Browsing by Author "Joshi, Anip"
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Publication Post Cholecystectomy Choledochoduodenal Fistula: A Case Report(Nepal Medical Association, 2024) Joshi, Anip; Shakya, Samita; Thapa, Surakshya; Sultan, Rifka; Rajbhandari, Alish; Baral, PriyaAbstract Choledochoduodenal fistula is an abnormal connection between the common bile duct and the duodenum. The commonest cause is cholecystolithiasis, however, other causes are iatrogenic factors, bile duct stones (choledocholithiasis), and chronic duodenal ulcers. Here, we report a case of choledochoduodenal fistula secondary to long standing choledocholithiasis post cholecystectomy who presented with intermittent abdominal pain in the past three years which revealed choledochoduodenal fistula during Endoscopic Retrograde Cholangiopancreatography. As the patient had recurrent pain along with choledocholithiasis, surgical intervention was indicated. Choledochoduodenal fistula is suspected in case of recurrent cholangitis and surgery is recommended for refractory and complicated cases. Surgical treatment is also recommended for larger fistulas and especially with non-resolving medical treatment. This case highlights the treatment option for choledocholithiasis with choledochoduodenal fistula.Publication Subcutaneous Fat Thickness and Superficial Surgical Site Infectionin Patients Undergoing Open Appendectomy: An ObservationalStudy(Nepal APF Hospital, 2026) Thapa, Kaushal Samsher; Joshi, Anip; Aryal, Rishikant; Maharjan, Suresh; Yadav, Saurav Suman; Shah, ArinaAbstract: Introduction: Appendectomy is done for the treatment of acute appendicitis. Surgical Site Infection is a common postoperative complication. Most of the time, body mass index is measured to determine the presence of obesity. Still, it cannot predict adiposity at the incision site, so subcutaneous fat, which can be measured easily at the incision site, can be a better predictor. This study aimed to find a correlation between subcutaneous fat thickness and superficial surgical site infection in patients undergoing emergency open appendectomy. Methods: This prospective observational study was done from July 2023 to July 2024, including 118 cases with a diagnosis of uncomplicated appendicitis. Ethical approval was taken from the Institutional Review Board (Ref: 534/2080/81). Data were collected as per the proforma and maintained in Microsoft excel. Statistical Package for the Social Sciences version 26 and Pearson correlation were used for statistical analysis. Results: Among 118 patients included, 11 (9.30%) had superficial surgical site infection, which was higher among female patients 6 (12%). The calculated cut-off subcutaneous fat thickness was 2.05 cm in our study. The estimated positive predictive value was 16.99% and the negative predictive value was 98.17% for subcutaneous fat in predicting infection. The receiver operating characteristic curve showed an area under the curve of 0.75, indicating that subcutaneous fat can be used as one of the predictors of superficial SSI infection. Conclusions: Patients with increased subcutaneous fat thickness at the incision site had a higher incidence of surgical site infection. This concluded that increased subcutaneous fat thickness increases the risk of superficial surgical site infection, and that local adiposity at the site of the incision is a good predictor of surgical site infection.Publication Surgical Service Utilization and In-Patient Satisfaction in Surgical Service(Nepal Health Research Council, 2023) Joshi, Anip; Shrestha, DeepaAbstract Background: The patient satisfaction study is an important and commonly used valid indicator for service quality improvement in healthcare institutions. The aim of this study was to assess the service utilization and patient satisfaction in patients admitted under surgical service in Bir Hospital. Methods: A prospective cross sectional analytical study was conducted in Bir Hospital, National Academy of Medical Sciences from February 2021 till June 2023. The patient satisfaction data was collected using the SAPS scale after obtaining ethical clearance from the Institutional Review Board. Data were entered and analyzed in Statistical Package for the Social Sciences version 20.0. Results: There were 152 patients included in the study categorized into conservative treatment group, elective surgery group and emergency surgery group. 32.9%(50) patients were “very satisfied”, 62.5%(95) patients were “satisfied”, 2.6%(4) were “neither satisfied nor dissatisfied” and 2%(3) were “dissatisfied” with the effect of their treatment/care. The mean satisfaction score in conservative treatment group was 22.13 ±2.53 as compared to the mean satisfaction in elective surgery group which was 21.11± 2.55 (P=0.036) and the mean satisfaction score in emergency surgery group which was 21.66 ±2.68 (P=0.64). Conclusions: The mean score and proportion of patient satisfaction regarding service utilization in patients admitted under surgical service were high with satisfaction score higher in emergency surgery group among the operative groups in Bir Hospital, National Academy of Medical Sciences. Keywords: Patient satisfaction; service utilization; surgical service.