications ; Pancreatic Fistula/etiology ; Pancreaticoduodenectomy/adverse effects ; Pancreaticoduodenectomy/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Tertiary Care Centers
    Language English
    Publishing date 2022-01-15
    Publishing country Nepal
    Document type Journal Article
    ZDB-ID 2209910-4
    ISSN 1815-672X ; 0028-2715
    ISSN (online) 1815-672X
    ISSN 0028-2715
    DOI 10.31729/jnma.7050
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Open Cholecystectomy among Patients undergoing Laparoscopic Cholecystectomy in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

    Katwal, Gaurav / Thapa, Yeshika / Shrestha, Aisha / Bhattarai, Abhishek / Tamrakar, Kishor Kumar / Neupane, Harish Chandra

    JNMA; journal of the Nepal Medical Association

    2022  Volume 60, Issue 249, Page(s) 444–447

    Abstract: Introduction: In the current era, laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstone disease. The aim of this study is to find out the prevalence of open cholecystectomy among patients undergoing laparoscopic ... ...

    Abstract Introduction: In the current era, laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstone disease. The aim of this study is to find out the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy in a tertiary care centre.
    Methods: It is a descriptive cross-sectional study done among 345 patients at the Department of Surgery of a tertiary care centre from June, 2020 to May, 2021 after receiving ethical clearance from the Institutional Review Committee (Reference number: CMC-IRC/0770798-271). Convenience sampling was done. Successive patients who underwent elective laparoscopic cholecystectomy during the study period were included. Standard 4 port laparoscopic technique was used for the laparoscopic cholecystectomy and sub-costal Kocher incision was used for the open cholecystectomy respectively. After data collection, entry and analysis were done in Microsoft Excel. Point estimate at a 95% Confidence Interval was calculated along with frequency and percentages for binary data.
    Results: Out of 345 patients, the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy was 6 (1.73%) (0.35-3.11 at a 95% Confidence Interval).
    Conclusions: This study showed that the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy was lower when compared to similar studies conducted in similar settings.
    Keywords: cholecystectomy; cholelithiasis; laparoscopic cholecystectomy.
    MeSH term(s) Cholecystectomy/methods ; Cholecystectomy, Laparoscopic/methods ; Cholelithiasis/epidemiology ; Cholelithiasis/surgery ; Cross-Sectional Studies ; Humans ; Tertiary Care Centers
    Language English
    Publishing date 2022-05-05
    Publishing country Nepal
    Document type Journal Article
    ZDB-ID 2209910-4
    ISSN 1815-672X ; 0028-2715
    ISSN (online) 1815-672X
    ISSN 0028-2715
    DOI 10.31729/jnma.7371
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Utility of the Parkland Grading Scale to determine intraoperative challenges during laparoscopic cholecystectomy: a validation study on 206 patients at an academic medical center in Nepal.

    Shrestha, Anup / Bhattarai, Abhishek / Tamrakar, Kishor Kumar / Chand, Manoj / Yonjan Tamang, Samjhana / Adhikari, Sampada / Neupane, Harish Chandra

    Patient safety in surgery

    2023  Volume 17, Issue 1, Page(s) 12

    Abstract: Background: Most of the scoring systems to predict difficult laparoscopic cholecystectomy are based on pre-operative clinical and radiological findings. Recently the Parkland Grading Scale system was introduced as a simple intra-operative grading scale. ...

