Papers by Narayan Belbase
Journal of Gandaki Medical College, Jun 20, 2024
Journal of Chitwan Medical College, Dec 31, 2023
Journal of College of Medical Sciences-Nepal, Mar 29, 2024
Journal of College of Medical Sciences-Nepal, Mar 29, 2024
Journal of Gandaki Medical College, Dec 30, 2023
Journal of Nobel Medical College, 2014
Objective: To evaluate the clinical profile of patients with gallbladder cancer. Methodology: Thi... more Objective: To evaluate the clinical profile of patients with gallbladder cancer. Methodology: This is a single institution based retrospective study of patients with gallbladder cancer who presented at College of Medical Sciences and Teaching Hospital, Bharatpur, Chitwan, Nepal. Patients presenting during the two years period from August 2011 to July 2013 were reviewed. Result: Out of 12 patients, 9 were females (75%) and 3 were males (25%), showing female preponderance. Most of the patients (75%) were in age group of 51-70 years. Only one patient (8%) was below 50 years of age. Main symptom was pain associated with anorexia, nausea & vomiting. Major signs were palpable mass, hepatomegaly and jaundice. All the histopathological reports were adenocarcinoma. 8 patients (66.66%) presented with advanced disease and were managed with extended cholecystectomy followed by systemic chemotherapy. Conclusions: Prevalence of gall bladder cancer is higher in females in our series. Most of the p...
Journal of College of Medical Sciences-Nepal, 2014
Objective To evaluate the clinical profile, management and early outcome of patients with gallbla... more Objective To evaluate the clinical profile, management and early outcome of patients with gallbladder cancer.Methods This is a single institution based retrospective study of patients with gallbladder cancer who presented at College of Medical Sciences and Teaching Hospital, Bharatpur, Chitwan, Nepal. Patients presenting during one year period from August 2012 to July 2013 were reviewed. Results Twelve cases of Gall Bladder Cancer were reviewed in this series. Out of 12 patients, 9 were females (75%) and 3 were males (25%), showing female preponderance. Most of the patients (75%) were in age group of 51-70 years. Only one patient (8%) was below 50 years of age. Main symptom was pain associated with anorexia, nausea & vomiting. Major signs were palpable mass, hepatomegaly and jaundice. All the cases had association with gall bladder stone. Of the total population, 50%(n=6) underwent extended cholecystectomy and rest of 6 cases were inoperable. Histopathological reports of all the ope...
Indian Journal of Cancer, 2017
Journal of College of Medical Sciences-Nepal, 2015
INTRODUCTION Primary tumors of the appendix are rare. They are usually diagnosed after pathologic... more INTRODUCTION Primary tumors of the appendix are rare. They are usually diagnosed after pathologic inspection of the appendix removed for suspected appendicitis. The main presentation is that of an acute appendicitis or as a palpable mass, mainly in the right lower quadrant. It mimics ovarian pathology in female because of close proximity to its anatomical structures. CASE PRESENTATION We report a case of 52 years female who presented to us in casualty with complains of pain abdomen and other findings suggestive of acute appendicitis. In spite of extensive preoperative investigations, the diagnosis was confirmed only after opening the abdomen as giant mucocele of appendix demanding right hemicolectomy as a treatment modality. CONCLUSION Although primary tumors of appendix is rare identity in the arena of surgery, it should be in the corner of thought as a possible diagnosis which require extensive surgery when compared to simple Appendicectomy.DOI: http://dx.doi.org/10.3126/jcmsn.v10...
Journal of College of Medical Sciences-Nepal, 2014
Background: Patients who undergo emergency colorectal cancer surgery has poor outcome compared to... more Background: Patients who undergo emergency colorectal cancer surgery has poor outcome compared to elective surgery, both in terms of morbidity and mortality. Approximately 15 to 30% of colorectal cancers present as an emergency, most often as obstruction or perforation. Objective: To compare surgical outcome and clinical profiles of emergency and elective cases for colorectal cancer. Methods: Retrospective analysis of 34 cases who underwent surgery for colorectal cancer between December 2011 to January 2013was carried out and their surgical outcomes, clinical presentation, demographic profile were analyzed. Results: The total numbers of patients included in this study were 34. Out of which 52.94 %( n=18) were emergency cases and 47.05 %( n=16) were elective. Male female ratio was 3:1 in emergency cases and 2.6:1 in elective cases. Per rectal bleeding (56%) and altered bowel habit (31.25%) was predominant clinical presentation in elective cases whereas intestinal obstruction (55.55%)...
Journal of College of Medical Sciences-nepal, May 1, 2023
The rectal foreign body is a rare presentation with rising incidence. We present a case of a 26-y... more The rectal foreign body is a rare presentation with rising incidence. We present a case of a 26-yearold heterosexual male with an alleged history of sexual assault with insertion of a large foreign body through the anus two days prior with peritonitis. After investigations, the patient underwent an exploratory laparotomy, foreign body removal, primary repair of perforation with a diverting colostomy. Diversion must be considered in cases where the extent of anal sphincter mechanism injury is in question. The patient had a good outcome. Assessment of the shape, size, nature, and location of the object through appropriate imaging is necessary. Exploratory laparotomy is inevitable in cases of perforation.
