Birat Journal of Health Sciences最新文献

{"title":"A 4 year retrospective study of facial dog bite injuries in patients reported to pediatric emergency, BPKIHS, Nepal.","authors":"M. Dali, B. Koirala, S. Shrestha, Gajendra Birajee","doi":"10.3126/bjhs.v8i1.57288","DOIUrl":"https://doi.org/10.3126/bjhs.v8i1.57288","url":null,"abstract":"Introduction: Dog bites facial injuries are a significant health care problem and their sequelae ranges from minor to fatal injuries. \u0000  \u0000Objectives: To determine the incidence of facial dog bite injuries and to assess the outcome as well as presentation of facial injuries among the children reported to the pediatric emergency, BPKIHS, Nepal. \u0000  \u0000Methodology: A study was conducted where the clinical records of children with facial dog bite injuries reported from 2015 to 2018, were assessed and analyzed.A proforma was designed to extract relevant clinical data from the case records. Information such as age, gender of the victims, anatomical site of the injury, interval between injury and presentation to the hospital, nature of injuries,profile(stray or pet)and immunization status the of dog ,outcome and complications were extracted. \u0000  \u0000Results: The incidence of facial dog bite injuries has significantly increasedpointing maleschool going children injured predominantly(70%).Seventeen(81%) victims had presented within 24 hrs of injury whereas two(9.5%) patients had reported after 24 hours and 72 hours of the injury. Nineteen patients were treated on the same dayunder local anesthesia, one under general anesthesia where thorough wound lavage with meticulous reapproximation followed by suturing was done. Full recovery was evident in eighteen (86%) cases with primary wound closure whereas two (14%) patients had undergone healing with secondary intention. \u0000Conclusion: There is an increase in incidence of dog bite facial injuries among children in our tertiary health care centre. Satisfactory healing outcomes were achieved with a thorough wound lavage and primary closure of non-infected wounds under appropriate rabies prophylaxis and proper antibiotic regimen.","PeriodicalId":31640,"journal":{"name":"Birat Journal of Health Sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45872420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Diagnostic Rigid Nasal Endoscopy in the evaluation of bleeding points and management of Epistaxis","authors":"P. Rajbhandari, B. Shrestha, M. Pokharel, A. Dhakal","doi":"10.3126/bjhs.v8i1.57283","DOIUrl":"https://doi.org/10.3126/bjhs.v8i1.57283","url":null,"abstract":"Introduction: Epistaxis is one of the most common ENT emergencies. Causes of epistaxis can be idiopathic, local, or associated with systematic conditions. Anterior rhinoscopy gives a limited view of the nasal cavity. Difficulty in the localization of bleeding points on anterior rhinoscopy is commonly encountered. We often face difficulty in the localization of bleeding points, especially the hidden areas. Nasal endoscopy helps to identify the hidden bleeding points and specifically control the bleeding. \u0000Objective: The main aim of our study was to visualize bleeding points and demonstrate the efficacy of nasal endoscopy in identifying the bleeding site and controlling epistaxis without nasal packing. \u0000Methodology This is a cross-sectional study done on patients who presented to the ENT Outpatient Department with complaints of nasal bleeding. They were evaluated by rigid nasal endoscopy for localization of bleeding points as well as control of epistaxis. \u0000Results: Highest number of cases were seen in the 26-35 years of age group. 69.7% (n=53) patients presented with anterior epistaxis and 28.9% (n=22) had posterior epistaxis. Most of the patients i.e.,57.9 %(n=44) had no obvious abnormality associated with epistaxis, followed by Deviated Nasal Septum with septal spur i.e.,34.2%(n=26). On localizing the bleeding points, 77.6% (n=59) of bleeding points were seen on the septum. 57.9% (n=44) of patients developed epistaxis on the right side. 58% (n=52) of patients were managed with endoscope-assisted chemical cauterization followed by endoscope-associated electro-cauterization using bipolar cautery. \u0000Conclusion: Rigid nasal endoscopy not only helps in localizing bleeding points but also in managing the cases and is gradually replacing conventional techniques like anterior and posterior nasal packing.","PeriodicalId":31640,"journal":{"name":"Birat Journal of Health Sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44380632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Use of Single Dose Preoperative Antibiotic versus both Pre and Post Operative Antibiotics in Patients Undergoing Laparoscopic Uncomplicated Appendectomy in Birat Medical College Teaching Hospital (BMCTH)","authors":"Bhupendra Charan Shrestha, Shivraj Sharma, R. Yadav, C. Agrawal, N. Pandit","doi":"10.3126/bjhs.v7i3.52768","DOIUrl":"https://doi.org/10.3126/bjhs.v7i3.52768","url":null,"abstract":"Introduction: