NepMed Repository :: Browsing by Author "Shrestha, SK"

Browsing by Author "Shrestha, SK"

Now showing 1 - 15 of 15

A Comparative Study on Epidemiology, Spectrum and Outcome Analysis of Physical Trauma cases Presenting to Emergency Department of Dhulikhel Hospital, Kathmandu University Hospital and its Outreach Centers in Rural Area
(Kathmandu University, 2013) Shrestha, R; Shrestha, SK; Kayastha, SR; Parajuli, N; Dhoju, D; Shrestha, D
ABSTRACT Background Physical trauma is one of the major cause of mortality and morbidity among young and active age group and its increasing trend is of main concern. There are only few studies concerning the spectrum of physical trauma in Nepal. Objective This study aims to evaluate the epidemiological spectrum, the extent, severity of the physical trauma and the outcome evaluation of patients with physical trauma over a period of one year in the emergency department of the Kathmandu University Hospital and compare the same parameters with those patients presenting to the various outreach centers of the hospital in the community. Methods Patient treatment files from the emergency department and the reports from various outreach centers were retrieved for a period of one year (May 2011 to April 2012). Epidemiological information, mode, type and anatomic location of injuries were recorded. Outcome evaluation was assessed by number of patients discharged from emergency department of the hospital or the outreach centers after the treatment, patients admitted for inpatient management and referred to other centers for further specialty management. Result In a period of one year, total 2205 (20%) of physical trauma cases presented to the emergency department and 1994 (6.12%) in the outreach centres. Most commonly involved age group in physical trauma both in Hospital set up and in Community set up were the young adults (15 to 49 years). Fall from height was the commonest mode of injury followed by road traffic accidents among the patients coming to the hospital while significant number of trauma patients coming to outreach centers were due to fall from height. In the hospital set up, 1525 (69.2%) of the cases were discharged while 537 (24.4%) needed inpatient management and 85 (3.8%) needed referral to other centers for the specialty management. In case of outreaches, half of the patients were discharged after the primary treatment and almost another half were referred to the hospital, mainly for need of further investigations. Conclusion Fall related injuries and road traffic accidents are the most common mode of trauma in the hospital set up and fall related injuries are the single most important mode of trauma seen in the outreaches. Mostly young adults in their active period of life are involved in physical trauma so appropriate preventive measures through public health approach should be included in comprehensive trauma management for reducing mortality and morbidity rates related to physical trauma. KEY WORDS Emergency department, outreach centers, physical trauma, trauma center
Comparative Study of Hyperbaric Bupivacaine Plus Ketamine Vs Bupivacaine Plus Fentanyl for Spinal Anaesthesia during Caeserean Section
(Kathmandu University, 2013) Shrestha, SK; Bhattarai, B; Shah, R
ABSTRACT Background Spinal anesthesia is widely used for caesarean section due to its rapid onset, low failure rate, complete analgesia. Addition of intrathecal ketamine and opioids to local anaesthetics seems to improve the quality of block and prolong the duration of analgesia. Objectives The purpose of this study was to compare the effect of intrathecal ketamine mixed with hyperbaric bupivacaine to intrathecal fentanyl mixed with hyperbaric bupivacaine. Methods One hundred parturients ASA Grade I scheduled for elective or semiurgent caesarean section under spinal anaesthesia were randomly divided into two groups. Group A received 2ml (10 mg) hyperbaric bupivacaine 0.5% plus 25 mg preservative free ketamine. Group B received 2ml (10mg) hyperbaric bupivacaine 0.5% plus 25μg fentanyl. The patients were observed intraoperatively for the onset of sensory block, degree of motor block and total duration of analgesia. Results The time to achieve Bromage scale 3 motor blockade was shorter in Group A than in Group B.