Dr Roshan Ghimire | Kathmandu Medical College (original) (raw)

Papers by Dr Roshan Ghimire

Research paper thumbnail of Outcome of Portal Vein Reconstruction Using Branch Patch Anastomosis in Pediatric Living Related Liver Transplant Recipients Weighing Less than 10 kg

Research paper thumbnail of Indocyanine green fluorescence imaging in gastrointestinal surgery

Journal of Kathmandu Medical College, Jun 29, 2023

Background: Prevention of post-operative anastomotic leak (AL) is significant challenge for surge... more Background: Prevention of post-operative anastomotic leak (AL) is significant challenge for surgeons, with roughly half of all AL cases linked to insufficient vascular supply, often undetectable during anastomosis. Recently, indocyanine green fluorescence (ICG) emerged as promising tool in visceral surgery due to its low cost, ease of use, wide availability, and low toxicity. In gastrointestinal surgery, ICG is primarily used for real-time intraoperative angiography, allowing surgeons to assess anastomotic stumps' perfusion before and after procedure. Objectives: To assess efficacy of ICG as an adjunct in preventing AL. Methods: This descriptive study conducted after ethical approval at Kathmandu Medical College Teaching Hospital from 2022 February 15 to 2023 January 30 included 111 patients enrolled via convenience sampling. During operation, surgeon used ICG fluorescence angiography on patients to determine perfusion status, which allowed for evaluation of transection line and post-anastomotic viability. Data were entered in Microsoft Excel sheet 2019 and descriptive analysis done regarding demographic data, changes in the transection line, and post-operative anastomotic leaks. Results: Total 111 patients with age 55.41 ± 13.63 years and male-female ratio of 2:1 participated in this study. ICG use resulted in changes to proximal resection margin for five (4.5%) patients. Clinical judgment and ICG fluorescence imaging showed a difference in bowel transection line of 0.5-1.5 cm. None of the patients who underwent proximal resection margin revision with the assistance of ICG experienced post-operative anastomotic leaks. Conclusion: ICG fluorescence can be used as an adjunct in determining the viability of anastomosis and prevent postoperative anastomosis leak.

Research paper thumbnail of Laparoscopic anatomical segmentectomy: A paradigm shift towards minimally invasive liver surgery in Nepal, a cohort study

Annals of medicine and surgery, Apr 18, 2023

Research paper thumbnail of Blunt Abdominal Trauma among Patients Admitted to the Department of Surgery at a Tertiary Care Centre: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association

Introduction: Blunt abdominal trauma bears significant morbidity and mortality worldwide and need... more 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 w...

Research paper thumbnail of Laparoscopic anatomical segmentectomy for hepatic hydatid cyst

International Journal of Surgery

Research paper thumbnail of Incidental carcinoma of gallbladder following laparoscopic cholecystectomy: A single center study

Grande Medical Journal

Background: Gallbladder adenocarcinoma is the most common malignant tumor of the biliary tract. M... more Background: Gallbladder adenocarcinoma is the most common malignant tumor of the biliary tract. Most of gall bladder cancers are detected incidentally only after pathological examination of the excised surgical specimens. In this study we investigated the characteristics of incidental gallbladder cancers in our center. Material & methods: We retrospectively reviewed all of the cholecystectomy specimens in sent for histopathology following laparoscopic cholecystectomy in the study period from January 2015 to October 2019. Clinicopathological characteristics were extracted from the patients' clinical charts, which included symptoms, radiological findings, laboratory data, and surgical procedures as well as outcome. Results: We identified 6 cases of incidental gall bladder cancer, consisting of 4 women and 2 men ranging in age from 28 to 77 years (mean age 60.5 after pathological study of 1530 resected gall bladders. Out of the 6 cases, 1 case was carcinoma in situ of gall bladder...

Research paper thumbnail of Single center experience of 3000 consecutive living donor hepatectomies

Journal of Liver Transplantation

Research paper thumbnail of Efficacy of Minimal Invasive Methods in Management of Traumatic Pancreatic Injury

Pancreas – Open Journal

Introduction Isolated pancreatic injury is relatively uncommon due to its mostly retroperitoneal ... more Introduction Isolated pancreatic injury is relatively uncommon due to its mostly retroperitoneal location. However, if present, it is associated with other visceral injuries and causes serious complications if expected management is delayed. Cases In this report we have discussed about the different minimal invasive management approaches in two cases of pancreatic injury. The first case had American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) grade IV pancreatic injury with late presentation who underwent ultrasound-guided percutaneous drainage of pseudocyst with video assisted lavage of cavity, followed by endoscopic retrograde cholangiopancreatography (ERCP) guided pancreatic duct stenting. Second case had AAST-OIS grade II pancreatic injury which was managed with serial percutaneous drainage. Conclusion Management of pancreatic injury is complex. Evolving trend of minimal invasive techniques of management for selected patients with higher grade pancreatic ...

