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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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Presentation and Outcomes of Gastric Cancer at a University Teaching Hospital in Nepal
Sah, Jayant Kumar,Singh, Yogendra P,Ghimire, Bikal Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.13
Background: Gastric cancer is the most common gastrointestinal cancer and a leading cause of cancer mortality in Nepal. Survival of gastric cancer patients depends on the stage at which diagnosis is made. The aim of this study was to analyze the presentation and outcomes of gastric cancer patients treated at a tertiary care hospital in Nepal. Materials and Methods: A retrospective analysis of 140 consecutive histologically proven gastric adenocarcinoma cases managed at the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal for the period of January 2009 to December 2013 was carried out. Results: One hundred forty out of the total 186 patients with histologically proven gastric adenocarcinoma, were admitted for surgery. The mean age was $59.6{\pm}12.4yrs$ (range 29 to 78 yrs) and the male: female ratio was 2:1. Sixty three (45%) patients featured Tibeto-Burman descent though this ethnic group accounts for only 18% of the Nepalese population. Two-thirds or more patients presented with abdominal pain, anorexia, weight loss and/or vomiting. In 86 (61.5%) of the patients the tumor was located in the lower $3^{rd}$ of the stomach and in only 15% of the patients the tumor was located at the upper $3^{rd}$. Early gastric cancer was diagnosed postoperatively in only 4%. In 54%, the disease was locally advanced and metastatic lesions were found in 14% of the patients. Subtotal (73) or total (11) curative gastrectomies (D1, D1+ or D2) were performed in 84 (60%) patients with average lymph node retrieval of $16.6{\pm}8.2$. Palliative gastrectomies or procedures were performed in 23% of the patients and no intervention (open & close/biopsy) was employed in 15% of the patients. Perioperative morbidity was seen in 10% and mortality in 4%. Three, four and five year survival rates up to the recent follow-up were 17.9%, 11.9% and 8.3%, respectively. Conclusions: Gastric cancer in Nepal is usually diagnosed at an advanced stage and has a poor prognosis. Thus, early detection is the key to improve the survival of gastric cancer patients.
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Unique Features of Gastric Cancer in Young Patients: Experience from a General Hospital in Nepal
Kandel, Bishnu Prasad,Singh, Yogendra Prasad,Ghimire, Bikal Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.5
Background: Gastric cancer, the fifth most common malignancy in the world, usually affects older individuals but can occur in younger age groups. In this study we compared the clinicopathological profile of young patients of gastric cancer with that of older patients. Materials and Methods: It is a prospective study of gastric cancer patients treated over three year period (January 2012 to December 2014). Data of patients were obtained from the medical record. Clinical and pathological characters of younger patients (age 40 years or less) were compared with older patients (age more than 40 years). Results: There were total of 152 patients treated during the study period. Twenty patients (13.2%) were less than 40 years of age and 132 (86.8%) were older. The male to female ratio in younger patients was 1:1.5 whereas in older patients it was 1:0.6. In the younger age group 14 patients (70%) had poorly differentiated adenocarcinoma in contrast to 45% in the older age group (p<0.01). Some 55% of younger and 42% of older patients had stage IV disease at presentation and curative surgery was not possible. Palliative surgery for gastric outlet obstruction or bleeding from the tumor was performed on 25% and 21% respectively. Conclusions: Gastric cancer in young people aged less than 40 years has unique characters like female predominance, unfavorable tumor biology, and advanced stage at presentation. There should be a high index of suspicion of gastric cancer even in young patients.
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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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