Browsing by Author "Limbu, Yugal"
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Publication Achalasia Cardia: A Case Series(Nepal Medical Association, 2024) Chapagain, Nibedita; Adhikari, Nishob; Acharya, Bidur Prasad; Limbu, Yugal; Ghimire, RoshanAbstract Achalasia cardia is a rare disorder that impacts the lower esophageal sphincter and esophageal body. Due to its wide range of symptoms, it can be difficult to diagnose. Here we report three cases of Achalasia Cardia during a period of 9 months. The first patient, an 18-year-old male, presented with dysphagia and was evaluated with barium swallow and high-resolution manometry (HRM) revealing Achalasia Cardia. In the second case, a 37-year-old female had a prolonged diagnostic journey due to multiple comorbidities before a barium swallow finally revealed achalasia cardia. The third patient, a 47-year-old female was promptly diagnosed with barium swallow. All the cases were successfully treated with laparoscopic Heller’s myotomy with anterior Dor’s fundoplication. This case series highlights the potential for delayed diagnosis and the importance of early recognition, tailored diagnostic approaches, and the efficacy of surgical management.Publication Blunt Abdominal Trauma among Patients Admitted to the Department of Surgery at a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Ghimire, Roshan; Acharya, Bidur Prasad; Pudasaini, Prashanta; Limbu, Yugal; Maharjan, Dhiresh Kumar; Thapa, Prabin BikramAbstract Introduction: Blunt abdominal trauma bears significant morbidity and mortality worldwide and needs careful evaluation and management for a better outcome, where the resources are limited and the impact of the financial burden is very important. Previously, many cases used to be managed with operative procedures, and now the trend has been shifting to non-operative management. This study aimed to determine the prevalence of blunt abdominal trauma among patients admitted to the Department of Surgery of a tertiary care centre. Methods: This was descriptive cross-sectional study done between 1 February 2022 to 31 January 2023 after taking ethical approval from the Institutional Review Committee (Reference number: 2312202103). The decision of non-operative versus operative treatment was decided with dynamic clinical evaluation and severity of intraabdominal injuries. Demographic data, the mechanism of injury, and both conservative and operative management were studied. All the patients who were more than 18 years of age, and admitted to the Department of Surgery were included in the study. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among a total of 1450 patients, the prevalence of blunt abdominal trauma was 140 (9.65%) (8.13-11.17, 95% Confidence Interval). A total of 61 (43.57%) were young within the age group of 18-30 with a male-female ratio of 4:1. Road traffic accidents 79 (56.43%) were the most common mechanism followed by falls from heights 51 (36.43%). Conclusions: The prevalence of blunt abdominal trauma among patients admitted to the Department of Surgery was found to be higher than in other studies done in similar settings.Publication Intraoperative Variations of the Gastrocolic Trunk of Henle noted in Gastrointestinal Surgeries(Nepal Health Research Council, 2024) Ghimire, Roshan; Thapa, Nishant; Acharya, Bidur Prasad; Sah, Bed Prakash; Limbu, Yugal; Regmee, Sujan; Maharjan, Dhiresh Kumar; Thapa, Prabin BikramBackground: The gastro-colic trunk of Henle is a venous trunk that comprises the veins draining the stomach and colon and is an important landmark for various gastro-intestinal surgeries. Understanding the anatomy of these vessels may enhance the surgical outcome. The aim of this study is, to assess the Intraoperative variations of the Gastrocolic Trunk of Henle noted in gastrointestinal surgeries in a tertiary care center. Methods: A descriptive cross-sectional study was conducted at Kathmandu Medical College Public Limited, a tertiary center in Nepal during the period of one year (1st January 2022, to 31st December 2022). All patients undergoing right hemicolectomy, gastrectomy, and pancreaticoduodenectomy were included in the study. Based on per-operative findings, the type of The gastro-colic trunk of Henle was noted during surgery. Results: A total of 49 patients underwent the above-mentioned surgeries during the study period. The gastro-colic trunk was found in 45 out of the 49 patients intraoperatively (91.84%), and the variations were distinguished. The most common configuration noted was the union of the right gastro-epiploic vein, the anterior superior pancreaticoduodenal vein, and the superior right colic vein (Type I), which was noticed in 46.67% of the patients. Conclusions: The intraoperative identification of the anatomy of The gastro-colic trunk of Henle is challenging because of its variable combinations of tributaries. Knowledge of variations in The gastro-colic trunk of Henle is important in preventing intraoperative bleeding, and during identification, the meticulousness of