Research paper thumbnail of Comparison of outcomes of recipient in living donor liver transplantation with donor age less than 55 years and more than 55 years: A propensity score matched study

Journal of Liver Transplantation

Research paper thumbnail of Management of Post Necrosectomy Gastric Fistula by Nasogastric and Biliary Drainage with Transhepatic Distal Tube Feeding

Journal of the Pancreas, 2021

Research paper thumbnail of An unusual case of subacute small bowel obstruction - Gallstone ileus

International Journal of Surgery Case Reports, 2022

Introduction and importance Gallstone ileus is caused by an impaction of one or more gallstones w... more Introduction and importance Gallstone ileus is caused by an impaction of one or more gallstones within the gastrointestinal tract, leading to mechanical intestinal obstruction. It is a rare complication of cholelithiasis leading to the formation of a cholecystoenteric fistula and is associated with high mortality rates. We report a case of atypical subacute small bowel obstruction due to gallstone ileus. Presentation of case An 82-year-old man, with previously diagnosed cholelithiasis, presented with abdominal pain and vomiting for nine days. The contracted gallbladder with distended bowel loops was visualized on abdominal ultrasound. Computed tomography of the abdomen and pelvis revealed dilated loops of the small intestine with a gallstone in the proximal ileum, causing intestinal obstruction with pneumobilia, suggesting gallstone ileus with cholecystoduodenal fistula. The patient underwent an emergency laparotomy and enterolithotomy to remove the impacting gallstone. The cholecystoduodenal fistula was left undisturbed due to the significant risk of duodenal injury. The patient had an uneventful postoperative recovery. Conclusion Gallstone ileus almost always requires surgical management. However, performing an interval biliary surgery is based on the clinical judgment of the surgeon. In our case, the patient's clinical status determined the treatment in which an enterotomy with stone extraction alone was largely sufficient, and has supported the literature. Gallstone ileus is an important differential diagnosis in elderly patients with gallstone disease, untreated or undiagnosed, presenting with features of small bowel obstruction.

Research paper thumbnail of Multimodal management of forgotten encrusted ureteral stents

Journal of Kathmandu Medical College, 2017

Background: Forgotten ureteral stents are seen in urologic practice because of ignorance of patie... more Background: Forgotten ureteral stents are seen in urologic practice because of ignorance of patients or failure of physician to counsel the patients. They can cause significant morbidity and pose a management and legal dilemma.Objectives: To evaluate the effi cacy and feasibility of different endourological approaches like percutaneous nephrolithotomy, ureteroscopic lithotripsy, cystolithotripsy and extracorporeal lithotripsy in the treatment of forgotten encrusted ureteral stents.Methods: Total 10 patients with forgotten encrusted double J stents from January 2013 to Nov 2015 were included. Mean age of the patients was 38.4 years (1.5 -5 years). All patients were evaluated for stent encrustation and associated stone burden by X-ray KUB and Intravenous Urography. Combined endourological procedures like percutaneous nephrolithotomy, ureteroscopic lithotripsy, cystolithotripsy and extracorporeal lithotripsy and even open surgery was done to remove these stents. The patients characteri...

Research paper thumbnail of Primary Grynfeltt Lumbar Hernia: A Case Report

Journal of Nepal Medical Association

A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. ... more A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. These defects are particularly common in Petit's inferior triangle or Grynfeltt-Lesshaft superior triangle. There are very few cases of primary lumbar hernias that have been described in literature till date. As it is a rare entity, it is often misdiagnosed, leading to delay in management. We present a case of a 66-year-old male with no previous surgery who presented with a mass in left lumbar region for last ten years. The mass gradually increased in size and caused vague dragging pain. On Computed tomography, the diagnosis of Grynfeltt hernia was made. The patient underwent a laparoscopic mesh repair and had an uneventful postoperative hospital stay. Although a rare entity, there should be a high degree of suspicion of a lumbar hernia when evaluating a case of a lumbar mass. Early diagnosis by computed tomography and management with open or minimally invasive techniques can prevent...

