NepMed Repository :: Browsing by Author "Bhandari, Ramesh S"

Browsing by Author "Bhandari, Ramesh S"

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Anorectal Autoeroticism: A Case Report
(Institute of Medicine, 2019) Tulachan, Pratikchya; Shrestha, Kenison; Chapagai, Manisha; Dhungana, Saraswati; Pant, Sagun B; Lama, Pratik; Bhandari, Ramesh S
ABSTRACT Introduction Anorectal autoeroticism is one kind of paraphilia where individual attains sexual pleasure through self inserting objects into ones rectum. We present here a case of 40 years old man presented in Surgery department with retention of steel glass into his rectum which he had inserted himself to achieve sexual satisfaction. Keywords: Anorectal autoeroticism, biopsychosocial factors, paraphilia
Clinicopathological Features of Gallbladder Carcinoma Managed in a Tertiary Level Hospital of Nepal
(Institute of Medicine, 2021) Dahal, Romi; Ghimire, Bikal; Kansakar, Prasan BS; Lakhey, Paleshwan Joshi; Bhandari, Ramesh S
ABSTRACT Introduction: Gallbladder carcinoma is a relatively rare disease in some parts of the world but is common in countries like Chile, Japan, India, and Nepal. Nepal stands as one of the five countries with the highest mortality. However, there are only a few studies published on this matter from Nepal. This study aims to study the demographic and clinicopathological features of gallbladder carcinoma managed in a tertiary level teaching hospital in Nepal. Methods: A retrospective analysis of all the patients with the diagnosis of gall bladder carcinoma in Tribhuvan University Teaching Hospital from 2018 to 2020 was done. Patient demographics, clinical characteristics, and laboratory parameters including tumor markers were analyzed. Results: Of the 59 patients, there were 33 (56%) females. The median age at diagnosis was 56 years. Among all, the most common presenting symptom was abdominal pain. Curative resection was done in 18 (30%) of the cases. Metastasis was present in 30% of the cases of which the liver was the most frequently involved organ. The mean carcinoembryonic antigen (CEA) level in unresectable cases was 18.65±22.53 nanograms per milliliter (ng/mL) which was higher than in resectable cases being 6.78±12.75 ng/mL. Similarly, the mean carbohydrate antigen 19-9 (CA 19-9) level in unresectable cases was 604.55±671.28 units/milliliter (U/ml), which was higher than the value in the resectable cases 89.44±273.67 U/ml. Conclusion:In this study, gall bladder carcinoma was more common in females below 60 years with vague abdominal pain as the most frequent presenting symptom. One-third of the evaluated cases were resectable. Unresectable cases were associated with high CEA and CA 19-9 levels. Keywords: CA 19-9, CEA, demography, gallbladder carcinoma
Diagnostic Accuracy of Peritoneoscopy to Determine the Cause of Low Serum Ascites Albumin Gradient
(Institute of Medicine, 2019) Parajuli, Pawan; Bhandari, Ramesh S; Pathak, Rahul; Sharma, Shashi; Khadga, Prem K; Jha, Anurag; Hamal, Rabin; Kafle, Brindeswari
ABSTRACT Introduction Ascites, a common entity in practice of gastroenterology is pathophysiologically divided into high SAAG and low SAAG category, to rapidly classify, formulate a workup plan and expedite the diagnosis. The cause of low SAAG ascites is often due to local peritoneal cause e.g peritoneal tuberculosis, peritoneal carcinomatosis etc, mandating the need of peritoneoscopy for definitive diagnosis. This study aims to present the peritoneoscopy and peritoneal biopsy result of patients with low SAAG ascites of uncertain etiology. Methods Peritoneoscopy was prospectively performed in 12 patients with low SAAG ascites of unclear etiology. Patients with low SAAG ascites and willing to give consent for peritoneoscopy were enrolled in the study. Patients underwent laparoscopic peritoneoscopy under general anesthesia and appropriate biopsies were taken during the procedure for histopathological analysis. Results Of the twelve patients with low SAAG enrolled in the study, 3 (25%) were male and 75% (9) were female. The success rate of the procedure was 100% and there was no procedure related complications. Specific findings were seen in all patients undergoing peritoneoscopy. Of the twelve patients, 9 (75%) patients has metastatic deposits in the peritoneum, 3 (25%) had benign etiology, 2/3rd (2) of whom had granulomatous deposits suggestive of tuberculosis and 1/3rd (1) had extensive dense adhesions and peritoneal fibrosis. Primary focus was revealed (ovary) in only 1 patient undergoing peritoneoscopy. Conclusion Peritoneoscopy with simultaneous biopsy is safe, efficient and accurate diagnostic method due to its high diagnostic capacity and low complication rate in selected patients who have low SAAG ascites of uncertain etiology. Keywords: Ascites, peritoneal carcinomatosis, peritoneoscopy
