NepMed Repository :: Browsing by Author "Kansakar, Prasan BS"

Browsing by Author "Kansakar, Prasan BS"

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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
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
Multidisciplinary Management of Hepatolithiasis at a Tertiary Care Center in Nepal
(Institute of Medicine, 2020) Maharjan, Narendra; Lakhey, Paleswan Joshi; Ghimire, Bikal; Kansakar, Prasan BS; Bhandari, Ramesh S
ABSTRACT Introduction; Hepatolithiasis is more prevalent in Far-East than in Middle-East countries. There are various treatment modalities available for hepatolithiasis like surgical and non-surgical procedures. Non-surgical procedures have higher recurrence rate. Methods: This is a descriptive retrospective study of the clinical data of hepatolithiasis patients treated at Tribhuvan University Teaching Hospital (TUTH), Maharajgunj from April 2016 to October 2019. Results: There were 14 patients and mean age was 45.8±14.8 years. It was more common in female (F: M = 4:3). Left sided hepatolithiasis was the most common type (50%). One (7.1%) patient had bilateral hepatolithiasis associated with unresectable cholangiocarcinoma. Eight (57.1%) patients were treated with surgical procedures; four (28.6%) patients underwent interventional radiological procedures and remaining two (14.3%) patients had combined surgical and intervetional radiological procedures. Complete stone clearance was achieved in 11 patients (78.57%). In surgical therapy group, seven out of eight (87.5%) patients achieved the complete stone clearance; two out of four (50%) patients in interventional radiology group and all patients in combined therapy group achieved the clearance. There was no recurrence among those patients who had complete stone clearance and there was no mortality. Conclusion: The management of hepatolithiasis should involve multi-modality (surgical and non-surgical) therapeutic techniques available, in order to achieve complete stone clearance and prevent the complications. Keywords: Hepatolithiasis, left lateral sectionectomy, percutaneous transhepatic biliary drainage
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 "Kansakar, Prasan BS"

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