Browsing by Author "Acharya, Bidur Prasad"
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Publication Achalasia Cardia: A Case Series(Nepal Medical Association, 2024) Chapagain, Nibedita; Adhikari, Nishob; Acharya, Bidur Prasad; Limbu, Yugal; Ghimire, RoshanAbstract 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.Publication Determination of the Surgical Margin in Laparoscopic Liver Resections Using Infrared Indocyanine Green Fluorescence(Nepal Health Research Council, 2025) Maharjan, Dhiresh Kumar; Acharya, Bidur Prasad; Maharjan, Prabir; Limbu, Ugal; Ghimire, Oshan; Thapa, Prabin BikramBackground: The advent of minimally invasive techniques has revolutionized liver surgery, with improvement in postoperative outcomes while maintaining oncological efficacy. Achieving tumor-negative resection margins remains critical for optimal oncological outcomes. Considering the adversity of tactile feedback in minimally invasive surgery complicating margin assessment, this study evaluated the efficacy of near-infrared indocyanine green fluorescence imaging in real-time surgical margin delineation during the hepatic resection. Methods: This is a single-centered, prospective, descriptive study conducted between 15th March 2022 and 15th March 2024 as per the revised STROBE guidelines. Patients were enrolled by convenient sampling and received 0.5 mg/kg of indocyanine green one day before surgery intravenously. During surgery, near infrared-indocyanine green imaging was recorded and utilized to assess the surgical margins along with the white light as well. The findings were compared and confirmed with the final histopathology report. Results: A total number of 21 patients were included in this study who underwent laparoscopic liver resection. Majority of cases were of colorectal liver metastasis (90%), and most of them were located at segment 4 (80%). Participants had a normal preoperative liver status with a median tumor size of 28 mm and a median number of 1.2. Indocyanine green fluorescence successfully delineated resection margins in all cases, and final histopathological assessment confirmed R0 resection status. No adverse reactions to the indocyanine green were reported. Conclusions: Near infrared-indocyanine green provided significant benefit regarding R0 resection in all cases confirmed with histopathology results for the intra-operative identification and demarcation of margins during laparoscopic hepatic resection. Keywords: Colorectal liver metastasis; indocyanine green; laparoscopic liver resection.Publication Intraoperative Variations of the Gastrocolic Trunk of Henle noted in Gastrointestinal Surgeries(Nepal Health Research Council, 2024) Ghimire, Roshan; Thapa, Nishant; Acharya, Bidur Prasad; Sah, Bed Prakash; Limbu, Yugal; Regmee, Sujan; Maharjan, Dhiresh Kumar; Thapa, Prabin BikramBackground: The gastro-colic trunk of Henle is a venous trunk that comprises the veins draining the stomach and colon and is an important landmark for various gastro-intestinal surgeries. Understanding the anatomy of these vessels may enhance the surgical outcome. The aim of this study is, to assess the Intraoperative variations of the Gastrocolic Trunk of Henle noted in gastrointestinal surgeries in a tertiary care center. Methods: A descriptive cross-sectional study was conducted at Kathmandu Medical College Public Limited, a tertiary center in Nepal during the period of one year (1st January 2022, to 31st December 2022). All patients undergoing right hemicolectomy, gastrectomy, and pancreaticoduodenectomy were included in the study. Based on per-operative findings, the type of The gastro-colic trunk of Henle was noted during surgery. Results: A total of 49 patients underwent the above-mentioned surgeries during the study period. The gastro-colic trunk was found in 45 out of the 49 patients intraoperatively (91.84%), and the variations were distinguished. The most common configuration noted was the union of the right gastro-epiploic vein, the anterior superior pancreaticoduodenal vein, and the superior right colic vein (Type I), which was noticed in 46.67% of the patients. Conclusions: The intraoperative identification of the anatomy of The gastro-colic trunk of Henle is challenging because of its variable combinations of tributaries. Knowledge of variations in The gastro-colic trunk of Henle is important in preventing intraoperative bleeding, and during identification, the meticulousness of surgery is redefined. Keywords: Gastrocolic trunk of Henle; hemicolectomy; venous drainage.Publication Lymph node Yield in Apical Tissue During Triangle Operation While Doing Whipples Operation: An Observational Study(Nepal Medical Association, 2025) Maharjan, Dhiresh Kumar; Pudasaini, Prashant; Acharya, Bidur Prasad; Limbu, Yugal; Ghimire, Roshan; Thapa, Prabin BIkramAbstract Introduction: The "TRIANGLE operation" involves the en-bloc removal of the tumor and the entire "mesopancreas" from the triangle-shaped space bounded by the superior mesenteric artery, coeliac trunk, and portal vein. This study assessed lymph node yield in apical tissue during the triangle operation. Methods: An observational cross-section study was conducted for two years at the Department of Gastrointestinal and General Surgery at a tertiary care center of Nepal. from 15th March 2022 to 15th March 2024. The operative procedure included pancreaticoduodenectomy or Whipple’s operation. Total sampling was done. Postoperative outcome and lymph node yeild of the surgeries were studied. Ethical approval was taken from the Institutional Review Committee (Reference No-1102202204). Results: A total of 56 patients underwent pancreaticoduodenectomy along with a triangle operation. The mean age of the patients was 56.38±14.79 years. Male: Female ratio was 1.2:1. Mean preoperative BMI was 24.41±4.72. The mean total lymph node yield was 20.95±8.57. Nineteen patients had a positive lymph node yield in the triangle tissue. The mean triangle lymph node yield was 10.59±4.92, and the mean positive lymph node was 2.58 ±1.64. Among 56 patients, nine patients had both apical margin and the rest of the triangle tissue margin positive. Ten patients had negative apical tissue margins, but the rest of the triangle tissue was positive, whereas, in thirty-seven patients, both the apical tissue and the rest of the triangle circumferential resection margin tissue were negative. Conclusions: This study emphasizes the importance of the inclusion of apical tissue dissection at the confluence of SMA and coeliac trunk to achieve R0 resection. However, a long-term follow is awaited.