Research paper thumbnail of Factors affecting attitude of medical students to pursue surgical career

Journal of Kathmandu Medical College, 2017

Background: Medical students are always in a dilemma for their career choice after under-graduati... more Background: Medical students are always in a dilemma for their career choice after under-graduation as there are multiple options and none of the choices come without any drawbacks. Multiple factors determine their preferences.Objective: This study aimed to identify the factors that determine career choice and to discuss how it affects the students in taking surgery as their career.Methods: A questionnaire was developed which included factors that encourage and also influence students to consider surgery as their career. A cross-sectional study was conducted among 292 participants and they were divided into two groups, preclinical and clinical students. The collected data was tabulated and analyzed using Statistical Package for Social Sciences version 20.Results: Out of the 292 students, 144 (49.32%) were males and 148 (50.68%) were females. Of the total, 233 (79.8%) students thought of choosing surgery as their career while 41 (14.04%) of the students disagreed for choosing surgery...

Research paper thumbnail of Primary Grynfeltt Lumbar Hernia: A Case Report

Journal of Nepal Medical Association, Feb 15, 2022

A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. ... more A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. These defects are particularly common in Petit's inferior triangle or Grynfeltt-Lesshaft superior triangle. There are very few cases of primary lumbar hernias that have been described in literature till date. As it is a rare entity, it is often misdiagnosed, leading to delay in management. We present a case of a 66-year-old male with no previous surgery who presented with a mass in left lumbar region for last ten years. The mass gradually increased in size and caused vague dragging pain. On Computed tomography, the diagnosis of Grynfeltt hernia was made. The patient underwent a laparoscopic mesh repair and had an uneventful postoperative hospital stay. Although a rare entity, there should be a high degree of suspicion of a lumbar hernia when evaluating a case of a lumbar mass. Early diagnosis by computed tomography and management with open or minimally invasive techniques can prevent complications.

Research paper thumbnail of Indications and outcome of surgical management of local complications of acute pancreatitis: a single-centre experience

International Surgery Journal, 2021

Background: Acute pancreatitis is a common and challenging disease that can develop both local an... more Background: Acute pancreatitis is a common and challenging disease that can develop both local and systemic complications. According to the Atlanta classification, local complications include peri-pancreatic collection, acute necrotic collection, pseudocyst and walled-off necrosis.Methods: A hospital-based retrospective study was conducted in the department of surgery at Kathmandu medical college teaching hospital. Patients were recruited using purposive sampling method and those who underwent laparoscopic, retroperitoneal or open surgical procedures for the management of local complications of acute pancreatitis from June 2017 to July 2021. The indication, perioperative outcome and associated complications were evaluated in all the cases.Results: Between June 2017 to July 2021, 432patients were admitted to the surgery department with acute pancreatitis or with complications of acute pancreatitis. Twenty-one patients required surgical intervention in the form of external drainage, c...

Research paper thumbnail of Primary Grynfeltt Lumbar Hernia: A Case Report

Journal of Nepal Medical Association, 2022

A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. ... more A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. These defects are particularly common in Petit's inferior triangle or Grynfeltt-Lesshaft superior triangle. There are very few cases of primary lumbar hernias that have been described in literature till date. As it is a rare entity, it is often misdiagnosed, leading to delay in management. We present a case of a 66-year-old male with no previous surgery who presented with a mass in left lumbar region for last ten years. The mass gradually increased in size and caused vague dragging pain. On Computed tomography, the diagnosis of Grynfeltt hernia was made. The patient underwent a laparoscopic mesh repair and had an uneventful postoperative hospital stay. Although a rare entity, there should be a high degree of suspicion of a lumbar hernia when evaluating a case of a lumbar mass. Early diagnosis by computed tomography and management with open or minimally invasive techniques can prevent...

Research paper thumbnail of Early Oral Feeding with Vascular Resection among Patients Undergoing Pancreatoduodenectomy in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association, 2022

Introduction: Pancreatoduodenectomy with vascular resection is performed in locally advanced peri... more Introduction: Pancreatoduodenectomy with vascular resection is performed in locally advanced periampullary malignancies. In our practice, early oral feeding is initiated in patients undergoing pancreatoduodenectomy. This study aims to find the prevalence of early oral feeding with vascular resection among patients undergoing pancreatoduodenectomy. Methods: This was a descriptive cross-sectional study conducted among hospital records of 152 patients who underwent pancreatoduodenectomy in the department of surgery of a tertiary care hospital from 2016 to 2020. Ethical approval was taken from the Institutional Review Committee (Reference number: 0812202102). Convenience sampling was done. Patients clinical and sociodemographic data were collected and analyzed using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean, and median. Results: Among 152 patients undergoing pancreatoduodenectom...

