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Papers by Surendra Shah

Journal of Society of Surgeons of Nepal, Jul 4, 2016

Journal of Nepal Health Research Council, 2020

Background: Post-operative pancreatic fistula is the single most common and most significant caus... more Background: Post-operative pancreatic fistula is the single most common and most significant cause of post-operative morbidity and perioperative mortality. Identification of at risk patient preoperatively help to take policy of extra vigilance to act on time. This study evaluated the predictive role and cut-off value of pancreatic configuration index to predict post-operative pancreatic fistula.Methods: This was a prospective observational study in patients who had undergone pancreaticoduodenectomy from March 2017 to June 2018 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The patients with age <16 years, those who underwent re-exploration or mortality before 3rd postoperative day, additional surgery besides pancreaticoduodenectomy were excluded from the study. Pancreatic configuration index was calculated as a ratio of pancreatic parenchymal thickness and pancreatic duct diameter. Predictive value of pancreatic configuration index in predicting post-operative pancr...

Journal of General Practice and Emergency Medicine of Nepal

Most foreign bodies in the bladder are self inserted via urethra for autoerotic stimulation. Most... more Most foreign bodies in the bladder are self inserted via urethra for autoerotic stimulation. Most of them are ashamed to admit they had introduced it for sexual gratification and diagnosis is made only when got into complication. We are reporting a case of young girl who has inserted broom stick into the urethra because of sexual curiosity and it was migrated to urinary bladder which was removed using cystoscopy. Post operative period was uneventful

Journal of Nepal Health Research Council, 2012

Common practice at most centers in the country is to continue intravenous (i.v.) fluid till morni... more Common practice at most centers in the country is to continue intravenous (i.v.) fluid till morning round next day following laparoscopic cholecystectomy (LC), assess patient and gradually allow oral diet. However this seems unnecessary in view of fast recovery after minimal invasive LC. The aim of this study was to observe the prospects and assess the acceptability, safety and benefit of early oral feeding and discontinuing i.v. fluid after LC. This cross-sectional observational study was carried out prospectively from Oct 1, 2009 to Sep 31, 2010 at Patan Hospital, a university teaching hospital. All elective LC patients were included. Oral liquid was introduced after four hours and i.v. fluid was stopped after six hr of LC. I.v. cannula was kept locked in situ. Vomiting, abdomen distension and reasons for continuation or resumption of i.v. fluids were recorded. During one year period 294 LC patients fulfilled study criteria. Average age was 40.8 years. Female accounted for 78.2%. ...

Nepalese Medical Journal, 2021

Introduction: Acute severe pancreatitis is associated with increased mortality. Several scoring s... more Introduction: Acute severe pancreatitis is associated with increased mortality. Several scoring systems have been used to predict severe acute pancreatitis which are either time-consuming or calculated 48 hours after admission. This study was aimed to assess the utility of neutrophils to lymphocyte ratio and platelet to lymphocyte ratio as an early predictor of severe acute biliary pancreatitis.Materials and Methods: This was a retrospective cohort study conducted from January 2017 to January 2020. Patients with non-biliary pancreatitis, referred after initial treatment, missed data, and acute pancreatitis with acute cholecystitis or cholangitis were excluded from the study. Data were collected from case sheets. Patients were divided into two groups according to the development of severe acute biliary pancreatitis based on the revised Atlanta Classification. Association of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with severe acute biliary pancreatitis was asse...

Journal of Institute of Medicine Nepal

Introduction Morbidity after pancreaticoduodenectomy (PD) still remains high. Postoperative pancr... more Introduction Morbidity after pancreaticoduodenectomy (PD) still remains high. Postoperative pancreatic fistula (POPF) is the most common cause of increased morbidity after PD. Assessment of predictability of risk score for severe postoperative complications was the objective of this study. MethodsThis was a retrospective observational study. Patients undergoing pancreaticoduodenectomy at Tribhuvan University Teaching Hospital (TUTH) between January 2017 to December 2017 were included in the study. Variables were recorded from case sheets of the patients. The “Risk Score” was calculated using the pancreatic duct diameter and body mass index (BMI). Association of risk score and severe postoperative complications were analyzed. ResultsA total number of patients were 43, including 23 (53.5%) males and 20 (46.5%) females. The mean age was 57.09 ± 11.85 years ranges from 29 years to 76 years. The POPF and delayed gastric emptying (DGE) was 23.3% (10/43); and post-pancreaticoduodenectomy h...