Acute appendicitis is one of the most common surgical emergency. Rationalized use of antibiotics prevents the risk of post operative complications. There is no conclusive recommendation on the duration of antibiotic usage and role of postoperative use of antibiotics in preventing complications in uncomplicated cases remains controversial till date. \u0000Objectives: To compare the effectiveness of single dose preoperative antibiotic with preoperative and postoperative antibiotics for patients undergoing laparoscopic uncomplicated appendectomy. \u0000Methodology: A total number of 113 patients who fulfilled the selection criteria underwent laparoscopic appendectomy for uncomplicated appendicitis and were randomly divided into two groups. Group A patients received only pre operative antibiotics whereas Group B patients received both preoperative and postoperative antibiotics. Patients of both the groups were followed up postoperatively till discharge from the hospital \u0000Results: In this study, patients who received only pre-operative antibiotic were 57 (50.4%) and patients who received both preoperative and postoperative antibiotics were 56(49.6%). SSI was detected in total of 2 patients (1.8%) one from each group and postoperative lump noted in right iliac fossa (RIF) in 2 patients (1.8%) one in each group intraoperatively in which further antibiotic was continued postoperatively. Hematoma, seroma and peritonitis were absent in both the groups. The difference between the two groups for incidence of SSI and postoperative RIF lump was statistically insignificant with P value of 0.748. \u0000Conclusion: Single dose preoperative antibiotic is sufficient in preventing postoperative complications in patients undergoing laparoscopic appendectomy for uncomplicated appendicitis. This can be recommended for implementation as standard operating protocol in such cases.","PeriodicalId":31640,"journal":{"name":"Birat Journal of Health Sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41585033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parental Stress and Coping Mechanisms in Rearing Children with Intellectual Disability: A Study Conducted in Kathmandu","authors":"A. Shrestha, Rajdevi Adhikari, Gopal Pokhrel","doi":"10.3126/bjhs.v7i3.52636","DOIUrl":"https://doi.org/10.3126/bjhs.v7i3.52636","url":null,"abstract":"Introduction: The birth of a child with an intellectual disability is the most traumatic event experienced by the parents and their families. The main objective of this study is to identify parental stress and coping in rearing children with intellectual disabilities in Kathmandu valley. \u0000Methodology: A descriptive cross-sectional study was conducted among 222 parents (either mothers or fathers) of children with an intellectual disability visiting nine organizations selected through probability proportionate to size sampling.  Data were collected through interview techniques using the Nepali-translated Parental Stress Scale and cope tool developed. \u0000Results: Maximum respondents (76.1%) were mothers with an overall mean age of 46.28±12.73 years. The major stress expressed was anxiety-related to a child's future after parents' death (19.8%) and most used coping measure was sharing feelings (44.6%) were expressed as major stress and coping measures used respectively. The overall mean score of parental stress was 64.58±9.22 and parental coping was 106.45±9.72. Maximum respondents have a moderate level of stress (54.5%) followed by severe stress (43.2%) and a moderate level of coping (86.9%) followed by a maximum level of coping (13.1%). There was a significant association of level of stress with relationship to the child, parent’s education, and presence of co-disability in the intellectually disabled child. There was a significant association of level of coping with parents’ education. \u0000Conclusion: Maximum respondents had a moderate level of stress and a moderate level of coping mechanisms. Parental stress was high in mothers, illiterate parents, and parents having an intellectually disabled child of 17 years or younger. Parental coping was high among Hindu and literate parents. \u0000 ","PeriodicalId":31640,"journal":{"name":"Birat Journal of Health Sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43599630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice of COVID-19 Preventive Measures and its Associated Factors among the Undergraduate Medical Students: A Cross-Sectional Study","authors":"A. Mishra, Karuna Bhattarai, S. Karki, Heera Kc, S. Parajuli","doi":"10.3126/bjhs.v7i3.52638","DOIUrl":"https://doi.org/10.3126/bjhs.v7i3.52638","url":null,"abstract":"Introduction: The COVID-19 is an emerging infectious disease with serious public health consequences. Appropriate practice of preventive measures and adherence to it play an essential role in reducing infection rates and controlling the spread of the disease. \u0000Objectives: This study aimed to assess the practices of COVID-19 preventive measures and its associated