Complications among Patients Undergoing Pancreaticoduodenectomy in Tertiary Care Centers of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Pancreaticoduodenectomy (Whipple procedure), even after significant evolution, continues to be associated with a high morbidity. The study aimed to find out the prevalence of complications following pancreaticoduodenectomies performed by a single surgeon over a span of 20 years in tertiary care hospitals of Nepal. METHODS: This was a descriptive cross-sectional study conducted from hospital records of patients who underwent pancreaticoduodenectomy between 1999 and 2019 at different institutions in Chitwan, where the principal author was involved. Ethical clearance was taken from the Institutional Review Committee. Convenience sampling was done. Patients' clinical characteristics and diagnoses were noted. Data entry was done using Statistical Package for the Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage. RESULTS: Out of 327 patients who underwent pancreaticoduodenectomy, complications were found in 125 (38.2%) (32.9-43.7 at 95% Confidence Interval). Respiratory complications were the commonest 32 (9.8%), followed by septicemia 25 (7.6%) and cardiac complications 24 (7.3%). Delayed gastric emptying and postoperative pancreatic fistula were seen in 11 (6.8%) and 4 (2.5%) in the first decade respectively. In the second decade, delayed gastric emptying was noted in 2 (1.2%) and postoperative pancreatic fistula in 1 (0.6%) patient. CONCLUSIONS: The prevalence of complications in our study was comparable to other national and international studies. Surgery-specific complications such as delayed gastric emptying and postoperative pancreatic fistula showed a decline over the decade.

Management of Traumatic Liver Injury in a Tertiary Care Hospital in Nepal.

BACKGROUND: The liver is most frequently injured solid organ in abdominal trauma. The non-operative management is the standard treatment for hemodynamically stable patients. This study analyse the epidemiological aspects, injury patterns, treatment modalities and outcome in patients with liver injuries only and associated injuries outside the liver. METHODS: This was a retrospective study in patients with liver injuries admitted from 1st March 2014 to 31st January 2019 at Chitwan Medical College and Hospital, Nepal. The patients were divided into two groups. Group A consisted of isolated liver injury and Group B liver injury with associated injury of other organs. Data were analysed by using descriptive statistics and Mann-Whitney U test. RESULTS: A total of 61 patients were admitted with liver injury. There were 18 (29.5 %) patients with liver injury alone (group A) and 43 (70.5 %)liver injury associated with other organs (group B). Low grade liver injuries were 48 (78.7 %) and high grade 13 (21.3 %). The operative management was done for one liver injury with biliary peritonitis in group A. In group B, 16 patients required laparotomy and operative management for associated abdomen injuries. CONCLUSIONS: Non-operative treatment modality in hemodynamically stable patients with isolated liver injuries was safe and effective.

(D+10) MELD as a novel predictor of patient and graft survival after adult to adult living donor liver transplantation.

We modified the previously described D-MELD score in deceased donor liver transplant, to (D+10)MELD to account for living donors being about 10 years younger than deceased donors, and tested it on living donor liver transplantation (LDLT) recipients. Five hundred consecutive LDLT, between July 2010 and December 2012, were retrospectively analyzed to see the effect of (D+10)MELD on patient and graft survival. Donor age alone did not influence survival. Recipients were divided into six classes based on the (D+10)MELD score: Class 1 (0-399), Class 2 (400-799), Class 3 (800-1199), Class 4 (1200-1599), Class 5 (1600-1999), and Class 6 (>2000). The 1 year patient survival (97.1, 88.8, 87.6, 76.9, and 75% across Class 1-5, P=.03) and graft survival (97.1, 87.9, 82.3, 76.9, and 75%; P=.04) was significantly different among the classes. The study population was divided into two groups at (D+10)MELD cut off at 860. Group 1 had a significantly better 1 year patient (90.4% vs 83.4%; P=.02) and graft survival (88.6% vs 80.2%; P=.01). While donor age alone does not predict recipient outcome, (D+10)MELD score is a strong predictor of recipient and graft survival, and may help in better recipient/donor selection and matching in LDLT.