Introduction: Surgical site infection is defined by the Centres for Disease Control and Prevention as a wound infection that occurs within 30 days of an operative procedure or within a year if an implant is left in place and the infection is thought to be secondary to surgery. It occupies 20% to 39% of all the infections acquired in hospitals. The aim of this study is to find out the prevalence of postoperative surgical site infections in the Department of General Surgery of a tertiary care centre. Methods: A descriptive cross-sectional study on a total of 384 post-operative patients of abdominal surgery was conducted in the Department of General Surgery of a tertiary care centre from August 1, 2020 to July 30, 2021 with ethical approval from the Institutional Review Committee (Reference number: 267). Convenience sampling was done. Post-operative patients fulfilling the inclusion and exclusion criteria were included in the study. Data were entered in Microsoft Excel and analyzed using the Statistical Package for the Social Sciences version 21.0. Point estimate was done at a 95% Confidence Interval along with frequency and percentages for binary data and mean with standard deviation for continuous data. Results: Among 384 patients, the prevalence of surgical site infection was found to be 65 (16.92%) (13.15-20.65 at a 95% Confidence Interval). The patients had a mean age of 42.06±21.92 years. Conclusions: The prevalence of surgical site infection was higher in our study in comparison to other similar studies conducted in similar settings.

Introduction: Blunt injury trauma is regularly encountered in the emergency department. Diagnostic tools that help in optimum management of blunt abdominal trauma include; Focussed Assessment Sonography for Trauma scan, Diagnostic peritoneal lavage and Computed Tomography scan. The aim of this study is to determine the validity of CT scan as an accurate diagnostic tool and its role in management of patients with blunt abdominal trauma. Methods: A prospective analysis of 80 patients of blunt abdomen trauma who were admitted in Manipal Teaching Hospital, Pokhara, Nepal within a span of 15 months was done. Demographic data, mechanism of trauma, management and outcomes were studied. Organ injuries were graded using the Organ Injury Scale guidelines. Results: Most of the patients in our study were in the age group of 21-40 years with an M: F ratio of 2.3:1. Road traffic accident (47.5%) was the most common mechanism of injury. Spleen (27.5%) was the commonest organ injured. CT scan was superior to FAST scan and had sensitivity of 97.3% specificity 75% positive predictive value 98.6%. FAST scan had sensitivity of 78.9%, specificity 50%, positive predictive value 96% with p- value of 0.0034. 81% of patients were conservatively managed. Conclusions: In conjunction with close clinical monitoring, CT scan is reliable in the evaluation and management of blunt abdominal trauma patients. Our study also shows CT as a superior diagnostic modality compared to FAST scan. Keywords: blunt abdominal trauma; CT scan; FAST scan; road traffic accident.

Background: Unanticipated cancellation of scheduled elective operations decreases theatre efficiency and is inconvenient to the patients, their families and the medical teams. It creates logistic and financial burden associated with extended hospital stay and repetitions of pre-operative preparations. The aim of this study is to determine the incidence and causes of cancellation of surgical operations in our centre and make recommendations to reduce it.Methods: This was a prospective cross-sectional study carried out over a period of one year in Manipal Teaching Hospital, Pokhara from July 12017 to June 2018. Consecutive sampling method was used. All patients booked for elective surgical procedures were enrolled in the study. The age, gender, diagnosis, proposed surgery and reasons for cancellation were documented and analysed.Results: A total of 794 patients were scheduled for elective surgical operations during the study period and 86 (10.83%) patients’ operations were cancelled. There were 54(62.79%) males and 32 (37.20%) females. Recent change in the medical status of the patient (n=18; 20.9%) was the main reason for cancellation of operation followed by overbooking (n=11; 12.7%), change in plan of management (n=9,10.4%).Conclusions: Avoidable factors are mainly responsible for cancellation of surgeries. Efficient management, pre-operative assessment, utilization of the few available hospital resources, improvement in communication between medical teams and patients would reduce the rate of cancellation of booked surgical procedures.Keywords: Cancellation; efficient management; elective operation.

Background: An intestinal stoma is an opening of the intestine on anterior abdominal wall made with an intention of either decompression of an obstructed colon or diversion of stool. Intestinal stomas may be temporary or permanent, depending on their role.   Objectives: The objective of this study was to determine the common indications and types of intestinal stomas, and outcomes of patients operated at Manipal Teaching Hospital, Pokhara, Nepal. Methodology:  A retrospective cross-sectional study was conducted in 105 patients of intestinal stomas from February 2017 to March   2020 in a teaching hospital after approval from institutional review committee. Data were derived from medical records of patients and operation logbooks with the consecutive sampling method. Data were analyzed with the help of the Statistical Package for Social Sciences (SPSS) version20 and p value < 0.05 was considered significant.  Results: Total of 105 patients with intestinal stomas was included for the study of which 82.9% (n=63) were emergency operations and 17.1% (n=13) were elective. There were 46 (43.80%) cases of ileostomy, 9(8.5%) jejunostomy and 50(47.6%) colostomy patients. Major indications of stoma formation were trauma 33.3% (n=35) and intestinal obstruction 22.8% (n=24). Complications were observed in 39 (37.14%) of the patients, with wound infection 11.8% (n=9) and peristomal dermatitis 11.8% (n=9) for ostomates being the commonest. Higher complications were seen with ileostomy as compared to colostomy (p=0.02) and loop ileostomy still higher than end ileostomy (p=0.00).  Conclusion: Common indications for intestinal stomas were abdominal trauma, enteric perforation, intestinal obstruction and colorectal carcinoma. Main complications included local skin problems, wound infection and retraction.

Introduction: Association between cholelithiasis and dyslipidemia has been shown in many studies. Recent studies have shown improvement in lipid profile following cholecystectomy. This study aimed to determine the changes in lipid profile and blood glucose level after cholecystectomy.Methods: Seventy-three patients of cholelithiasis were studied prospectively. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), atherogenic index (AI) and fasting blood sugar (FBS) levels were estimated pre-operatively. Further, the same parameters were studied after cholecystectomy after one week and one-month intervals. None of the patients received any lipid-lowering drug or dietary restriction. Results were analysed and compared.Results: Of the 73 patients with cholelithiasis, 66% were female and 34% male. The mean age of patients was 40.53± 13.16 years. 56% of patients with cholelithiasis had a deranged lipid profile. TC was significantly decreased at one week (p=0.002) and one month (p=0.00) interval after cholecystectomy while TG levels also decreased significantly at one month postoperative (p=0.001). There were no significant differences in LDL-c however improvement was seen on HDL-c. Blood glucose level also increased significantly (p=0.028) after one month of cholecystectomy.Conclusion: Cholelithiasis is associated with an abnormal lipid profile. Cholecystectomy leads to a significant decrease in some of the parameters of lipid profile and the atherogenic index. The presence of gall stones thus should be perceived in the context of metabolic syndrome, which may be investigated and treated.