(p= 0.445) whereas time to achieve highest dermatomal level of sensory block was shorter in Group A than in Group B (p= 0.143). The duration of spinal analgesia was longer in Group B than in Group A (p= 0.730). The frequency of side effect such as sedation score was higher in Group A compared to Group B (p= 0.048). The incidence of pruritus was significantly higher in Group B compared to Group A (p = 0.000). Conclusion Addition of preservative free ketamine lead to faster onset of sensory and motor blockade, although it did not prolong the duration of spinal analgesia compared to addition of fentanyl in parturients undergoing caesarean section with spinal anaesthesia. KEY WORDS Bupivacaine, caesarean section, fentanyl, ketamine, spinal anaesthesia
Comparison of sniffing position and simple head extension for visualization of glottis during direct laryngoscopy
(Kathmandu University, 2011) Bhattarai, B; Shrestha, SK; Kandel, S
ABSTRACT Background The ability of good glottis visualization during direct laryngoscopy is major determinant of easy tracheal intubation. Sniffing position for laryngoscopy is considered as gold standard and ideal position. Several studies have questioned the validation of sniffing potion. Objectives This study aims to compare relative efficacy of sniffing position and simple head extension for visualization of glottis during direct laryngoscopy. Methods Four hundred patients undergoing elective surgery under general anesthesia requiring endotracheal intubation were randomized into two groups and study was concluded. Glottic visualization was assessed using modified Cormack and Lehane classification. After laryngoscopy, tracheal intubation was performed and intubation difficulty scale was noted. Results Both the groups were comparable regarding glottis visualization. Both the groups were comparable in demographic profiles. All the intubation difficulty scale variables were comparable in both the groups except N3. Total Intubation Difficulty Score was better in sniffing position than in simple head extension group. Conclusion Glottic visualization and intubation difficulty score was better in sniffing position as compared to simple head extension. KEY WORDS sniffing position, simple head extension, direct laryngoscopy
Comparison of Ultrasound Guided Transversus Abdominis Plane Block Versus Local Wound Infiltration for Post Operative Analgesia in Patients Undergoing Gynaecological Surgery Under General Anaesthesia
(Kathmandu University, 2014) Ranjit, S; Shrestha, SK
ABSTRACT Background Transversus abdominis plane block has been recently developed as a part of multimodal post operative analgesic techniques. We compared the analgesic efficacy of this technique with local bupivacaine infiltration in patients undergoing gynaecological surgeries with pfannenstiel incision and lower midline incision under general anaesthesia. Objectives To evaluate the efficacy of ultrasound guided transversus abdominis plane block for postoperative analgesia. Methods Patients were randomly allocated to three groups: control group (n=15), transversus abdominis plane block group (n=15), who received bilateral transversus abdominis plane blockwith 0.25% bupivacaine, and local infiltration group (n=15), who received local wound infiltration with 0.25% bupivacaine at the end of surgery. All patients received intramuscular diclofenac 12 hourly and intravenous tramadol SOS in the postoperative period. Visual analogue scores for pain were assessed at 1,2,4,8,12 and 24 hours postoperatively and these were compared between the three groups. Average tramadol consumption in 24 hours were also compared among the three groups. Data were subjected to univariate ANOVA test and chi- square test. Level of significance was set at 0.05. Results Visual analogue scores were significantly less in transversus abdominis plane block group and effect lasted up to 12 hours at rest postoperatively and 8 hours during cough and movement. Conclusion Bilateral Transversus abdominis plane block was effective in reducing postoperative pain scores for 8 to 12 hours postoperatively. This block was also successful in reducing postoperative opioid requirement. KEY WORDS Postoperative analgesia, transversus abdominis plane block, ultrasound guidance, visual analogue score.
