Browsing by Author "Karki, B"
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Publication Evolving Experience in The Management of Empyema Thoracis(Kathmandu University, 2011) Shrestha, K; Shah, S; Shrestha, S; Thulung, S; Karki, B; Pokhrel, DPABSTRACT Background Empyema thoracis a disease of significant morbidity and mortality, especially in the developing world. However, the optimal management of empyema thoracis remains controversial. Objective To analyse evolving experience in clinical presentation, management, outcome and factors contributing to adverse morbidity in empyema thoracis. Methods This is hospital based retrospective study of patients who were diagnosed with empyema thoracis in cardiothoracic and vascular surgery (CTVS) unit, Bir Hospital, Kathmandu, Nepal over a period of one year (July 2009 to June 2010). A total of forty-six adult cases were categorized into two treatment groups: (i) thoracotomy for decortication (ii) segmentectomy, lobectomy and redo-thoracotomy for pneumonectomy. The median duration of illness prior to hospital admission was compared. The presence of loculated pleural fluid determined the need for thoracotomy. Results Out of forty-six cases, twenty- nine (63.04%) who had early thoracotomy (<22 days) had prompt symptomatic recovery. Forteen out of seventeen (82.35%) of the patients who were initially treated with thoracocentesis or tube thoracostomy eventually needed thoracotomy. There was a positive shift in management towards early thoracotomy resulting in prompt symptomatic recovery. Significant complications were noted in eight patients who had delayed thoracotomy. Complications included recurrent empyema with lung abscess (n = 3), restrictive lung disease (n = 3), bronchopleural fistula (n = 1) and scoliosis (n=1). Conclusion Early thoracotomy and decortication was found to be an excellent surgical procedure with good functional results and high patient satisfaction rate. KEY WORDS empyema, thoracotomy, complicationsPublication Laparoscopic Cholecystectomy: Conversion Rate and Associated Factors for Conversion(Kathmandu University, 2019) Malla, BR; Shakya, YR; Rajbhandari, N; Karki, BABSTRACT Background Laparoscopic cholecystectomy is the standard surgical treatment of gall bladder disease. However, conversion to open cholecystectomy is inevitable in certain cases. Different centers has reported different conversion rate and factors associated with conversion. Objective To identify the conversion rate, postoperative complication and factors associated with conversion. Method This retrospective study included all laparoscopic cholecystectomy cases attempted in Dhulikhel hospital during the year 2015 and 2016. Records of all patients were reviewed to find out demography of the patients, indications of laparoscopic cholecystectomy, rate of conversion to open, underlying reasons for conversion and postoperative complications. Result Out of 644 cases of laparoscopic cholecystectomy, 452 (70.18%) were female and 192 (29.81%) were male with the mean age of 39 years. Over all conversion rate to open cholecystectomy was 1.86% with the frozen calot’s triangle as the most common reason for conversion. The overall postoperative complication was found to be 1.24% with no major bile duct injury. Acute cholecystitis is a significant preoperative predictor for the conversion into open cholecystectomy. Conclusion Laparoscopic cholecystectomy can safely be done with low conversion rate and complication. Appreciation of the predictor factors help the patient and surgeon for appropriate treatment plan. KEY WORDS Laparoscopic cholecystectomy, Conversion, Open cholecystectomy