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Research paper thumbnail of Status of clipless laparoscopic cholecystectomy in a tertiary care hospital of Nepal: A descriptive cross-sectional study

Deleted Journal, Apr 29, 2024

Background & Objectives: In this modern age, the preferred course of treatment for gallstone dise... more Background & Objectives: In this modern age, the preferred course of treatment for gallstone disease symptoms is laparoscopic cholecystectomy. For securing both the cystic duct and artery with a single ligation (SLAD), is a quicker and safe procedure. The study was aimed to determine the status of clipless laparoscopic cholecystectomy in a tertiary care hospital of Nepal. Materials and Methods: A total of 205 patients with gallstone, who underwent laparoscopic cholecystectomy at tertiary center of Nepal of age group 16-70 years were included. During the procedure the cystic duct and artery was tied with single ligation. Data were subjected to Microsoft excel 16 for analysis. Results: Laparoscopic cholecystectomy was performed in 205 patients with gallstone. Average age of patients was 31.54 yrs. There was female predominance in the study. The cystic duct and artery were tied in single ligature using nonabsorbable Silk 2-0. The mean time taken for ligation was 120.78 ± 26.92seconds. Bile leakage and intra-op bleeding were found in two patients without any mortality. Conclusion: In laparoscopic cholecystectomy, a viable and secure alternate technique for securing the cystic artery and duct is single ligation with the use of nonabsorbable thread. Even though it is a common procedure, it has an additional benefit over clips when dealing with thick, edematous cystic artery and duct complexes. It lowers the threat of surgical morbidity and does not increase the intra operative time.

Research paper thumbnail of Optimizing Trauma Patient Management:A Collaborative Approach Between Emergency Medicine, General Surgery And Orthopedics Departments

North American Academic Research, 2024

Objective: To explore the effect of multidisciplinary team (MDT) in MIHS Provincial hospitals on ... more Objective: To explore the effect of multidisciplinary team (MDT) in MIHS Provincial hospitals on severe trauma patients. Method: This study reviewed the treatment of patients with severe trauma in MIHS Provincial Hospital of Janakpurdham, Nepal from January 2023 to May 2024. The patients' gender, age, injury mechanism, etc.; the start indicators: the Glasgow coma scale (GCS), trauma index (TI), injury severity score (ISS); the start related indicators: time for activation, time for MDT to arrive, time for CT scan, time for damage control surgery; patient treatment and prognosis: ICU (intensive care unit) length of stay, number of cured and discharged patients, number of dead cases, number of patients transferred to rehabilitation hospital, were all analyzed. It discussed the composition of MDT, the initiation scheme, the indicators of initiation of MDT for severe trauma, and analyzed the correlation between the application of MDT and the prognosis of patients. Result：From January 2023 to May 2024, 112 trauma patients were treated by MDT(Emergency Medicine, General Surgery and Orthopedics Departments) in MIHS Provincial Hospital Janakpurdham, Nepal. There were 69 males and 43 females. The minimum age was 15 years, the maximum age was 89 years, most of them were 36-55 years old. The main injury mechanism was traffic accident injury. The GCS, TI, ISS were 13.0±2.9, 13.0±2.8, and 21.5±11.9, respectively. It took 3.7±0.8 minutes to start the call, 6.1±0.9 minutes for MDT personnel to arrive at the emergency rescue area, 72.3±21.1 minutes for fast CT and 190.2±92.5 minutes for injury control operation. All the hospitalized patients were treated effectively. ICU (Intensive care unit) hospitalization time was 12.6±6.7 days. 55 discharged patients were cured, 5 died (1 died of hemorrhagic shock, 4 died of severe brain injury) and 52 transferred to rehabilitation hospital. Conclusion：The treatment of severe trauma patients by MDT (Emergency Medicine, General Surgery and Orthopedics Departments) in MIHS provincial hospitals can greatly improve the ability and level of treatment of severe trauma patients, improvement for the lack of treatment of severe trauma especially multiple trauma patients in hospitals and improve the treatment effect of severe trauma patients. It provides a reference model for large hospitals to treat patients with severe trauma and multiple trauma with collaborative approach.

