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

Browsing by Author "Shrestha, Sujan"

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Guillain Barre Syndrome associated with COVID-19 Infection: A Case Report
(Nepal Medical Association, 2021) Shrestha, Sujan; KC, Niranjan; Hirachan, Niroj
Abstract: Coronavirus Disease has become a global pandemic after its emergence at the end of 2019 as a cluster of pneumonia. Apart from respiratory symptoms, neurologic complications are also common, mostly in hospitalized patients. More than 80 percent of patients have neurological symptoms during their disease course of which most common is encephalopathy. However, data on neurological complications like Guillain-Barré syndrome associated with coronavirus-2019 are scarce. Here, we report a case of a 64-years-old female patient with typical clinical and electrophysiological manifestations of Acute motor axonal neuropathy variant, who was reported positive with polymerase chain reaction for severe acute respiratory syndrome coronavirus-2, 13 days before the onset of acute bilateral weakness of extremities, areflexia, and normal sensory examination. Cerebrospinal fluid and electrophysiological examination were also suggestive. The neurological symptoms improved during treatment with immunoglobulins. Quick recognition of symptoms and diagnosis is important in the management of Guillain-Barré syndrome associated with coronavirus-2019.
Management of Choledochal Cyst: Experience from A Tertiary Care Center of Nepal
(Institute of Medicine, 2021) Shrestha, Sujan; Ghimire,Bikal; Kansakar, Prasan; Bhandari, Ramesh S; Lakhey, Paleshwan Joshi
ABSTRACT Introduction: Choledochal cysts are infrequent congenital cystic dilation of the biliary tract. The aim of this study is to analyze the clinicopathological profile and short-term operative outcomes of patients with choledochal cysts. Methods: This is a retrospective study of 32 consecutive patients of choledochal cyst who underwent multidisciplinary management in last two and half years at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results: A total of 32 patients, 9 males and 23 females were operated. The average age at diagnosis was 24.67±16.4 years (range from 2 to 56 years). The most common presenting symptoms were pain 31(96.88%), jaundice 10(31.25%) and mass 5(15.63%). Triad of pain, jaundice and mass was present in 4(12.5%). Transabdominal Ultrasonography (100%) was the initial diagnostic modality followed by Magnetic resonance cholangiopancreatography (MRCP) (68.75%), and contrast enhanced computed tomography (CECT) (31.25%). Endoscopic retrograde cholangiopancreatography (ERCP) was done for stent placement in 3 (9.38%) patients with severe cholangitis. Type IVA (37.5%) was the most common type of CC followed by type IC (31.23%), type IB (15.65%), type IA (12.5%) and type IVB (3.12%). Abnormal pancreaticobiliary duct junction was observed in 3 (9.38%) patients. All patients underwent open cyst excision with Roux-en-Y hepaticojejunostomy (HJ). The overall morbidity was seen in 6 patients (18.75%). There was no mortality. None of our patient had cholangiocarcinoma on pathological examination. Conclusion: Choledochal cyst was common in young females. Type IC and IVA choledochal cyst were the most common types and majority of them were symptomatic. Cyst excision with Roux-en-Y hepaticojejunostomy was the commonest surgical treatment modality and had excellent perioperative outcome Keywords: Choledochal cyst, cyst excision, Roux-en-Y hepaticojejunostomy
Surgeon-Powered Robotics in Minimally Invasive Surgery: Case Report from Nepal
(Institute of Medicine, 2023) Shrestha, Sujan; Gautam, Sujan; Shrestha, Sandip; Subedi, Sushil K; KC, Ajay; Pradhan, Susan
ABSTRACT Minimally-invasive surgery is the standard of care in many surgical diseases. Robotic surgery has mitigated nearly all limitations of laparoscopic surgery but with a big cost tag. Surgeon-powered robotic instruments were developed with the concept of providing similar advantages to the robotic platforms but with affordable costs. We report three cases of hernia, one hiatus hernia, and two inguinal hernias managed using surgeon-powered robotics platform. It provides additional maneuverability in minimal invasive surgical dissection and suturing. Surgeon powered robotic surgery may be a cost-effective viable alternative to robotic surgery in developing country like Nepal. Keywords: Hiatus hernia; inguinal hernia; Nissen fundoplication; robotic surgery; surgeon-powered robotic surgery
Surgical Training in Resource-Limited Settings: Cost-Effective, Portable and Reproducible Personal Laparoscopic Endotrainer
(Institute of Medicine, 2023) Shrestha, Sujan; KC, Ajay; Shrestha, Shiba
ABSTRACT Introduction: Minimal invasive surgery (MIS) is standard of approach for many surgical pathologies. The best way to enhance the psychomotor skills for MIS is through the disciplined and structured time with the Endotrainer. The cost and portability of available Endotrainer is the main reason for surgeons and residents allocating minimal time for training. Our goal was to create cost-effective and portable Endotrainer that enables skill development at home and classroom setting. Methods: The framework of this Endotrainer was made-up of local plywood. The anterior surface was divided into nearly equal superior and inferior surface by horizontal plywood stick. A rectangular window was created at the anterior surface for mobile phone or tablet or iPad placement. Similarly, two 8 mm hole were drilled and padded with locally available rubber washer inferior and lateral to rectangular window as laparoscopic ports. For light commercially available mini dimmable LED was installed. The final trainer box was similar in shape and size of medium suitcase, which was portable and could house laparoscopic hand instruments and training pads. Conclusion: The Endotrainer was easy and cost-effective to assemble. Embodying the essence of portability and reproducibility, this trainer box offers a personal practice tool that empowers trainee to sharpen their skills at their home or classroom. Keywords: Endotrainer; laparoscopy; minimal invasive surgery

Browsing by Author "Shrestha, Sujan"

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