    Abstract Background: Most of the scoring systems to predict difficult laparoscopic cholecystectomy are based on pre-operative clinical and radiological findings. Recently the Parkland Grading Scale system was introduced as a simple intra-operative grading scale. This study aims to utilize the Parkland Grading Scale system to assess the intraoperative challenges during laparoscopic cholecystectomy.
    Method: This was a prospective, cross-sectional study done at Chitwan Medical College and Teaching Hospital, Chitwan, Nepal. All the patients underwent laparoscopic cholecystectomy from April 2020 to March 2021. Based on the initial intra-operative finding, Parkland Grading Scale was noted and at the end of the surgery, the level of difficulty was given by the operating surgeon. All the pre-operative, intra-operative, and post-operative findings were compared with the scale.
    Results: Out of 206 patients, there were 176 (85.4%) females, and 30 (14.6%) males. The median age was 41 years (Range 19-75). The median body mass index was 23.67 kg/m2. There were 35(17%) patients with a history of previous surgery. The rate of conversion to open surgery was 5.8%. According to Parkland Grading Scale, 67(32.5%), 75(36.4%), 42(20.4%), 15(7.3%), and 7(3.4%) were graded as grade 1, 2, 3, 4, and 5 respectively. There was a difference in the Parkland grading scale in patients with a history of acute cholecystitis, gallbladder wall thickness, pericholecystic collection, stone size, and body mass index (p < 0.05). The total operative time, level of difficulty in surgery, rate of help needed from colleagues or replacement as the main surgeon, bile spillage, drain placement, gallbladder decompression, and conversion rate all increased with an increase in scale (p < 0.05). There was a significant increase in the development of post-operative fever, and post-operative hospital stay as the scale increased (p < 0.05). The Tukey-Kramer test for all pair-wise comparisons revealed that each grade was significantly different from each other (p < 0.05) on the difficulty of surgery except for grade 4 from 5.
    Conclusion: Parkland Grading Scale system is a reliable intra-operative grading system to assess the difficulty in laparoscopic cholecystectomy and helps the surgeon to change the strategy of surgery. An increase in scale is associated with an increased difficulty level of the surgery.
    Language English
    Publishing date 2023-05-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 2409244-7
    ISSN 1754-9493
    ISSN 1754-9493
    DOI 10.1186/s13037-023-00364-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Role of liver enzymes in patients with blunt abdominal trauma to diagnose liver injury.

    Shrestha, Anup / Neupane, Harish Chandra / Tamrakar, Kishor Kumar / Bhattarai, Abhishek / Katwal, Gaurav

    International journal of emergency medicine

    2021  Volume 14, Issue 1, Page(s) 7

    Abstract: Background: The liver is the second most injured organ following blunt abdominal trauma (BAT) after the spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it may not readily ... ...

    Abstract Background: The liver is the second most injured organ following blunt abdominal trauma (BAT) after the spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it may not readily available in all the hospitals. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury.
    Method: The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) from February 2019 to May 2020. It was a prospective observational study. All the patients with BAT were received by on-duty surgical residents in the emergency department. Based on the imaging and operative finding, patients with liver injury and without liver injury were noted with the associated injury. For comparisons of clinical and grading characteristics between the two groups (liver injury and no liver injury), the chi-squared test was used for categorical variables as appropriate, and the Mann-Whitney U test used for quantitative variables (AST and ALT). The comparisons between more than two groups (grade of injury) were performed using the Kruskal-Wallis test. The receiver operating characteristic (ROC) was used to calculate the optimal cut-off value of AST and ALT.
    Results: Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (< 0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89 (95% confidence interval 0.86-0.98) and of ALT was 0.92 (95% confidence interval 0.83-0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT, respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7%, a specificity of 90%, a positive predictive value of 86.8%, and a negative predictive value of 77.6%. The corresponding values for ALT ≥ 80 U/l were 77.8%, 94.1%, 92.1%, and 82.8%, respectively.
    Conclusion: In conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l, respectively. The elevated level of AST and ALT might assist the emergency physicians and surgeons to timely refer the suspected patients with the liver injury to a tertiary center.
    Language English
    Publishing date 2021-01-19
    Publishing country England
    Document type Journal Article
    ZDB-ID 2411462-5
    ISSN 1865-1380 ; 1865-1372
    ISSN (online) 1865-1380
    ISSN 1865-1372
    DOI 10.1186/s12245-021-00332-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Medical Thoracoscopy for Undiagnosed Exudative Pleural Effusion: Experience from Two Tertiary Care Hospitals of Nepal.

