Browsing by Author "Pradhan, Sumita"
Now showing 1 - 2 of 2
Results Per Page
Sort Options
Publication Day One Drain Amylase as a Predictor of Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy(Nepal Health Research Council, 2022) Pradhan, Sumita; Kandel, Bishnu; Bhandari, Ramesh Singh; Lakhey, Paleswan JoshiAbstract Background: Postoperative pancreatic fistula remains the most challenging complication following pancreaticoduodenectomy. As per the definition by the International Study Group on Pancreatic Fistula, post operative pancreatic fistula is diagnosed on or after postoperative day 3. However, several studies have demonstrated that drain fluid amylase on postoperative day 1 may be a better predictor. This study was conducted to determine the diagnostic value of day one drain amylase in predicting the development of post-operative pancreatic fistula. Methods: This was a prospective observational study of patients, who underwent pancreaticoduodenectomy between April 2016 and May 2017. Post operative pancreatic fistula was defined by the International Study Group on Pancreatic Fistula (2005) criteria. The diagnostic value of day one drain amylase was determined by doing a receiver operating curve analysis and compared with the postoperative day 3 value. Results: A total of 49 patients were included. Post operative pancreatic fistula developed in 28 patients (Grade A - 40.8%; B - 12.2%; C - 4.1%). Receiver operating curve analysis confirmed the predictive relationship of day one drain amylase with an area under the curve of 0.79 and kappa 0.5. For clinically relevant postoperative pancreatic fistula, day 3 drain amylase was the better predictor (AUC for DFA3 was 0.73 while AUC for DFA1 was 0.51). A day one drain amylase cut-off value of 350 U/L demonstrated a sensitivity of 75% and specificity of 77.8% with an accuracy of 76.2%. Conclusions: Day one drain amylase predicts postoperative pancreatic fistula in patients following pancreaticoduodenectomy but for clinically relevant postoperative pancreatic fistula, day three drain amylase is a better predictor. Keywords: Amylase; drain fluid amylase; pancreaticoduodenectomy; Pancreatic fistulaPublication Management and Early Outcomes of Bile Duct Injuries at University Teaching Hospital(Institute of Medicine, Tribhuvan University, 2024) Bhandari, Suyog; Thapa, Pradip; Sharma, Deepak; Maharjan, Narendra; Pradhan, Sumita; Kandel, Bishnu Prasad; Lakhey, Paleswan Joshi; Bhandari, Ramesh SinghAbstract: Introduction Bile duct injury (BDI) management depends upon the type, clinical presentation, available resources and expertise. Some BDI may be managed with endoscopic intervention with Endoscopic Retrograde Cholangio-pancreaticography (ERCP), sphincterotomy and/or stenting while others may require complex surgery and percutaneous interventions by interventional radiologists (IR). This study aimed to evaluate the management strategies and early outcomes of bile duct injuries at Tribhuvan University Teaching Hospital. Methods In this retrospective analysis, bile duct injuries in patients treated at Tribhuvan University Teaching Hospital, Kathmandu, Nepal over a period of two years were included (January 2020 to December 2022). In this study we have described the clinical presentation, Strasberg classification of BDI grade, different management techniques and their early outcomes. We calculated number and percentages for categorical variables, mean and standard deviation for continuous data. Results Out of 26 bile duct injuries, 12 (46.2%) patients underwent surgical management, 9 (34.6%) underwent percutaneous intervention and 5 (19.2%) underwent endoscopic intervention. Majority of the patient 15 (57.7%) had stricture as an indication for management. Patients who underwent surgical, endoscopic, and percutaneous management showed good early outcomes in 12, 5, and 8 patients respectively. The mean duration of hospital stay was 11.8±5.2 days and CCI was 15.2±9.7, for patients with index presentation who underwent surgery. Conclusion Management of bile duct injuries require multidisciplinary team approach and favorable outcomes can be achieved when managed with expertise at tertiary centers. Surgical management remains essential for complex cases, while percutaneous and endoscopic interventions offer viable alternatives for less severe injuries.