INTRODUCTION: Laparoscopic cholecystectomy is the most commonly performed general surgical procedure. During the COVID-19 pandemic, general recommendation worldwide is to postpone elective surgeries as far as possible to decrease the resource utilization and also aerosol-related transmission among hospital staff and patients. We conducted this study to see the burden of gallbladder disease, their management and outcomes of all patients who presented to our centre during first wave of COVID-19 pandemic. METHODS: We conducted a retrospective analysis of all patients who underwent laparoscopic cholecystectomy at the Hospital for Advanced Medicine and Surgery (HAMS) after the commencement of strict lockdown in the first wave of the COVID-19 pandemic. Ethical approval for the study was taken from Nepal Health Research Council. All the surgeries were performed as per HAMS interim policy for infection prevention and control during the COVID-19 pandemic. Data were extracted from the discharge sheet and outcomes in terms of duration of hospitalization, morbidity, mortality, and COVID -19 infection among patient and operating team staff after surgery were assessed. RESULTS: Out of 110 cases operated for gallbladder disease, 90 patients were included in the study with complete data. The most common presentations were dyspepsia (28) and biliary colic (22). Patients were managed with laparoscopic cholecystectomy (79), percutaneous cholecystostomy (4), laparoscopic subtotal cholecystectomy (5), open cholecystectomy (1). The median duration of hospitalization 22 hours. There was no COVID-19 transmission among staff and patients. CONCLUSIONS: Laparoscopic cholecystectomies are feasible during COVID-19 pandemic and safely performed following infection prevention guidelines. It can be still be performed in day case basis to decrease the bed occupancy and avoiding crowd in hospitals.

Groove pancreatitis is uncommon form of chronic pancreatitis common in patients with history of smoking and alcohol abuse. High index of suspicion is required as it may masquerade pancreatic ductal adenocarcinoma and both of these conditions are difficult to differentiate preoperatively. Pancreaticoduodenectomy has good outcome in patient with Groove pancreatitis. Hence, we are reporting a case report of Groove pancreatitis in 40 years gentleman, who was being managed by multiple endoscopic dilatations, later underwent pancreaticoduodenectomy for persistent symptoms. He had no perioperative morbidity and doing well in 24 months follow up.

Introduction: Despite the availability of a number of specialties, only few areas come as a choice for post-graduation. The main purpose of this study was to determine the perception of undergraduate students towards anesthesiology and the factors that determine considering or not considering anesthesiology as a career. Methods: A questionnaire based cross-sectional study was conducted among medical interns at KIST Medical College in January 2018. Seventy interns participated in this study. The questionnaire sought information on their perception and reasons for considering or not considering anesthesiology. Results: Majority  of the  medical  interns  [58  (82.85%)]  had  decided  the  subject  to  specialize  in  future. Forty one (70.68%) chose surgery as their career choice. It was followed by Internal medicine- 35(60.34%), Anesthesia- 21(36.2%), Orthopedics- 19(32.75%) and Gynecology- 8(13.79%). Among the participants who chose anesthesia as their career choice, five (8.62%) stated anesthesia as their first career preference, three (5.17%) as their second and 13(22.41%) as their third career preference. The positive key attributes of choosing anesthesiology was mostly because they were interested in critical care 19(90.47%), satisfaction from the immediate result seen 15(71.42 %) and minimum patient contact 12(57.14%). The negative attributes of anesthesiology highlighted were risky job 23 (46.93%), lack of recognition by patient 13 (26.53%) and minimum patient contact 12 (24.48%). Conclusion: Findings suggests that perceptions of medical students towards anesthesiology are manifold. Duration of internship has biggest influence on motivating undergraduate students towards pursuing anesthesiology as a career.

Introduction: Laparoscopic surgery is an established treatment modality worldwide. Opportunities to acquire this skill using expensive simulation at workplace are not always feasible due to cost, time and accessibility constraints. Nep-Endotrainer is a cost effective homemade laparoscopic simulation tool built in Nepal. Methods: Nep-Endotrainer was built using plastic manikins easily available in market. Nine apertures were created with a drilling machine, four on each side of umbilicus and one at the epigastric region. These apertures were covered by thick piece of rubber of vehicle tire with apertures in them. Logitech® C270 HD webcam was fixed interiorly with metal screws. The base of the manikin was fixed to a wooden board with hinge joint. Five different interchangeable training modules were assembled in 10×10 cm2 size wooden boards. The LED light was fixed interiorly near the web camera. The camera USB can be easily connected with laptops, tablets and mobile phones. We used discarded hand instruments from laparoscopic centers to reduce the cost of the endotrainer. Conclusion: Nep-Endotrainer is accessible to any personal budget and can be readily constructed. It allows more frequent practice at home, outside the venue and hours of surgical departments.

Introduction: Septoplasty without turbinoplasty is one of the main reasons for failure of procedure in case of deviated nasal septum with inferior turbinate hypertrophy. Septoturbinoplasty is the procedure of choice for complete treatment. The main objective is to find out the prevalence of endoscopic septoturbinoplasty among patients undergoing surgery in Department of Otolaryngology-Head and Neck of a tertiary care hospital. Methods: This was a descriptive cross-sectional study in Department of Otolaryngology-Head and Neck Surgery done over a period of 1 year duration from 1st August 2020 to 31st July 2021 among 1248 patients who underwent surgery in the department. Ethical Approval was taken from Institutional Review Committee of Kathmandu Medical College and Teaching Hospital (Reference number: 2207202004). A convenience sampling technique was used. Two different techniques, Microdebrider Assisted Turbinoplasty and Outfracture with Submucosal Diathermy were used in surgery. Nasal Obstruction and Symptom Evaluation Scale questionnaire was used pre and postoperatively for data collection. Data were analyzed in Statistical Package for the Social Sciences version 16. Point estimate at 95% Confidence Interval was calculated, with frequency, percentage, mean and standard deviations. Results: Out of 1248 patients, about 92 (7.37%) patients (4.95-10.14 at 95% Confidence Interval) underwent septoturbinoplasty. The mean Nasal Obstruction and Symptom Evaluation Scale before surgery was 75.21±6.19. Conclusions: The prevalence of septoturbinoplasty in our study is similar to other studies done in similar settings. We found almost complete resolution of breathing problems following endoscopic septoturbinoplasty, hence improving quality of life.

Pancreatic injury following blunt trauma abdomen is presentation with significant morbidity and mortality. Our first case here is the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) Grade V pancreaticoduodenal injuries following penetrating injury managed with pancreaticoduodenectomy and the second case is blunt trauma to the abdomen with pancreatic tail transection which is American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) Grade III that was managed with Endoscopic Retrograde Cholangiopancreaticography (ERCP) and pancreatic duct stenting. The outcome depends on early diagnosis and needs a high index of suspicion due to subtle clinical and radiological findings initially. Hemodynamically unstable patients may have other associated visceral and vascular injuries, and damage control strategy will be a suitable option. Same sitting resection procedures like pancreaticoduodenectomy are rarely performed. Pancreatic injuries can often be managed non-operatively with percutaneous drainage and pancreatic duct stenting.