    Shrestha, Bishow Kumar / Adhikari, Shital / Thakur, Binay Kumar / Kadaria, Dipen / Tamrakar, Kishor Kumar / Devkota, Mukti

    JNMA; journal of the Nepal Medical Association

    2020  Volume 58, Issue 223, Page(s) 158–164

    Abstract: Introduction: Medical thoracoscopy has recently gained renewed interest due to its minimal invasive nature and high yield diagnostic outcome. This study aims to observe diagnostic yield and safety of medical thoracoscopy in undiagnosed exudative pleural ...

    Abstract Introduction: Medical thoracoscopy has recently gained renewed interest due to its minimal invasive nature and high yield diagnostic outcome. This study aims to observe diagnostic yield and safety of medical thoracoscopy in undiagnosed exudative pleural effusion.
    Methods: This is a descriptive cross-sectional study conducted in two tertiary care hospitals in Chitwan from March 2018 to May 2018. Ethical approval from the Institutional Review Board was obtained. Convenient sampling was done that included all the patients who met criteria for undiagnosed exudative pleural effusion after diagnostic thoracocentesis. Patients having contraindication to procedure and who refused consent were excluded. Statistical analysis was performed using IBM SPSS Statistics 20 and data are presented as mean ±SD and frequency (percentage).
    Results: A total of 14 patients underwent rigid medical thoracoscopy. All 14 patients had unilateral pleural effusion. The overall diagnostic yield was 100%. Malignancy was the most frequent histopathology diagnosis seen in 11 (78.57%) patients, the commonest being metastatic adenocarcinoma in 8 (57.1%). Pleural tuberculosis and acute-on-chronic pleuritis were seen in 2 (14.3%) and 1 (7.1%) patients, respectively. Pleural deposits and hemorrhagic pleural fluid were the two commonest findings, seen in 10 (70.1%) and 9 (64.3%) patients, respectively. Two (14.3%) patients clinically treated as tuberculous pleural effusion was re-diagnosed to have metastatic adenocarcinoma. Procedure related mortality and major complications were nil. Common procedure-related minor complications observed were mild to moderate pain and mild bleeding, observed in 3 (21.4%) and 2 (14.3%) patients, respectively.
    Conclusions: Medical thoracoscopy is a safe, well-tolerated and high yield procedure in undiagnosed exudative pleural effusion. This art of medicine should be promoted in daily medical practice.
    MeSH term(s) Adult ; Aged ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Nepal ; Pleural Effusion/diagnosis ; Pleural Effusion/etiology ; Tertiary Care Centers ; Thoracoscopy ; Tuberculosis/complications ; Tuberculosis/diagnosis
    Language English
    Publishing date 2020-04-28
    Publishing country Nepal
    Document type Journal Article ; Multicenter Study
    ZDB-ID 2209910-4
    ISSN 1815-672X ; 0028-2715
    ISSN (online) 1815-672X
    ISSN 0028-2715
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  6. Article ; Online: Medical Thoracoscopy for Undiagnosed Exudative Pleural Effusion: A Descriptive Cross-sectional Study.

    Shrestha, Bishow Kumar / Adhikari, Shital / Thakur, Binay Kumar / Kadaria, Dipen / Tamrakar, Kishor Kumar / Devkota, Mukti

    JNMA; journal of the Nepal Medical Association

    2020  Volume 58, Issue 223, Page(s) 158–164

    Abstract: Introduction: Medical thoracoscopy has recently gained renewed interest due to its minimal invasive nature and high yield diagnostic outcome. This study aims to observe diagnostic yield and safety of medical thoracoscopy in undiagnosed exudative pleural ...