Diagnostic Accuracy of Peritoneoscopy to Determine the Cause of Low Serum Ascites Albumin Gradient
(Institute of Medicine, 2019) Parajuli, Pawan; Bhandari, Ramesh S; Pathak, Rahul; Sharma, Shashi; Khadga, Prem K; Jha, Anurag; Hamal, Rabin; Kafle, Brindeswari
ABSTRACT Introduction Ascites, a common entity in practice of gastroenterology is pathophysiologically divided into high SAAG and low SAAG category, to rapidly classify, formulate a workup plan and expedite the diagnosis. The cause of low SAAG ascites is often due to local peritoneal cause e.g peritoneal tuberculosis, peritoneal carcinomatosis etc, mandating the need of peritoneoscopy for definitive diagnosis. This study aims to present the peritoneoscopy and peritoneal biopsy result of patients with low SAAG ascites of uncertain etiology. Methods Peritoneoscopy was prospectively performed in 12 patients with low SAAG ascites of unclear etiology. Patients with low SAAG ascites and willing to give consent for peritoneoscopy were enrolled in the study. Patients underwent laparoscopic peritoneoscopy under general anesthesia and appropriate biopsies were taken during the procedure for histopathological analysis. Results Of the twelve patients with low SAAG enrolled in the study, 3 (25%) were male and 75% (9) were female. The success rate of the procedure was 100% and there was no procedure related complications. Specific findings were seen in all patients undergoing peritoneoscopy. Of the twelve patients, 9 (75%) patients has metastatic deposits in the peritoneum, 3 (25%) had benign etiology, 2/3rd (2) of whom had granulomatous deposits suggestive of tuberculosis and 1/3rd (1) had extensive dense adhesions and peritoneal fibrosis. Primary focus was revealed (ovary) in only 1 patient undergoing peritoneoscopy. Conclusion Peritoneoscopy with simultaneous biopsy is safe, efficient and accurate diagnostic method due to its high diagnostic capacity and low complication rate in selected patients who have low SAAG ascites of uncertain etiology. Keywords: Ascites, peritoneal carcinomatosis, peritoneoscopy
Management of Postpancreatectomy Hemorrhage Following Pancreaticoduodenectomy at a Tertiary Care Center in Nepal
(Institute of Medicine, 2020) Subedi, Nirajan; Kandel, Bishnu; Ghimire, Bikal; Kansakar, Prasan BS; Bhandari, Ramesh S; Lakhey, Paleswan Joshi
ABSTRACT Introduction: Postpancreatectomy hemorrhage (PPH) is an important complication which significantly increases morbidity and mortality following pancreaticoduodenectomy (PD). This study aims to find the incidence, classification, management, and mortality associated with PPH following PD. This study also describes the changes in management and outcomes between the period of 2004-2014 and 2015-2019 in our institute as in the later time period there was use of CT angiography and interventional radiology (IR) to identify and control the bleeding site. Methods: This is a retrospective study in which medical records of patients having PPH following PD between 2004-2019 were analyzed. The grading and classification were done according to the International Study Group of Pancreatic Surgery (ISGPS). Management and outcomes were analyzed using standard descriptive statistics. Results: A total of 43 patients developed PPH out of 336 PDs. Out of 43 patients, 4 (9.3%) had Grade A, 16 (37.2%) had Grade B and 23 (53.5%) had Grade C PPH. Fifteen (35%) patients were managed conservatively, seven (16.2%) with IR procedure and 21 (48.8%) were reexplored. There were 16 (37.2%) mortalities, out of different factors- intraoperative blood loss >500 ml showed the predictability for mortality (p= 0.01). On comparing two time periods it was seen that the PPH rate was almost similar but the mortality decreased from 58.8% to 23.07%. Conclusion: PPH following PD is associated with high mortality. Increased use of IR procedure and CT angiography can decrease the relaparotomy rates and eventually decrease mortality. Keywords: Interventional radiology, pancreaticoduodenectomy, postpancreatectomy hemorrhage
Management of Choledochal Cyst: Experience from A Tertiary Care Center of Nepal
(Institute of Medicine, 2021) Shrestha, Sujan; Ghimire,Bikal; Kansakar, Prasan; Bhandari, Ramesh S; Lakhey, Paleshwan Joshi