Research paper thumbnail of Non-operative management of anal fissure: success vs failure

Zenodo (CERN European Organization for Nuclear Research), Oct 28, 2022

Anal fissure is a linear rip or ulcer in the anal mucosa. Defecation causes a searing agony, "lik... more Anal fissure is a linear rip or ulcer in the anal mucosa. Defecation causes a searing agony, "like passing shattered glass," according to patients, followed by hours of scorching sensation in the anus. The most common presenting symptoms are distress during and after defecation. Women of childbearing age and beyond, as well as those who have just given birth, are the most likely to experience fissures. Anal fissure occurs in around 11% of people during the course of their lives. In this article, we analyze the available data to determine if non-surgical therapies for anal fissure are effective and safe. Due to the danger of incontinence and the handicap that comes along with anal fissure surgery, non-invasive medical solutions have been researched. Recently, pharmaceutical approaches have been employed to obtain fissure healing by relaxing the anal smooth muscle, thereby accomplishing reversibly what occurs during surgery.

Research paper thumbnail of Non-operative management of anal fissure: success vs failure

North American Academic Research, 2022

Anal fissure is a linear rip or ulcer in the anal mucosa. Defecation causes a searing agony, "lik... more Anal fissure is a linear rip or ulcer in the anal mucosa. Defecation causes a searing agony, "like passing shattered glass," according to patients, followed by hours of scorching sensation in the anus. The most common presenting symptoms are distress during and after defecation. Women of childbearing age and beyond, as well as those who have just given birth, are the most likely to experience fissures. Anal fissure occurs in around 11% of people during the course of their lives. In this article, we analyze the available data to determine if non-surgical therapies for anal fissure are effective and safe. Due to the danger of incontinence and the handicap that comes along with anal fissure surgery, non-invasive medical solutions have been researched. Recently, pharmaceutical approaches have been employed to obtain fissure healing by relaxing the anal smooth muscle, thereby accomplishing reversibly what occurs during surgery.

Research paper thumbnail of Status of clipless laparoscopic cholecystectomy in a tertiary care hospital of Nepal: A descriptive cross-sectional study

Deleted Journal, Apr 29, 2024

Background & Objectives: In this modern age, the preferred course of treatment for gallstone dise... more Background & Objectives: In this modern age, the preferred course of treatment for gallstone disease symptoms is laparoscopic cholecystectomy. For securing both the cystic duct and artery with a single ligation (SLAD), is a quicker and safe procedure. The study was aimed to determine the status of clipless laparoscopic cholecystectomy in a tertiary care hospital of Nepal. Materials and Methods: A total of 205 patients with gallstone, who underwent laparoscopic cholecystectomy at tertiary center of Nepal of age group 16-70 years were included. During the procedure the cystic duct and artery was tied with single ligation. Data were subjected to Microsoft excel 16 for analysis. Results: Laparoscopic cholecystectomy was performed in 205 patients with gallstone. Average age of patients was 31.54 yrs. There was female predominance in the study. The cystic duct and artery were tied in single ligature using nonabsorbable Silk 2-0. The mean time taken for ligation was 120.78 ± 26.92seconds. Bile leakage and intra-op bleeding were found in two patients without any mortality. Conclusion: In laparoscopic cholecystectomy, a viable and secure alternate technique for securing the cystic artery and duct is single ligation with the use of nonabsorbable thread. Even though it is a common procedure, it has an additional benefit over clips when dealing with thick, edematous cystic artery and duct complexes. It lowers the threat of surgical morbidity and does not increase the intra operative time.

