Browsing by Author "Shah, Surendra"
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Publication Laparoscopic Appendectomy versus Open Appendectomy in Acute Appendicitis(Nepal Health Research Council, 2022) Nepal, Yugal Jyoty; Paudyal, Sanjaya; Shah, Surendra; Giri, NirajAbstract Background: Appendectomy is the most common emergency surgical procedure performed. Appendectomy is performed by either open or laparoscopic methods. However, there is lack of consensus regarding the most appropriate method. This study aimed to compare the outcomes of laparoscopic and open appendectomy in the treatment of acute appendicitis. Methods: Fifty-two patients undergoing appendectomy were analyzed in this prospective comparative study, with 26 patients each in laparoscopic and open group. The outcomes were measured in terms of operative time, postoperative pain at 4, 6 and 12 hours, length of hospital stay, postoperative complications according to modified Clavien Dindo classification and cost analysis. Results: Laparoscopic group had longer time after completion of surgery till exit from operation theatre (30 min in laparoscopic and 20 min in open, p<0.01) and significantly higher cost (Nrs. 26295 for laparoscopic and Nrs. 19575 for open, p<0.01) than open appendectomy. Operative time, time from entering operation theatre till being kept in operation table, time from being kept in operation table till initiation of anesthesia, postoperative pain at 4,6 and 12 hours and postoperative complications were insignificant in both groups. Conclusions: The results suggest that laparoscopic appendectomy group had longer recovery time after operation and was costlier than open appendectomy. Thus, the decision of the operative procedure can be based on the patient’s preference. Keywords: Appendectomy; laparoscopic appendectomy; open appendectomyPublication Risk Score for Prediction of Severe Postoperative Complications After Pancreaticoduodenectomy(Institute of Medicine, 2021) Shah, Surendra; Bhandari, Ramesh S; Vaidya, Pradeep; Singh, Yogendra P; Lakhey, Paleswan JoshiABSTRACT Introduction: Morbidity after pancreaticoduodenectomy (PD) still remains high. Postoperative pancreatic fistula (POPF) is the most common cause of increased morbidity after PD. Assessment of predictability of risk score for severe postoperative complications was the objective of this study. Methods: This was a retrospective observational study. Patients undergoing pancreaticoduodenectomy at Tribhuvan University Teaching Hospital (TUTH) between January 2017 to December 2017 were included in the study. Variables were recorded from case sheets of the patients. The “Risk Score” was calculated using the pancreatic duct diameter and body mass index (BMI). Association of risk score and severe postoperative complications were analyzed. Results: A total number of patients were 43, including 23 (53.5%) males and 20 (46.5%) females. The mean age was 57.09 ± 11.85 years ranges from 29 years to 76 years. The POPF and delayed gastric emptying (DGE) was 23.3% (10/43); and post-pancreaticoduodenectomy hemorrhage (PPH) was 11.6% (5/43). Severe postoperative complications were present in 13.9% (6/43) patients. In univariate analysis, pancreatic duct diameter (p=0.045) and Risk Score (p=0.02) were significantly associated with severe postoperative complications after PD. However none of them were significant in multivariate analysis. Conclusion: Risk score failed to predict severe postoperative complication after pancreaticoduodenectomy. Keywords: Pancreaticoduodenectomy, postoperative pancreatic fistula, severe postoperative complications