Research paper thumbnail of Jnma I Vol 52 I No. 12 I Issue 196 I

Background: Acute abdominal pain is a common condition presenting to both the emergency departmen... more Background: Acute abdominal pain is a common condition presenting to both the emergency department (ED) and surgical admission unit. Increase in serum amylase levels are found in much gastrointestinal pathology. Serum amylase level is consistently high in acute pancreatitis though high values are not pathognomonic of pancreatitis .The aim of this study to assess the level of serum amylase in various diseases presenting with acute abdominal pain and to evaluate the role of routine measurement of serum amylase in the screening of patient with acute abdominal pain for the diagnosis of acute pancreatitis in a prospective series.

Research paper thumbnail of Early Re- Laparoscopy in Suspected Bile Duct Injuries after Laparoscopic Cholecystectomy

Birat Journal of Health Sciences, 2021

Introduction: Management of patients with suspected bile leak or bile duct injury after laparosco... more Introduction: Management of patients with suspected bile leak or bile duct injury after laparoscopic cholecystectomy is challenging. Early laparoscopy in these groups of patients will benefit in terms of diagnostic as well therapeutic purpose. Objective: This study is done to assess utility of early re-laparoscopy in suspected bile duct injury in early postoperative period following laparoscopic cholecystectomy. Methodology: It is a descriptive study of all consecutive patients who underwent diagnostic as well therapeutic re-laparoscopy when required in suspected bile duct injury in early postoperative laparoscopic cholecystectomy that is within 72 hours of presentation. Study was conducted over a period from June 2019 to December 2020 at Kathmandu medical College, Sinamangal, Kathmandu, Nepal. Relaparoscopic operative findings and therapeutic intervention done were recorded. Result: The mean age at presentation was 34.6 years and male to female ratio was 1:1.8. During the study per...

Research paper thumbnail of Outcome of Portal Vein Reconstruction Using Branch Patch Anastomosis in Pediatric Living Related Liver Transplant Recipients Weighing Less than 10 kg

Research paper thumbnail of Indocyanine green fluorescence imaging in gastrointestinal surgery

Journal of Kathmandu Medical College, Jun 29, 2023

Background: Prevention of post-operative anastomotic leak (AL) is significant challenge for surge... more Background: Prevention of post-operative anastomotic leak (AL) is significant challenge for surgeons, with roughly half of all AL cases linked to insufficient vascular supply, often undetectable during anastomosis. Recently, indocyanine green fluorescence (ICG) emerged as promising tool in visceral surgery due to its low cost, ease of use, wide availability, and low toxicity. In gastrointestinal surgery, ICG is primarily used for real-time intraoperative angiography, allowing surgeons to assess anastomotic stumps' perfusion before and after procedure. Objectives: To assess efficacy of ICG as an adjunct in preventing AL. Methods: This descriptive study conducted after ethical approval at Kathmandu Medical College Teaching Hospital from 2022 February 15 to 2023 January 30 included 111 patients enrolled via convenience sampling. During operation, surgeon used ICG fluorescence angiography on patients to determine perfusion status, which allowed for evaluation of transection line and post-anastomotic viability. Data were entered in Microsoft Excel sheet 2019 and descriptive analysis done regarding demographic data, changes in the transection line, and post-operative anastomotic leaks. Results: Total 111 patients with age 55.41 ± 13.63 years and male-female ratio of 2:1 participated in this study. ICG use resulted in changes to proximal resection margin for five (4.5%) patients. Clinical judgment and ICG fluorescence imaging showed a difference in bowel transection line of 0.5-1.5 cm. None of the patients who underwent proximal resection margin revision with the assistance of ICG experienced post-operative anastomotic leaks. Conclusion: ICG fluorescence can be used as an adjunct in determining the viability of anastomosis and prevent postoperative anastomosis leak.