Research paper thumbnail of Optimizing Trauma Patient Management:A Collaborative Approach Between Emergency Medicine, General Surgery And Orthopedics Departments

North American Academic Research, 2024

Objective: To explore the effect of multidisciplinary team (MDT) in MIHS Provincial hospitals on ... more Objective: To explore the effect of multidisciplinary team (MDT) in MIHS Provincial hospitals on severe trauma patients. Method: This study reviewed the treatment of patients with severe trauma in MIHS Provincial Hospital of Janakpurdham, Nepal from January 2023 to May 2024. The patients' gender, age, injury mechanism, etc.; the start indicators: the Glasgow coma scale (GCS), trauma index (TI), injury severity score (ISS); the start related indicators: time for activation, time for MDT to arrive, time for CT scan, time for damage control surgery; patient treatment and prognosis: ICU (intensive care unit) length of stay, number of cured and discharged patients, number of dead cases, number of patients transferred to rehabilitation hospital, were all analyzed. It discussed the composition of MDT, the initiation scheme, the indicators of initiation of MDT for severe trauma, and analyzed the correlation between the application of MDT and the prognosis of patients. Result：From January 2023 to May 2024, 112 trauma patients were treated by MDT(Emergency Medicine, General Surgery and Orthopedics Departments) in MIHS Provincial Hospital Janakpurdham, Nepal. There were 69 males and 43 females. The minimum age was 15 years, the maximum age was 89 years, most of them were 36-55 years old. The main injury mechanism was traffic accident injury. The GCS, TI, ISS were 13.0±2.9, 13.0±2.8, and 21.5±11.9, respectively. It took 3.7±0.8 minutes to start the call, 6.1±0.9 minutes for MDT personnel to arrive at the emergency rescue area, 72.3±21.1 minutes for fast CT and 190.2±92.5 minutes for injury control operation. All the hospitalized patients were treated effectively. ICU (Intensive care unit) hospitalization time was 12.6±6.7 days. 55 discharged patients were cured, 5 died (1 died of hemorrhagic shock, 4 died of severe brain injury) and 52 transferred to rehabilitation hospital. Conclusion：The treatment of severe trauma patients by MDT (Emergency Medicine, General Surgery and Orthopedics Departments) in MIHS provincial hospitals can greatly improve the ability and level of treatment of severe trauma patients, improvement for the lack of treatment of severe trauma especially multiple trauma patients in hospitals and improve the treatment effect of severe trauma patients. It provides a reference model for large hospitals to treat patients with severe trauma and multiple trauma with collaborative approach.

Research paper thumbnail of Non-operative management of anal fissure: success vs failure

Zenodo (CERN European Organization for Nuclear Research), Oct 28, 2022

Anal fissure is a linear rip or ulcer in the anal mucosa. Defecation causes a searing agony, "lik... more Anal fissure is a linear rip or ulcer in the anal mucosa. Defecation causes a searing agony, "like passing shattered glass," according to patients, followed by hours of scorching sensation in the anus. The most common presenting symptoms are distress during and after defecation. Women of childbearing age and beyond, as well as those who have just given birth, are the most likely to experience fissures. Anal fissure occurs in around 11% of people during the course of their lives. In this article, we analyze the available data to determine if non-surgical therapies for anal fissure are effective and safe. Due to the danger of incontinence and the handicap that comes along with anal fissure surgery, non-invasive medical solutions have been researched. Recently, pharmaceutical approaches have been employed to obtain fissure healing by relaxing the anal smooth muscle, thereby accomplishing reversibly what occurs during surgery.

Research paper thumbnail of Non-operative management of anal fissure: success vs failure

North American Academic Research, 2022

Anal fissure is a linear rip or ulcer in the anal mucosa. Defecation causes a searing agony, "lik... more Anal fissure is a linear rip or ulcer in the anal mucosa. Defecation causes a searing agony, "like passing shattered glass," according to patients, followed by hours of scorching sensation in the anus. The most common presenting symptoms are distress during and after defecation. Women of childbearing age and beyond, as well as those who have just given birth, are the most likely to experience fissures. Anal fissure occurs in around 11% of people during the course of their lives. In this article, we analyze the available data to determine if non-surgical therapies for anal fissure are effective and safe. Due to the danger of incontinence and the handicap that comes along with anal fissure surgery, non-invasive medical solutions have been researched. Recently, pharmaceutical approaches have been employed to obtain fissure healing by relaxing the anal smooth muscle, thereby accomplishing reversibly what occurs during surgery.