Effect of Sildenafil Citrate on Pulmonary Arterial Systolic Pressure and Sub-maximal Exercise Capacity in Chronic Obstructive Pulmonary Disease
(Kathmandu University, 2017) Shrestha, SK; Srivastava, B; Karki, M; Khatri, DB; Pradhan, RM
ABSTRACT Background Pulmonary hypertension (PH) often complicates Chronic Obstructive Pulmonary Disease (COPD). Sildenafil reduces pulmonary arterial pressure associated with multitude of diseases. Objective To evaluate the use of Sildenafil in Pulmonary Hypertension associated with COPD. Method This randomized control study enrolled 72 patients: 61 completed the study. Thirty- patients with COPD received Sildenafil 25 mg thrice daily and 31 patients with COPD received optimal medical therapy for four weeks. Symptom assessment and dyspnoea grading was done with modified Borg scale and Modified Medical Research Council (MMRC) grade. The functional assessment was done with WHO functional classification. The estimation of pulmonary arterial systolic pressure and six minute walking distance was done before and after four weeks of the administration of therapy in both groups. Adverse reaction profiling was done for Sildenafil. The primary outcomes were the changes in pulmonary arterial systolic pressure and six minute walk test. The secondary outcomes were change in modified Borg scale for dyspnoea, MMRC grading and WHO functional class. Result The mean decrease in pulmonary arterial systolic pressure in Sildenafil group was significant as compared to controls (9.87+7.84 mmHg Vs 5.93+7.44 mmHg, P=0.048). The mean increase in six minute walk distance was significantly more in cases as compared to controls (48.13+25.79 m Vs 32.59+32.96 m,P=0.047). The changes in modified Borg scale was not significant (1.20+1.92 to 1.55+1.23; P=0.401). There was significant changes in MMRC grade (p=0.037). There was no significant change in WHO functional class after four weeks (p=0.071). Conclusion Sildenafil marginally decreased pulmonary arterial systolic pressure and increased six minute walk distance in COPD patients. It improved MMRC grading without affecting modified Borg’s Scale and WHO functional class. KEY WORDS Chronic obstructive pulmonary disease, Pulmonary hypertension, Sildenafil, Six minute walk distance
Improving Knowledge, Skill and Confidence of Novice Medical Doctors in Trauma Management with Principles of ABCDE
(Kathmandu University, 2018) Shrestha, R; Khadka, SK; Thapa, S; Shrestha, B; Shrestha, SK; Ranjit, S; Pradhan, BB; Shakya, YR; Lama, D; Shrestha J
ABSTRACT Background Trauma is one of the major public health concerns clamming about five million death annually worldwide. Experience and confidence of a doctor in the management of trauma patients have big impact on the overall outcome. Objective This study aims to evaluate the outcome of a trauma course in improving the knowledge, skill and confidence of novice doctors in managing trauma victims. Method A pre/post test analytical study was carried out among novice medical doctors from Kathmandu University School of Medical Science (KUSMS) who participated in a standard two and a half day trauma course, that utilizes the principles of ABCDE, as a part of their regular training. Pre-course knowledge and skill were compared with immediate post-course scores on the same guidelines. Objective structured and subjective written feedbacks from the participants were analyzed qualitatively to identify the perceptions of candidates. Result Sixty-eight males and twenty-nine females completed the course. The average pre- test scores in knowledge and skill were 8.3(33.2%) and 19.6(78.5%) respectively. Similarly the post-test scores were 16.04(64.2%) and 22.45 (89.5%) respectively, showing statistically significant improvements (P 0.000). The mean percentage improvement in knowledge was 48.8% and that in skill was 160.9%. The feedback analysis showed majority of the participants were satisfied with the course and they perceived improved “self-confident” in handling trauma cases. Conclusion All the novice doctors should participate in a standard trauma course hence their knowledge, skill and confidence in handling a trauma can be improved. KEY WORDS Emergency room trauma course (ERTC), Interns, Knowledge and skill, Principles of ABCDE, Simulation, Skill stations, Trauma, Trauma course
Modified Limberg Flap for Pilonidal Sinus
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2017) Thapa, Prabin Bikram; Maharjan, DK; Ghimire, R; Shrestha, SK
Abstract: Background: Pilonidal sinus disease is a common condition usually seen in young adults. Although several methods of treatment have been described, but all have been associated with high recurrence rates. This study was carried out to evaluate the advantages and results of rhomboid excision and Limberg flap reconstruction in the management of pilonidal sinus disease. Objective: To evaluate the advantages and results of rhomboid excision and Limberg flap reconstruction in the management of pilonidal sinus disease Material and Methods: This was prospective descriptive study conducted in Unit III, Department of Surgery, Kathmandu Medical College Teaching Hospital from August 2013 to August 2015. First 50 patients with diagnosis of pilonidal sinus were included .Exclusion criteria was patients with pilonidal abscess. Results: Total 50 patient were included in 2 years time. Mean age was 23.48 ± 3.9 years with all male patients only. Median duration of surgery was 32 ± 4.4 minutes .Median time for normal activities was 21± 3.9 days and median follow up time was 18±8.5 months. No recurrence was noted till then. Post surgery, patient applied hair removal cream: 44%, hair shaving: 34% and laser therapy for hair follicles: 22%. Conclusion: Modified Limberg flap is better option for pilonidal sinus with least recurrence. However, post surgical counseling for hair removal is very important in order to prevent recurrence and should be multidisciplinary approach along with dermatologist colleagues. Keywords: pilonidal sinus, modified limberg flap, hair removal
