Browsing by Author "Bhandari, RS"
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Publication A Retrospective study of Intussusception of the bowel in adults(Institute of Medicine, 2015) Bhattarai, A; Poudyal, S; Bhandari, RS; Lakhey, PJ; Singh, KPAbstract Introduction: Intussusception is the leading cause of intestinal obstruction in children. In contrast to childhood intussusception, adult intussusception accounts for only 5% of all intussusceptions with 90% having a lead point, a well-defined pathological abnormality. Adult intussusceptions pose a further challenge as they are often presented with acute, subacute or chronic non-specific symptoms. Computed tomography is the most sensitive diagnostic modality and can distinguish between intussusception with and without a lead point. Surgery is the definitive treatment of adult intussusceptions. So the aim was to evaluate adults with intussusception in and to assess its etiology, clinical features, diagnosis and management. Methods: A retrospective review of adults aged >16 years with a diagnosis of intussusceptions between 1998- 2013 was done. Results: There were 22 cases of adult intussusceptions. Mean age was 44 years (17-86 years). Abdominal pain, nausea, vomiting and rectal bleeding were the most common symptoms. There were 2 cases of retrograde jejunogastric intussusception, 5 cases of jejunojejunal intussusceptions, 3 cases of ileoileal intussusceptions, 11 cases of ileocolic intussuscetpions and 1 case of colocolic intussusception. In seventeen cases, the lead point for intussusception was identified out of which 13 cases had benign pathology and 4 cases had malignant pathology. In five cases cause was not found. All cases were treated surgically except one case of jejunogastric intussusception which was reduced endoscopically. Mean duration of hospital stay was 13 days (5-30 days). Postoperative period was uneventful except surgical site infection in 8 cases and 1 case developed ECF which was managed conservatively. There was one mortality because of chest infection. Conclusion: Adult intussusception is an unusual and challenging condition having a well- defined pathological abnormality in most of the cases. Treatment usually requires resection of the involved bowel segment. Keywords: Adult Intussusception, Computed tomography, SurgeryPublication Early Outcome of Liver Resections in Octogenarians(Kathmandu University, 2015) Bhandari, RS; Riddiough, G; Muralidharan, V; Christophi, CABSTRACT Background Reports on safety and feasibility of liver resection in patients 80 years and older are very limited. Objective Here, we intend to analyze the perioperative outcomes of liver resections in octogenarians performed at a single tertiary level teaching hospital over a ten years period. Method Retrospective review of the medical records (between 2004 to 2014) of patients of the defined age group was performed. Clinicopathological features, indications, extent of resections, intraoperative parameters, postoperative complications and final outcome were analyzed. Findings were compared with similar studies published in literature. Result Total 19 (11 male, 8 female, maximum age 85 years) patients of the study group underwent liver resection during the defined period. Commonest indication was colorectal liver metastasis (9 patients). One patient had pancreaticodudenectomy for periampullary malignancy four years prior to present with liver metastasis and subsequently had liver resection for recurrence of disease. Except one, all had open surgery. Types of resection ranged from sub segmental to major right (8 patients) and left (1 patient) hepatectomy. Total 3 (27%) out of 11 patients on whom drain was not placed required radiological drainage of abdominal collection. One patient developed liver abscess postoperatively and was also successfully drained under radiological guidance. Only 2 (10.5%) had prolonged Intensive Care Unit (ICU) stay and remaining patients were discharged to ward after 24 hrs of observation in high dependency/Intensive care unit. Median hospital stay was 11 days. Postoperative complications were 3 of grade II, 4 of grade IIIa, 1 of IIIb and 2 of IVa. Total 9 patients were discharged to rehabilitation centers and remaining 10 could be discharged home. There was 0% mortality. Conclusion In appropriately selected cases, when performed in specialized tertiary centers excellent perioperative outcomes of liver resections can be achieved even in patients of 80 years of age and above. KEY WORDS Elderly, liver, morbidity, mortality, octogenarians, resectionPublication Gall Bladder complications of Typhoid(Institute of Medicine, 2009) Bhandari, RS; Luitel, BR; Lakhey, PJ; Singh, KPAbstract Surgical complications of typhoid fever usually involve gut but infrequently typhoid fever also involves gallbladder. Complications range from acalculous cholecystitis to perforation. We present a series of three cases which included acalculous cholecystitis, gangrenous cholecystitis and perforation of gallbladder. Investigations revealed them to be a complication of Enteric fever. Acalculous cholecystitis was managed conservatively; gangrenous cholecystitis and perforated gallbladder underwent emergency cholecystectomy. All three cases were discharged after treatment and are doing well on follow up. Keywords: Gallbladder, perforation, typhoidPublication Incisional hernia repair(Institute of Medicine, 2010) Bhattarai, A; Bhandari, RSAbstract Introduction: Incisional hernia is a late complication of any abdominal surgery, including both laparotomy and laparoscopic. It occurs at the site of previous incision through weak scar. Hernia occurs as a result of excessive tension and inadequate healing of previous incision which is often associated with surgical site infection or severe bouts of coughing in the early post operative period or injury to the nerve supplying the abdominal wall. This study was performed with objectives to review clinical profile and management of incisional hernia in Tribhuvan University Teaching Hospital (TUTH). Methods: A retrospective study was conducted at TUTH, over the period of 18 month from, Jan 2007 to June 2008. All patients with a history of abdominal surgery with a complaint of swelling over previous incision site were