Plastic Surgery International, 2011

B.P. Koirala Institute of Health Sciences, Dharan, Nepal, is the only tertiary care referral cent... more B.P. Koirala Institute of Health Sciences, Dharan, Nepal, is the only tertiary care referral centre in the eastern region of Nepal. This paper discusses the author’s experience of starting a plastic surgery unit in eastern Nepal regarding need and present status of plastic surgery care in Nepal. Methods. We analyzed the data of patients treated in Plastic surgery unit from July 2007 to February 2009. We did evaluation regarding type of patients, procedures, and their outcome. We also evaluated the limitations and their possible solutions to overcome the barriers to establish effective plastic surgical centers in developing countries. Results. Plastic surgery services were started as a unit in general surgery by single plastic surgeon and one general surgery resident on rotation. Total 848 patients were treated for different plastic-surgery-related conditions, which included 307 acute burn patients 541 general plastic surgery patients. Trauma constituted the major bulk 22%, followed ...

Journal of General Practice and Emergency Medicine of Nepal

Introduction: Laparoscopic cholecystectomy (LC) is generally preferred over conventional open cho... more Introduction: Laparoscopic cholecystectomy (LC) is generally preferred over conventional open cholecystectomy (OC) for cholelithiasis. This study was conducted to analyze the effect of gender on the severity of symptomatic gallstone disease and difficulties in laparoscopic cholecystectomy. Method: This was a cross-sectional study from February 15, 2007 to February 14, 2008 in the department of surgery at B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. All the patients with symptomatic gallstone disease who were underwent cholecystectomy were included in the study. Those patients, who underwent cholecystectomy in association with other abdominal surgery, were excluded from the study. Result: The peak age of patients who underwent cholecystectomy for gallstone in male was 41 to 60 years and in female 21 to 40 years. Acute cholecystitis was common in male i.e. 28 (39.44%). Distended gallbladder, thickened gallbladder wall, adhesion to gallbladder, and frozen calot’s...

Introduction: With advent of URSL (ureterorenoscopy and lithotripsy) and other minimally invasive... more Introduction: With advent of URSL (ureterorenoscopy and lithotripsy) and other minimally invasive technique viz; SWL (shock wave lithotripsy), PCNL (percutaneous nephrolithotomy), the urinary stones management has taken a giant leap to serve mankind. The aim of this study is to review a wide series of ureteral stones in which ureteroscopy combined with endoscopic lithotripsy was chosen as the first approach for the treatment of ureteral calculi and to study its diagnostic efficacy. Methods: This is a retrospective study that was carried out in Patan Hospital from Feburary 2010 to Jan 2013. In all cases preoperatively intravenous urography, and a plain film of the urinary tract was taken before the procedure. The operations were carried out with the patient under general anesthesia. Rigid ureteroscopes and the pneumatic lithotripter were used. The fragments were extracted with forceps or baskets assisted with saline flush. Results: We analyzed the result of URSL done in our hospital for variety of urology problem. We found age group 20-40, being the most common group to develop urinary calculus. Most of our patient had single stone of size >5mm. Upper ureter, mid ureter and distal ureter comprises of 4, 30 and 56 stone respectively. Our success rate of URS insertion is 96%(96/100) with complete stone fragmentation with expulsion of the fragments occurred in 97.8%(88/90). Our major perioperative complication were 3% without mortality. Conclusion: URS is useful for diagnostic purpose & URSL is safe and treatment of choice for mid and lower ureteic calculus

Journal of Patan Academy of Health Sciences, Jul 20, 2015

Introductions: With the advent of newer technology, the era of open surgery for gall bladder dise... more Introductions: With the advent of newer technology, the era of open surgery for gall bladder diseases has been preferably taken over by laparoscopic cholecystectomy. However, certain cases still require conversion to open surgery. In this review we aim to analyze the reason for conversion.

Journal of General Practice and Emergency Medicine of Nepal

Introduction: With advent of URSL (ureterorenoscopy and lithotripsy) and other minimally invasive... more Introduction: With advent of URSL (ureterorenoscopy and lithotripsy) and other minimally invasive technique viz; SWL (shock wave lithotripsy), PCNL (percutaneous nephrolithotomy), the urinary stones management has taken a giant leap to serve mankind. The aim of this study is to review a wide series of ureteral stones in which ureteroscopy combined with endoscopic lithotripsy was chosen as the first approach for the treatment of ureteral calculi and to study its diagnostic efficacy. Methods: This is a retrospective study that was carried out in Patan Hospital from Feburary 2010 to Jan 2013. In all cases preoperatively intravenous urography, and a plain film of the urinary tract was taken before the procedure. The operations were carried out with the patient under general anesthesia. Rigid ureteroscopes and the pneumatic lithotripter were used. The fragments were extracted with forceps or baskets assisted with saline flush. Results: We analyzed the result of URSL done in our hospital ...