Patient’s Mode of Transportation Presented in the Emergency Department of a Tertiary Care Centre, Kavre, Nepal
(Kathmandu University, 2018) Shrestha, SK; Koirala, K; Amatya, B
ABSTRACT Background In many developing countries, emergency medical services, especially pre-hospital emergency care, has long been neglected. It is the major obstacle for provision of timely care. Patients are regularly brought to emergency department by the relatives in taxis, bus or other readily available mode of transportation that lacks emergency medical services. Development the Nepal Ambulance Service established its first proper ambulance service in Nepal in 2011 and Dhulikhel Emergency Medical Services in 2013 at Dhulikhel Hospital, Kathmandu University Hospital. Proper pre- hospital emergence medical service can improve survival rates. Objective To determine the mode of transportation used by patients to arrive at the emergency department and effectiveness of medical services specific to Dhulikhel Hospital, Kavre, Nepal. Method In this study, 160 patients who arrived to emergency department during one-month period were included. The emergency physicians and paramedics collected data on a predesigned questionnaire regarding demographic details, mode of transport used by the patients to arrive emergency department, reason for not using ambulance, knowledge on emergency medical services at Dhulikhel Hospital and their acceptability for those services. Result Mean age of the patients was 46±18 years and (52%) were men. Out of them, only 31% arrived to the emergency department by ambulance while the rest other patients used other forms of transport such as private vehicles (21%), bus (16%), taxi (13%), motorbike (11%) and van (7%). Among 50 patients who used ambulance, 24% of the patients who used Dhulikhel Hospital ambulance received medical care and trained medical staff services; all patients were satisfied with the services. 155 out of 160 patients mentioned the need of a trained medical personal in ambulance. The mean duration for waiting time for ambulance was 33.78 minutes. The main reasons to not using ambulance were they did not know the ambulance number, ability to find other vehicles easily and having own private vehicle. Conclusion A prominent proportion of patients did not arrive by ambulance to the emergency department and the main reason was that they didn’t know the number of ambulance service. Developing three-digit phone number for ambulance service at the local level will make people easier to remember and contact. Similarly, education and training must be developed to improve emergency medical services. These strategies along with team management of patients could significantly improve patient care in Nepal. KEY WORDS Emergency care, Mode of transportation, Ambulance, Dhulikhel emergency medical services
Preemptive use of Small Dose Fentanyl Suppresses Fentanyl Induced Cough
(Kathmandu University, 2012) Shrestha, SK; Bhattarai, B; Shah, RS
ABSTRACT Background Fentanyl, a synthetic opioid, is a popular choice amongst anaesthesiologists in the operating room. Pre induction intravenous fentanyl bolus is associated with coughing in 28 – 65% of patients. Fentanyl induced cough is not always benign and can be remarkably troublesome at the most critical moment of anaesthesia when airway reflex is lost. Objectives To study the effect of pre emptive use of minimal dose fentanyl through the peripheral venous cannulae on the incidence of cough by a larger bolus of intravenous fentanyl. Methods One hundred and fifty patients aged 18 -75 years undergoing elective surgical procedures were randomized into three groups of 50 each. The first group received 0.5 ml saline 0.9 % intravenously one minute prior to the administration of fentanyl 150μg (3 ml); the second group received pre emptive fentanyl 25μg(0.5ml) prior to the administration of fentanyl 125μg(2.5ml); and the third group received preemptive fentanyl 25 μg(0.5ml), followed by the administration of fentanyl 150μg(3ml).. Based on the number of coughs observed, cough severity was graded as mild(1-2), moderate (3-5),or severe (>5). Results The incidence of fentanyl induced cough was significantly lower in both pre emptive group 4(8%) for 125μg fentanyl and 7(14%) for 150μg than in the saline group 15(30%). Conclusion Pre- emptive use of minimal dose fentanyl 25μg administered one minute before a larger bolus dose of fentanyl (125 or 150μg ) can effectively suppress cough. KEY WORDS Cough, fentanyl, pre emptive
Prevalence of peripheral arterial disease by ankle-brachial index and its correlation with carotid intimal thickness and coronary risk factors in Nepalese population over the age of forty years