Research paper thumbnail of Laparoscopic anatomical segmentectomy: A paradigm shift towards minimally invasive liver surgery in Nepal, a cohort study

Annals of medicine and surgery, Apr 18, 2023

Research paper thumbnail of Blunt Abdominal Trauma among Patients Admitted to the Department of Surgery at a Tertiary Care Centre: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association

Introduction: Blunt abdominal trauma bears significant morbidity and mortality worldwide and need... more 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 w...

Research paper thumbnail of Laparoscopic anatomical segmentectomy for hepatic hydatid cyst

International Journal of Surgery

Research paper thumbnail of Incidental carcinoma of gallbladder following laparoscopic cholecystectomy: A single center study

Grande Medical Journal

Background: Gallbladder adenocarcinoma is the most common malignant tumor of the biliary tract. M... more Background: Gallbladder adenocarcinoma is the most common malignant tumor of the biliary tract. Most of gall bladder cancers are detected incidentally only after pathological examination of the excised surgical specimens. In this study we investigated the characteristics of incidental gallbladder cancers in our center. Material & methods: We retrospectively reviewed all of the cholecystectomy specimens in sent for histopathology following laparoscopic cholecystectomy in the study period from January 2015 to October 2019. Clinicopathological characteristics were extracted from the patients' clinical charts, which included symptoms, radiological findings, laboratory data, and surgical procedures as well as outcome. Results: We identified 6 cases of incidental gall bladder cancer, consisting of 4 women and 2 men ranging in age from 28 to 77 years (mean age 60.5 after pathological study of 1530 resected gall bladders. Out of the 6 cases, 1 case was carcinoma in situ of gall bladder...

Research paper thumbnail of Single center experience of 3000 consecutive living donor hepatectomies

Journal of Liver Transplantation

Research paper thumbnail of Efficacy of Minimal Invasive Methods in Management of Traumatic Pancreatic Injury

Pancreas – Open Journal

Introduction Isolated pancreatic injury is relatively uncommon due to its mostly retroperitoneal ... more Introduction Isolated pancreatic injury is relatively uncommon due to its mostly retroperitoneal location. However, if present, it is associated with other visceral injuries and causes serious complications if expected management is delayed. Cases In this report we have discussed about the different minimal invasive management approaches in two cases of pancreatic injury. The first case had American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) grade IV pancreatic injury with late presentation who underwent ultrasound-guided percutaneous drainage of pseudocyst with video assisted lavage of cavity, followed by endoscopic retrograde cholangiopancreatography (ERCP) guided pancreatic duct stenting. Second case had AAST-OIS grade II pancreatic injury which was managed with serial percutaneous drainage. Conclusion Management of pancreatic injury is complex. Evolving trend of minimal invasive techniques of management for selected patients with higher grade pancreatic ...

Research paper thumbnail of Comparison of outcomes of recipient in living donor liver transplantation with donor age less than 55 years and more than 55 years: A propensity score matched study

Journal of Liver Transplantation

Research paper thumbnail of Management of Post Necrosectomy Gastric Fistula by Nasogastric and Biliary Drainage with Transhepatic Distal Tube Feeding

Journal of the Pancreas, 2021

Research paper thumbnail of An unusual case of subacute small bowel obstruction - Gallstone ileus

International Journal of Surgery Case Reports, 2022

Introduction and importance Gallstone ileus is caused by an impaction of one or more gallstones w... more Introduction and importance Gallstone ileus is caused by an impaction of one or more gallstones within the gastrointestinal tract, leading to mechanical intestinal obstruction. It is a rare complication of cholelithiasis leading to the formation of a cholecystoenteric fistula and is associated with high mortality rates. We report a case of atypical subacute small bowel obstruction due to gallstone ileus. Presentation of case An 82-year-old man, with previously diagnosed cholelithiasis, presented with abdominal pain and vomiting for nine days. The contracted gallbladder with distended bowel loops was visualized on abdominal ultrasound. Computed tomography of the abdomen and pelvis revealed dilated loops of the small intestine with a gallstone in the proximal ileum, causing intestinal obstruction with pneumobilia, suggesting gallstone ileus with cholecystoduodenal fistula. The patient underwent an emergency laparotomy and enterolithotomy to remove the impacting gallstone. The cholecystoduodenal fistula was left undisturbed due to the significant risk of duodenal injury. The patient had an uneventful postoperative recovery. Conclusion Gallstone ileus almost always requires surgical management. However, performing an interval biliary surgery is based on the clinical judgment of the surgeon. In our case, the patient's clinical status determined the treatment in which an enterotomy with stone extraction alone was largely sufficient, and has supported the literature. Gallstone ileus is an important differential diagnosis in elderly patients with gallstone disease, untreated or undiagnosed, presenting with features of small bowel obstruction.

