Browsing by Author "Thapa, Prabin Bikram"
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Publication Blunt Abdominal Trauma among Patients Admitted to the Department of Surgery at a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Ghimire, Roshan; Acharya, Bidur Prasad; Pudasaini, Prashanta; Limbu, Yugal; Maharjan, Dhiresh Kumar; Thapa, Prabin BikramAbstract Introduction: Blunt abdominal trauma bears significant morbidity and mortality worldwide and needs careful evaluation and management for a better outcome, where the resources are limited and the impact of the financial burden is very important. Previously, many cases used to be managed with operative procedures, and now the trend has been shifting to non-operative management. This study aimed to determine the prevalence of blunt abdominal trauma among patients admitted to the Department of Surgery of a tertiary care centre. Methods: This was descriptive cross-sectional study done between 1 February 2022 to 31 January 2023 after taking ethical approval from the Institutional Review Committee (Reference number: 2312202103). The decision of non-operative versus operative treatment was decided with dynamic clinical evaluation and severity of intraabdominal injuries. Demographic data, the mechanism of injury, and both conservative and operative management were studied. All the patients who were more than 18 years of age, and admitted to the Department of Surgery were included in the study. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Among a total of 1450 patients, the prevalence of blunt abdominal trauma was 140 (9.65%) (8.13-11.17, 95% Confidence Interval). A total of 61 (43.57%) were young within the age group of 18-30 with a male-female ratio of 4:1. Road traffic accidents 79 (56.43%) were the most common mechanism followed by falls from heights 51 (36.43%). Conclusions: The prevalence of blunt abdominal trauma among patients admitted to the Department of Surgery was found to be higher than in other studies done in similar settings.Publication Determination of the Surgical Margin in Laparoscopic Liver Resections Using Infrared Indocyanine Green Fluorescence(Nepal Health Research Council, 2025) Maharjan, Dhiresh Kumar; Acharya, Bidur Prasad; Maharjan, Prabir; Limbu, Ugal; Ghimire, Oshan; Thapa, Prabin BikramBackground: The advent of minimally invasive techniques has revolutionized liver surgery, with improvement in postoperative outcomes while maintaining oncological efficacy. Achieving tumor-negative resection margins remains critical for optimal oncological outcomes. Considering the adversity of tactile feedback in minimally invasive surgery complicating margin assessment, this study evaluated the efficacy of near-infrared indocyanine green fluorescence imaging in real-time surgical margin delineation during the hepatic resection. Methods: This is a single-centered, prospective, descriptive study conducted between 15th March 2022 and 15th March 2024 as per the revised STROBE guidelines. Patients were enrolled by convenient sampling and received 0.5 mg/kg of indocyanine green one day before surgery intravenously. During surgery, near infrared-indocyanine green imaging was recorded and utilized to assess the surgical margins along with the white light as well. The findings were compared and confirmed with the final histopathology report. Results: A total number of 21 patients were included in this study who underwent laparoscopic liver resection. Majority of cases were of colorectal liver metastasis (90%), and most of them were located at segment 4 (80%). Participants had a normal preoperative liver status with a median tumor size of 28 mm and a median number of 1.2. Indocyanine green fluorescence successfully delineated resection margins in all cases, and final histopathological assessment confirmed R0 resection status. No adverse reactions to the indocyanine green were reported. Conclusions: Near infrared-indocyanine green provided significant benefit regarding R0 resection in all cases confirmed with histopathology results for the intra-operative identification and demarcation of margins during laparoscopic hepatic resection. Keywords: Colorectal liver metastasis; indocyanine green; laparoscopic liver resection.Publication Intraoperative Variations of the Gastrocolic Trunk of Henle noted in Gastrointestinal Surgeries(Nepal Health Research Council, 2024) Ghimire, Roshan; Thapa, Nishant; Acharya, Bidur Prasad; Sah, Bed Prakash; Limbu, Yugal; Regmee, Sujan; Maharjan, Dhiresh Kumar; Thapa, Prabin BikramBackground: The gastro-colic trunk of Henle is a venous trunk that comprises the veins draining the stomach and colon and is an important landmark for various gastro-intestinal surgeries. Understanding the anatomy of these vessels may enhance the surgical outcome. The aim of this study is, to assess the Intraoperative variations of the Gastrocolic Trunk of Henle noted in gastrointestinal surgeries in a tertiary care center. Methods: A descriptive cross-sectional study was conducted at Kathmandu Medical College Public Limited, a tertiary center in Nepal during the period of one year (1st January 2022, to 31st December 2022). All patients undergoing right hemicolectomy, gastrectomy, and pancreaticoduodenectomy were included in the study. Based on per-operative findings, the type of The gastro-colic trunk of Henle was noted during surgery. Results: A total of 49 patients underwent the above-mentioned surgeries during the study period. The gastro-colic trunk was found in 45 out of the 49 patients intraoperatively (91.84%), and the variations were distinguished. The most common configuration noted was the union of the right gastro-epiploic vein, the anterior superior pancreaticoduodenal vein, and the superior right colic vein (Type I), which was noticed in 46.67% of the patients. Conclusions: The intraoperative identification of the anatomy of The gastro-colic trunk of Henle is challenging because of its variable combinations of tributaries. Knowledge of variations in The gastro-colic trunk of Henle is important in preventing intraoperative bleeding, and during identification, the meticulousness of surgery is redefined. Keywords: Gastrocolic trunk of Henle; hemicolectomy; venous drainage.Publication Modified Limberg Flap for Pilonidal Sinus(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2017) Thapa, Prabin Bikram; Maharjan, DK; Ghimire, R; Shrestha, SKAbstract: 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