included in this study. Results: Twenty two patients who had undergone hernia repair during the period were included. Mean age of presentation was 47 years with the range of 27 to 80 year. Among them 17 were female and five were male. Among 17 female patients, 15 had history of laparotomy through lower midline incision and two had history of minilaparotomy for tubal ligation. Eleven patients had symptoms less than five years and 11 had more than five years. For 18 cases mesh repair was done while herniorraphy was performed in 4 cases. No complications were observed during one year follow up. Conclusions: Incisional hernia is more common in females after lower midline abdominal surgery. Mesh repair is the ideal recommended treatment except in very small incisional hernia where primary repair can be done. Keywords: Incisional hernia, laparotomy, mesh repairPublication Prediction of Postoperative Major Complications in Pancreaticoduodenectomy -a Prospective Comparative Analysis of Braga and WHipple-ABACUS Scores(Kathmandu University, 2023) Sah, DN; Lakhey, PJ; Bhandari, RSABSTRACT Background Major complications following pancreaticoduodenectomy have a severely deleterious effect on postoperative course, rather than just occurrence of pancreatic fistula. Surgical risk stratification with Braga and WHipple-ABACUS have been proposed and validated. Objective The study aimed at comparing the Braga and WHipple-ABACUS scores for prediction of major complications following pancreaticoduodenectomies. Method This was a prospective observational study at the Tribhuvan University Teaching Hospital from February 2018 to April 2019. After ethical approval, all consecutive 41 patients who underwent pancreaticoduodenectomies were included. Each patient was graded in Braga and WHipple-ABACUS scores. Perioperative events occurring over 30 days were graded as per Clavien -Dindo complications for pancreatic surgery. The predictive value of the scores were assessed using a receiver operating characteristic curve analysis. The categorical data were compared using the Pearson χ2 test or Fisher’s exact test. Result Over period of 14 months, total of 41 patients (M:F=2.15:1) with median age of 58 years (range, 21-86) underwent pancreatoduodenectomy. The mean scores were Braga (4.6±3.1) and WHipple-ABACUS (1.8±1.6). Major complications over 30 days were developed in 11 patients with five mortality. There were significant differences in mean values of Braga score (7.0±3.4 vs 3.7±2.6, p-value=0.02) and WHipple- ABACUS score (3.2±1.8 vs 1.3±1.3, p-value=0.01) in patients with major complications to those without respectively. The area under curves for Braga and WHipple-ABACUS scores were 0.800 and 0.779 respectively. Conclusion Both WHipple-ABACUS and Braga scores are easy to calculate and predict the development of major complications significantly in patients undergoing pancreatoduodenectomy. KEY WORDS Braga score, Pancreaticoduodenectomy, Post-operative pancreatic fistula, WHipple- ABACUS scorePublication Prediction of surgical site infection and other adverse postoperative outcomes(Institute of Medicine, 2009) Luitel, BR; Kandel, SP; Shrestha, B; Sapkota, R; Bhandari, RSAbstract Background: To predict surgical site infection, hospital acquired pneumonia, wound dehiscence, and mortality based on SENIC index in Nepalese perspective in surgical patients. Methods: A Retrospective study was conducted at Department of Surgery, Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from October 2007 to September 2008. Surgicalinfection risk factors assessed by the traditional wound-classification system (clean, cleancontaminated, contaminated, and dirty-infected wound) and by the SENIC risk index (length of intervention more than 2 hours, more than three discharge diagnoses, abdominal surgery, and contaminated or dirty infected wound) were compared by Receiver Operating Characteristic (ROC) curve. Results: The SENIC index showed a good ability to predict SSI, Hospital Acquired pneumonia, wound dehiscence and in hospital mortality. If the index score is higher, the outcome is poorer. By using SENIC index score the area under ROC curve for SSI, pneumonia, wound dehiscence and in hospital mortality was 82.2±4.8, 90.5±2.4, 85.1 ±4.7 and 96.9±1.2 % respectively with sensitivity above 95% for all the parameters. Conclusion: This study shows that the SENIC risk index results are reproducible, and the index can be used to predict rates of SSI and other adverse postoperative complications in developing countries as well. Keywords: Prediction, SENIC Index, surgical site infectionPublication Rectal injury attributable to enema(Institute of Medicine, 2017) Pradhan, S; Adhikari, A; Bhandari, RSAbstract Constipation is one of the most common complaints in the general population, and is associated with substantial economic cost. Postoperative ileus (POI) maybe one of the contributory factor for no passage of stool. Despite a lack of strong evidence for their clinical utility, laxatives or prokinetics have been used to treat POI in clinical practice. Many a times, patients self-medicate or take over-the-counter drugs to treat constipation and sometime end up with complications requiring urgent medical consultation. Dietary modification, laxatives are some of the first line treatment of constipation. Bowel cleansing enemas are also frequently used to relieve constipation. Though, very effective, sometimes may cause serious adverse events. Some of the common side effects are anal irritation, burning sensation, diarrhea, nausea and cramps. Bowel injuries following use of bowel cleansing enema is a rare incident. We report two cases that developed rectal injury following use of enema (glycerin 15% w/v and sodium chloride 15% w/v).Publication Spontaneous omental hematoma(Institute of Medicine, 2009) Bhandari, RS; Sapkota, R; Mishra, P; Singh, KPAbstract Spontaneous omental bleeding is a rare entity, and usually presents with various combination of sudden abdominal pain, shock, peritonitis and hemoperitoneum. A 68 year female presenting with acute abdomen and without antecedent trauma had obscure hemoperitoneum. Exploration revealed hemoperitoneum and hemorrhagic omentum with a huge clot. Keywords: Spontaneous omental hematoma, acute abdomen, hemoperitoneum, surgery