Journal of Society of Surgeons of Nepal <p>Journal of Society of Surgeons of Nepal is the official, peer reviewed journal of the Society of Surgeons of Nepal.</p> Society of Surgeons of Nepal en-US Journal of Society of Surgeons of Nepal 1815-3984 Artificial Intelligence in Surgery: A practice with precision <p>No abstract available.</p> Rupesh Mukhia Copyright (c) 2021 Rupesh Mukhia 2021-12-31 2021-12-31 24 2 34 35 10.3126/jssn.v24i2.42828 Outcome Following Decompressive Craniectomy in a Tertiary Care Center in Nepal <p><strong>Introduction: </strong>Decompressive Craniectomy (DC) is a common neurosurgical procedure performed to reduce the intractable intracranial pressure in various neurosurgical diseases (infarction, hemorrhage, traumatic brain injury). The main aim of the study was to describe the demographic, clinical and operative characteristics of patients who underwent DC for different conditions and to correlate the outcome with various preoperative and intraoperative factors in our center.</p> <p><strong>Methods: </strong>This was a retrospective study of patients who underwent DC for various neurosurgical diseases from January 2019 to January 2021 in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The chart of the patients were retrieved from the medical records and additional information obtained via telephone.</p> <p><strong>Results: </strong>A total of 55 patients were enrolled in the study with a mean age of 43.0 + 17.3 years and male:female ratio of 1.5:1. There were 20 (36.4%) patients who presented with trauma and 35 (63.6%) patients with non traumatic origin. Among them, 28 (51%) patients presented with GCS&lt;8 and 27 (49%) patients with GCS&gt;8 and 37 (67.3%) patients with unequal pupil. At the end of six months follow up, the favorable outcome was seen in 23 (41.8%) patients. The only factor significantly associated with favorable outcome was the preoperative pupillary status.</p> <p><strong>Conclusion: </strong>In our cohort the preoperative pupillary status (bilateral equal and reactive pupil) was the variable significant for favourable outcome in patients undergoing DC.</p> Ashim Gurung Anjan Singh Karki Dipendra Kumar Shrestha Binod Rajbhandari Amit B Pradhanang Gopal Sedhain Sushil Kumar Shilpakar Mohan Raj Sharma Copyright (c) 2021 Ashim Gurung, Anjan Singh Karki, Dipendra Kumar Shrestha, Binod Rajbhandari, Amit B Pradhanang, Gopal Sedhain, Sushil Kumar Shilpakar, Mohan Raj Sharma 2021-12-31 2021-12-31 24 2 36 41 10.3126/jssn.v24i2.42829 Failure to Rescue After Abdominal Surgery: an Audit on Incidence and Predictors <p><strong>Introduction: </strong>Failure-to-rescue (FTR), defined as death after a surgical complication, is a quality metric that is an important variable affecting mortality rates in hospitals. This study aims to analyze complications, FTR rates, and its predictors at the index hospital setting.</p> <p><strong>Methods: </strong>This was a retrospective cohort study performed at an academic hospital from 2015 to 2020 in the Department of Surgical Gastroenterology. We included all patients who had major complications following elective major benign or malignant abdominal surgeries. The primary and secondary endpoint was FTR rates and the overall major complications and deaths, re-operation rate, and its predictors respectively.</p> <p><strong>Results</strong>: Among 762 patients, the rate of any major complication was 14.9% . The overall mortality rate was 2.8%. However, the mortality rate among patients with complications was 27.4% (FTR). Twenty-seven (52.9%) patients underwent re-operation for complications, out of which 70% survived. Three (21.4%) patients had a delay in prompt diagnosis and interventions of complications and had FTR due to the anastomotic leak and bleeding. The ASA grade, co-morbidities,, re-operation, and nature of the disease (benign vs. malignant) did not predict the FTR.</p> <p><strong>Conclusion:</strong> This study conducted at an academic, low-volume center had higher rates of FTR. It can be further reduced by both prompt and appropriate interventions of postoperative complications in a multidisciplinary setup.</p> Narendra Pandit Kunal B Deo Laligen Awale Sameer Bhattarai Tek Narayan Yadav Copyright (c) 2021 Narendra Pandit, Kunal B Deo, Laligen Awale, Sameer Bhattarai, Tek Narayan Yadav 2021-12-31 2021-12-31 24 2 42 45 10.3126/jssn.v24i2.42830 Our experience of scalp reconstruction in a tertiary care centre of Nepal <p><strong>Introduction: </strong>Scalp defects are difficult to manage due to their inelastic nature, thus possess significant surgical and aesthetic concerns. The objective of the study was to analyse various scalp defects in terms of their clinical presentation, management and outcome in the context of Nepal.