Browsing by Author "Regmee, Sujan"
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Publication Early Oral Feeding with Vascular Resection among Patients Undergoing Pancreatoduodenectomy in a Tertiary Care Hospital: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Regmee, Sujan; Limbu, Yugal; Parajuli, Anuj; Ghimire, Roshan; Maharjan, Dhiresh Kumar; Shrestha, Suman; Thapa, Prabin BikramAbstract: Introduction: Pancreatoduodenectomy with vascular resection is performed in locally advanced periampullary malignancies. In our practice, early oral feeding is initiated in patients undergoing pancreatoduodenectomy. This study aims to find the prevalence of early oral feeding with vascular resection among patients undergoing pancreatoduodenectomy. Methods: This was a descriptive cross-sectional study conducted among hospital records of 152 patients who underwent pancreatoduodenectomy in the department of surgery of a tertiary care hospital from 2016 to 2020. Ethical approval was taken from the Institutional Review Committee (Reference number: 0812202102). Convenience sampling was done. Patients clinical and sociodemographic data were collected and analyzed using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean, and median. Results: Among 152 patients undergoing pancreatoduodenectomy, early oral feeding with vascular resection was done in 17 (11.18%) (6.17-16.19 at 95% Confidence Interval). Portal vein and superior mesenteric artery were resected in one (5.88%) and hepatic artery in one (5.88%) patient. Type I, III and IV reconstruction was done in nine (52.9%), five (29.41%) and one (5.88%) respectively. Clinically relevant delayed gastric emptying and postoperative pancreatic fistula were seen in two (11.7%). Complication of Clavien–Dindo Grade III or higher was seen in one (5.88%) patient. One (5.88%) mortality was noted. Conclusions: The prevalence of early oral feeding with vascular resection among patients undergoing pancreatoduodenectomy was similar to other studies done in similar settings. Early enteral feeding is well tolerated in patients undergoing pancreatoduodenectomy with vascular resection.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 Perioperative Modification in Cirrhotic Patient Undergoing Pancreatoduodenectomy: A Case Report(Institute of Medicine, 2022) Regmee, Sujan; Limbu, Yugal; Ghimire, Roshan; Maharjan, Dhiresh K; Shrestha, Suman K; Thapa, Prabin BABSTRACT Hepatic cirrhosis can be present in associated with patients undergoing pancreatoduodenectomy (PD). Many peri-operative measures need to be considered on such patients. A 83 years old gentleman presented with pain abdomen, Ultrasonographic evidence of dilated extrahepatic biliary system and distended gall bladder and contrast enhanced computed tomography (CECT) scan of the abdomen with features of a pancreatic head mass, further confirmed to be adenocarcinoma by endoscopic ultrasound (EUS) and biopsy. These findings were present on the background of Non-Alcoholic Steato-Hepatitis (NASH) associated liver cirrhosis, with Child–Turcotte–Pugh (CTP) score of 5 (CTP A) and Model For End-Stage Liver Disease- sodium (MELDNa) score of 13. The patient underwent PD. Histopathological evaluation showed a p T3 N2 moderately differentiated adenocarcinoma of the pancreatic head with Ishak scoring of liver biopsy 6. The postoperative course of the patient was uneventful and was discharged from the hospital on the 5th post-operative day. No readmission or re-operation was required. Keywords: Pancreatoduodenectomy, pancreatoduodenectomy in liver cirrhosis, pancreatoduodenectomy modification in cirrhosisPublication 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.Publication Recurrent Dermatofibrosarcoma Protuberance: A Case Report(Nepal Medical Association, 2021) Shah, Shiv Raj; Regmee, Sujan; Maharjan, Dhiresh Kumar; Thapa, Prabin BikramAbstract: Dermatofibrosarcoma protuberance represents less than 0.1% of all tumors, treatment of which requires wide local excision (≥5cm) but recurrence is not rare. Here we present a 32-year male presented with a swelling of 15 x 6cm over the left lumbar region for which he underwent excision three years ago, the histopathological examination of the swelling, showed a malignant mesenchymal tumor and Immunohistochemistry features were suggestive of Dermatofibrosarcoma protuberance. After three years of interval, he again presented with complaints of swelling in the previously operated site for nine months and underwent excision of the mass with Split Thickness Skin Graft. Although the tumor was confined to the skin and subcutaneous tissue in the present case, the patient didn’t undergo any adjuvant radiotherapy to avoid a possible relapse that would infiltrate deeper structures for the first time. Being a recurrent tumor, long-term follow-up is strongly recommended.Publication Spigelian Hernia: A Case report(Nepal Medical Association, 2024) Shrestha, Prinsa; K C, Gaurab; Acharya, Bidur; Shah, Shiv Raj; Regmee, SujanAbstract A Spigelian hernia is a hernia through the Spigelian fascia which are difficult to diagnose as they do not present with a subcutaneous swelling and can be dangerous as there is a high risk of incarceration. We report a case of a 51-year-old female who presented to our surgical unit with epigastric pain for 5 days. She was diagnosed with Spigelian hernia with esophagitis and antral gastritis with the help of a computed tomography scan and upper gastrointestinal endoscopy. The diagnosis was confirmed on diagnostic laparoscopy and transabdominal preperitoneal repair of the defect was performed using prolene mesh. Her post-operative period was uneventful. Spigelian hernias are rare and patients can present with atypical symptoms as in this case. Thus, imaging plays a vital role in diagnosis. Management is surgical and has good outcomes.