Journal of Society of Surgeons of Nepal
Introduction: During hanging maneuver liver resection, a tunnel is created at the interface of th... more Introduction: During hanging maneuver liver resection, a tunnel is created at the interface of the liver and Inferior venacava (IVC). Gap between the middle and right hepatic vein is known as Fossa venacava. A gap between the Inferior right hepatic vein and the Caudate vein is known as a Vein gap. The Fossa venacava and Vein gap provide a safe plane for the insertion of forceps during tunneling. The aim of this study is to determine the topography of this safe plane. Methods: A cross-sectional study was done. Twenty livers were used in our study. Major hepatic veins, distance of Vein gap, Fossa venacava, and each vessel present at the interface between liver and IVC was measured by a Vernier caliper. All the collected data was entered and analyzed by using Statistical Package for Social Sciences version 20 (SPSS-20). Results: The average length of retro hepatic IVC was 49.5±10.5 mm and the diameter of 25.6±4.4 mm. The inferior right hepatic vein was present in 60% of cases while th...
Journal of College of Medical Sciences-Nepal
Introduction The posterior approach to liver resection is technically difficult, especially when ... more Introduction The posterior approach to liver resection is technically difficult, especially when there is a bulky tumor or dense adhesion of right lobe of liver with the risk of tumor dissemination and hepatic vein avulsion. To prevent this, anterior approach of liver resection was used; however, it is technically challenging and can lead to a false line of transection and difficulty in controlling bleeding in deeper parenchymal plane. These technical difficulties are overcome by hanging maneuver liver resection which eases the process of anterior approach. The Objectives of our study were to observe the technical safety, operative duration, operative blood loss, and perioperative complications of hanging maneuver in liver resection. Methods This is a cross-sectional study on the patients who underwent hanging maneuver of liver resection at our center. The perioperative data were analyzed. Descriptive variables were described using frequency and percentage; continuous variables were...
Journal of Gandaki Medical College-Nepal
Introduction: Transversus Abdominis Release is a noble technique for the repair of complex ventra... more Introduction: Transversus Abdominis Release is a noble technique for the repair of complex ventral hernia, where the posterior component separation allows a huge pre-peritoneal space advantageous for the placement of large-sized mesh. It has less wound morbidity as compared to anterior component separation due to the preservation of skin perforators. The main objective of this study was to evaluate one-year follow-up results in terms of recurrence, wound morbidity, and various techniques for managing complications of Transversus Abdominis Release. Methods: This is a descriptive crosssectional study that was conducted at the department of surgery, College of Medical Sciences Teaching Hospital. Among 41 patients with complex ventral hernia, 34 patients met the inclusion criteria. Demographic data, intra-operative events like bleeding, operative duration, intraoperative complications, post-operative events like duration of hospital stay, wound morbidity, and follow-up data were analyze...
Journal of Society of Surgeons of Nepal, Dec 30, 2022
Introduction: Perforations of the gastrointestinal tract are frequently encountered surgical emer... more Introduction: Perforations of the gastrointestinal tract are frequently encountered surgical emergencies associated with high morbidity and gastrointestinal tract perforations, their presentations, mode of surgery, complications and factors associated with mortality. Methods: This was an analytical cross-sectional study conducted in the were included in this study. Patients demographics, comorbidities, preoperative investigation, site and cause of perforation, type of surgery and postoperative complications were recorded. Results: A total 100 patients with gastrointestinal perforations were of onset of pain. Peptic ulcer disease as a cause of perforation was presentation, presence of comorbidities, systolic blood pressure less associated with high mortality. Conclusion commonly encountered. Acid peptic disease, trauma and infections are the leading causes of perforations. Increasing age, delay in presentation, comorbidities, oliguria and hypotension are the factors associated with high mortality.
Annals of Medicine and Surgery, 2019
Background: Clinicians must maintain an index of suspicion to diagnose an anorectal foreign body ... more Background: Clinicians must maintain an index of suspicion to diagnose an anorectal foreign body (FB). The patient may not be forthcoming with information secondary to embarrassment or possibly psychiatric issues. Providers must express empathy and compassion while maintaining nonjudgmental composure. Despite accounts of anal FB insertion, this pathology is lacking level one evidence-based surgical algorithms. Case presentation: A 46-year-old male psychiatric patient presented in septic shock, complaining of lower abdominal/pelvic pain starting 1 week prior. His past medical history was significant for schizophrenia, bipolar disorder, and noncompliance with medications. CT of the abdomen/pelvis revealed a rectal perforation with free air and a FB which appeared to be a screwdriver. Fluid resuscitation and broad-spectrum antibiotics were administered. In the operating room, after unsuccessful transrectal removal, an exploratory laparotomy was performed. The metallic end of the screwdriver had perforated the rectosigmoid. Resection of the perforated rectum with removal of the screwdriver, incision and drainage of a large right buttock abscess and colostomy was performed. The patient recovered and was discharged to behavioral health. At 2 weeks follow-up the patient was doing well with a functioning colostomy and reversal was planned for later this year. Conclusion: This case highlights the importance of maintaining a high index of suspicion when encountering psychiatric patients with nonspecific lower abdominal or anorectal pain with inconsistent presentations. Controversy exists regarding the type of surgical treatment in case of anorectal perforation. More research is needed to provide surgeons with evidence-based standardized methods for dealing with these rare pathologies.
