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RISS 인기검색어
- 검색키워드
- 저자 : ( Ramesh Singh Bhandari ) (검색결과 6 건)
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( Ramesh Singh Bhandari ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Major liver resections in high volume center around the world have become a safe procedure. With proper training and improved perioperative care, major liver resections are being safely performed even in low volume center of the underdevel oped country. Here, the author is presenting the outcome of major liver resections performed independently after complet ing two years of HPB training. Methods: The presenting surgeon received two years of HPB training at high volume centers in Melbourne. The surgeon had received general surgical training in Nepal and had worked for few years prior to receiving HPB training. Retrospective review of the medical records of major liver resections performed by single sur geon following fellowship training were reviewed. Indications, ex tent of hepatectomy and perioperative outcomes were analyzed. Results: Total 49 liver resections have been performed by the single surgeon out of which 30 were major liver resections (Three or more segments) over 6 years period. Out of them, to tal 14 were for malignant conditions, 14 benign and two were trauma hepatectomy. There were 13 Right hepatectomy, 7 left, 2 extended right, 6 non anatomical, 1 HPD and 1 ALPPS pro cedure. Two patients were operated following right portal vein ligation. There was 25% morbidity (Clavien Dindo Grade 1-3, SSI, Chest infection, UTI, Transfusion, bile leak). Post hepatecto my liver failure (PHLF) was 3% and mortality was 6.6% (1 Post AlPPS Sepsis, 1 PHLF). Conclusions: With proper training and improved perioperative care, major liver resection can be performed safely with accept able outcome even in low volume centers of developing nations.
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Management of Choledochal Cyst: An Institutional Review from a Tertiary Referral Center in Nepal
( Sujan Shrestha ),( Bikal Ghimire ),( Prasan Kansakar ),( Ramesh Singh Bhandari ),( Paleswan Joshi Lakhey ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Choledochal cysts (CC) are a rare congenital cystic dilation of the biliary tract. Methods: This is a retrospective study of 32 consecutive patients of CC who underwent multidisciplinary management in last 2 and half years at a tertiary referral center from Nepal. Results: A total of 32 patients, 9 males and 23 females were operated. The average age at diagnosis was 25 years (range from 2 to 56 years). The most common presenting symptoms were pain 31(96.88%), jaundice 10(31.25%) and mass 5 (15.63%). Triad of pain, jaundice and mass was present in 4 (12.5%). Transabdominal Ultrasonography (100%) was the initial diagnostic modality of choice followed by MRCP (68.75%), and CECT (31.25%). ERCP was done for stent placement in 3 (9.38%) patients with severe cholangitis. Type IVA (37.5%) was the most common type of CC followed by type IC (31.23%), type IB (15.65%), type IA (12.5%) and type IVB (3.12%). Abnormal pancreaticobiliary duct junction was observed in 3 (9.38%) patients. All patients underwent open cyst excision with Roux-en-Y hepaticojejunostomy (HJ). There were 2 patients who underwent relaparotomy for efferent loop obstruction and Peterson hernia. None of our patient had cholangiocarcinoma on pathological examination. Conclusions: Choledochal cyst is rare cystic dilatation of biliary tract. Surgery (Cyst excision with Roux-en-Y hepaticojejunostomy) is treatment of choice. Although the incidence of cholangiocarcinoma is less, long-term surveillance is essential.
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Analysis of the Cases with Carcinoma Gallbladder (CA GB) in a Tertiary Level Hospital of Nepal
( Romi Dahal ),( Bika Lghimire ),( Prasan Kansakar ),( Ramesh Singh Bhandari ),( Paleswan Joshi Lakhey ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1
Aims: Gallbladder cancer (GC) is a relatively rare disease in some parts of world but is common in countries like Chile, Japan India and Nepal. Nepal stands as one of the five countries with the highest mortality. Methods: A retrospective analysis of the consecutive operated and non-operated admitted cases of GC in TUTH from 2018 to 2019 was done. Patient demographics, disease characteristics, diagnostic modalities and various curative and palliative treatment variables were analyzed. Results: Of the 59 patients, there were 33 females (56%) who outnumbered the 26 males(44%) with a male to female ratio of 0.7:1. The median age at diagnosis was 56 years with younger group (<60 years) comprising 62.7% of the disease. Among all, the most common presenting symptom was abdominal pain followed by jaundice. Onset of first symptoms was within mean duration of 40 days (SD 37.45 days). USG and CT availability (100%) lead to preoperative diagnosis in majority. Curative resection (extended cholecystectomy) was done in 16 (27%). The most common anatomic location of mass was fundic followed by neck. Pathological examinations revealed most cases of adenocarcinoma. Of the advanced metastatic Ca GB in 30% of cases, the most common site of metastasis was liver. Mean survival after diagnosis in advanced cases was 4.5 months. Conclusions: CA GB is more common in Nepal, more among females and younger patients often presenting with pain abdomen and jaundice. Most are advanced at the time of diagnosis Radical surgery can be offered to few patients where the outcome seems reasonably good.
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Repair of Bile Duct Injury Experience at TU Teaching Hospital, Nepal
( Dhruba Narayan Sah ),( Yogendra Prasad Singh ),( Pradip Vaidya ),( Paleswan J Lakhey ),( Ramesh Singh Bhandari ),( Prasan B Kansakar ),( Bikal Ghimire ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Iatrogenic bile duct injuries (BDI) following cholecys tectomy is a substantial problem in the era of laparoscopic advancement in surgical gastroenterology. Early and accurate diagnosis and management involving multidisciplinary team are of paramount importance. Though endoscopic procedures are most frequently used in management of BDI, surgical repair is the necessity especially in cases of complete transection. Aim of the review is to analyze our experience of management of BDI Methods: This is retrospective analysis of all operated cases of BDI Between May 2014 - December 2017. Patients’ clinical details, investigations, operative details, perioperative outcomes and follow-up were recorded. Data were analyzed using Statis tical Package of Social Sciences 23 Results: Total of 23 cases of BDI were operated at TUTH over 42 months out of which 87% were female with age range 17-59 years. Majority cases occurred following laparoscopic cholecystectomy (34.8% while conversion from laparoscopic to open in 26.1 %) and 30.4 % following open cholecystectomy. Injury identified mostly in early postoperative period (69.6 %). E3 (60.9%) injury was most common followed by E2 (21.7%). Median time of repair were 90 days (7 weeks- 25 years). Roux-en-Y Hepaticojejunostomy (HJ) done in 20 cases, 2 cases had revised HJ while 1 case had Right hepatectomy and HJ. Median duration of follow-up of 20 months (range, 4-44) revealed ex cellent outcomes. Conclusions: Roux-en-Y HJ is the most frequent surgical treat ment along with control of sepsis and delayed repair after de lineating the proper anatomy for better outcomes in hands of experienced hepatobiliary surgeons.
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