Research paper thumbnail of Multimodal management of forgotten encrusted ureteral stents

Journal of Kathmandu Medical College, 2017

Background: Forgotten ureteral stents are seen in urologic practice because of ignorance of patie... more Background: Forgotten ureteral stents are seen in urologic practice because of ignorance of patients or failure of physician to counsel the patients. They can cause significant morbidity and pose a management and legal dilemma.Objectives: To evaluate the effi cacy and feasibility of different endourological approaches like percutaneous nephrolithotomy, ureteroscopic lithotripsy, cystolithotripsy and extracorporeal lithotripsy in the treatment of forgotten encrusted ureteral stents.Methods: Total 10 patients with forgotten encrusted double J stents from January 2013 to Nov 2015 were included. Mean age of the patients was 38.4 years (1.5 -5 years). All patients were evaluated for stent encrustation and associated stone burden by X-ray KUB and Intravenous Urography. Combined endourological procedures like percutaneous nephrolithotomy, ureteroscopic lithotripsy, cystolithotripsy and extracorporeal lithotripsy and even open surgery was done to remove these stents. The patients characteri...

Research paper thumbnail of Primary Grynfeltt Lumbar Hernia: A Case Report

Journal of Nepal Medical Association

A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. ... more A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. These defects are particularly common in Petit's inferior triangle or Grynfeltt-Lesshaft superior triangle. There are very few cases of primary lumbar hernias that have been described in literature till date. As it is a rare entity, it is often misdiagnosed, leading to delay in management. We present a case of a 66-year-old male with no previous surgery who presented with a mass in left lumbar region for last ten years. The mass gradually increased in size and caused vague dragging pain. On Computed tomography, the diagnosis of Grynfeltt hernia was made. The patient underwent a laparoscopic mesh repair and had an uneventful postoperative hospital stay. Although a rare entity, there should be a high degree of suspicion of a lumbar hernia when evaluating a case of a lumbar mass. Early diagnosis by computed tomography and management with open or minimally invasive techniques can prevent...

Research paper thumbnail of Factors affecting attitude of medical students to pursue surgical career

Journal of Kathmandu Medical College, 2017

Background: Medical students are always in a dilemma for their career choice after under-graduati... more Background: Medical students are always in a dilemma for their career choice after under-graduation as there are multiple options and none of the choices come without any drawbacks. Multiple factors determine their preferences.Objective: This study aimed to identify the factors that determine career choice and to discuss how it affects the students in taking surgery as their career.Methods: A questionnaire was developed which included factors that encourage and also influence students to consider surgery as their career. A cross-sectional study was conducted among 292 participants and they were divided into two groups, preclinical and clinical students. The collected data was tabulated and analyzed using Statistical Package for Social Sciences version 20.Results: Out of the 292 students, 144 (49.32%) were males and 148 (50.68%) were females. Of the total, 233 (79.8%) students thought of choosing surgery as their career while 41 (14.04%) of the students disagreed for choosing surgery...

Research paper thumbnail of Primary Grynfeltt Lumbar Hernia: A Case Report

Journal of Nepal Medical Association, Feb 15, 2022

A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. ... more A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. These defects are particularly common in Petit's inferior triangle or Grynfeltt-Lesshaft superior triangle. There are very few cases of primary lumbar hernias that have been described in literature till date. As it is a rare entity, it is often misdiagnosed, leading to delay in management. We present a case of a 66-year-old male with no previous surgery who presented with a mass in left lumbar region for last ten years. The mass gradually increased in size and caused vague dragging pain. On Computed tomography, the diagnosis of Grynfeltt hernia was made. The patient underwent a laparoscopic mesh repair and had an uneventful postoperative hospital stay. Although a rare entity, there should be a high degree of suspicion of a lumbar hernia when evaluating a case of a lumbar mass. Early diagnosis by computed tomography and management with open or minimally invasive techniques can prevent complications.