factors among the undergraduate medical students at Birat Medical College Teaching Hospital. \u0000Methodology: A cross-sectional study was conducted from 25 July 2021 to 25 December 2021 among the medical students at Birat Medical College Teaching Hospital, Morang, Nepal. The complete enumeration of 146 medical students were carried out. Ethical clearance was obtained from the Institutional Review Committee at Birat Medical College Teaching Hospital. A semi-structured questionnaire using Google forms was used for data collection. Univariate and bivariate analysis were done. A p-value less than 0.05 was considered statistically significant. \u0000Results: The mean score for practices of preventive measures towards COVID-19 was 16.58±2.73. More than half of the participants (54.1%) adopted good practices. The most frequently performed practice was wearing face masks when going outside the home (98.6%), followed by hand washing using soap and water for at least 20 seconds regularly (96.6%) and covering the mouth when coughing or sneezing with a tissue paper/a disposable handkerchief (96.6%). Moreover, most of the participants used alcohol-based hand sanitizer if soap and water were not available (95.2%), stayed at home when they felt flu-like symptoms (95.2%), visited the nearest health facility when getting sick (95.2%), and avoided close contact with sick individuals with flu-like symptoms (93.2%). Age, gender, ethnicity, religion, marital status, academic year, average monthly family income, any health insurance and vaccination status were not significantly associated with the practice of COVID-19 preventive measures. \u0000Conclusion: More than half of the participants adopted good practices of preventive measures towards COVID-19. Lower practice scores among medical students is the matter of concern.","PeriodicalId":31640,"journal":{"name":"Birat Journal of Health Sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46275790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public or Private/Home: Where and Why are Ill Neonates Sought out for Health Care?","authors":"Kamal Bahadur Budha, Chiranjivi Adhikari","doi":"10.3126/bjhs.v7i3.52633","DOIUrl":"https://doi.org/10.3126/bjhs.v7i3.52633","url":null,"abstract":"Introduction: Care seeking behavior is a process of taking actions in the pursuit of health gain and obtaining treatment. Various factors influence mothers to choose public or private health care facilities for neonatal health and illness, which may help policy makers to achieve the Universal Health Coverage (UHC). \u0000Objective: The study aimed to find out the factors associated with maternal care-seeking behaviors of their neonates’ health and illness. \u0000Methodology: A cross-sectional study was carried out among 248 mothers having neonates up to six months with the history of illness during their neonatal period, selected by applying 30 cluster sampling strategy. We entered data and then analyzed in SPSS with chi-square test and logistic regression methods. \u0000Results: Majority of ill neonates (68%) were sought out in public health facilities in Jumla. A few (6%) were taken to private facilities whereas more than one-fourth (28%) were either sought out nowhere or treated at home traditionally. Proportion of fever and acute respiratory infections (ARI) among neonates was almost half (46.4%) and one-fifth (19%), respectively. Multivariate logistics regression showed that mothers with primary education and above had an odds of 25 (95% CI, 1.44-333.0) , with a self-decision had an odds of 11.29 (95% CI, 2.26-56.00), and walking distance of ≤30 minutes to health facility had an odds of 104.2 (95% CI, 3.80-2821.4), for seeking out the remedy in public health facilities for their neonates. \u0000Conclusions: The study concluded that more than half neonates were ill from different diseases and more than two-thirds of them were taken to public health facilities to seek out for remedy. Maternal education having at least primary level, with a self-decision, and less distance to health facilities were the probable factors of choosing public health facilities for seeking out the remedy for a neonatal illness. Nonetheless, further studies with larger sample size and stronger designs are warranted for a firmer conclusion.","PeriodicalId":31640,"journal":{"name":"Birat Journal of Health Sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45160324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Analysis of Spinal Anesthesia for Daycare Surgery during the COVID-19 Pandemic","authors":"P. Bhattarai, Bikash Khadka, Hemant Adhikari, Rinku Khadka, Apurb Sharma","doi":"10.3126/bjhs.v7i3.52759","DOIUrl":"https://doi.org/10.3126/bjhs.v7i3.52759","url":null,"abstract":"Introduction: We preferred general anesthesia over spinal anesthesia for day care surgeries in our center. During COVID-19 pandemic, we planned subarachnoid blocks for daycare surgeries, to minimize aerosol generation and to reduce virus transmission risk to health care