Tracheal Resection and Anastomosis for Postintubation Tracheal Stenosis

Introduction: Tracheal stenosis is one of the dreaded complication of tracheal intubation. Tracheal resection and anastomosis is an established definitive treatment for stenosis more than one cm. Here, we present a case of postintubation tracheal stenosis managed by resection and anastomosis, first of its kind in our centre. Case Report: We present a case of 26-year female who underwent tracheal intubation during her treatment of tubercular meningitis. Two weeks later, she returned with respiratory difficulty. A diagnosis of post-intubation tracheal stenosis was made. Tracheal resection and anastomosis was done. Recovery was uneventful and she was discharged on 14th post-operative day. Conclusion: Post-intubation tracheal stenosis is still a dreaded complication even after the introduction of high volume low pressure cuff. They can be successfully managed. Care personnel in intensive care unit (ICU) should perform to prevent this complication

Single dose Intraoperative Antibiotics versus Postoperative Antibiotics for Patient Undergoing Laparoscopic Cholecystectomy for Symptomatic Cholelithiasis

Introduction: Surgical site infection is a common complication shown in literature following cholecystectomies. Smaller incision and use of trocars in laparoscopic cholecystectomy lessen the contamination resulting in less chances of surgical site infection. However, in fear of postoperative infection, many opt for the prolonged postoperative use of antibiotic and there is growing consensus against it. Antibiotics not only increases the cost and hospital stay duration but it aids in emergence of multidrug resistance. Because of the controversies, we conducted this clinical trial to see whether a single prophylactic dose of antibiotic at the time of induction of anesthesia for laparoscopic cholecystectomy was equally effective in controlling post-operative infection as multi-dose antibiotics during and post-operative period. Methods: The study was conducted at the department of general surgery, Lumbini Medical College Teaching Hospital, from November  2015 to October 2016. All cases with symptomatic cholelithiasis subjected for laparoscopic cholecystectomy were enrolled. Patients were randomized into two groups; Group SD received single dose of an intravenous dose of amikacin 500 mg, at induction of anesthesia and Group MD received multiple intravenous dose of amikacin, during and postoperatively for two days. Complications, hospital stay, and treatment cost in two groups were compared and analyzed. Results: There were a total of 240 patients in the study, 118 in Group SD and 122 in Group MD. Post-operative infection rate was 4.2% (n= 5, N=118) in Group SD and 3.3% (n=4, N=122) in Group MD; the difference was not significant (p=0.75). Hospital stay was prolonged and cost was higher significantly in Group MD. Conclusion: Single dose of prophylactic antibiotic, administered at induction of anesthesia, is equally effective as multiple doses of post surgical antibiotics to prevent post-operative infection in patients undergoing elective laparoscopic cholecystectomy for uncomplicated cholelithiasis

Complications of Percutaneous Nephrolithotomy and their Management

Introduction: Increasing global prevalence of nephrolithiasis has resulted in the development of new minimally invasive techniques and has also led to the resurgence of established methods such as percutaneous nephrolithotomy (PCNL). This procedure is now recommended as the first option for the treatment of single large or multiple renal stones and those in the inferior calyx. This study was done to assess the complications of PCNL and their management, in our centre. Methods: Medical records of 144 patients who underwent PCNL at Lumbini Medical College Teaching Hospital, during the last one year were reviewed. The demographic data, size, tract number and location of the calculi, and intraoperative and postoperative complications were evaluated. The various parameters of the calculi were evaluated. Descriptive analysis with frequencies was done. Results: Complications occurred in 13 (9.02%) patients. Post operative bleeding occurred in seven (4.8%) patients, out of which one patient developed pseudoaneurysms and the other developed arteriovenous fistula. One patient developed hypovolemic shock immediately after surgery. Frequent blockage of urine, excessive drainage of urine from the drain site, hemothorax and colonic perforation was seen in one  patient each. One patient had mortality due to post operative bleeding. Complications increased with the number and size of stones and number and site of the tracts. Conclusion: Percutaneous nephrolithotomy has low complication rate in experienced hands and complications depend upon stone size, history of open stone surgery, tract number, and tract location

Incidence of Carcinoma Prostate in Transurethral Resection Specimen in a Teaching Hospital of Nepal

Introduction: As suggested through several autopsy studies there is a high prevalence of latent prostate  cancer in the population. A much smaller proportion of prostate  cancer is detected because of clinical symptoms. This study was done to identify the rates of incidentally detected prostate cancer in patients undergoing surgical management of Benign Prostatic Hyperplasia (BPH) in our centre. Methods: A retrospective review was done on all transurethral resections of the prostate (TURP)  cases from May 2014 to May 2015 at a single tertiary care institution. One hundred and three men, aged 40 to 88 year, underwent TURP and their specimens were sent for the  histopathological analysis. Results: Five (4.85%) patients were diagnosed with the prostate  cancer. All the five patients had Gleason score of seven or more. Two patients had moderately differentiated adenocarcinoma  with Gleason score of seven. Three patients had poorly differentiated adenocarcinoma with Gleason score of eight or above. The Prostate cancer was seen only  in the age group above 65 years but it was not statistically significant. Conclusion: Our series demonstrated that 4.85% of patients had latent prostate  cancer. It occurs mainly in men above 65 years of age though this was not statistically significant