    Abstract Introduction: Medical thoracoscopy has recently gained renewed interest due to its minimal invasive nature and high yield diagnostic outcome. This study aims to observe diagnostic yield and safety of medical thoracoscopy in undiagnosed exudative pleural effusion.
    Methods: This is a descriptive cross-sectional study conducted in two tertiary care hospitals in Chitwan from March 2018 to May 2018. Ethical approval from the Institutional Review Board was obtained. Convenient sampling was done that included all the patients who met criteria for undiagnosed exudative pleural effusion after diagnostic thoracocentesis. Patients having contraindication to procedure and who refused consent were excluded. Statistical analysis was performed using IBM SPSS Statistics 20 and data are presented as mean±SD and frequency (percentage).
    Results: A total of 14 patients underwent rigid medical thoracoscopy. All 14 patients had unilateral pleural effusion. The overall diagnostic yield was 100%. Malignancy was the most frequent histopathology diagnosis seen in 11 (78.57%) patients, the commonest being metastatic adenocarcinoma in 8 (57.1%). Pleural tuberculosis and acute-on-chronic pleuritis were seen in 2 (14.3%) and 1 (7.1%) patients, respectively. Pleural deposits and hemorrhagic pleural fluid were the two commonest findings, seen in 10 (70.1%) and 9 (64.3%) patients, respectively. Two (14.3%) patients clinically treated as tuberculous pleural effusion was re-diagnosed to have metastatic adenocarcinoma.  Common procedure-related minor complications observed were mild to moderate pain and mild bleeding, observed in 3 (21.4%) and 2 (14.3%) patients, respectively.
    Conclusions: Medical thoracoscopy is a safe, well-tolerated and high yield procedure in undiagnosed exudative pleural effusion. This art of medicine should be promoted in daily medical practice.
    Language English
    Publishing date 2020-03-30
    Publishing country Nepal
    Document type Journal Article
    ZDB-ID 2209910-4
    ISSN 1815-672X ; 0028-2715
    ISSN (online) 1815-672X
    ISSN 0028-2715
    DOI 10.31729/jnma.4873
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Management of Traumatic Liver Injury in a Tertiary Care Hospital in Nepal.

    Neupane, Harish Chandra / Tamrakar, Kishor Kumar / Bhattrai, Abhishek / Tamang, Tseten Yonjen / Bista, Bishnu / Chaulagain, Rajib

    Journal of Nepal Health Research Council

    2020  Volume 17, Issue 4, Page(s) 537–542

    Abstract: Background: The liver is most frequently injured solid organ in abdominal trauma. The non-operative management is the standard treatment for hemodynamically stable patients. This study analyse the epidemiological aspects, injury patterns, treatment ... ...

    Abstract Background: The liver is most frequently injured solid organ in abdominal trauma. The non-operative management is the standard treatment for hemodynamically stable patients. This study analyse the epidemiological aspects, injury patterns, treatment modalities and outcome in patients with liver injuries only and associated injuries outside the liver.
    Methods: This was a retrospective study in patients with liver injuries admitted from 1st March 2014 to 31st January 2019 at Chitwan Medical College and Hospital, Nepal. The patients were divided into two groups. Group A consisted of isolated liver injury and Group B liver injury with associated injury of other organs. Data were analysed by using descriptive statistics and Mann-Whitney U test.
    Results: A total of 61 patients were admitted with liver injury. There were 18 (29.5 %) patients with liver injury alone (group A) and 43 (70.5 %)liver injury associated with other organs (group B). Low grade liver injuries were 48 (78.7 %) and high grade 13 (21.3 %). The operative management was done for one liver injury with biliary peritonitis in group A. In group B, 16 patients required laparotomy and operative management for associated abdomen injuries.
    Conclusions: Non-operative treatment modality in hemodynamically stable patients with isolated liver injuries was safe and effective.
    MeSH term(s) Abdominal Injuries/surgery ; Abdominal Injuries/therapy ; Adolescent ; Adult ; Female ; Humans ; Liver/injuries ; Male ; Middle Aged ; Nepal ; Retrospective Studies ; Tertiary Care Centers ; Trauma Severity Indices ; Young Adult
    Language English
    Publishing date 2020-01-21
    Publishing country Nepal
    Document type Journal Article
    ZDB-ID 2551251-1
    ISSN 1999-6217 ; 1727-5482
    ISSN (online) 1999-6217
    ISSN 1727-5482
    DOI 10.33314/jnhrc.v17i4.1958
    Database MEDical Literature Analysis and Retrieval System OnLINE

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