ABSTRACT Introduction: Choledochal cysts are infrequent congenital cystic dilation of the biliary tract. The aim of this study is to analyze the clinicopathological profile and short-term operative outcomes of patients with choledochal cysts. Methods: This is a retrospective study of 32 consecutive patients of choledochal cyst who underwent multidisciplinary management in last two and half years at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results: A total of 32 patients, 9 males and 23 females were operated. The average age at diagnosis was 24.67±16.4 years (range from 2 to 56 years). The most common presenting symptoms were pain 31(96.88%), jaundice 10(31.25%) and mass 5(15.63%). Triad of pain, jaundice and mass was present in 4(12.5%). Transabdominal Ultrasonography (100%) was the initial diagnostic modality followed by Magnetic resonance cholangiopancreatography (MRCP) (68.75%), and contrast enhanced computed tomography (CECT) (31.25%). Endoscopic retrograde cholangiopancreatography (ERCP) was done for stent placement in 3 (9.38%) patients with severe cholangitis. Type IVA (37.5%) was the most common type of CC followed by type IC (31.23%), type IB (15.65%), type IA (12.5%) and type IVB (3.12%). Abnormal pancreaticobiliary duct junction was observed in 3 (9.38%) patients. All patients underwent open cyst excision with Roux-en-Y hepaticojejunostomy (HJ). The overall morbidity was seen in 6 patients (18.75%). There was no mortality. None of our patient had cholangiocarcinoma on pathological examination. Conclusion: Choledochal cyst was common in young females. Type IC and IVA choledochal cyst were the most common types and majority of them were symptomatic. Cyst excision with Roux-en-Y hepaticojejunostomy was the commonest surgical treatment modality and had excellent perioperative outcome Keywords: Choledochal cyst, cyst excision, Roux-en-Y hepaticojejunostomy
Post-operative Pancreatitis as a Predictor of Postoperative Pancreatic Fistula in Patients Following Pancreaticoduodenectomy
(Nepal Health Research Council, 2022) Subedi, Nirajan; Ghimire, Bikal; Kansakar, Prasan B S; Bhandari, Ramesh S; Lakhey, Paleswan J; Singh, Yogendra P
Abstract Background: Postoperative pancreatic fistula remains the single most important determinant of morbidity and mortality following pancreaticoduodenectomy. A new entity was proposed by Saxon Connor “Post-Operative pancreatitis”, which is defined by raised serum amylase more than the upper limit of institutional serum amylase value on Post-Operative day 0 or 1. There has been shown to be an association between postoperative pancreatitis and postoperative pancreatic fistula. We have conducted this study to see the incidence of postoperative pancreatitis and its association with postoperative pancreatic fistula. Methods: This was a prospective observational study. All patients undergoing pancreaticoduodenectomy at a tertiary care center for one and a half years were included. A cut-off value of serum amylase 80U/L was used to make a diagnosis of postoperative pancreatitis. The patients were followed up for one month. Pancreas specific complications were defined according to the definition given by the International Study Group of Pancreatic Surgery. Results: A total of 49 pancreaticoduodenectomies were done in the given period. The incidence of postoperative pancreatitis was 31(63.3%) and postoperative pancreatic fistula was 19(38.8%). Postoperative pancreatic fistula was seen in 19(61.2%) of patients having postoperative pancreatitis (P<0.001). Post-operative pancreatitis was also significantly associated with post pancreatectomy hemorrhage, increased hospital stay, and mortality. In multivariate analysis, preoperative endoscopic biliary drainage and increased serum amylase on the first postoperative day came out to be an independent predictor of postoperative pancreatic fistula. Conclusions: Post-operative Pancreatitis was associated with an increased incidence of Post-operative pancreatic fistula and other postoperative complications like Post pancreatectomy hemorrhage and mortality. Keywords: Pancreaticoduodenectomy; postoperative pancreatitis; postoperative pancreatic fistula; post pancreatectomy haemorrhage
Role of Preoperative CEA, CA 19-9, NLR and PLR as Predictors of Adverse Prognostic Pathological Features of Gastric Carcinoma Patients in a Tertiary Centre of Nepal