</p> <p><strong>Methods: </strong>This was a retrospective review conducted by analysing clinical records of all the scalp reconstructions performed at Tribhuvan University Teaching Hospital (TUTH) from May 2018 to March 2021. </p> <p><strong>Results: </strong>Among the 69 patients operated there were 37 females and 32 males. Most patients were in the age group of 0-10 years and 31-40 years with mean age of 30 years. Most common cause for defect was trauma (27 cases), followed by post oncologic resection (15), burn (11), raw area post craniotomy (7) and benign scalp lesions in 9 cases. Skin grafting was the most common procedure performed (16 cases), followed by transposition flap (15), primary closure (13), rotation flap (9) and free flap in 4 cases. Four patients had tissue expander placed over the scalp. Four patients had developed graft loss, two had infection post operatively requiring intervention, five had wound dehiscence and there was one free flap failure. There were two mortalities both due to pneumonia post operatively.</p> <p><strong>Conclusion</strong>: Defect size, location, presence or absence of pericranium and quality of surrounding scalp tissue all influence the selection of reconstructive technique.</p> Bikesh Rajbhandari Himalaya Niraula Manish Devkota Samit Sharma Sangam Rayamajhi Jayan Man Shrestha Ishwor Lohani Copyright (c) 2021 Bikesh Rajbhandari, Himalaya Niraula, Manish Devkota, Samit Sharma, Sangam Rayamajhi, Jayan Man Shrestha, Ishwor Lohani 2021-12-31 2021-12-31 24 2 46 50 10.3126/jssn.v24i2.42832 Infectious complications during the initial 225 cases of standard PCNL: A single center experience <p><strong>Introduction: </strong>Percutaneous nephrolithotomy(PCNL) has emerged as the treatment of choice for medium to large urinary stones. Infection is a life threatening complication and is the most common cause of death following PCNL. This study aimed to examine different predictors of infective complications in PCNL.</p> <p><strong>Methods: </strong>This retrospective study was done on patients who underwent PCNL between 2016 and 2020 at a tertiary level medical college hospital. Medical records were reviewed for study variables.</p> <p><strong>Results: </strong>Two hundred and twenty five cases were included out of which 121 were male. A total of 151 complications were recorded among which 27(17.88%) were major complications. Infectious complications were seen in 67 (29.77%) patients among which 39 cases (17.33%) were febrile urinary tract infections. Urosepsis developed in four patients and one patient died due to urosepsis related complication. Female (p=0.003), Diabetes mellitus (p=0.002), positive urine culture (p=0.0001), stone location (p=0.01), degree of hydronephrosis (p=0.001), duration of surgery (p=0.001), number of access tracts (p=0.0001), and initial 100 cases (p=0.001) were associated with post PCNL infections.</p> <p><strong>Conclusion: </strong>Female, Diabetes mellitus, preoperative urine culture positivity, stone location, degree of hydronephrosis, duration of the operation, number of access tracts and surgeon experience are risk factors for post PCNL infections. Surgeons should be extra vigilant during their initial period. Urinary tract infection should be treated and extra care should be taken when operating in female patients giving ample attention to preoperative investigations.</p> Kushal Karki Narayan Bhusal Copyright (c) 2021 Kushal Karki, Narayan Bhusal 2021-12-31 2021-12-31 24 2 51 57 10.3126/jssn.v24i2.42835 Scar after Intradermal Mattress versus Subcuticular Continuous Sutures: A comparative study <p><strong>Introduction</strong>: Subcuticular continuous technique and buried mattress suture produce good results. The study compared results following these techniques using POSAS.</p> <p><strong>Methods</strong>: Patients were enrolled on out-patient basis and grouped into I for Intradermal Buried Vertical Mattress Suture (IBVMST) and II for Subcutaneous Continuous with absorbable suture techniques (SCAST) and followed up to six months. Suture time, number of sutures and POSAS items were evaluated, correlated and analyzed.