Introduction: Parotid tumors represent about 80% of all salivary gland tumors. Our study was cond... more Introduction: Parotid tumors represent about 80% of all salivary gland tumors. Our study was conducted to assess the clinical features, diagnostic accuracy of fine needle aspiration cytology (FNAC), surgical outcome and histological pattern of all patients underwent parotid surgery for parotid tumor at Patan Hospital. Methods: All data of patients who underwent parotid surgery from 2060 to 2067 BC at Patan Hospital were collected retrospectively from medical files and analyzed. Results: Among 18, all were presented with lump in the parotid region. Mean age of the patients was 45 years. Malignancy was common among older age group (mean age 51 vs 44 for benign). The overall accuracy in detecting malignant tumors was 88.89% with positive predictive and negative predictive values 100% and 83.24% respectively. Out of 18 histological reports, 15(83.33%) were benign lesions, pleomorphic adenoma was being most common 9(60%) among benign lesions, and 3(16.67%) were malignant lesions. Conclus...

Journal of Patan Academy of Health Sciences, 2020

Introduction: Perioperative strategies have been changing due to the COVID-19 pandemic to prevent... more Introduction: Perioperative strategies have been changing due to the COVID-19 pandemic to prevent the risk of postoperative complications and transmission of infection. This study was aimed to assess the outcome of gastrointestinal surgery and the risk of transmission by implementing COVID-19 testing criteria and surgical strategy. Method: This was a retrospective descriptive study conducted at the department of surgery at Patan Hospital, Nepal, during COVID-19 lock-down from 24 march to 15 June 2020. All patients who underwent gastrointestinal (GI) surgery were included. High-risk patients (as defined by the Hospital Incident Command System, HICS) were tested for COVID-19 preoperatively. Surgery was performed in COVID operating room with full protective gear. Low-risk patients were not tested for COVID-19 preoperatively and performed surgery in non-COVID OR. Data from patient’s case-sheets were analyzed descriptively for age, gender, comorbidities, hospital stay, RT-PCR results, su...

Journal of Society of Surgeons of Nepal, Jul 4, 2016

Journal of Nepal Health Research Council, 2020

Background: Post-operative pancreatic fistula is the single most common and most significant caus... more Background: Post-operative pancreatic fistula is the single most common and most significant cause of post-operative morbidity and perioperative mortality. Identification of at risk patient preoperatively help to take policy of extra vigilance to act on time. This study evaluated the predictive role and cut-off value of pancreatic configuration index to predict post-operative pancreatic fistula.Methods: This was a prospective observational study in patients who had undergone pancreaticoduodenectomy from March 2017 to June 2018 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The patients with age <16 years, those who underwent re-exploration or mortality before 3rd postoperative day, additional surgery besides pancreaticoduodenectomy were excluded from the study. Pancreatic configuration index was calculated as a ratio of pancreatic parenchymal thickness and pancreatic duct diameter. Predictive value of pancreatic configuration index in predicting post-operative pancr...

Journal of General Practice and Emergency Medicine of Nepal

Most foreign bodies in the bladder are self inserted via urethra for autoerotic stimulation. Most... more Most foreign bodies in the bladder are self inserted via urethra for autoerotic stimulation. Most of them are ashamed to admit they had introduced it for sexual gratification and diagnosis is made only when got into complication. We are reporting a case of young girl who has inserted broom stick into the urethra because of sexual curiosity and it was migrated to urinary bladder which was removed using cystoscopy. Post operative period was uneventful

Journal of Nepal Health Research Council, 2012

Common practice at most centers in the country is to continue intravenous (i.v.) fluid till morni... more Common practice at most centers in the country is to continue intravenous (i.v.) fluid till morning round next day following laparoscopic cholecystectomy (LC), assess patient and gradually allow oral diet. However this seems unnecessary in view of fast recovery after minimal invasive LC. The aim of this study was to observe the prospects and assess the acceptability, safety and benefit of early oral feeding and discontinuing i.v. fluid after LC. This cross-sectional observational study was carried out prospectively from Oct 1, 2009 to Sep 31, 2010 at Patan Hospital, a university teaching hospital. All elective LC patients were included. Oral liquid was introduced after four hours and i.v. fluid was stopped after six hr of LC. I.v. cannula was kept locked in situ. Vomiting, abdomen distension and reasons for continuation or resumption of i.v. fluids were recorded. During one year period 294 LC patients fulfilled study criteria. Average age was 40.8 years. Female accounted for 78.2%. ...