(Institute of Medicine, 2019) Mandal, Rajesh K; Bhandari, Ramesh S; Lakhey, Paleswan J; Singh, Yogendra P; Vaidya, Pradeep; Kansakar, Prasan BS; Ghimire, Bikal; Kandel, Bishnu P
ABSTRACT Introduction According to GLOBOCAN 2018, gastric carcinoma is the fifth most common cancer (5.7%) and third most common cause of cancer related death (8.2%) worldwide. Delayed presentation and advanced disease at diagnosis, owing to the overlapping symptoms, can be attributed to its high mortality. Gastrectomy is one of the most commonly performed surgery at our centre. This study aims to study the role of pre-operative serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) as predictors of adverse prognostic pathological features of gastric carcinoma patients who were considered for surgery at our centre. Methods This is a retrospective analysis of prospectively maintained database of all operated gastric carcinoma patients since June 2016 to January 2019. Various pre-operative variables including serum CEA level, serum CA 19-9 level, NLR and PLR were collected. Intra-operative surgical procedures performed and post-operative pathologic variables like tumor size, stage, grade, lymph node ratio (LNR), lymphovascular invasion (LVI) and perineural invasion (PNI) were collected. Results A total 60 patients were planned for surgical intervention over this duration. Mean age of the population was 56.8±12.5 years with slight male predominance (i.e. 55%). Mean CEA level was 6.17 ng/ml and CA 19-9 level was 72.1 U/ml. The mean NLR and PLR of the study population was 3.4 and 200 respectively. Fifty four patients had distal tumors and six had proximal tumors. Curative surgery was performed in 40 patients out of which 37 underwent subtotal gastrectomy and three underwent total gastrectomy. D2 gastrectomy was performed in 55% patients treated with curative intention. Advanced disease (T2 and above) was seen in 86.7% of patients. Preoperative CEA, CA 19-9, NLR, PLR were evaluated for association with pathologic features like tumor size, T stage, grade of tumor, LNR, LVI, and PNI but statistical analysis failed to show any significant association. Conclusion Advanced disease at presentation is common in gastric carcinoma. Preoperative clinical parameters including tumor markers CEA, CA 19-9, NLR and PLR may not be useful to diagnose the advanced disease in gastric carcinoma patients. Keywords: Gastric carcinoma, gastrectomy, CEA, CA 19-9, NLR, PLR
Surgery for Solid Pseudopapillary Neoplasm: Observational Study at a Nepalese Tertiary Center
(Institute of Medicine, 2023) Sah, Dhruba N; Bhandari, Ramesh S; Kansakar, Prasan BS; Ghimire, Bikal; Lakhey, Paleswan Joshi
ABSTRACT Introduction: Solid pseudopapillary neoplasms (SPN) are rare, relatively indolent tumors with potential malignant behavior. This study aimed to analyze the clinicopathological details, surgical management, and short- and long-term outcomes of operated cases of SPN. Methods: This was an observational descriptive study of diagnosed SPNs confirmed histopathologically after surgical resections at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from 2006 November to 2019 January. Patient’s clinical details, surgical procedures, perioperative outcomes, and follow-up were recorded. Long-term follow-up was evaluated for a minimum of three years post-surgery. Results: Over 13 years, a total of 15 cases with a median age of 22 years (11-52) were encountered and had female predominance (14, 93.3%). Five cases were diagnosed incidentally, while pain abdomen (5, 33.3%) was the most common presentation followed by lump (4, 26.7%). There were four tumors in the head of the pancreas, two in the uncinate process, two in the neck, four in the body, and three in the tail of the pancreas. Four cases underwent pancreaticoduodenctomy, three cases underwent enucleation, and four cases underwent central pancreatectomy. Similarly, one patient underwent spleen preserving distal pancreatectomy and three patients underwent distal pancretosplenectomy. Postoperatively, 20% developed major complications with Clavien-Dindo (grade III & above) out of which one patient had mortality. Over the median follow-up of 72 months, no recurrences were noted. Conclusion: Solid pseudopapillary neoplasms were relatively rare. Complete surgical resection was the most commonly used surgical management, post-operative complications were minimal and survival rate was excellent. Keywords: Pancreas; solid pseudopapillary neoplasm; surgery

Browsing by Author "Bhandari, Ramesh S"

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