Browsing by Author "Neupane, Harish Chandra"
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Publication Complications among Patients Undergoing Pancreaticoduodenectomy in Tertiary Care Centers of Nepal: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Neupane, Harish Chandra; Tamang, Tseten Yonjen; Timalsina, Santosh; Tamrakar, Kishor Kumar; Bhattarai, AbhishekAbstract: Introduction: Pancreaticoduodenectomy (Whipple procedure), even after significant evolution, continues to be associated with a high morbidity. The study aimed to find out the prevalence of complications following pancreaticoduodenectomies performed by a single surgeon over a span of 20 years in tertiary care hospitals of Nepal. Methods: This was a descriptive cross-sectional study conducted from hospital records of patients who underwent pancreaticoduodenectomy between 1999 and 2019 at different institutions in Chitwan, where the principal author was involved. Ethical clearance was taken from the Institutional Review Committee. Convenience sampling was done. Patients’ clinical characteristics and diagnoses were noted. Data entry was done using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage. Results: Out of 327 patients who underwent pancreaticoduodenectomy, complications were found in 125 (38.2%) (32.9-43.7 at 95% Confidence Interval). Respiratory complications were the commonest 32 (9.8%), followed by septicemia 25 (7.6%) and cardiac complications 24 (7.3%). Delayed gastric emptying and postoperative pancreatic fistula were seen in 11 (6.8%) and 4 (2.5%) in the first decade respectively. In the second decade, delayed gastric emptying was noted in 2 (1.2%) and postoperative pancreatic fistula in 1 (0.6%) patient. Conclusions: The prevalence of complications in our study was comparable to other national and international studies. Surgery-specific complications such as delayed gastric emptying and postoperative pancreatic fistula showed a decline over the decade.Publication Open Cholecystectomy among Patients undergoing Laparoscopic Cholecystectomy in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Katwal, Gaurav; Thapa, Yeshika; Shrestha, Aisha; Bhattarai, Abhishek; Tamrakar, Kishor Kumar; Neupane, Harish ChandraAbstract Introduction: In the current era, laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstone disease. The aim of this study is to find out the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy in a tertiary care centre. Methods: It is a descriptive cross-sectional study done among 345 patients at the Department of Surgery of a tertiary care centre from June, 2020 to May, 2021 after receiving ethical clearance from the Institutional Review Committee (Reference number: CMC-IRC/0770798-271). Convenience sampling was done. Successive patients who underwent elective laparoscopic cholecystectomy during the study period were included. Standard 4 port laparoscopic technique was used for the laparoscopic cholecystectomy and sub-costal Kocher incision was used for the open cholecystectomy respectively. After data collection, entry and analysis were done in Microsoft Excel. Point estimate at a 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results: Out of 345 patients, the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy was 6 (1.73%) (0.35-3.11 at a 95% Confidence Interval). Conclusions: This study showed that the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy was lower when compared to similar studies conducted in similar settings.Publication Preoperative Prediction of Difficult Laparoscopic Cholecystectomy using Risk Score for Conversion from Laparoscopic to Open Cholecystectomy: An Observational Study(Institute of Medicine, Tribhuvan University, 2024) Acharya, Bishal; Neupane, Harish Chandra; Tamrakar, Kishor Kumar; Ghimire, Iswar Chandra; Subedee, Aadesh; Sarraf, Soni Kumari; Aryal, Shishir; Yadav, Bidhyanand; Dulal, Saujan; Gole, Senjisha LamaAbstract: Introduction Laparoscopic cholecystectomy requires experts for the best result. Occasionally laparoscopic cholecystectomy becomes difficult, requiring conversion to open cholecystectomy and also endangers patients causing potential biliovascular and bowel injury. This study aims to predict difficult laparoscopic cholecystectomy using RSCLO scoring system. Methods A prospective observational study was conducted including 116 diagnosed case of cholelithiasis undergoing elective laparoscopic cholecystectomy from July 2023 to March 2024. Scores were given on history, physical examination and ultrasonographic findings on admission as per the RSCLO scoring system. Intraoperatively, difficult laparoscopic cholecystectomyn criteria included: Time taken >60 min or bile/stone spillage or injury to bile duct/artery or conversion to open surgery. The end point of study was the end of surgery. Results The mean age was 46.23+15.36 years with female predominance of 69%. Preoperatively, 31.9% patients were predicted to have difficult cholecystectomy and intraoperatively 37.1% had difficulty (pearson chi-square 77.096, p value <0.001). Age >50 years, male gender and prior history of hospitalization because of gallbladder pathology were significantly associated with difficult laparoscopic cholecystectomy. There was no open conversion, no intraoperative biliovascular or bowel injury. Sensitivity and specificity of RSCLO score with cut off value of >6 was 94.6% and 90%, respectively, with AUROC 0.922. Conclusion RSCLO scoring system is useful for prediction of difficult laparoscopic cholecystectomy and patients with high risk can be counseled preoperatively about intraoperative difficulty.