Browsing by Author "Singh, YP"
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Publication Building a health research culture in Nepal: An initiative from the Institute of Medicine(Institute of Medicine, 2016) Singh, YPNA.Publication Giant retroperitoneal lipoma(Institute of Medicine, 2007) Kansakar, P; Ghimire, B; Rajbhandary, A; K.C., H; Singh, YP; Vaidya, PAbstract Case report: This is a case report of a retroperitoneal lipoma.The patient was admitted with complaints of abdominal distention and early satiety. Contrast enhanced CT scan of abdomen showed a large mass of fat density arising from the retroperitoneum measuring 30 x 25 x 20cm displacing the left kidney towards the midline and anteriorly. Fat plane was maintained with surrounding structures. The patient underwent exploratory laparotomy and the lipoma was excised. The lesion measured 30 x 20 cm and weighed 5.1 kgs. Since the left kidney was displaced anteriorly and towards the midline, nephropexy was performed. Histopathology revealed benign lipoma. Post operative period was uneventful. Keywords: Lipoma, retroperitoneal mass, displaced kidneyPublication Laparoscopic management of hydatid cyst of liver(Institute of Medicine, 2016) Pradhan, S; Ghimire, B; Kansakar, P; Singh, Bhandari R; Joshi, Lakhey P; Singh, YP; Vaidya, P; Mishra, P; Singh, KPAbstract Introduction: The surgical treatment of liver hydatid disease has evolved dramatically and laparoscopic treatment has shown encouraging results with the advantages of minimally invasive surgery. We conducted this study to determine the outcome of laparoscopic management of hydatid disease of the liver. Methods: Consecutive patients with this disease reporting to our department from July 2014 to July 2015 were offered laparoscopic management. All patients received pre- and postoperative albendazole. The laparoscopic technique consisted of aspiration of the cyst fluid, sterilization, suction and drainage of the cavity, deroofing and addition of omentoplasty. Age, sex, duration of surgery, surgical morbidity, hospital stay and evidence of hydatid cyst recurrence were measured. Results: Twenty six patients had laparoscopic treatment for hepatic hydatid cysts. Females were 18 (69.2%) and males were 8 (30.8%). Mean age of patients was 37.46 ± 15.96 years (range 17-74 years). Pain was the commonest presentation occurring in 21 (80.8%). The right lobe of the liver was most commonly involved in 20 patients (76.9%). The mean cyst size was 6.77 cm (range, 5 cm to 12 cm). Minor spillage of cyst contents occurred in 5 patients (19.23%) and major spillage occurred in 1 patient (3.8%). The mean duration of surgery was 84.81±28.93 minutes (range 50-150 minutes). Conversion was needed in 2 (7.7%). Complications included port-site infection in 2 (7.7%), bile leak in 3 (11.5%), fever in 5 (19.2%) and chest infection in 2 (7.7%) cases. Mean hospital stay is 4.58 ± 3.40 days (range 3-16). There was no mortality in the series. The average follow-up period is 7.81 ±2.57 months. There have been no recurrences to date however 1 patient was lost to follow up. Conclusion: Laparoscopic management of hydatid cysts of the liver is a safe and effective option with advantage of minimally invasive surgery in properly selected patients. Keywords: Hydatid cyst, Laparoscopy, EchinococcusPublication Limburg Flap Closure for Pilonidal Sinus Disease(Institute of Medicine, 2014) Ghimire, B; Singh, YPAbstract Introduction: Though Pilonidal sinus disease (PSD) is a benign disease it can be debilitating at times. Though there are many techniques for treating the disease, they have prolonged recovery and risk of recurrence. Limberg flap repair is a novel technique as it is curative with minimal incidence of recurrence and the healing is better Methods: All patients diagnosed with PSD irrespective of their age were included in the study and underwent Limberg Flap Closure under spinal anesthesia in prone position. Results: During the study period of two years, eleven patients were operated. Most of them were young males. Admission was usually for 4 days (3 to 7 days). One patient had superficial surgical site infection which healed after 10 days one patient developed seroma which was asymptomatic and three patients had hypoesthesia on the upper portion of the flap. There was no recurrence over three years follow up Conclusion: Limberg Flap Closure for Pilonidal Sinus Disease is a safe procedure with acceptable