Research paper thumbnail of Indications and outcome of surgical management of local complications of acute pancreatitis: a single-centre experience

International Surgery Journal, 2021

Background: Acute pancreatitis is a common and challenging disease that can develop both local an... more Background: Acute pancreatitis is a common and challenging disease that can develop both local and systemic complications. According to the Atlanta classification, local complications include peri-pancreatic collection, acute necrotic collection, pseudocyst and walled-off necrosis.Methods: A hospital-based retrospective study was conducted in the department of surgery at Kathmandu medical college teaching hospital. Patients were recruited using purposive sampling method and those who underwent laparoscopic, retroperitoneal or open surgical procedures for the management of local complications of acute pancreatitis from June 2017 to July 2021. The indication, perioperative outcome and associated complications were evaluated in all the cases.Results: Between June 2017 to July 2021, 432patients were admitted to the surgery department with acute pancreatitis or with complications of acute pancreatitis. Twenty-one patients required surgical intervention in the form of external drainage, c...

Research paper thumbnail of Primary Grynfeltt Lumbar Hernia: A Case Report

Journal of Nepal Medical Association, 2022

A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. ... more A weakening or defect in posterolateral abdominal wall can lead to development of lumbar hernia. These defects are particularly common in Petit's inferior triangle or Grynfeltt-Lesshaft superior triangle. There are very few cases of primary lumbar hernias that have been described in literature till date. As it is a rare entity, it is often misdiagnosed, leading to delay in management. We present a case of a 66-year-old male with no previous surgery who presented with a mass in left lumbar region for last ten years. The mass gradually increased in size and caused vague dragging pain. On Computed tomography, the diagnosis of Grynfeltt hernia was made. The patient underwent a laparoscopic mesh repair and had an uneventful postoperative hospital stay. Although a rare entity, there should be a high degree of suspicion of a lumbar hernia when evaluating a case of a lumbar mass. Early diagnosis by computed tomography and management with open or minimally invasive techniques can prevent...

Research paper thumbnail of Early Oral Feeding with Vascular Resection among Patients Undergoing Pancreatoduodenectomy in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association, 2022

Introduction: Pancreatoduodenectomy with vascular resection is performed in locally advanced peri... more Introduction: Pancreatoduodenectomy with vascular resection is performed in locally advanced periampullary malignancies. In our practice, early oral feeding is initiated in patients undergoing pancreatoduodenectomy. This study aims to find the prevalence of early oral feeding with vascular resection among patients undergoing pancreatoduodenectomy. Methods: This was a descriptive cross-sectional study conducted among hospital records of 152 patients who underwent pancreatoduodenectomy in the department of surgery of a tertiary care hospital from 2016 to 2020. Ethical approval was taken from the Institutional Review Committee (Reference number: 0812202102). Convenience sampling was done. Patients clinical and sociodemographic data were collected and analyzed using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency, percentage, mean, and median. Results: Among 152 patients undergoing pancreatoduodenectom...

Research paper thumbnail of Jnma I Vol 52 I No. 12 I Issue 196 I

Background: Acute abdominal pain is a common condition presenting to both the emergency departmen... more Background: Acute abdominal pain is a common condition presenting to both the emergency department (ED) and surgical admission unit. Increase in serum amylase levels are found in much gastrointestinal pathology. Serum amylase level is consistently high in acute pancreatitis though high values are not pathognomonic of pancreatitis .The aim of this study to assess the level of serum amylase in various diseases presenting with acute abdominal pain and to evaluate the role of routine measurement of serum amylase in the screening of patient with acute abdominal pain for the diagnosis of acute pancreatitis in a prospective series.

Research paper thumbnail of Early Re- Laparoscopy in Suspected Bile Duct Injuries after Laparoscopic Cholecystectomy

Birat Journal of Health Sciences, 2021

Introduction: Management of patients with suspected bile leak or bile duct injury after laparosco... more Introduction: Management of patients with suspected bile leak or bile duct injury after laparoscopic cholecystectomy is challenging. Early laparoscopy in these groups of patients will benefit in terms of diagnostic as well therapeutic purpose. Objective: This study is done to assess utility of early re-laparoscopy in suspected bile duct injury in early postoperative period following laparoscopic cholecystectomy. Methodology: It is a descriptive study of all consecutive patients who underwent diagnostic as well therapeutic re-laparoscopy when required in suspected bile duct injury in early postoperative laparoscopic cholecystectomy that is within 72 hours of presentation. Study was conducted over a period from June 2019 to December 2020 at Kathmandu medical College, Sinamangal, Kathmandu, Nepal. Relaparoscopic operative findings and therapeutic intervention done were recorded. Result: The mean age at presentation was 34.6 years and male to female ratio was 1:1.8. During the study per...