(Kathmandu University, 2007) Sodhi, HS; Shrestha, SK; Rauniyar, R; Rawat, B
Objectives: Noninvasive measures of subclinical atherosclerosis such as the ankle brachial index (ABI) and common carotid artery intima-media thickness (CCA IMT) could improve risk prediction and provide more focused primary prevention strategies. This report describes the prevalence of subclinical atherosclerotic vascular disease in a Nepalese population over the age of forty years as measured by ABI and CCA IMT and their association with established cardiovascular risk factors. Materials and methods: Ultrasonic evaluation of ABI and CCA IMT was done in 195 individuals of age 40 years and above who had presented to an outpatient department. Patients with established diagnosis of coronary artery disease or symptomatic for peripheral arterial disease were excluded from the study. Results: The prevalence of atherosclerotic disease as measured by ABI was 18.5% and there was a statistically significant correlation between ABI and CCA IMT and other established cardiovascular risk factors such as smoking, diabetes mellitus and hypertension. Conclusions: We recommend that ABI as measured by sphygmomanometer be incorporated into routine cardiovascular screening and when found to be abnormal further confirmed by Doppler assessment of ABI and CCA IMT as surrogate markers of atherosclerotic vascular disease. Key words: atherosclerosis, cardiovascular disease, peripheral vascular disease, carotid arteries
Reasons for Summoning Ambulance Services in the Hilly Region of Nepal
(Kathmandu University, 2019) Shrestha, SK; Jacobson, C; Dahal, S; Shrestha, R; Weiner, Y; Sheridan, A
ABSTRACT Background Nepal lacks a unified and countrywide emergency medical services system as other developing countries. However, the emergence of ambulance service initiatives in the past decade shows a promising future for pre-hospital care. Nepal Ambulance Service (Est. 2011) and Dhulikhel Emergency Medical Services (Est. 2013) are the existing emergency medical services initiatives in Nepal. Objective To describe the reason for summoning ambulance services and demographics of the patients who were transported by Dhulikhel Emergency Medical Services at Dhulikhel hospital, hilly region of Nepal. Method One thousand three hundred and ninety three patient records at Dhulikhel hospital transported by Dhulikhel Emergency Medical Services during the five-year period (2013 - 2018) were included in the study. Chief complaints and demographic data were collected and categorized into overarching systemic categories. Result Among 1393 patients, majority were female (60.4%) and the most common age group was 20-29 years. The most common reason for calling ambulances was gastrointestinal problem (22.6%). Similarly, respiratory (17%), obstetric and gynecological (15.2%), trauma (12.7%) and neurological (9.6%) problems were other common reasons. The number of respiratory problem was increased during the winter season. The overall percentage of patients arriving at hospital with trauma problems was increased steadily, but it was not statistically significant. Conclusion Gastrointestinal problem was the most common reason, followed by respiratory and obstetric and gynecological problems for summoning ambulances services in the hilly regions of Nepal. The incidence of respiratory problem significantly increased during the winter season. KEY WORDS Ambulance services, Dhulikhel hospital, Emergency medical services, Pre-hospital care
Six Minute Walk Distance and Reference Equations in Normal Healthy Subjects of Nepal
(Kathmandu University, 2015) Shrestha, SK; Srivastava, B
ABSTRACT Background The self-paced six minute walk test is a simple assessment for sub-maximal functional capacity. It correlates well with sophisticated tests and gives good prediction for morbidity, mortality, quality of life and pulmonary functions. Objective To evaluate six minute walk distance in healthy adults to identify reference values and formulate reference equations. Method We conducted six minute walk test on 250 random volunteers at and above 18 years of age as per standard protocol. Age, gender, height and weight were measured. Pre- test and post-test vital parameters were recorded including pulse oximetry. The six minute walking distance was identified in all subjects. Multiple regression analysis was done to formulate regression equations to predict six minute walking distance. This also correlated age, gender, height, weight, body mass index with six minute walking distance. Result The mean six minute walking distance was 489±86 meters with males walking 509±82 meters and females 445±78 meters. Age, gender, weight and body mass index had significant contribution for prediction of six minute walking distance. Gender was the single most important predictor. Height had the least significance. Depending on coefficients of these variables we formulated three regression equations and tested them for accurate prediction. The two best equations were identified as: Predicted SMWD = 395–1.5xAge+2.47xWT–35.89xGender and Predicted SMWD = 440–1.82xAge–53.07xGender+5.12xBMI. Conclusion Gender, age and height are the most important predictors of six minute walking distance. Reference values and equations for both genders, different age groups with varying weights were derived for local population. KEY WORDS Predicted equation, reference values, six minute walk test.