surgery is redefined. Keywords: Gastrocolic trunk of Henle; hemicolectomy; venous drainage.Publication Laparoscopic Cholecystectomy in Situs Inversus Totalis with Stage 5 Chronic Kidney Disease: A Case Report(Nepal Medical Association, 2023) Raut, Sneha; Limbu, Yugal; Pudasaini, Prashanta; Gongal, Swagat; Maharjan, Dhiresh KumarAbstract Situs inversus totalis is a rare congenital anomaly in which the abdominal and thoracic organs are transposed in a mirror image. Diagnosis and management of cholelithiasis in patients with situs inversus totalis pose a challenge due to the anatomical variation. A laparoscopic cholecystectomy in such a case can be technically challenging, especially for a right-handed surgeon. In this case report, we present a case of a 38-year-old male with symptomatic cholelithiasis in a chronic kidney disease stage five patient under maintenance hemodialysis planned for recipient renal transplant. A laparoscopic cholecystectomy considered the gold standard for symptomatic cholelithiasis was performed with a three-port technique. The technical challenges anticipated due to anatomical variation were managed by intraoperative modifications. In conclusion, laparoscopic cholecystectomy in patients with situs inversus totalis can be done with technical modifications and re-orientation of visual motor skills.Publication Lymph node Yield in Apical Tissue During Triangle Operation While Doing Whipples Operation: An Observational Study(Nepal Medical Association, 2025) Maharjan, Dhiresh Kumar; Pudasaini, Prashant; Acharya, Bidur Prasad; Limbu, Yugal; Ghimire, Roshan; Thapa, Prabin BIkramAbstract Introduction: The "TRIANGLE operation" involves the en-bloc removal of the tumor and the entire "mesopancreas" from the triangle-shaped space bounded by the superior mesenteric artery, coeliac trunk, and portal vein. This study assessed lymph node yield in apical tissue during the triangle operation. Methods: An observational cross-section study was conducted for two years at the Department of Gastrointestinal and General Surgery at a tertiary care center of Nepal. from 15th March 2022 to 15th March 2024. The operative procedure included pancreaticoduodenectomy or Whipple’s operation. Total sampling was done. Postoperative outcome and lymph node yeild of the surgeries were studied. Ethical approval was taken from the Institutional Review Committee (Reference No-1102202204). Results: A total of 56 patients underwent pancreaticoduodenectomy along with a triangle operation. The mean age of the patients was 56.38±14.79 years. Male: Female ratio was 1.2:1. Mean preoperative BMI was 24.41±4.72. The mean total lymph node yield was 20.95±8.57. Nineteen patients had a positive lymph node yield in the triangle tissue. The mean triangle lymph node yield was 10.59±4.92, and the mean positive lymph node was 2.58 ±1.64. Among 56 patients, nine patients had both apical margin and the rest of the triangle tissue margin positive. Ten patients had negative apical tissue margins, but the rest of the triangle tissue was positive, whereas, in thirty-seven patients, both the apical tissue and the rest of the triangle circumferential resection margin tissue were negative. Conclusions: This study emphasizes the importance of the inclusion of apical tissue dissection at the confluence of SMA and coeliac trunk to achieve R0 resection. However, a long-term follow is awaited.Publication Previous Abdominal Scars among Patients Undergoing Laparoscopic Cholecystectomy in a Tertiary Care Centre(Nepal Medical Association, 2023) Ghimire, Roshan; Pudasaini, Prashanta; Acharya, Bidur Prasad; Limbu, Yugal; Regmee, SujanAbstract Introduction: Abdominal scars result from various open abdominal surgeries. Laparoscopic surgery in previous open abdominal surgery possesses various challenges to the surgeon like gaining access to the abdominal cavity, and difficulty in dissection due to dense adhesions from previous surgeries for various intraabdominal pathologies. This study aimed to find out the prevalence of previous abdominal scars among patients undergoing laparoscopic cholecystectomy in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients undergoing laparoscopic cholecystectomy in a tertiary care centre from 1 May 2022 to 30 April 2023 after taking ethical approval from the Institutional Review Committee. Palmer's point approach via Hassen open technique or direct optical entry was used for cases with previous abdominal scars to gain access to the abdominal cavity. Patients with symptomatic gallstone diseases were included in the study whereas patients with cholecystitis, pancreatitis, and previous cesarean scar were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 160 patients undergoing laparoscopic cholecystectomy, previous abdominal scars was found in 40 (25%) patients. Conclusions: The prevalence of previous abdominal scars contributing to intraoperative and post-operative difficulties among patients undergoing laparoscopic cholecystectomy was found to be higher than in studies done in similar settings.