NepMed Repository :: Browsing by Author "Sapkota, Ranjan"

Browsing by Author "Sapkota, Ranjan"

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Clinical Profile of Thoracoscopic Bullectomy in Treatment of Pneumothorax
(Nepal Health Research Council, 2024) Gautam, Pratima; Sapkota, Ranjan; Shrestha, Suraj; Mainali, Prakash
Background: In pneumothorax patients requiring surgery for various indications, thoracotomy was the traditional approach until the advent of video-assisted thoracoscopic surgery. In the last decade, role of thoracoscopy in the surgical management of pneumothorax has been consolidated and established. In this study, we aim to report our experience of thoracoscopy in the surgical management of pneumothorax. Methods: A descriptive review of prospectively maintained data on all the patients undergoing thoracoscopic bullectomy for pneumothorax was done. Result: Over the period of 9 years, a total of 120 patients underwent thoracoscopic bullectomy. Among them, 95 entered final analysis. Most common age group was 21-40 years, with male predominance (80%); most common diagnosis was primary pneumothorax (67%), first episode (74%), and on the right (65%) side; commonest symptom was shortness of breath (84%) of a median duration of 7 days. A chest tube was placed in 96% of patients before the operation. Commonest radiological finding was multiple bullae (45%) in the apical region (71%). Majority of patients underwent surgery via 3 ports, and a single bulla in the apical region was the most common intraoperative finding. Among the postoperative complications which occurred in 17%, an air leak was present in 9%. The median intensive care stay was 23 hours, the median chest tube duration was 3 days, and the median hospital stay was 9 days. Conclusions: Thoracoscopy can be used as a safe, feasible, and effective procedure in patients presenting with pneumothorax with minimal postoperative complications. Keywords: Bullectomy; pneumothorax; video-assisted thoracoscopic surgery.
Early Experience of Cardiac Surgery in the Maldives
(Institute of Medicine, 2019) Sapkota, Ranjan; Shafiu, Mohamed; Razzag, Dusooma A; Patil, Priyanka B; Sadoon, Haytham M Y; Abouhabiba, Karim M; Vivehananthan, Sivaranjani P; Shinde, Dipti S; Moosa, Mohamed F; Sattar, Fathmath A A; Gautam, Mani P; Bhadauria, Prateek S
ABSTRACT Introduction From stitching a heart wound to the current level of sophistication, cardiac surgery has come a long way as a discipline. Heart surgery in South Asia has advanced tremendously; both, quantitatively and qualitatively. This is a report of the first fifteen surgeries done in the Maldives where cardiac surgery has started as an organized program. Methods Data on the first fifteen consecutive cardiac surgeries done in our hospital, over a period of 7 months, was analyzed. We briefly describe our usual perioperative management, and the pretext of the beginning of the cardiac surgery program. Results Fifteen patients, 13 males, aged 59.9±13.8 years, with a EuroScore of 0.9±0.4%, were operated. Eleven underwent CABG; and four had a valve replacement. Nine out of 11 had TVD, including 6 who had an LMCA disease. The first surgery was an off-pump CABG. The CABG group had a total of 2-5 grafts. Pump and cross-clamp times were 239.6 (± 56.1) min and 154.2 (± 45) min respectively. Five (33.3%) had at least one non-fatal complication. Two (13.2%) required re-exploration for mediastinal bleeding. The length of hospital stay was 16.5 days (±6.9 days). The chest tubes stayed for an average of 4.8 (±0.7) days. There was no in-hospital, 30-day and 90-day mortality recorded. Conclusion Cardiac surgery has begun in the Maldives. It is safe and feasible to sustain cardiac surgery program in the country, provided continued national support and international collaboration is ensured. Keywords: Cardiac surgery; coronary artery bypass; Maldives; valve replacement
Nepal’s First Laser Bronchoscopy: A Case Report
(Institute of Medicine, 2021) Sapkota, Ranjan; Shrestha, Bibhush
ABSTRACT Light Amplification by Stimulated Emission of Radiation (Laser) is an essential tool for a thoracic surgeon in the management of tracheobronchial lesions: alone or on combination with other modalities of treatment. Post-tracheostomy tracheal stenosis (PTTS) is a well-known entity and often a challenging problem to manage. Here we report a successful use of endotracheal Laser, yet unreported in available English Literature from Nepal, in a 24 year man with PTTS after a protracted hospital stay for traumatic brain injury. The use of Laser bronchoscopy in such cases is safe and feasible, alone or in combination with tracheal dilatation. Keywords: Bronchoscopy, dilatation, post-tracheostomy tracheal stenosis, laser
Surgical Management of Post-Intubation Tracheal Injuries: A Single-Center Experience from Nepal
(Institute of Medicine, 2022) Sapkota, Ranjan; Shrestha, Bibhush; Sharma, Aakriti
ABSTRACT Introduction: Despite various improvements in technology and patient care, tracheal intubation and tracheostomy still result in significant tracheal injuries like stenosis and airway fistula. Pressure necrosis by the inflated balloon is the commonest culprit. Post-intubation tracheal stenosis is a major indication for tracheal resection and anastomosis. This study was done to find out the indications and results of surgery for post-intubation tracheal lesions. Methods: It was a descriptive observational study of patients with post-intubation tracheal lesions managed in Manmohan Cardiothoracic Vascular and Transplant Center over a period of 20 years (2001 to 2021). Results: Twenty five patients were treated for post-intubation tracheal lesions. Four had isolated tracheo-esophageal fistula (TEF); eighteen had an isolated tracheal stenosis and three had both. Most had a tracheal resection and end-end anastomosis (REEA) via a cervical approach, resecting an average of 2.7 cm of tracheal length. The average size of stenotic lumen was 4.32 mm. There were no operative deaths. Two patients expired within a month of surgery: one due to fatal restenosis and the other due to sepsis. There were a few immediate and a few long-term complications. The average follow-up period was 5 years. Conclusion: Among the various post-intubation lesions, tracheal stenosis is the commonest indications for surgery. The management is challenging but safe and feasible, with a multidisciplinary team approach. Keywords: Endotracheal intubation, resection and anastomosis, tracheal stenosis, tracheostomy, tracheo-esophageal fistula

Browsing by Author "Sapkota, Ranjan"

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