Nepalese Medical Journal, 2021

Introduction: Acute severe pancreatitis is associated with increased mortality. Several scoring s... more Introduction: Acute severe pancreatitis is associated with increased mortality. Several scoring systems have been used to predict severe acute pancreatitis which are either time-consuming or calculated 48 hours after admission. This study was aimed to assess the utility of neutrophils to lymphocyte ratio and platelet to lymphocyte ratio as an early predictor of severe acute biliary pancreatitis.Materials and Methods: This was a retrospective cohort study conducted from January 2017 to January 2020. Patients with non-biliary pancreatitis, referred after initial treatment, missed data, and acute pancreatitis with acute cholecystitis or cholangitis were excluded from the study. Data were collected from case sheets. Patients were divided into two groups according to the development of severe acute biliary pancreatitis based on the revised Atlanta Classification. Association of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with severe acute biliary pancreatitis was asse...

Journal of Institute of Medicine Nepal

Introduction Morbidity after pancreaticoduodenectomy (PD) still remains high. Postoperative pancr... more Introduction Morbidity after pancreaticoduodenectomy (PD) still remains high. Postoperative pancreatic fistula (POPF) is the most common cause of increased morbidity after PD. Assessment of predictability of risk score for severe postoperative complications was the objective of this study. MethodsThis was a retrospective observational study. Patients undergoing pancreaticoduodenectomy at Tribhuvan University Teaching Hospital (TUTH) between January 2017 to December 2017 were included in the study. Variables were recorded from case sheets of the patients. The “Risk Score” was calculated using the pancreatic duct diameter and body mass index (BMI). Association of risk score and severe postoperative complications were analyzed. ResultsA total number of patients were 43, including 23 (53.5%) males and 20 (46.5%) females. The mean age was 57.09 ± 11.85 years ranges from 29 years to 76 years. The POPF and delayed gastric emptying (DGE) was 23.3% (10/43); and post-pancreaticoduodenectomy h...

Plastic Surgery International, 2011

B.P. Koirala Institute of Health Sciences, Dharan, Nepal, is the only tertiary care referral cent... more B.P. Koirala Institute of Health Sciences, Dharan, Nepal, is the only tertiary care referral centre in the eastern region of Nepal. This paper discusses the author’s experience of starting a plastic surgery unit in eastern Nepal regarding need and present status of plastic surgery care in Nepal. Methods. We analyzed the data of patients treated in Plastic surgery unit from July 2007 to February 2009. We did evaluation regarding type of patients, procedures, and their outcome. We also evaluated the limitations and their possible solutions to overcome the barriers to establish effective plastic surgical centers in developing countries. Results. Plastic surgery services were started as a unit in general surgery by single plastic surgeon and one general surgery resident on rotation. Total 848 patients were treated for different plastic-surgery-related conditions, which included 307 acute burn patients 541 general plastic surgery patients. Trauma constituted the major bulk 22%, followed ...

Journal of General Practice and Emergency Medicine of Nepal

Introduction: Laparoscopic cholecystectomy (LC) is generally preferred over conventional open cho... more Introduction: Laparoscopic cholecystectomy (LC) is generally preferred over conventional open cholecystectomy (OC) for cholelithiasis. This study was conducted to analyze the effect of gender on the severity of symptomatic gallstone disease and difficulties in laparoscopic cholecystectomy. Method: This was a cross-sectional study from February 15, 2007 to February 14, 2008 in the department of surgery at B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. All the patients with symptomatic gallstone disease who were underwent cholecystectomy were included in the study. Those patients, who underwent cholecystectomy in association with other abdominal surgery, were excluded from the study. Result: The peak age of patients who underwent cholecystectomy for gallstone in male was 41 to 60 years and in female 21 to 40 years. Acute cholecystitis was common in male i.e. 28 (39.44%). Distended gallbladder, thickened gallbladder wall, adhesion to gallbladder, and frozen calot’s...