</p> <p><strong>Results</strong>: Included were 63 patients. No significant difference was noted in Total OSAS as well as in Overall Opinion Scores between both groups, although group I scars were significantly better in relief and pliability, with p value of 0.019 and 0.018, respectively. In group I, category 1-2cm wounds needed more repair time; significant correlation was found between number of stitches and total POSAS; surface area and vascularity were significantly related with Observer Opinion and more scars were smooth, flexible, thinner and less vascular. In group II, category &gt;5cm wounds needed more closure time; surface area was significantly related to Observer Opinion and scars were less expanded. In both groups, colour was significantly correlated with Patient Opinion. Total POSAS difference between the two groups was insignificant 0.9305, indicating no technique was superior, despite favourable group I results. </p> <p><strong>Conclusion</strong>: No group was superior but revealed differences. The scars from IBVMST were favoured by observer opinions while scars from SCAST by patient opinions. More of IBVMST scars were smooth, flexible, thinner and less vascular but more of SCAST scars were less expanded. Lastly, short wounds closure are quicker with IBVMST while long wounds closure are quicker with SCAST.</p> Krishna Manandhar Copyright (c) 2021 Krishna Manandhar 2021-12-31 2021-12-31 24 2 58 63 10.3126/jssn.v24i2.42836 Zinner syndrome – a rare radiological diagnosis in a young male presenting with recurrent dysuria <p>Zinner syndrome is a rare congenital abnormality of the mesonephric (Wolffian) duct consisting of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ipsilateral ejaculatory duct obstruction. The syndrome usually presents in the second or third decade of life mainly after the beginning of sexual activity and usually in the form of voiding manifestations. The main imaging modality is magnetic resonance imaging (MRI); however, usually suspected in transabdominal sonography, which may give initial clue to the diagnosis. Herein, we report a rare case of a 24 - year male with right renal agenesis with cystic pelvic mass diagnosed as Zinner syndrome via multimodality imaging.</p> Dinesh Chataut Surendra Rayamajhi Sundar Suwal Ajit Thapa Copyright (c) 2022 Dinesh Chataut, Surendra Rayamajhi, Sundar Suwal, Ajit Thapa 2021-12-31 2021-12-31 24 2 64 66 10.3126/jssn.v24i2.42837 Minimal invasive approach for Giant Pulmonary Hydatid cyst <p>Hydatid cyst is a major health problem in agricultural countries caused by larval stage of Echinococcus granulosus. Hydatid cysts of 10 cm or greater in diameter are called “giant” cysts and traditionally have been considered to be more difficult to treat surgically.</p> <p>A 30 year male presented with complaints of cough and chest pain for three days and a CECT chest suggesting lung abscess. When thoroughly evaluated with bedside ultrasound, it was revealed to be a case of giant Hydatid cyst. The patient underwent cystostomy with closure of bronchial opening with capitonnage with minimal invasive approach (VATS assisted minithoracotomy).</p> <p>Even Giant Hydatid cyst can be managed with VATS, avoiding formal thoracotomy. Preoperative sonoscopy can localize the exact site for port placement and guide the surgeons on the operation table.</p> Deepak Raj Singh Abhishek Thapa Mahipendra Tiwari Copyright (c) 2021 Deepak Raj Singh, Abhishek Thapa, Mahipendra Tiwari 2021-12-31 2021-12-31 24 2 67 70 10.3126/jssn.v24i2.42838 Neglected Retained Suprapubic Catheter with Varied Management Options: A Case Series <p>Supra-pubic catheterization of bladder is used as a short or long term alternative to per-urethtral catheterization.</p> <p>Some catheter materials are more resistant to encrustation than others. If kept indwelling for longer duration, sooner or later all catheters cause complications like urinary tract infection (UTI), trauma, peri-catheter leakage, non-deflation of balloon, encrustations and stone formations resulting into retained catheter.</p> <p>Stone formation over neglected indwelling catheter is not an unusual clinical scenario and its management depends on etiology of catheter retention and complication.</p> <p>This article discusses etiopathogenesis, clinical presentations, diagnosis and varied management options used for the neglected retained supra-pubic catheter in three cases</p> Venkat A Gite Shashank Sharma Mayank Agrawal Vivek Shaw Copyright (c) 2021 Venkat A Gite, Shashank Sharma, Mayank Agrawal, Vivek Shaw 2021-12-31 2021-12-31 24 2 71 74 10.3126/jssn.v24i2.42839