professions. \u0000Objectives: This study intended to compare time of discharge after  subarachnoid block with general anesthesia in day care surgeries. We compare time to achieve post-anesthetic discharge score (PADS) equal to or more than nine; need for overnight hospitalization; and complications. \u0000Methodology: A retrospective analysis of cases posted for elective daycare surgery in our institute during COVID-19 pandemic from April 2020 to July 2020 were identified. We compared  time to  discharge home in patients who received general anesthesia and spinal anesthesia. Normality of distribution was determined using Two sample Kolmogorov-Smirnov Tes. Student t test was used for normally distributed data, Mann-Whitney U test was used for non-normal distributed data. Categorical variables were analyzed using a chi-squared or Fisher’s exact test.  \u0000Results: A total of 2214 patients were included in this study.181 patients remained for analysis; 70 in the general anesthesia group and 91  in the spinal anesthesia group. Mean time (+SD) to achieve PADS score in group GA is 263.47(+75.06) whereas in group SAB was 339.55(+156.903). Mean time (+SD) taken to discharge home in group GA was 296.08(+74.76) whereas in group SAB was 365.66(+158.68) minutes respectively. Post hoc power of the study was 95.8. \u0000Conclusion: With low dose bupivacaine, spinal anesthesia is a safe alternative for ambulatory day care surgeries.","PeriodicalId":31640,"journal":{"name":"Birat Journal of Health Sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49397138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relation of Antral Follicular Count and Follicular Stimulating Hormone with Anti-Mullerian Hormone in Determining Ovarian Reserve in Infertile Women Presenting in a Tertiary Health Centre of Nepal","authors":"Bhuwan Prasad Ojha, A. Ghimire, Padam Raj Panta, N. Ojha","doi":"10.3126/bjhs.v7i3.52635","DOIUrl":"https://doi.org/10.3126/bjhs.v7i3.52635","url":null,"abstract":"Introduction: Infertility is a disorder of the reproductive system defined by failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Globally, about 10-15% married couples are sub-fertile. 20-40% of female factors for infertility include ovarian cause. Ovarian reserve refers to the size of resting primordial follicle in the ovaries which determines the capacity of the ovary to provide egg cells for fertilization resulting in a successful pregnancy. Ovarian reserve is one of the most reliable investigations to determine ovarian regression, which regresses with age. Follicular Stimulating Hormone (FSH), Estradiol (E2), Antral Follicular Count (AFC) and Anti-Mullerian Hormone (AMH) are investigations to determine ovarian reserve. \u0000Objective: To determine the correlation of antral follicular count and follicular stimulating hormone with anti-mullerian hormone in determining ovarian reserve among infertile women attending infertility clinic of Tribhuvan University Teaching Hospital (TUTH). \u0000Methodology: This was a prospective, hospital based study conducted among 78 patients attending infertility clinic in the Department of Obstetrics and Gynecology at TUTH, Kathmandu from 14th April 2017 to 13th April 2018. After taking history and examination, routine infertility investigation was sent. On the Day 2 or Day 3 of the cycle, serum FSH and AMH were sent. On the 3-5 day of the cycle, trans-vaginal scan was done for antral follicular count. Follicular monitoring was done every alternate day from day 9 of natural cycle till the follicle became 18 to 22 mm. If no follicle developed even after day 20 of menstruation, monitoring was stopped and development of follicle or failure was noted. This monitoring was done in single cycle. Early follicular phase serum FSH, AMH and AFC were correlated in relation to follicular development. \u0000Result: Among 78 patients included, mean age was 27.6 ± 3.14 years. The mean FSH, AMH and total AFC were 6.46 ± 1.90 IU/ml, 5.01 ± 3.46 ng/ml and 15.88 ± 5.21 respectively. A strong positive linear correlation between AFC and AMH (p<0.001, r=0.811) and weakly negative correlation between FSH and AMH (p=0.182, r= -0.153) was found. \u0000Conclusion: Serum AFC level showed a strong positive correlation with AMH and could be used as an alternative to AMH to assess ovarian reserve.","PeriodicalId":31640,"journal":{"name":"Birat Journal of Health Sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42949185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in Contrast Sensitivity among Patients with Diabetic Mellitus Type II","authors":"S. Shrestha, G. Prasai, R. Shrestha, O. K. Malla","doi":"10.3126/bjhs.v7i3.52634","DOIUrl":"https://doi.org/10.3126/bjhs.v7i3.52634","url":null,"abstract":"Introduction: Eye being one of the target organs of diabetes mellitus has many pathological consequences, one possibly being contrast sensitivity. Contrast sensitivity is required for daily activities like in situations of low light, fog or driving at night. The study was conducted to find out contrast sensitivity among diabetic \u0000Methodology: A hospital based descriptive cross- sectional study of contrast sensitivity was conducted among type II diabetics with or without retinopathy at Kathmandu Medical College from April to December 2018. Patient demographics and comprehensive clinical examinations findings were recorded in a specially designed proforma. Convenience sampling was done and informed consent was taken. \u0000Leas symbol low contrast test 10M was used for contrast sensitivity testing. The contrast levels of the test lines on the five pages are 25%, 10%, 5%. 