Browsing by Author "Shah, C"
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Publication A Five Years Review Intra-Operative Cholangiogram(Nepal Health Research Council, 2011) Shah, J N; Shah, CBackground: Intra-operative cholangiogram is often performed to detect concurrent common bile duct stones in cholecystectomy patients. Routine cholangiogram add to cost and exposes patients to unnecessary exploration of common bile duct due to frequent false positive results. Thus, there is need of better indicators for cholangiogram in order to minimize unnecessary procedure and its morbidity. Methods: A retrospective analysis of patients undergoing intra-operative cholangiogram during open or laparoscopic cholecystectomy was done at Patan Hospital from Oct 1, 2005 to Sep 31, 2009. Indications and outcome of cholangiogram were analyzed together with findings of common bile duct exploration. Results: A total of 68 (2.8%, 68/2400) intra-operative cholangiogram were done in 2400 cholecystectomy patients during five years period. Eight (11.8%, 8/68) patients had abnormal findings. Two (3%, 2/68) patients with abnormal cholangiogram had stones in common bile duct. There was no mortality in this series. Conclusions: Existing indications of intra-operative cholangiogram detects only small percentage of patients with bile duct stones and has high false positive results. This unnecessarily increases bile duct exploration, cost and morbidity. Thus, there is need to redefine indications for intra-operative cholangiogram. Keywords: biliary pancreatitis, cholecystectomy, common bile duct, intra-operative cholangiogram.Publication A Five Years Review Intra-Operative Cholangiogram(Nepal Health Research Council, 2011) Shah, J N; Shah, CBackground: Intra-operative cholangiogram is often performed to detect concurrent common bile duct stones in cholecystectomy patients. Routine cholangiogram add to cost and exposes patients to unnecessary exploration of common bile duct due to frequent false positive results. Thus, there is need of better indicators for cholangiogram in order to minimize unnecessary procedure and its morbidity. Methods: A retrospective analysis of patients undergoing intra-operative cholangiogram during open or laparoscopic cholecystectomy was done at Patan Hospital from Oct 1, 2005 to Sep 31, 2009. Indications and outcome of cholangiogram were analyzed together with findings of common bile duct exploration. Results: A total of 68 (2.8%, 68/2400) intra-operative cholangiogram were done in 2400 cholecystectomy patients during five years period. Eight (11.8%, 8/68) patients had abnormal findings. Two (3%, 2/68) patients with abnormal cholangiogram had stones in common bile duct. There was no mortality in this series. Conclusions: Existing indications of intra-operative cholangiogram detects only small percentage of patients with bile duct stones and has high false positive results. This unnecessarily increases bile duct exploration, cost and morbidity. Thus, there is need to redefine indications for intra-operative cholangiogram. Keywords: biliary pancreatitis, cholecystectomy, common bile duct, intra-operative cholangiogram.Publication Comparison between Simple and Classical Techniques to Create Closed Pneumoperitoneum(Kathmandu University, 2021) Gharti, BB; Shrestha, PM; Shrestha, A; Basnet, RB; Shah, C; Adhikari, BABSTRACT Background Closed method of pneumoperitoneum using Veress needle is an established technique. Classical closed technique is popular. Simple technique is a modified closed technique. Objective To compare the classical and simple techniques of closed pneumoperitoneum. Method This study was conducted in the department of urology, Bir hospital from August 1st 2019 to March 30th 2021. Total 114 patients were randomized into simple and classical technique of creating closed pneumoperitoneum. Time taken for creation of pneumoperitoneum, complications and failure of creating pneumoperitoneum in each group noted and analyzed. Chi square test, Fischer exact test and student t test were used and p < 0.05 considered significant. Result Among 114 patients, 61 in simple and 53 in classical technique allocated. In simple technique, mean age was 42.98±18.21 years, BMI was 21.84±2.57 kg/m2, mean time for pneumoperitoneum creation was 108.07±21.14 seconds. In classical technique, mean age was 40.15±17.58 years, BMI was 21.94±2.54 (kg/m2), mean time for pneumoperitoneum creation was 189.70±32.21 seconds. Mean time was less in simple technique than classical technique (p < 0.001). Complication rate observed was 6% in each technique (p=0.797) with cumulative rate of 10%. Omental injury was seen in 3.2% in simple technique and 5.6% in classical technique (p=0.662). Retroperitoneal insufflation was seen in 6.5% in simple technique and 5.6% in classical technique (p=0.842). No failed pneumoperitoneum was observed in both groups. Conclusion Simple technique is as effective, reproducible and safe method as classical technique of creating closed pneumoperitoneum. KEY WORDS Classical technique, Pneumoperitoneum, Veress needle