Browsing by Author "Tamrakar, Kishor Kumar"
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Publication Open Cholecystectomy among Patients undergoing Laparoscopic Cholecystectomy in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Katwal, Gaurav; Thapa, Yeshika; Shrestha, Aisha; Bhattarai, Abhishek; Tamrakar, Kishor Kumar; Neupane, Harish ChandraAbstract Introduction: In the current era, laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstone disease. The aim of this study is to find out the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy in a tertiary care centre. Methods: It is a descriptive cross-sectional study done among 345 patients at the Department of Surgery of a tertiary care centre from June, 2020 to May, 2021 after receiving ethical clearance from the Institutional Review Committee (Reference number: CMC-IRC/0770798-271). Convenience sampling was done. Successive patients who underwent elective laparoscopic cholecystectomy during the study period were included. Standard 4 port laparoscopic technique was used for the laparoscopic cholecystectomy and sub-costal Kocher incision was used for the open cholecystectomy respectively. After data collection, entry and analysis were done in Microsoft Excel. Point estimate at a 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results: Out of 345 patients, the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy was 6 (1.73%) (0.35-3.11 at a 95% Confidence Interval). Conclusions: This study showed that the prevalence of open cholecystectomy among patients undergoing laparoscopic cholecystectomy was lower when compared to similar studies conducted in similar settings.Publication Preoperative Prediction of Difficult Laparoscopic Cholecystectomy using Risk Score for Conversion from Laparoscopic to Open Cholecystectomy: An Observational Study(Institute of Medicine, Tribhuvan University, 2024) Acharya, Bishal; Neupane, Harish Chandra; Tamrakar, Kishor Kumar; Ghimire, Iswar Chandra; Subedee, Aadesh; Sarraf, Soni Kumari; Aryal, Shishir; Yadav, Bidhyanand; Dulal, Saujan; Gole, Senjisha LamaAbstract: Introduction Laparoscopic cholecystectomy requires experts for the best result. Occasionally laparoscopic cholecystectomy becomes difficult, requiring conversion to open cholecystectomy and also endangers patients causing potential biliovascular and bowel injury. This study aims to predict difficult laparoscopic cholecystectomy using RSCLO scoring system. Methods A prospective observational study was conducted including 116 diagnosed case of cholelithiasis undergoing elective laparoscopic cholecystectomy from July 2023 to March 2024. Scores were given on history, physical examination and ultrasonographic findings on admission as per the RSCLO scoring system. Intraoperatively, difficult laparoscopic cholecystectomyn criteria included: Time taken >60 min or bile/stone spillage or injury to bile duct/artery or conversion to open surgery. The end point of study was the end of surgery. Results The mean age was 46.23+15.36 years with female predominance of 69%. Preoperatively, 31.9% patients were predicted to have difficult cholecystectomy and intraoperatively 37.1% had difficulty (pearson chi-square 77.096, p value <0.001). Age >50 years, male gender and prior history of hospitalization because of gallbladder pathology were significantly associated with difficult laparoscopic cholecystectomy. There was no open conversion, no intraoperative biliovascular or bowel injury. Sensitivity and specificity of RSCLO score with cut off value of >6 was 94.6% and 90%, respectively, with AUROC 0.922. Conclusion RSCLO scoring system is useful for prediction of difficult laparoscopic cholecystectomy and patients with high risk can be counseled preoperatively about intraoperative difficulty.