2.5%and 1.2%. Data was analyzed in excel and SPSS (version21). Results were expressed in frequency, percentage and mean as required. Association of contrast sensitivity with age, gender, duration of diabetes, blood sugar level and diabetic retinopathy was tested using chi square test. \u0000Results: Among the 45 study population, female to male ratio was 1:2. Age ranged from 25 to 76 years with maximum patients in the age group 51-60 years. Blood sugar was controlled in 33.33%. Contrast sensitivity was decreased in 40%. Among the patients with decreased contrast sensitivity, blood sugar was uncontrolled in 66.67%. Similarly, 72.2% of participants with decreased contrast sensitivity had no diabetic retinopathy. The association of contrast sensitivity with age of the patient, gender, duration of diabetes mellitus, blood sugar level and diabetic retinopathy was not statistically significant with p values 0.34, 0.52, 0.07, 1 and 0.89 respectively.                                                                                                                                                \u0000Conclusion: Contrast sensitivity can be decreased among patients with type II diabetes mellitus irrespective of gender, age of the patient, duration of diabetes, control of blood sugar and presence or absence of diabetic retinopathy.","PeriodicalId":31640,"journal":{"name":"Birat Journal of Health Sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46466043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study between Laparoscopic Common Bile Duct Exploration plus Cholecystectomy versus Endoscopic Retrograde Cholangiopancreatography plus Cholecystectomy for Cholecysto-Choledocholithiasis","authors":"R. Yadav, B. Purbey, S. Yadav, Bhupendra Charan Shrestha, N. Paudyal, K. R. Yadav, A. Bhattarai","doi":"10.3126/bjhs.v7i3.52770","DOIUrl":"https://doi.org/10.3126/bjhs.v7i3.52770","url":null,"abstract":"Introduction: The management of concomitant gallbladder and common bile duct stones have been debated between both endoscopic and laparoscopic techniques. \u0000Objective: The objective of this study is to compare the efficacy, safety, cost and surgical outcomes of laparoscopic common bile duct exploration plus cholecystectomy and endoscopic retrograde cholangiopancreatography plus cholecystectomy. \u0000Methodology: This is a comparative interventional study carried out among 62 patients with concomitant gallstones and common bile duct stones. The study population was divided into two groups by simple randomized sampling technique (lottery technique). Group A underwent laparoscopic common bile duct exploration followed by laparoscopic cholecystectomy in one stage (single-staged management). Group B underwent endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy in second hospital visit (two-staged management). \u0000Results: Complete clearance of the stone with a single attempt was achieved in Group A compared to Group B as 8 patients had  gone for a second attempt in group B. Post operative pancreatitis was higher i.e. 24(77.41%) in Group B with statically significance (p value <0.005). Other complications like bleeding i.e. 29(93.54% in A and 26(83.87%) in B group, perforation was also noted during the study period that includes 29(93.54%) in B group. The mean operative time was longer in Group A i.e. 130.2 ± 41.5 minutes while in Group B was 78.5± 10.2 minutes which was statistically significant (p <0.001).The cost of procedure was higher for patients undergoing two-staged management.   \u0000Conclusion: The complete clearance of the stone with a single attempt was achieved in Group A compared to Group B where 8 patients had a second attempt. Also incidence of pancreatitis was higher in Group B and statically significant. Other complications like bleeding perforation was also noted during the study period in B group. The mean operative time was longer in Group A which was statistically significant. However, for those patients with concomitant gallbladder and common bile duct stones, single-staged management consisting of laparoscopic common bile duct exploration and laparoscopic cholecystectomy could be the preferred method of treatment where the expertise and facilities are available.","PeriodicalId":31640,"journal":{"name":"Birat Journal of Health Sciences","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45128146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}