Study on Acute Renal Colic and Comparison of Diclofenac and Ketorolac in Pain Management in University Hospital, Kavre, Nepal
(Kathmandu University, 2019) Shrestha, SK; Parajuli, S; Nyaupane, SP; Joshi, HN
ABSTRACT Background Acute renal colic is the most frequent clinical presentations of renal stone and a common cause of patient visits to emergency departments worldwide. The prevalence of the renal stone disease has increased steadily over the past decades. Objective To describe the prevalence, epidemiological features and clinical management of renal colic patients at emergency department in Kathmandu University Hospital, Kavre, Nepal. Method Two hundred and thirty-six patients with acute renal colic presented in emergency department during a six-months period were included in the study. Using a standard predesigned proforma, demographic characteristics, presenting symptoms, practice of pain management and outcome were investigated. Renal colic attacks in patients were defined according to International Classification of Diseases, Tenth Revision, and Clinical Modification-10. Result Prevalence of renal colic was 2.61%. Mean age of the patients was 33.9±13.7 years. More than half of participants were male (54%). Majority of the patients (47.9%) were from Kavrepalanchowk district. The most common presenting symptom of the patients was flank pain on affected side (79.2%). In almost 43% of patients, diclofenac sodium was administered as a first line analgesic. There was no significant difference between diclofenac and ketolorac with respect to the need of second line analgesic (Chi-square value: 0.19, p value = 0.664). Conclusion Prevalence of renal colic was 2.61% at Dhulikhel hospital. More male pateints were affected and the most common presenting symptom was flank pain on the affected. Diclofenac and ketorolac are equally effective for the pain management of renal colic patients. KEY WORDS Diclofenac, Emergency department, Epidemiology, Renal colic
Total thyroidectomy: the treatment of choice in differentiated thyroid carcinoma
(Kathmandu University, 2005) Shrestha, SK; Joshi, MR; Sharma, SK
Introduction: Clinically detectable thyroid carcinoma constitutes less than 1% of human cancers. Ninety percent of all thyroid malignancies are differentiated papillary and follicular carcinoma. Surgery plays a key role in differentiated thyroid carcinoma as it carries excellent prognosis, lower recurrence rate and low mortality rate but controversy persists for extent of surgery and optimal surgical management of lymph node metastasis. Patient and Method: A retrospective analysis was done for the cases that underwent total thyroidectomy with lymph node dissection for differentiated carcinoma of thyroid in Kathmandu Medical College during two year periods (Oct 2001 to Oct 2003). Result: In our experience with 18 cases of Differentiated Thyroid Carcinoma (DTC) treated with total thyroidectomies and lymph node dissection, papillary carcinoma was predominant with 83% incidence. Disease was prevalent in 50 to 60year age group. Except two cases of transient hypocalcaemia and few wound related complications, there have been no other complications. Conclusion: Total thyroidectomy with lymph node dissection is safe and effective, so, the treatment of choice in cases of differentiated thyroid carcinoma.
Use of percutaneous thread loop to hold the vermiform appendix during laparoscopic appendectomy
(Kathmandu University, 2007) Joshi, MR; Shrestha, SK; Thapa, PB; Koirala, U; Bhattarai, P; Dongol, UMS; Singh, DR; Sharma, SK
Introduction: Laparoscopic appendectomy, although not as widely performed as laparoscopic cholecystectomy, it has got definite advantage over the conventional open procedure. Controversy exists regarding the closure of stump. Our institute practices intracorporeal knot tying using 3 ports. Difficulties are observed in three port technique to hold the appendix during knot tying. We use a percutaneous thread loop. Advantage of the use of loop was evaluated. Patients and method: Prospective study was carried out during 18 months. Total cases were randomly divided in non-loop and with loop group. Operative procedure was same. Cases were compared in terms of operating time, post-operative hospital stay and complications. Results: Total patients were 66. Thirty two in non-loop group and 34 in with loop group. Mean age was 27.89 yrs. Most of the cases were females (62%). Mean operating time was less in loop group although statistically not significant. There was no difference in post operative hospital stay. Use of loop was not associated with added complications. Conclusion: Use of percutaneous loop to hold the appendix reduces the operating time and replaces the need of fourth port. It is safe and effective without any increased morbidity. Key words: Laparoscopic appendectomy, Intracorporeal knot, Percutaneous loop

Browsing by Author "Shrestha, SK"

Results Per Page

Sort Options