morbidity and less risk of recurrence. Keywords: Pilonidal sinus disease, Limberg flap closure, Khomboid excision, ScrumaPublication Peutz-Jehger’s Syndrome presenting as adult intussusception(Institute of Medicine, 2009) Athar, Z; Rajbhandari, A; Kansakar, P; Singh, YP; Vaidya, PAbstract Abstract: Peutz- Jehger’s syndrome is an autosomal dominant disorder. It is the second most common hamartomatous syndrome with hamartomatous polyp of gastrointestinal tract and cutaneous melanin deposit. Majority of patients remain relatively asymptomatic. Some present with abdominal pain secondary to obstruction or impending obstruction owing to an intussuscepted polyp with GI bleeding. We report a case of 21 year male who presented with upper central abdominal pain, distension, vomiting and blood mixed stool. He also had black colored spots on perioral region and fingers. Ultrasound revealed mass lesion with echogenic centre suggestive of intussusception. Emergency laparotomy revealed jejunojejunal intususception with gangreneous intussusceptum and two other large polyps. Resection anastomosis of jejunum and excision of polyps was done. Peutz – Jehger’s syndrome is a rare but important cause of intussusception in adults presenting with cutaneous manifestations and features of intestinal obstruction Keywords: Cutaneous melanin, Hamartomatous polyp, Intussusception, Peutz Jegher’s syndromePublication Post Operative Diagnosis of Early Gastric Cancer in a Low Risk Population and the Possibility of Risk Stratified Screening(Kathmandu University, 2014) Ghimire, B; Singh, YP; Timalsina, SABSTRACT Background Gastric cancer is the second commonest cause of cancer related mortality worldwide. Though its incidence is more in Eastern Asia, it is increasing in the South Asian subcontinent. The diagnosis of early gastric cancer (EGC) confined to the mucosa or submucosa, is an important concern due to a better outcome at this stage where five year survival rates could increase by 90 percent. Though mass screening is done in few countries, it has not been applied in developing countries like Nepal. Preoperative diagnosis of EGC is rare in Nepal. The aim of this study is to analyze the clinico- pathological features of postoperative cases of gastric cancer managed in a tertiary care university hospital of Nepal. Methods All patients with histological diagnosis of gastric cancer admitted in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal during the three year period (September 2010 to August 2013) were analyzed retrospectively. Results Ninety two patients with endoscopic diagnosis of gastric cancers were admitted during the past three years. The mean age was 60 years ranging from 28 years to 85 years with the male to female ratio of 2.8:1. Five patients were younger than 40 years and all were in advanced stage. Thirty five percent of the patients belonged to Janajatis (Hill) community though they comprise only 23% of the population and about 65% of them belonged to an area involving 25% of the country. Seventy six cases were operated. Out of 92 patients, 4 patients were diagnosed as early gastric cancer post operatively. All patients with early gastric cancer were above 50 years with CT Scan abdomen revealing focal thickening without lymphadenopathy. Conclusion Over the years, the incidence of gastric cancer is increasing in Nepal. Though 92% are advance gastric cancers, few have been diagnosed and treated early. A screening program in a country like Nepal with diverse ethnicity and difficult terrain might be helpful if it targets high risk people in high risk areas. KEY WORDS Advanced gastric cancer, early gastric cancer, ethnicity, low riskPublication Round Block Technique in Management of Breast Lesions(Kathmandu University, 2019) Khanal, S; Singh, YP; Sharma, R; Pandit, KABSTRACT The basic tenets of oncoplastic surgery essentially includes volume displacement and volume replacement. The round block technique, so-called donut mastopexy or Benelli mastopexy, is frequently used as a volume displacement technique in breast conserving surgery for benign multicentric fibroadenomas and early breast cancers. Such techniques are still underused in Nepal. In this article we present on four cases managed with original round block technique and followed prospectively with their outcome. KEY WORDS Breast cancer, Fibroadenoma, Oncoplasty, Sentinel lymph nodePublication Simple Oncoplastic Breast Conserving