Introduction: With advent of URSL (ureterorenoscopy and lithotripsy) and other minimally invasive... more Introduction: With advent of URSL (ureterorenoscopy and lithotripsy) and other minimally invasive technique viz; SWL (shock wave lithotripsy), PCNL (percutaneous nephrolithotomy), the urinary stones management has taken a giant leap to serve mankind. The aim of this study is to review a wide series of ureteral stones in which ureteroscopy combined with endoscopic lithotripsy was chosen as the first approach for the treatment of ureteral calculi and to study its diagnostic efficacy. Methods: This is a retrospective study that was carried out in Patan Hospital from Feburary 2010 to Jan 2013. In all cases preoperatively intravenous urography, and a plain film of the urinary tract was taken before the procedure. The operations were carried out with the patient under general anesthesia. Rigid ureteroscopes and the pneumatic lithotripter were used. The fragments were extracted with forceps or baskets assisted with saline flush. Results: We analyzed the result of URSL done in our hospital for variety of urology problem. We found age group 20-40, being the most common group to develop urinary calculus. Most of our patient had single stone of size >5mm. Upper ureter, mid ureter and distal ureter comprises of 4, 30 and 56 stone respectively. Our success rate of URS insertion is 96%(96/100) with complete stone fragmentation with expulsion of the fragments occurred in 97.8%(88/90). Our major perioperative complication were 3% without mortality. Conclusion: URS is useful for diagnostic purpose & URSL is safe and treatment of choice for mid and lower ureteic calculus

Journal of Patan Academy of Health Sciences, Jul 20, 2015

Introductions: With the advent of newer technology, the era of open surgery for gall bladder dise... more Introductions: With the advent of newer technology, the era of open surgery for gall bladder diseases has been preferably taken over by laparoscopic cholecystectomy. However, certain cases still require conversion to open surgery. In this review we aim to analyze the reason for conversion.

Journal of General Practice and Emergency Medicine of Nepal

Introduction: With advent of URSL (ureterorenoscopy and lithotripsy) and other minimally invasive... more Introduction: With advent of URSL (ureterorenoscopy and lithotripsy) and other minimally invasive technique viz; SWL (shock wave lithotripsy), PCNL (percutaneous nephrolithotomy), the urinary stones management has taken a giant leap to serve mankind. The aim of this study is to review a wide series of ureteral stones in which ureteroscopy combined with endoscopic lithotripsy was chosen as the first approach for the treatment of ureteral calculi and to study its diagnostic efficacy. Methods: This is a retrospective study that was carried out in Patan Hospital from Feburary 2010 to Jan 2013. In all cases preoperatively intravenous urography, and a plain film of the urinary tract was taken before the procedure. The operations were carried out with the patient under general anesthesia. Rigid ureteroscopes and the pneumatic lithotripter were used. The fragments were extracted with forceps or baskets assisted with saline flush. Results: We analyzed the result of URSL done in our hospital ...

Introduction: Parotid tumors represent about 80% of all salivary gland tumors. Our study was cond... more Introduction: Parotid tumors represent about 80% of all salivary gland tumors. Our study was conducted to assess the clinical features, diagnostic accuracy of fine needle aspiration cytology (FNAC), surgical outcome and histological pattern of all patients underwent parotid surgery for parotid tumor at Patan Hospital. Methods: All data of patients who underwent parotid surgery from 2060 to 2067 BC at Patan Hospital were collected retrospectively from medical files and analyzed. Results: Among 18, all were presented with lump in the parotid region. Mean age of the patients was 45 years. Malignancy was common among older age group (mean age 51 vs 44 for benign). The overall accuracy in detecting malignant tumors was 88.89% with positive predictive and negative predictive values 100% and 83.24% respectively. Out of 18 histological reports, 15(83.33%) were benign lesions, pleomorphic adenoma was being most common 9(60%) among benign lesions, and 3(16.67%) were malignant lesions. Conclus...

Journal of Patan Academy of Health Sciences, 2020

Introduction: Perioperative strategies have been changing due to the COVID-19 pandemic to prevent... more Introduction: Perioperative strategies have been changing due to the COVID-19 pandemic to prevent the risk of postoperative complications and transmission of infection. This study was aimed to assess the outcome of gastrointestinal surgery and the risk of transmission by implementing COVID-19 testing criteria and surgical strategy. Method: This was a retrospective descriptive study conducted at the department of surgery at Patan Hospital, Nepal, during COVID-19 lock-down from 24 march to 15 June 2020. All patients who underwent gastrointestinal (GI) surgery were included. High-risk patients (as defined by the Hospital Incident Command System, HICS) were tested for COVID-19 preoperatively. Surgery was performed in COVID operating room with full protective gear. Low-risk patients were not tested for COVID-19 preoperatively and performed surgery in non-COVID OR. Data from patient’s case-sheets were analyzed descriptively for age, gender, comorbidities, hospital stay, RT-PCR results, su...