Browsing by Author "Pradhan, Sumita"
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Publication Analysis of Outcomes of Surgery for Chronic Pancreatitis according to International Study Group for Pancreatic Surgery Reporting System(Institute of Medicine, 2025) Bista, Nimesh; Lakhey, Paleswan Joshi; Kandel, Bishnu Prasad; Pradhan, Sumita; Maharjan, Narendra; Sharma, Deepak; Koirala, Nishnata; Bhandari, Ramesh SinghABSTRACT Introduction: Due to lack of standard reporting system for chronic pancreatitis that could include all the aspect of the disease process. International Study Group for Pancreatic Surgery (ISGPS) formulated a framework for reporting the surgery for chronic pancreatitis. This framework incorporates our recent understanding, management and outcomes of chronic pancreatitis. We aimed to report surgery performed at our department for chronic pancreatitis with this standard reporting system. Methods: From January 2021 to December 2024, 32 patient who underwent surgery for chronic pancreatitis were enrolled in the study. Patients details of clinical baseline prior to surgery, morphology of diseased pancreas, type of surgery and post operative outcomes were evaluated and reported according to four domains of ISGPS. Results: A total of 32 patients underwent surgery. Alcohol was the etiology in six (18.75 %) and rest were identified as idiopathic. Diabetes was prevalent in 13 (40.6%) of patient with exocrine insufficiency in only one patient. All patient had parenchymal calcification. Ductal stone was present in 29 (90.6%) with stricture in 16 (50.0%) patients. Longitudinal pancreatojejunostomy with partial pancreatic head resection was the most common surgery performed in 27 (84.3%) patients. Postoperatively two patients had major complications. There was no 90 days re-operation and mortality. Conclusion:This reporting system is feasible to report surgery for chronic pancreatitis. However, large scale prospective study validation is required. Keywords: Chronic pancreatitis; ISGPS; reporting; surgeryPublication 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.Publication Outcome of Management of Walled-Off Necrosis: An Experience from University Hospital of Nepal(Institute of Medicine, 2024) Thapa, Pradip; Bhandari, Suyog; Sharma, Deepak; Maharjan, Narendra; Pradhan, Sumita; Kandel, Bishnu Prasad; Bhandari, Ramesh Singh; Lakhey, Paleswan JoshiABSTRACT Introduction:The patients with walled-off necrosis after acute necrotizing pancreatitis may require multiple interventions and may be associated adverse outcomes. Intensive care unit admission for organ failure and multistage step-up approaches are the cornerstones of optimal management. This study was conducted to evaluate the clinical characteristics and outcomes of the different strategies for the management of walled-off necrosis. Methods: This is a retrospective cross-sectional study of the patients with walled-off necrosis, managed from July 2022 to January 2024. The demographic data, clinical parameters and outcomes of different strategies including percutaneous and endoscopic drainage and laparoscopic and open necrosectomy were analyzed. Results: Twenty-five patients diagnosed with walled-off necrosis were evaluated. The mean age of those patients was 41.64±12.44 years, and 13 (52%) were females. The median time interval between the onset of acute pancreatitis and percutaneous drainage was 31 (28-42) days. Seventeen (68%) patients were managed with percutaneous transgastric drainage. Among four (16%) patients requiring step-up approach, one required endoscopic ultrasound guided drainage, two (8%) underwent open necrosectomy, one underwent laparoscopic necrosectomy. The median length of hospital stay was 16 (3-60) days. There were four (16%) mortalities, two (8%) after percutaneous drainage only, one after endoscopic ultrasound guided drainage and one after open necrosectomy, all due to sepsis and multiple organ failure. Conclusion: Initial percutaneous transgastric drainage is feasible, safe and effective in the management of majority of patients with walled-off necrosis, thereby reducing further invasive interventions and improving the overall outcomes of the patients. Keywords: Acute necrotizing pancreatitis; percutaneous drainage; step-up approach; walled-off necrosis