Annals of Hepato-Biliary-Pancreatic Surgery
Journal of College of Medical Sciences-Nepal, Sep 30, 2021
Acute appendicitis (AA) is the most common surgical emergency of the abdomen and appendectomy is ... more Acute appendicitis (AA) is the most common surgical emergency of the abdomen and appendectomy is one of the most frequently performed surgical procedures. Laparoscopic appendectomy (LA) is one of the commonest surgical procedure in most of the tertiary center and is being an effective alternative to open appendectomy (OA). Despite continuing evolution in laparoscopic appendectomy, this procedure continue to carry the risk of conversion to open appendectomy. The objective was to analyze the factor, identify the predictors for difficult laparoscopic appendectomy. Methods The study was conducted in College of Medical Sciences, Bharatpur. All patients who underwent laparoscopic appendectomy from 1st January 2020 to 30th December 2020 were included in the study after taking written informed consent. A detailed performa was developed to record information regarding patient history, physical examination, laboratory parameters, ultrasonography (USG) findings, CT findings and intra-operative details. Laparoscopic appendectomy done in more than 120 minutes, converted into open due to difficulty in surgery and not due to complications, severe adhesions were considered to be a case of difficult appendectomy. Results In our study total 94 patients underwent laparoscopic appendectomy among which 16 (17.02%) cases had difficult appendectomy. The incidence of difficult appendectomy was higher among older age group, male sex, long duration of symptoms, high white blood cell count, difficult anatomy, pre existing co-morbid condition, extreme findings on computed tomography and ultrasonography (USG). Operating time, anaesthetic time, and duration of hospital stay were longer after difficult appendectomy. Conclusions Identifying the potential factors for conversion preoperatively may assist the surgeons in making decisions concerning the management of patients with appendicitis and in the judicious use of laparoscopic appendectomy. From our study we found that independent predictors for difficult appendectomy are old age, male sex, prolonged duration of symptoms, high white blood cell count, higher body mass index (BMI), extreme inflammation in computed tomography scan and ultrasonography. Proceeding directly with open appendectomy under these circumstances may reduce operative time, reduce hospital stay and morbidity.
Journal of College of Medical Sciences-Nepal
Introduction: The POSSUM score is one of the several risk scores to predict postoperative morbidi... more Introduction: The POSSUM score is one of the several risk scores to predict postoperative morbidity and mortality in the surgical domain.This study was designed to assess the validity of POSSUM scoring system in patients undergoing gastrointestinal surgeries in our setup and to analyse the outcome and compare the observed and expected values. Methods: An analytical cross sectional study was conducted among 100 patients in the Department of Surgical Gastroenterology after taking ethical approval from COMS-IRC. Data was analysed using SPSS -20 via descriptive and inferential statistical tools. p-value <0.05 was considered statistical significant. Results: Using POSSUM score the expected morbidity was 54% and mortality was 21.47%.The observed morbidity was 54% and mortality was 13%. The observed to expected (O: E) morbidity was 1.03 and mortality was 0.61 and there was no statistically significant difference between observed and expected value. The area under curve for POSSUM mortal...
Background: Prostate cancer incurs a substantial incidence and mortality burden, and it ranks amo... more Background: Prostate cancer incurs a substantial incidence and mortality burden, and it ranks among the top ten specific causes of death in males. Objectives : To explore the situation of prostate cancer in a cohort of healthy population in Eastern Nepal. Methods: This study was conducted in the Department of General surgery at B. P. Koirala Institute of Health Sciences, Dharan, Nepal in the department of surgery from July 2010 to June 2011. Males above 50 years visiting Surgical Outpatient Department in BPKIHS were enrolled in the study. Screening camps were organized in four Teaching district hospitals of BPKIHS in Eastern Nepal. Digital rectal examination (DRE) was done by the trained professionals after collecting blood for serum prostatic specific antigen (PSA). Trucut biopsy was done for all individuals with abnormal PSA, DRE or both findings. Results: A total of 1521 males more than 50 years of age were assessed and screened after meeting inclusion criteria. Maximum individua...
Uploads
Papers by Narayan Belbase