Surgery for Breast Cancer in a University Hospital(Kathmandu University, 2023) Khanal, S; Singh, N; Singh, YPABSTRACT Background The principle of oncoplastic surgery is the removal of tumors with negative margins as well as maintaining the contour of the breast. The goals are to achieve local control and best cosmesis. Objective The objective of this study was to assess patients’ satisfaction with different techniques of simple oncoplastic breast conserving surgery (BCS) for early breast cancer. Method This was a retrospective study of early breast cancer cases operated during the period 2009 to 2017. All the patients were under regular follow up for at least five years after surgery. Original Harvard/NSABP/RTOG scale was used to evaluate cosmesis at one year after surgery. Result Median age of the patients was 43 years with median size of tumor being 2.5 cm. All of the patients had good to excellent cosmetic outcome. One patient (4.5%) had margin positivity. All patients were disease free and happy with the cosmesis at five years although one patient did not have whole breast radiotherapy. Conclusion Simple oncoplastic breast conserving surgery techniques in upper part of breast are simple, feasible and improve cosmetic outcome with low margin positivity and good disease-free five-year survival. KEY WORDS Breast cancer, Breast conserving surgery, MammaplastyPublication Surgical Management of Primary Hyperparathyroidism: An Institutional Study on Surgical Quality Control(Institute of Medicine, 2017) Nepal, B; Singh, YP; Pokhrel, A; Sayami, P; Sayami, GAbstract Introduction: Surgery is key treatment of primary hyperparathyroidism. With the inclusion of serum calcium measurement in routine biochemistry panel, majority of primary hyperparathyroidism can be detected in earlier asymptomatic phase. Preoperative localization by Ultrasonography and Sestamibi scan combined together along with CT or MRI in ectopic adenoma enables for focused minimal invasive surgery. Intraoperative intact PTH (IPTH) measurement is used as a surgical quality control in primary hyperparathyroidism surgery. This study was undertaken to look into current status of surgical management of primary hyperparathyroidism in the tertiary care center in Nepal. Methods: This was a prospective observational study conducted in Department of Surgery. Tribhuvan University Teaching Hospital Kathmandu, Nepal from November 2014 to October 2016. Demography profile, preoperative symptoms, duration of symptoms, preoperative serum calcium, phosphate, immediate preoperative iPTH level and intraoperative iPTH level, post-operative calcium level and localization techniques were recorded. Final pathology report of each of the patients were recorded. Results: Thirteen patients were operated for primary hyperthyroidism. Mean age of the patients was 36:15 years. None of the patient had multi-glandular disease on preoperative localization. Mean preoperative Calcium level was 12.8±0.9 mg/dl and mean preoperative iPTH level was 998+805 pg ml. As Intraoperative iPTH measurement was used to ascertain the successful adenoma removal, mean IPTH intraoperative iPTH after the removal of the adenoma was 175±167 pg/ml. Mean difference of iPTH was 823±725 (p 0.024). There was mean decrease of 81% of iPTH after surgery well above 50% decrease confirmatory of successful adenoma removal. None of patients had reported with recurrent symptoms till date. Conclusion: Hypercalcemia should be subjected for iPTH scanning to identify more asymptomatic patients and Surgery is key treatment and intraoperative iPTH assay is used for confirmation of adenoma removal. Keywords: Hypercalcemia, Primary Hyperprathyroidism, Focused Parathyroidectomy, iPTH monitoringPublication Various presentations of Meckel’s Diverticulum(Institute of Medicine, 2005) Kumar, S; Singh, YP; Vaidya, PAbstract Background – Meckel’s diverticulum is very difficult to diagnose. The aim of this study was to study the various presentations of Meckel’s diverticulum in TUTH in one year. Methods – Retrospective study of nine patients admitted from emergency in one year data was done. Result - In acute abdomen we have to think about Meckel’s diverticulum and its complications. The diagnosis of symptomatic Meckel’s diverticulum is difficult to make, especially in adults. The diagnosis must be considered in anyone with unexplained abdominal complaints, nausea and vomiting, or intestinal bleeding.